bluuebunny/crossref_metadata_2025 huggingface dataset:
The Americanization of Euro‐English
Authors: MODIANO MARKO
Published: February 2007

ABSTRACT: In this paper I argue that Mid‐Atlantic should replace British English as the educational standard in Europe. The English spoken by Europeans is increasingly influenced by American English. As a result, a new variety of the language has emerged. Europeans, in increasing numbers, speak Mid‐Atlantic, a variety that encourages neutral pronunciation and a vocabulary based on the interlocutor's frame of reference. Traces of both AmE and BrE are included in Mid‐Atlantic. Extreme features of the British accent are avoided. Pronunciation which is overtly British is discussed. Samples are also provided of lexical items which are everyday language in Britain or the US but which are often incomprehensible to some native‐language speakers as well as to others. Reference is made to grammar and style. The political aspects of learning a specific variety of English, as well as the future of Mid‐Atlantic, is discussed. In conclusion, it is pointed out that the development of Mid‐Atlantic will most likely continue and in time will establish its own frame of reference, and as such be less dependent on American and British standards.
Sociolinguistic aspects of siSwati‐English bilingualism
Authors: KAMWANGAMALU NKONKO M.
Published: February 2007

ABSTRACT:This paper is a pilot study of bilingualism in siSwati and English in Swaziland. Swaziland has been the site of contact between siSwati and English since long before it became a British colony in 1903. As a result, there has naturally been a great deal of what Haugen (1972) has termed ‘interlingual contagion’ in both directions. The study describes some aspects of this interlingual contagion, with a focus on borrowing and code‐switching on the one hand, and on the derivatives of these phenomena ‐the ‘Englishization’(Kachru, 1983) of siSwati and the ‘Swazification’ of English ‐on the other. These phenomena and their derivatives are examined via a model of bilingualism which presumes that they all carry indexical meanings both on the societal and individual levels.
Presence of the cagA Gene in the Majority of Helicobacter pylori Strains Is Independent of Whether the Individual Has Duodenal Ulcer or Asymptomatic Gastritis
Authors: Go Mae F. , Graham David Y.
Published: February 2007

Background
Helicobacter pylori infection presents as many different diseases, including asymptomatic gastritis, peptic ulcer disease, and gastric cancer. Although the virulence factor(s) responsible for different H. pylori‐related diseases have not been identified, several candidate genes are being investigated for such an association. The polymerase chain reaction (PCR) frequently is used to assess the presence of genetic factors associated with pathogenesis of disease; the cagA gene and its product have been postulated to have a disease‐specific relationship to peptic ulcer and gastric cancer because of differential expression in these diseases compared to histological gastritis alone.

Materials and Methods.Genomic DNA was amplified by PCR, using synthetic oligonucleotide primers to the cagA gene to determine the prevalence of the cagA gene in 60 H. pylori isolates obtained from well‐documented duodenal ulcer or asymptomatic gastritis patients (30 each). Results were confirmed by hybridization with a 1.4‐Kb cagA probe.

Results.The expected PCR product was obtained in 90% of isolates from duodenal ulcer patients, compared to 70% of isolates from individuals with asymptomatic gastritis. The PCR products were polymorphic in size, suggesting cagA gene sequence differences among isolates. Evaluation for the presence of the cagA gene by hybridization with a 1.4‐Kb cagA probe showed a homologous product in 29 of 30 strains [96.7%; 95% confidence interval (CI) = 83–100%] from duodenal ulcer patients versus 25 of 30 strains (83.3%; 95% CI = 65–94%) obtained from individuals with asymptomatic gastritis (p= 0.19).

Conclusions.The high prevalence of the cagA gene in asymptomatic gastritis suggests that it will not prove to be a useful marker to distinguish more virulent or disease‐specific H. pylori strains. The genetic heterogeneity among H. pylori strains makes PCR an unwise choice as the single method to determine prevalence of a putative virulence factor. In evaluation of the prevalence of a gene or genetic factor in a population of H. pylori, hybridization with extended probes might be important to ensure that the results are representative of the organism's genotype.
Conservation and Diversity of the Helicobacter pylori Copper‐Transporting ATPase Gene (copA) Sequence Among Helicobacter Species and Campylobacter Species Detected by PCR and RFLP
Authors: Ge Zhongming , Jiang Qin , Taylor Diane E.
Published: February 2007

Background
Helicobacter pylori is a causative pathogen of such human stomach diseases as chronic type B gastritis, ulcer, and possibly gastric carcinoma. As a co‐factor in various redox enzymes and an essential trace metal required for the synthesis of metalloproteins, copper might play a role in the pathogenesis of H. pylori. A gene, copA, associated with copper transport, has been isolated from H. pylori UA802. In this study, conservation and diversity of this gene were analyzed among some Helicobacter and Campylobacter species.

Materials and Methods.Twenty‐one clinical isolates and strains of helicobacters and campylobacters were used in this study. Methods including polymerase chain reaction (PCR) amplification, restriction fragment‐length polymorphisms (RFLPs), and hybridization were employed to carry out this work.

Results.The copA gene was highly conserved in all the H. pylori isolates tested (Helicobacter nemestrinae and Helicobacter felis but not in Helicobacter mustelae and the Campylobacter species), whereas the sequence downstream of the copA appears to diverge among H. pylori isolates. In addition, two restriction patterns of the PCR‐amplified copA fragments from seven H. pylori isolates and H. nemestrinae were identified, and the RFLP of H. nemestrinae was identical to that of one of the H. pylori isolate group.

Conclusions.The adenosine triposphatase‐derived copper‐transporting mechanism is employed by various H. pylori strains, H. nemestrinae, H. felis, and perhaps by other Helicobacter species. The nucleotide mutations have risen in the copA gene. It appears that there is a genetic relatedness of the copA gene to H. pylori and H. nemestrinae.
Helicobacter pylori and the Surface Mucous Gel Layer of the Human Stomach
Authors: Shimizu Toshiki , Akamatsu Taiji , Sugiyama Atsushi , Ota Hiroyoshi , Katsuyama Tsutomu
Published: February 2007

BackgroundThe colonization of Helicobacter pylori in the surface mucous gel layer (SMGL) was investigated.

Materials and Methods.Surgically removed stomachs were obtained from patients and included gastric ulcer (4 cases), duodenal ulcer (2), and gastric cancer (24). Five of these cases were examined at 8, 19, 28, 143, and 171 days after the end of eradication therapy. For the preservation of the SMGL, these specimens were fixed in cold Carnoy's solution, cleared in xylene, and embedded in paraffin. Serial sections were obtained and were stained by dual staining with the galactose oxidasecold thionin Schiff reaction followed by paradoxical Concanavalin A staining and immunostaining for H. pylori.

Results.
H. pylori characterstically attached to surface mucous cells and colonized in the SMGL. H. pylori in the SMGL was more abundant than that attached to the surface mucous cells. The degree of H. pylori infection both on the surface of surface mucous cells and in the SMGL correlated well with the severity of gastritis. In the SMGL, this organism obviously preferred to colonize in the layer of surface mucous cell‐type mucins, and the multilaminated structure of the SMGL deteriorated markedly. Eradication of H. pylori restored the structure of the SMGL, and the inflammatory reaction decreased gradually.

Conclusion.The SMGL is an indispensable site of H. pylori colonization, and this organism damaged the gastric mucosa partially by causing deterioration of the SMGL. Removal of the organism from the SMGL should be considered for eradication of this organism.
Corrected Identity of Isolates of Helicobacter Pylori Reference Strain NCTC11637
Authors: Akopyants Natalia S. , Jiang Qin , Taylor Diane E. , Berg Douglas E.
Published: February 2007

Background.

The reference strains NCTC11637 and NCTC11638 were among the very first Helicobacters ever cultured and have been distributed through national reference culture collections to researchers throughout the world. Because H. pylori is an extremely diverse species, such reference strains are invaluable as universal standards, provided that they are identified correctly.

Materials and Methods.

H. pylori strains (previously called “NCTC11637”) from three different sources and NCTC11638 were fingerprinted by the arbitrarily primed polymerase chain reaction (PCR) (also known as random amplified polymorphic DNA, or RAPD) method and further were characterized by NotI digestion and pulsed field gel electrophoresis of total genomic DNA (NotI‐PFGE) and by restriction of PCR‐amplified ureCD and flaA gene segments.

Results.

RAPD tests of two “NCTC11637” strains from different sources (CCUG17874, UA1178) indicated that they were closely related or identical to NCTC11638. Given the diversity of H. pylori strains and the high sensitivity of the RAPD method, close matches in RAPD patterns from independent clinical isolates are not expected. In contrast, the version of “NCTC11637” from the American Type Culture Collection (ATCC 43504) did not match NCTC11638 in RAPD fingerprint. Concordant results were obtained by NotI‐PFGE and by restriction of PCR amplified gene segments.

Conclusions.

Two unrelated versions of the reference (type) H. pylori strain NCTC11637 are in general circulation and are distinguished easily by DNA fingerprinting. One matches another reference strain, NCTC11638, whereas the other is distinct from it, as expected of independent clinical isolates. Knowing which “NCTC11637” reference strain one has could be important, especially because H. pylori strains probably are diverse in phenotypic traits that are important for colonization or disease.
Helicobacter pylori Infection Among Patients with Alcoholic and Nonalcoholic Cirrhosis
Authors: Schmulson Max J. , León Gilberto De , Kershenovich Amir , Vargas‐Vorackova Florencia , Kershenobich David
Published: February 2007

Background.

The prevalence of Helicobacter pylori in patients with alcoholic and nonalcoholic cirrhosis is uncertain. The present study was aimed at determining the prevalence of H. pylori infection among cirrhotic patients and to explore its relationship to demography, etiology of cirrhosis, and liver function.

Materials and Methods.

Thirty‐three cirrhotic patients were included. H. pylori infection was determined by the 14C urea breath test (n = 30) and endoscopy with antral biopsy (n = 4). Etiology of cirrhosis was classified as alcoholic or nonalcoholic. The rate of H. pylori infection was related to age, gender, etiology, Child‐Pugh grading, portal hypertension, and portal‐systemic encephalopathy (PSE). None of the patients received antibiotics for at least the last 3 months.

Results.

Twelve alcoholic and 21 nonalcoholic cirrhotics, with a median age of 57 years and a male:female ratio of 1 : 1.4 were studied. Overall H. pylori prevalence was 45.5%. This prevalence varied from 47.1% to 43.8% in those younger and older than the median age, and from 35.7% to 52.6% in men and women, respectively. Fifty percent of alcoholic and 42.9% of nonalcoholic cirrhotics were H. pylori–positive. According to Child‐Pugh grading, 69% of grade A, 40% of grade B, and 0% of grade C were infected (  p = .03). Among patients with PSE, 25% were H. pylori–positive compared to 52% of those without PSE (  p = .24).

Conclusions.

The prevalence of H. pylori infection in cirrhotics is 45.5%. Prevalence was unrelated to age, gender, and etiology of cirrhosis. An inverse relation to the Child‐Pugh grading and a tendency to a lower prevalence in PSE was found.
Relationship Between Migraine and Patent Foramen Ovale: A Study of 121 Patients with Migraine
Authors: Domitrz Izabela , Mieszkowski Jerzy , Kamińska Anna
Published: February 2007

Background.—Migraine is a common neurological disorder, the origins of which remain unknown. Patent foramen ovale (PFO) is considered to have a role in migraine. The relationship between migraine and patent foramen ovale may be stronger in patients suffering from migraine with aura compared to patients with common migraine.

Objectives.—The aim of the study was to evaluate the frequency of PFO in patients with migraine with aura (MA+) and compare it with the prevalence of PFO in migraine patients without aura (MA−), and in a healthy age‐matched control group. We investigated PFO association with migraine, considering such factors as: A type of migraine aura, frequency of attacks, familial occurrence, sex and age of patients.

Patients.—121 patients: 61 patients suffering from migraine with aura, 60 without aura and 65 normal controls. The group of patients with migraine with aura was divided into subgroups regarding to the type of aura.

Methods.—In order to detect PFO the contrast transcranial Doppler was performed during Valsalva maneuver.

Results.—The presence of PFO was found in 33/61 (54%) patients with MA(+) compared to 15/60 (25%) without aura and 16/65 (25%) control subjects. The difference between MA(+) patients and MA(−) patients and the difference between MA(+) patients and control group was statistically significant (P < .05). There was no association between type of migraine aura and PFO, as well as we found no association between PFO and frequency of attacks, familial occurrence, sex and age of patients and PFO.

Conclusions.—Our findings suggest possible association of migraine with aura and PFO. It seems that PFO does not influence the type of aura and frequency of attacks of migraine as well as it is not associated with familial occurrence of migraine.
Normal Atrial Activation and Voltage During Sinus Rhythm in the Human Heart: An Endocardial and Epicardial Mapping Study in Patients with a History of Atrial Fibrillation
Authors: LEMERY ROBERT , BIRNIE DAVID , TANG ANTHONY S.L. , GREEN MARTIN , GOLLOB MICHAEL , HENDRY MATT , LAU ERNEST
Published: February 2007

Background:
The three‐dimensional contributions to human atrial activation in sinus rhythm have not been specifically characterized. We evaluated the sequence of endocardial and epicardial activation and voltage of the atria during normal sinus rhythm.

Methods and Results: The study group includes 35 patients with history of symptomatic atrial fibrillation. Prior to catheter ablation of atrial fibrillation, we performed multielectrode electroanatomic mapping during sinus rhythm, endocardially of the RA, LA, and coronary sinus (CS) and, in 10 patients, epicardially of the transverse sinus and oblique sinus. Following activation of the atrial region of the sinus node, the epicardial transverse sinus was activated 11 ± 18 msec later, while the earliest endocardial LA activation occurred in the region of Bachmann's bundle at 31 ± 13 msec, significantly earlier than the earliest epicardial LA activation of the oblique sinus at 54 ± 10 msec (P < 0.002). The posterior LA revealed complex types of activation in 66% of patients analyzed, due to the convergence of wavefront propagation from the CS, oblique sinus, and endocardial LA. Bipolar voltage measurements revealed significantly higher values for the epicardium (mean 3.05 ± 1.31 mv) than for the endocardium (mean 1.65 ± 0.75 mv), P < 0.0001 between both groups.

Conclusions: In sinus rhythm, we have characterized endocardial and epicardial atrial activation and voltage, and provide an analysis and understanding of the genesis of the P wave complex in humans.
Resynchronization or Dyssynchronization—Successful Treatment with Biventricular Stimulation of a Child with Obstructive Hypertrophic Cardiomyopathy without Dyssynchrony
Authors: RADOSLAW LENARCZYK , OSKAR KOWALSKI , TOMASZ KUKULSKI , JACEK KOWALCZYK , ZBIGNIEW KALARUS
Published: February 2007

CRT in a Child with Hypertrophic Cardiomyopathy. We present a case of a 10‐year‐old boy with hypertrophic cardiomyopathy, intraventricular pressure gradient of 104 mmHg, and indications for prophylactic ICD implantation. Based on intraoperative pressure measurements, the child was implanted with biventricular ICD. During 2.5 months of observation, the patient's functional status improved significantly, as shown by subjective and objective parameters and, moreover, the pressure gradient fell to 12 mmHg. Significant electrical and mechanical cardiac dyssynchrony appeared parallel to clinical improvement.
Mechanism of the Conversion of a Pulmonary Vein Tachycardia to Atrial Fibrillation in Normal Canine Hearts: Role of Autonomic Nerve Stimulation
Authors: HORIKAWA‐TANAMI TOMOE , HIRAO KENZO , FURUKAWA TOSHIYUKI , ISOBE MITSUAKI
Published: February 2007

Introduction: The role of the autonomic nervous system in inducing pulmonary vein (PV)‐triggered atrial fibrillation (AF) and the termination mechanism of the AF are unknown. The purpose of this study was to elucidate the mechanism of the conversion of a tachycardia within a PV into AF under autonomic stimulation and the termination mechanism of the AF in normal canine hearts.

Methods and Results: In open‐chest dogs, the electrophysiologic parameters were measured under vagal stimulation (VS) or an isoproterenol administration. The effects of the VS or isoproterenol on the PV tachycardias (PVTs), which were created by burst pacing from a PV or the application of aconitine onto the PV, were evaluated. Pilsicainide, a Na channel blocker, was administered during the induced AF. VS and isoproterenol shortened the atrial and PV effective refractory periods. In the pacing model, the VS converted the PV rapid activations into sustained AF in 9 of 12 dogs during pacing cycle lengths ≤120 msec, but the isoproterenol did not cause any sustained AF. In the aconitine model, the VS increased the rate of the aconitine‐induced PVTs and transformed them into sustained AF in all 14 dogs, whereas the isoproterenol did not induce AF, and decreased the PVT rate. In all 14 dogs the sustained AF was terminated by pilsicainide, which had suppressive effects on the PVT as well as atria and PV‐atrial junction.

Conclusions: These findings indicate that the vagal effects affecting the PVT and atria facilitate the onset and maintenance of PV‐triggered AF in normal canine hearts.
Apical Sorting by Galectin‐3‐Dependent Glycoprotein Clustering
Authors: Delacour Delphine , Greb Christoph , Koch Annett , Salomonsson Emma , Leffler Hakon , Le Bivic Andre , Jacob Ralf
Published: February 2007

Epithelial cells are characterized by their polarized organization based on an apical membrane that is separated from the basolateral membrane domain by tight junctions. Maintenance of this morphology is guaranteed by highly specific sorting machinery that separates lipids and proteins into different carrier populations for the apical or basolateral cell surface. Lipid‐raft‐independent apical carrier vesicles harbour the beta‐galactoside‐binding lectin galectin‐3, which interacts directly with apical cargo in a glycan‐dependent manner. These glycoproteins are mistargeted to the basolateral membrane in galectin‐3‐depleted cells, dedicating a central role to this lectin in raft‐independent sorting as apical receptor. Here, we demonstrate that high‐molecular‐weight clusters are exclusively formed in the presence of galectin‐3. Their stability is sensitive to increased carbohydrate concentrations, and cluster formation as well as apical sorting are perturbed in glycosylation‐deficient Madin‐Darby canine kidney (MDCK) II cells. Together, our data suggest that glycoprotein cross‐linking by galectin‐3 is required for apical sorting of non‐raft‐associated cargo.
A Comprehensive School‐Based Clinic: University and Community Partnership
Authors: McClowry Sandee G. , Galehouse Pam , Hartnagle William , Kaufman Howard , Just Barbara , Moed Richard , Patterson‐Dehn Cathleen
Published: February 2007

purpose. To describe the evolution and current status of a university and community partnership engaged in operating an urban elementary school‐based clinic (SBC)

population. The children at the school who are eligible to receive care at the SBC include 500 elementary students and 200 adolescents who attend a magnet junior high school housed in the same building. The vast majority of the children attending the school are from families whose incomes are below the national poverty level. Eighty‐five percent of the children are black. Fifteen percent are Hispanic, non‐white.

conclusions. A variety of services and programs are offered to the children and their families for the promotion of health and the prevention of mental disorders. Service, education, and research occur simultaneously to achieve the multiple goals of the partners and participants.

practice implications. Advanced practice nurses can provide quality health and mental health care services for school‐age children and their families through SBCs. Institutional partnerships, capitalizing on each other's strengths, can expand the availability of SBC offerings.
Issues in Pediatric Research: Safeguarding the Children
Authors: Conrad Barbara , Horner Sharon
Published: February 2007

purpose. To address the ethical question: “How can one safeguard children who participate in research?”

patient population. Infants through adolescents.

conclusions. Federal guidelines that delineate when research is allowable with children may not be enough to ensure children's safety from harm.

practice implications. Risk evaluation conducted by those who understand child development because such understanding allows one to better anticipate children's potential exposure to harm. Safeguarding children requires a conscientious effort to envision children's understanding of events, their potential reactions, and the possible immediate and long‐term consequences. This understanding provides the foundation for implementing sound research procedures to safeguard the children.
Daytime and Nighttime Wetting in Children: A Review of Management
Authors: Kelleher Ruth E.
Published: February 2007

purpose. To describe the types of voiding dysfunction common to children, review pertinent literature on enuresis, discuss treatment options, and explore the nurse's role in identifying and managing children with voiding difficulties.

population. Children beyond the age of normal toileting who continue with uncontrolled urination either during the day, at night, or both.

conclusion. Inappropriate urination in children is a common occurrence. Ninety‐five percent of voiding problems are functional, and 5 percent represent pathologic conditions. There is widespread misunderstanding among parents, teachers, and primary care providers on the causes and management options for these children.

practice implications. Pediatric nurses are in key positions to identify children with voiding problems. Once the problem has been acknowledged, nurses can assess the problem and its impact on the family; educate parents, children, and others regarding causes; discuss management options; and refer children for medical intervention when necessary.
Mastery of Stress in Mothers of Preterm Infants
Authors: Younger Janet B. , Kendell Mary Jean , Pickler Rita H.
Published: February 2007

purpose. To explore the relationships among, stress, social support, mastery, and depression

design. Descriptive correlational study

setting. 60‐bed, Level 3 NICU in an urban medical center in a Mid‐Atlantic state

participants. 31 mothers who delivered infants born between 26 and 36 weeks gestation. Inclusion criteria included no maternal illness or complications requiring hospitalization beyond four days, and no report of a recent major stressful life event other than the birth of the child.

major outcome measures. The Mastery of Stress Instrument, the Account of Social Resources Inventory, and the Center for Epidemiologic Studies‐Depression Scale

results. Social support was positively related to mastery and inversely related to depression.

conclusions. Mothers of preterm infants experienced significant levels of stress and depression in the early postpartum period.
Gastroesophageal Reflux
Authors: Berube Melinda , Froese‐Fretz Ann
Published: February 2007

Ask the Expert provides research‐based answers to practice questions submitted by JSPN readers.
Children With Asthma
Authors: Simkins Rosemary A. , Froese‐Fretz Ann
Published: February 2007

Ask the Expert provides answers to clinical questions for nurses in practice settings. Where possible, evidence from research is used to support the experts' recommendations.
A Randomized Trial of Heparin and Saline for Maintaining Intravenous Locks in Neonates
Authors: Heilskov Joni , Kleiber Charmaine , Johnson Karen , Miller June
Published: February 2007

purpose. To determine, the effects of saline, heparin 2 units (U) per ml saline, and heparin 10 U/ml saline flush solutions on the duration of intravenous (IV) locks and the incidence of IV infiltration in neonates.

design. Randomized double‐blind experiment.

setting. Tertiary‐care nursery.

participants. Neonates (N = 90) hospitalized at birth in the intensive, intermediate care, or newborn units.

main outcome measures. Total hours from the time the IV was inserted to the time the IV was removed; hours from the time the IV was first flushed to the time the IV was removed; number of IVs removed because of infiltration.

results. No statistical or clinical differences between the three groups for duration of IV nor for incidence of complications.

conclusions. The use of heparin in IV lock flush solution did not affect the duration of IV locks nor the incidence of infiltration in neonates.
The Effectiveness of a Standardized Educational Program for Children Using Patient‐Controlled Analgesia
Authors: Kotzer Anne Marie , Coy Julie , LeClaire Andrea D.
Published: February 2007

purpose. To examine the effectiveness of two types of preoperative education (routine education and a standardized educational program) for children undergoing spinal fusion.

design. Two group, phase‐lag design.

setting. Tertiary pediatric hospital.

participants. Children ages 8‐18 years (N = 93)

main outcome measures. Adolescent Pediatric Pain Tool, Child Pain Scale, Post‐PCA Satisfaction Interview, and PCA infusion pump data.

results. No statistically significant differences between the groups on any of the main outcome variables. Children and parents reported, however, that the SEP provided them with invaluable information regarding the use of PCA and alleviated their concerns about getting “hooked on drugs,” overdosing, side effects, and being able to get pain relief when needed.

conclusion. Children having spine fusion surgery experienced severe postoperative pain that was not ameliorated by optimizing use of PCA through standardized education. Further testing of the SEP with other populations is needed in order to more fully realize its potential for influencing pain outcomes.
Pediatric Nursing Resources in Cyberspace
Authors: Kuntz Kathleen Ryan
Published: February 2007

Purpose. To provide information on pediatric nursing resources on the Internet.

POPULATION. Pediatric nurses in all settings.

CONCLUSIONS. A basic understanding of essentials for “surfing the web” will open the doors to unprecedented opportunities to query, find, and share information with others.

PRACTICE IMPLICATIONS. Pediatric nurses in every setting can benefit from access to the Internet and knowledge of what resources are available to enhance their practice and support their clients.
Providing Care to Children and Their Families in the Emergency Center
Authors: Kemp Virginia H. , Woodring Barbara
Published: February 2007

Role Play is an issues‐related forum to engender dialogue about the roles assumed by nurses who care for children and their families.
Pediatric Registered Nurse Usage and Perception of EMLA
Authors: May Karen , Britt Robin , Newman Mary M.
Published: February 2007

issues and purpose. Pediatric nurses do not consistently use the anesthetic cream for children. This study examined availability, use, and perception of driving and restraining forces for use of EMLA cream for venipuncture and IV catheter insertion.

design and methods. In this descriptive study, surveys were sent to 400 randomly selected pediatric RNs. Surveys were returned by 211 nurses from 36 states.

results. Driving forces for EMLA usage included ease of use and increased patient rapport. Restraining forces were focused on barriers to accessing EMLA. Positive perceptions of EMLA were affected by ease of accessibility.

practice implications. Use of EMLA may be enhanced by standard orders, inservice instruction, and stocking EMLA on the patient care unit.
Quality Care in an Era of Retrenchment
Authors: Biester Doris J. , Duggan Mary , Perkins Mary , Powers Linda K. , Classick Susan
Published: February 2007

source and purpose. Constraints in the healthcare delivery system are resulting in unprecedented challenges to quality nursing care. In response to concerns expressed by readers in a JSPN survey, we solicited input from prominent SPN members.

conclusions. Quality care can be sustained through nurses' creativity, flexibility, leadership, and collaboration. The context for quality care is an organizatinal environment with attention to critical analysis, careful resource utilization, and improved outcomes.

practice implications. Nurses can not only maintain premium standards of quality care but, by assuming leadership, help shape the future of health care.
‘Tis the Season
Authors: Dolan Susan , Froese‐Fretz Ann
Published: February 2007

Ask the Expert provides answers to clinical questions for nurses in practice settings. Where possible, evidence from research is used to support the experts' recommendations.
Pediatric Short Bowel Syndrome: Pathophysiology, Nursing Care, and Management Issues
Authors: Jakubik Louise D. , Colfer Andrea , Grossman Michael B.
Published: February 2007

ISSUES AND PURPOSE. A comprehensive overview of the etiology, pathophysiology, nursing care, and medical and surgical management of the child with short bowel syndrome (SBS), which follows massive anatomical or functional loss of the small intestine.

CONCLUSIONS. The outlook for children with SBS has improved due to recent advances in parenteral and enteral nutrition, pharmacologic interventions, and surgical options.

PRACTICE IMPLICATIONS. Nurses whose practice reflects an in‐depth knowledge of the etiology, pathophysiology, medical and surgical management, nursing interventions, and complications of SBS will be equipped to provide quality care for children and families affected by SBS.
Pediatric Nursing Comes Full Circle
Authors: Katzenberger Jodi , Ruesch Ann , Winch Anne E.
Published: February 2007

Role Play is an issues‐related forum to engender dialogue about the roles assumed by nurses who care for children and their families.
Clinical and Economic Outcomes of Infants Receiving Breast Milk in the NICU
Authors: Barton Amy J. , Danek Gale , Owens Brenda
Published: February 2007

ISSUES AND PURPOSE. This study compared clinical and economic outcomes for infants who were exclusively fed breast milk and infants who were fed commercial formula.

DESIGN AND METHODS. A retrospective medical record review from a regional neonatal intensive care unit (N = 80) using consultation logs from the lactation coordinator and a matched sample of formula‐fed infants.

RESULTS. Neither clinical (weight gain, length of stay, days of parenteral nutrition) nor economic outcomes (direct variable costs, net revenue) differed significantly between the groups.

PRACTICE IMPLICATIONS. While it may not be possible to demonstrate sufficient cost savings while the infant resides within the NICU to justify a lactation coordinator, long‐term clinical and economic outcomes may be sensitive to this specialized nursing service.
Tar Wars: Educating Today's Youth About Tomorrow's Health
Authors: Slagle Jennifer , Ketron Amy , Coulston Jennifer , Cahow Julie , Willock Katherine M. , Winch Anne
Published: February 2007

Role Play is an issues‐related forum to engender dialogue about the roles assumed by nurses who care for children and their families.
To Bridge a Quality Chasm: Connect With the Guidelines
Authors: Gallagher Carolyn
Published: February 2007

ISSUES AND PURPOSE. A wide chasm exists between the care we have and the care we could have. This article will inform nurses about the pediatric quality “chasm“ by identifying practice variations from evidence‐based guidelines for common childhood conditions.

CONCLUSIONS. Nurses are accountable for providing state‐of‐the‐art, evidence‐based care to children. The pediatric quality chasm calls for nurses to stand up and speak out for children, to use and develop tools that activate the best scientific knowledge, and to empower parents to make it happen.

PRACTICE IMPLICATIONS. Advocacy and patient‐centered care are nurses' means to partner with parents and collaborate with colleagues to connect with the guidelines and bridge the quality chasm.
PERFORMANCE APPRAISAL OF BEHAVIOR‐BASED COMPETENCIES: A RELIABLE AND VALID PROCEDURE
Authors: CATANO VICTOR M. , DARR WENDY , CAMPBELL CATHERINE A.
Published: February 2007

A new performance appraisal system, developed for promotions in the Royal Canadian Mounted Police non‐commissioned officer ranks, fairly differentiated among candidates. Members (N= 6,571) illustrated their performance on core competencies with behavioral examples. Supervisors and then review boards used a BARS procedure to reliably rate performance. Both candidates and supervisors supported the system. The performance appraisal scores predicted career advancement in the organization.
Utilization of Shallow Geophysical Sensing at Two Abandoned Municipal/Industrial Waste Landfills on the Missouri River Floodplain
Authors: Rudy Richard J. , Caoile John A.
Published: February 2007

In the past 30 to 40 years, floodplain areas of large rivers, such as the Missouri River, have been extensively used for large industrial and municipal landfills. Many of these sites are now causing varying degrees of ground water contamination. Rapid geophysical characterization techniques have proven useful for delineation of anomalous areas indicative of potential contaminant plumes. These methods have also resulted in a cost effective approach to the location and number of monitoring wells.

An effective technique to initially characterize ground water contamination at such landfills along the Missouri River in northwestern Missouri involved a combination of electrical resistivity and electromagnetic conductivity methods. Resistivity was used to obtain soundings of the alluvium by using a modified Wenner array and to corroborate shallow electromagnetic conductivity measurements by using short Wenner array electrode spacings.

Upon confirmation of similar measurements of the upper soils for the two methods, numerous electromagnetic conductivity traverses were made at each landfill site. The data generated from these surveys were graphed and contoured to delineate anomalous areas. Based on the geophysical study, a ground water monitoring well network was then designed for each landfill.

As a result, a minimal number of wells were required to initially characterize the ground water quality at these two sites. In general, analysis of water samples from these wells displayed good correlation with the geophysical results.
Ground Water Instrumentation Program of the U.S. Geological Survey
Authors: Cordes Edwin H.
Published: February 2007

The U.S. Geological Survey has been Involved, for many years, in a variety of ground water data collection and sampling programs. The constraints imposed by logistics and the environment often preclude the use of commercial and industrial equipment; thus the survey is forced to do in‐house design and development of selected instruments or modify existing equipment to fit the specific need. Ground water instrumentation currently being designed and developed include: (1) running time totalizer (2) cross‐correlation pipe flowmeter (3) ground water monitoring system, and (4) small‐diameter deep well pump. A description and principle of operation for each of the developments are presented.
Darcian Flow Characteristics Upgradient of a Kettle Pond Determined by Direct Ground Water Flow Measurement
Authors: Kerfoot William B.
Published: February 2007

In glacial outwash deposits, the movement of ground water Is determined by small scale irregularities in the pattern of hydraulic conductivity. Permeability determinations on split spoon samples obtained from coring the site are not sufficient to predict the patchiness of flow since it cannot define continuity of the strata. The lattice work pattern can be determined by vertical profiling with direct ground water flow measurement. The rate and direction of flow is combined with head gradient changes to compute hydraulic conductivity changes across the site.

The results of the tests can be plotted on triangular graphs depicting the fundamental Darcy equation. The local conditions reflect a mathematical “patchiness” of hydraulic conductivity unique to outwash deposits.

The procedure was employed to determine flow characteristics and define the zone of contribution to porous bottom kettle lakes. The zone of contribution was defined by projecting backward from the vertical profiling and shallow measurements and taking into account the daily rain water recharge rate across the site.

For the unconfined aquifer north of the pond, shallow ground water flow measurements were necessary to define the recharge portion of the shoreline. Vertical profiling was required to define the recharge volume since the rate of flow was not even with depth. A simple differential equation for determining the recharge area is presented along with the calculations.
A Systematic Approach for Evaluating the Quality of Ground Water Monitoring Data
Authors: Campbell Jill A. , Mabey William R.
Published: February 2007

The recognition and assurance of the quality of ground water monitoring data are crucial to the correct assessment of the magnitude and extent of a ground water contamination problem. This article addresses an approach being developed to systematically evaluate the quality of a given set of ground water monitoring data collected during site investigation/ remedial action efforts. The system consists of a checklist of criteria, grouped into four major categories, which can be applied to laboratory or field measurements.

The first category, basis of measurement, considers whether the appropriate sampling, boring and/or analytical methods were chosen to obtain the measurement and the limitations of each method. Secondly, application of the method is assessed. This includes examination of the extent to which procedures were correctly performed, the use of quality control measures and calibration, and possible sources of error in the measurements. Third, evaluation of applied statistical methods is made, with consideration given to which statistics are meaningful in a given context and whether measurements are reproducible. The final category, corroborative information, considers whether independent data or other information are available that add credibility to the values measured.

In this approach, a “high quality” data value is defined as one in which accuracy is supported by meeting the preceding criteria. When accompanied by precision information, high quality data allow for defensible assessments and actions. This evaluation system is useful in developing monitoring programs and in guiding documentation of field and laboratory methods during data collection. It relies heavily on experienced judgment and can be catalyst for the beneficial exchange of knowledge and ideas among ground water professionals.
The Effect of Three Drilling Fluids on Ground Water Sample Chemistry
Authors: Brobst Robert B. , Buszka Paul M.
Published: February 2007

Three monitoring wells were installed in borings that were constructed using water‐based drilling fluids containing either (1) guar bean, (2) guar bean with breakdown additive, or (3) bentonite. These fluids were selected to observe their effect on the chemistry of subsequent water samples collected from the wells. The wells were installed to depths of 66 feet, 100.5 feet and 103 feet, respectively, in fine‐to‐medium sand and gravel outwash deposits near Antigo, Wisconsin. Drilling fluids were necessary to maintain an open borehole during well construction through strata containing cobbles and boulders.

The bentonite and guar drilling fluids caused temporarily elevated concentrations of chemical oxygen demand (COD) in ground water samples collected from the monitoring wells. Using standard development, purging and sampling procedures, elevated COD concentrations persisted for about 50 days for the well bored with the guar‐with‐additive fluid, 140 days for the bentonite well and 320 days for the guar well. Unfiltered ground water samples for all wells had greater concentrations of COD than samples filtered through a 0.45 micron filter. Sulfate concentrations also decreased with time in the guar‐with‐additive well and bentonite well, but not in the guar well.

The elevated COD concentrations are attributed to the large concentrations of oxidizable carbon present in the guar bean drilling fluid and in the organic polymers present in the bentonite drilling fluid. Well development and purging procedures, including borehole flushing, surging, bailing and/or chemically induced viscosity breakdown of the guar mud decreased the time before background conditions were achieved. Future research should evaluate the physical and geochemical interaction of different drilling fluid compositions with a variety of geologic matrices and drilling, well development and well purging techniques.
A Field Terminal for Collection and Analysis of Geological and Hydrogeological Data
Authors: Petsonk Andrew M.
Published: February 2007

Having immediate, automated field access to data gathered during geological and hydrogeological investigations can be crucial to definition of the scope and direction of test procedures, as well as to the interpretability of results. A portable, briefcase‐sized data collection and analysis instrument has therefore recently been developed. It is capable of operating as a standalone or operator‐guided field unit. This terminal is pre‐programmed for a number of standard applications, several of which involve BAT® tools, e.g., permeability tests made using the BAT Ground Water Monitoring System. It can, however, be used with a wide range of other tools for controlling data collection during pumping, penetration and pressometer tests, etc.

An operator's terminal and independent data collection microcontroller are the major components of this system. Data may be collected from any combination of four ports: an internal, programmable interval timer, a pulser (shaft encoder), and two 14‐bit analog‐to‐digital (A/D) inputs. The latter are primarily used for pressure or resistance transducers. Reading of data may be triggered automatically by the timer and/or pulser, or be performed upon operator command. Many thousands of data points may be stored in the microcontroller, representing one or several tests of any type, intermixed. Via the operator's terminal, any subset of this stored data may be examined, erased, modified or analyzed. A 26‐character LCD display and a four‐color printer/plotter are used to record data and results of analyses. Data may also be transferred to an external computer for more extensive manipulation.

Three examples of how this terminal may be used in the field in connection with site investigations are presented in this paper. They involve (a) measurement of saturated hydraulic conductivity, (b) determination of soil stratigraphy using pore pressure sounding, and (c) water network profiling.
Sources of Ground Water Salinization in Parts of West Texas
Authors: Richter Bernd C. , Kreitler Charles W.
Published: February 2007

Abstract

Determination of chemical constituent ratios allows distinction between two salinization mechanisms responsible for shallow saline ground water and vegetative‐kill areas in parts of west Texas. Mixing of deep‐basin (high Cl) salt water and shallow (low Cl) ground water results in saline waters with relatively low Ca/Cl, Mg/Cl, SO44/ Cl, Br/Cl, and NO3/Cl ratios. In scattergrams of major chemical constituents vs. chloride, plots of these waters indicate trends with deep‐basin brines as high Cl end members. Evaporation of ground water from a shallow water table, in contrast, results in saline water that has relatively high Ca/Cl, Mg/Cl, SO4/Cl, and Br/CL ratios. Trends indicated by plots of this water type do not coincide with trends indicated by plots of sampled brines. Leaching of soil nitrate in areas with a shallow water table accounts for high NO3 concentrations in shallow ground water.
Opinion I
Authors: Gibb James P.
Published: February 2007

This is the first of four “Point‐Counterpoint” articles planned to appear in this column. These articles are based on discussion sessions held at the Sixth National Aquifer Restoration and Ground Water Monitoring Conference. A brief article outlining each speaker's opinion is offered first, followed by a transcript of the discussion session during which attendees have a chance to ask the speakers questions on the subject.
Natural Attenuation of Aromatic Hydrocarbons in a Shallow Sand Aquifer
Authors: Barker J.P. , Patrick G. C. , Major D.
Published: February 2007

Inadvertent release of petroleum products such as gasoline into the subsurface can initiate ground water contamination, particularly by the toxic, water‐soluble and mobile gasoline components: benzene, toluene and xylenes (BTX). This study was undertaken to examine the processes controlling the rate of movement and the persistence of dissolved BTX in ground water in a shallow, unconfined sand aquifer.

Water containing about 7.6 mg/ L total BTX was introduced below the water table and the migration of contaminants through a sandy aquifer was monitored using a dense sampling network. BTX components migrated slightly slower than the ground water due to sorptive retardation. Essentially all the injected mass of BTX was lost within 434 days due to biodegradation. Rates of mass loss were similar for all monoaromatics; benzene was the only component to persist beyond 270 days. Laboratory biodegradation experiments produced similar rates, even when the initial BTX concentration varied.

A dominant control over BTX biodegradation was the availability of dissolved oxygen. BTX persisted at the field site in layers low in dissolved oxygen. Decreasing mass loss rates over time observed in the field experiment are not likely due to first‐order deeradation rates, but rather to the persistence of small fractions of BTX mass in anoxic layers.