bluuebunny/crossref_metadata_2025 huggingface dataset:
Cesarean Section: Norwegian Women Do as Obstetricians Do—Not as Obstetricians Say
Authors: Finsen Vilhjalmur , Storeheier Andreas Hopstock , Aasland Olaf Gjerløw
Published: May 2008

ABSTRACT:  Background:
The worrying trend of an ever‐increasing incidence of delivery by cesarean section has been commented on repeatedly. Studies from the United Kingdom and the United States have found that many obstetricians would choose cesarean section for themselves without strict medical indication, whereas similar studies from Denmark and Norway have indicated that almost none would choose cesarean section for themselves. The purpose of this study was to report the proportion of Norwegian obstetricians who have children born by cesarean section and to compare the rate with that among other physicians and that with the general population.
Methods:
Questionnaires were sent to 1,500 random members of the Norwegian general public, 1,500 randomly selected physicians, and 423 random surgeons asking whether they had children born by cesarean section. All were between the ages of 40 and 65 years.
Results:
The response rate was 78 percent. In the general public with children, 12 percent reported that one or more of them were born by cesarean section. The average was 8 percent among those with only basic schooling compared with 16 percent (p < 0.02) among those who had been to university for more than 4 years. This figure was 19 percent among physicians in general (p < 0.001 compared with the general population), 26 percent among surgeons, and 27 percent among the 189 specialists in obstetrics and gynecology (p < 0.02 compared with the physicians in general). Conclusion: The rate of cesarean section in the general population is unlikely to fall as long as so many obstetricians have their own children delivered by cesarean section. (BIRTH 35:2 June 2008)
Asthma Pharmacotherapy Prescribing in the Ambulatory Population of the United States: Evidence of Nonadherence to National Guidelines and Implications for Elderly People
Authors: Navaratnam Prakash , Jayawant Sujata S. , Pedersen Craig A. , Balkrishnan Rajesh
Published: May 2008

OBJECTIVES: To examine the level of physician adherence to the Expert Panel Report 2 (EPR‐2) pharmacotherapy guidelines of the asthma population, specifically in the elderly ambulatory patient population of the United States.

DESIGN: Retrospective cross‐sectional study using a national survey.

SETTING: National Ambulatory Medical Care Survey data of U.S. elderly patients from 1998 through 2004.

PARTICIPANTS: The weighted population sample size was 82,020,318 patients. There were 1,540 observations in this study (preweighted sample size) and 96 strata, with 446 population sampling units (PSUs). There were 11,868,340 patients that were elderly, and they accounted for 14.5% of the overall population sampled.

MEASUREMENTS: Specific patient demographic variables, physician demographic variables, and information about asthma medications prescribed were extracted from the data set and analyzed. Descriptive statistics for the patient demographic, physician demographic, and asthma pharmacotherapy variables were generated. A series of logistic regression models were created, with the choice of asthma pharmacotherapy agent used as the dependent variable and patient and physician demographic variables as the independent variables.

RESULTS: A major finding was that physicians were not adherent to the National Asthma Education and Prevention Program EPR‐2 asthma pharmacotherapy guidelines. Another finding was that, although elderly patients (aged ≥65) were exposed to more‐stable patterns of care, they were less likely to be prescribed controller medications, long‐acting bronchodilators (LABAs), combinations of inhaled corticosteroids and LABAs, and short‐acting beta agonists than patients aged 35 to 64.

CONCLUSION: A more‐concerted effort needs to be undertaken to improve physician adherence to the EPR‐2 guidelines, especially in prescribing asthma pharmacotherapy to elderly patients.
Effects of the Location of Myocardial Infarction on the Spectral Characteristics of Ventricular Fibrillation
Authors: SÁNCHEZ‐MUÑOZ JUAN J. , ROJO‐ÁLVAREZ JOSÉ L. , GARCÍA‐ALBEROLA ARCADIO , EVERSS ESTRELLA , REQUENA‐CARRIÓN JESÚS , ORTIZ MERCEDES , ALONSO‐ATIENZA FELIPE , VALDÉS‐CHAVARRI MARIANO
Published: May 2008

Background: The location of the myocardial infarction (MI) might modify the spectral characteristics of ventricular fibrillation (VF) in humans.

Objective: To evaluate the effect of the location of the infarcted area on the spectral parameters of VF.

Methods: Patients with chronic MI (29 anterior, 32 inferior) and induced VF during cardioverter defibrillator implant were retrospectively studied. Dominant frequency (fd), organization index (OI), and power of the harmonic peaks were calculated in the device‐stored electrograms (EGM) during sinus rhythm (SR) and VF.

Results: The fd of the VF was not affected by the left ventricular ejection fraction (LVEF) or the MI location (anterior: 4.54 ± 0.74 Hz, inferior: 4.77 ± 0.48 Hz, n.s.). The OI was also similar in both groups. However, in patients with inferior MIs, normalized peak power at fd was higher (118.3 ± 18.5 vs 100.6 ± 28.2, P < 0.01) and the normalized peak power of the harmonics was lower than in the anterior MI group. The analysis of EGM during SR showed similar results. The size of the necrotic area and its distance to the recording electrode might partially explain these results.

Conclusion: In our series, the spectral characteristics of the EGMs during VF showed significant differences depending on the MI localization. A higher fraction of energy (in the low‐frequency region) was seen in inferior MIs, whereas the peak power at the harmonics increased in anterior MIs. A similar effect was seen during SR and VF, suggesting that it is caused by local electrophysiology abnormalities induced by the MI rather than by different intrinsic characteristics of the VF.
AV Junctional Ablation Allowing More Effective Delivery of Cardiac Resynchronization Therapy in Patients with Intra‐ and Interatrial Conduction Delay
Authors: HERWEG BENGT , ILERCIL ARZU , MADRAMOOTOO CHRIS , ALI RIAS , BAROLD S. SERGE
Published: May 2008

We report two patients with cardiac resynchronization therapy (CRT) devices and evidence of refractory heart failure in whom impaired intraatrial conduction in one patient, and interatrial conduction in the other, prohibited optimization of the atrioventricular (AV) timing sequence. The patient with intraatrial conduction delay exhibited late right atrial sensing and latency during right atrial pacing that required programming of a short‐sensed AV delay and long‐paced AV delay (wide differential AV delay). In both patients AV junctional ablation and echocardiography‐guided device optimization significantly improved heart failure.
Time Course of Effects of Cardiac Resynchronization Therapy in Chronic Heart Failure: Benefits in Patients with Preserved Exercise Capacity
Authors: PIEPOLI MASSIMO F , VILLANI GIOVANNI Q , CORRÀ UGO , ASCHIERI DANIELA , RUSTICALI GUIDO
Published: May 2008

Objectives: To assess in patients with chronic heart failure the effect of cardiac resynchronization therapy (CRT) over 12 months' follow‐up the time course of the changes in functional and neurohormonal indices and to identify responders to CRT.

Methods: Eighty‐nine patients (74.1 ± 1 years, left ventricular ejection fraction [LVEF] < 35%), QRS complex duration >150 ms, in stable New York Heart Association (NYHA) class III or IV on optimal medical treatment were prospectively randomized either in a control (n = 45) or CRT (n = 44) group and underwent clinical evaluation, cardiopulmonary exercise testing (CPET), 2D‐Echo, heart rate variability (HRV), carotid baroreflex (BRS), and BNP assessments before and at 6‐ and 12‐month follow‐up.

Results: In the CRT group, improvement of cardiac indices and BNP concentration were evident at medium term (over 6 months) follow‐up, and these changes persisted on a longer term (12 months) (all P < 0.05). Instead CPET indices and NYHA class improved after 12 months associated with restoration of HRV and BRS (all P < 0.05). We identified 26 responders to CRT according to changes in LVEF and diameters. Responders presented less depressed hemodynamic (LVEF 25 ± 1.0 vs 22 ± 0.1%), functional (peak VO2 10.2 ± 0.2 vs 6.9 ± 0.3 ml/kg/min), and neurohormonal indices (HRV 203.6 ± 15.7 vs 147.6 ± 10.ms, BRS 4.9 ± 0.2 vs 3.6 ± 0.3 ms/mmHg) (all P < 0.05). In the multivariate analysis, peak VO2 was the strongest predictor of responders.

Conclusions: Improvement in functional status is associated with restoration of neurohormonal reflex control at medium term. Less depressed functional status (peak VO2) was the strongest predictor of responders to CRT.
Does Size Really Matter? A Comparison of the Riata Lead Family Based on Size and Its Relation to Performance
Authors: CORBISIERO RAFFAELE , ARMBRUSTER REBECCA
Published: May 2008

Background:Recently, the performance and safety of smaller diameter implantable cardioverter defibrillator (ICD)leads has been questioned. The purpose of this analysis was to determine the impact of size on lead performance and perforation rates by comparing the performance of 7 French (7F) and 8 French (8F) leads with similar design characteristics implanted by a single operator.

Methods:Patients implanted with a Riata 1580 (8F) or 7000 (7F) series leads (St. Jude Medical, Sylmar, CA, USA) over a 2‐year period were evaluated to compare performance and perforation rates.

Results:There were 357 Riata 8F leads and 357 Riata 7F leads implanted in 714 patients. Follow‐up ranged from 1 to 24 months. The 8F leads were implanted in the right ventricular apex more often than were 7F leads (129 or 37% vs 72 or 20%, P < 0.0001). Oversensing that did not result in therapy occurred in 2 pts (0.56%) with 8F leads and 1 pt. (0.28%) with a 7F lead (P = 0.56). Oversensing with therapy occurred once in both groups (0.28%, P = NS). One perforation occurred in each group (0.28%, P = NS). Both occurred in leads that were implanted in the right ventricular apex (P = 0.02).

Conclusions:The performance of St. Jude Medical 7F and 8F Riata leads was similar. The incidence of lead‐related adverse events was within or below the low end of published acceptable ranges for ICD lead perforation and sensing anomalies. Perforations were less likely to occur in leads that were implanted in nonapical positions.
Ranolozine‐Induced Suppression of Ventricular Tachycardia in a Patient with Nonischemic Cardiomyopathy: A Case Report
Authors: MURDOCK DAVID K. , KALIEBE JEFF , OVERTON NAOMI
Published: May 2008

Ranolazine is an antianginal agent, which inhibits the abnormal inward Na+ current and by this inhibition decreases diastolic cardiomyocyte calcium levels and improves electrical stability. Ranolazine has also been shown to be a potent inhibitor of after depolarizations and triggered activity. In this case report, we describe the dramatic antiarrhythmic effects of ranolazine in a patient with nonischemic cardiomyopathy who had malignant ventricular tachycardia. Further research on the antiarrhythmic properties of ranolazine appears warranted.
Precipitation of Ventricular Fibrillation by Intravenous Diltiazem and Metoprolol in a Young Patient with Occult Wolff‐Parkinson‐White Syndrome
Authors: KIM ROBERT J. , GERLING BARBARA R. , KONO ALAN T. , GREENBERG MARK L.
Published: May 2008

We report the case of a young man who presented with a rapid, narrow‐complex atrial fibrillation. A few hours after being administered intravenous metoprolol and diltiazem for rate control, he developed intermittent ventricular preexcitation on the electrocardiogram (ECG) and experienced ventricular fibrillation, from which he was successfully defibrillated. A subsequent electrocardiogram in sinus rhythm demonstrated previously unknown Wolff‐Parkinson‐White pattern. A left lateral accessory pathway was successfully ablated. Wolff‐Parkinson‐White syndrome should be included in the differential diagnosis when a young patient presents with atrial fibrillation, even if the ventricular complexes on the ECG are not preexcited.
Partial Inhibition of Ongoing Antitachycardia Pacing Sequence Due to T‐Wave Oversensing
Authors: MANOLIS ATHANASIOS G. , CHATZIS DIMITRIOS G. , KOUVELAS KOSTAS , KYRIAKIDES ZENON S.
Published: May 2008

We describe a case of partial inhibition of ongoing antitachycardia pacing scheme in an implantable cardioverter defibrillator (ICD) recipient with heart failure of ischemic etiology. The cause of inhibition was related to intermittent oversensing of paced T wave and sensing of intrinsic ventricular activation. In our effort to solve this problem, we reprogrammed the paced ventricular blanking period to a higher level.
Short PR Interval in the Absence of Preexcitation: A Characteristic Finding in a Patient with Fabry Disease
Authors: ARYANA ARASH , FIFER MICHAEL A. , RUSKIN JEREMY N. , MELA THEOFANIE
Published: May 2008

Fabry disease (FD) is a rare lysosomal storage disease characterized by intracellular deposition of glycosphingolipids that can involve various organs including the heart. Here, we report the finding of a short PR interval in a patient with FD and recurrent syncope associated with short atrial‐His (A‐H) and His‐ventricular (H‐V) intervals in the absence of preexcitation. While electrocardiographic abnormalities are not uncommon among FD patients, there have been few reports on electrophysiological studies performed on these patients. The exact mechanism for the short A‐H and H‐V intervals remains unclear, but they may result from accelerated conduction in the AV node—His—Purkinje system.
Joint Regression Analysis of Correlated Data Using Gaussian Copulas
Authors: Song Peter X.‐K. , Li Mingyao , Yuan Ying
Published: May 2008

SummaryThis article concerns a new joint modeling approach for correlated data analysis. Utilizing Gaussian copulas, we present a unified and flexible machinery to integrate separate one‐dimensional generalized linear models (GLMs) into a joint regression analysis of continuous, discrete, and mixed correlated outcomes. This essentially leads to a multivariate analogue of the univariate GLM theory and hence an efficiency gain in the estimation of regression coefficients. The availability of joint probability models enables us to develop a full maximum likelihood inference. Numerical illustrations are focused on regression models for discrete correlated data, including multidimensional logistic regression models and a joint model for mixed normal and binary outcomes. In the simulation studies, the proposed copula‐based joint model is compared to the popular generalized estimating equations, which is a moment‐based estimating equation method to join univariate GLMs. Two real‐world data examples are used in the illustration.
Bayesian Nonparametric Estimation of Continuous Monotone Functions with Applications to Dose–Response Analysis
Authors: Bornkamp Björn , Ickstadt Katja
Published: May 2008

Summary In this article, we consider monotone nonparametric regression in a Bayesian framework. The monotone function is modeled as a mixture of shifted and scaled parametric probability distribution functions, and a general random probability measure is assumed as the prior for the mixing distribution. We investigate the choice of the underlying parametric distribution function and find that the two‐sided power distribution function is well suited both from a computational and mathematical point of view. The model is motivated by traditional nonlinear models for dose–response analysis, and provides possibilities to elicitate informative prior distributions on different aspects of the curve. The method is compared with other recent approaches to monotone nonparametric regression in a simulation study and is illustrated on a data set from dose–response analysis.
Simultaneous Factor Selection and Collapsing Levels in ANOVA
Authors: Bondell Howard D. , Reich Brian J.
Published: May 2008

SummaryWhen performing an analysis of variance, the investigator often has two main goals: to determine which of the factors have a significant effect on the response, and to detect differences among the levels of the significant factors. Level comparisons are done via a post‐hoc analysis based on pairwise differences. This article proposes a novel constrained regression approach to simultaneously accomplish both goals via shrinkage within a single automated procedure. The form of this shrinkage has the ability to collapse levels within a factor by setting their effects to be equal, while also achieving factor selection by zeroing out entire factors. Using this approach also leads to the identification of a structure within each factor, as levels can be automatically collapsed to form groups. In contrast to the traditional pairwise comparison methods, these groups are necessarily nonoverlapping so that the results are interpretable in terms of distinct subsets of levels. The proposed procedure is shown to have the oracle property in that asymptotically it performs as well as if the exact structure were known beforehand. A simulation and real data examples show the strong performance of the method.
On Comparison of Mixture Models for Closed Population Capture–Recapture Studies
Authors: Xuan Mao Chang , You Na
Published: May 2008

Summary A mixture model is a natural choice to deal with individual heterogeneity in capture–recapture studies. Pledger (2000, Biometrics56, 434–442; 2005, Biometrics61, 868–876) advertised the use of the two‐point mixture model. Dorazio and Royle (2003, Biometrics59, 351–364; 2005, Biometrics61, 874–876) suggested that the beta‐binomial model has advantages. The controversy is related to the nonidentifiability of the population size (Link, 2003, Biometrics59, 1123–1130) and certain boundary problems. The total bias is decomposed into an intrinsic bias, an approximation bias, and an estimation bias. We propose to assess the approximation bias, the estimation bias, and the variance, with the intrinsic bias excluded when comparing different estimators. The boundary problems in both models and their impacts are investigated. Real epidemiological and ecological examples are analyzed.
A Comparison of Methods for Estimating the Causal Effect of a Treatment in Randomized Clinical Trials Subject to Noncompliance
Authors: Little Roderick J. , Long Qi , Lin Xihong
Published: May 2008

Summary We consider the analysis of clinical trials that involve randomization to an active treatment (T = 1) or a control treatment (T = 0), when the active treatment is subject to all‐or‐nothing compliance. We compare three approaches to estimating treatment efficacy in this situation: as‐treated analysis, per‐protocol analysis, and instrumental variable (IV) estimation, where the treatment effect is estimated using the randomization indicator as an IV. Both model‐ and method‐of‐moment based IV estimators are considered. The assumptions underlying these estimators are assessed, standard errors and mean squared errors of the estimates are compared, and design implications of the three methods are examined. Extensions of the methods to include observed covariates are then discussed, emphasizing the role of compliance propensity methods and the contrasting role of covariates in these extensions. Methods are illustrated on data from the Women Take Pride study, an assessment of behavioral treatments for women with heart disease.
Effective Strategies for Implementing a Multicenter International Clinical Trial
Authors: Aitken Leanne M. , Pelter Michele M. , Carlson Beverly , Marshall Andrea P. , Cross Rebecca , McKinley Sharon , Dracup Kathleen
Published: May 2008

Purpose:

International collaboration in research is essential in order to improve worldwide health. The purpose of this paper is to describe strategies used to administer an international multicenter trial to assess the effectiveness of a nursing educational intervention.

Design:

The study design was a two‐group randomized multicenter international clinical trial conducted to determine whether a brief education and counselling intervention delivered by a nurse could reduce prehospital delay in the event of symptoms suggestive of acute coronary syndrome (ACS) in patients previously diagnosed with cardiovascular disease.

Method:

A flexible but well‐defined project structure showed intervention consistency in five sites among three countries and included experienced project coordinators, multidimensional communication methods, strategies to optimize intervention fidelity, site‐specific recruitment and retention techniques, centralized data management, and consideration of ethical and budgetary requirements.

Findings:

Staff at five sites enrolled 3,522 participants from three countries and achieved 80% follow‐up obtained at both 12 and 24 months.

Conclusion:

Multidimensional approaches to maintain consistency across study sites, while allowing flexibility to meet local expectations and needs, contributed to the success of this trial.

Clinical Relevance:

In order to support appropriate development of an evidence base for practice, nursing interventions should be tested in multiple settings. A range of strategies is described in this paper that proved effective in conducting a multicenter international trial.
Interaction of Duration of Homelessness and Gender on Adolescent Sexual Health Indicators
Authors: Rew Lynn , Grady Matthew , Whittaker Tiffany A. , Bowman Katherine
Published: May 2008

Purpose:

The purpose of this analysis was to determine the effects of duration of homelessness and gender on personal and social resources, cognitive‐perceptual factors, and sexual health behaviors among homeless youth.

Design:

Cross‐sectional analysis of data collected at baseline from 461 homeless adolescents who participated in a sexual health intervention study was done.

Method:

Data were collected via laptop computers from homeless adolescents (mean age = 19.52 + 1.91 years) in both comparison and intervention groups before the initiation of the intervention.

Findings:

Significant interaction effects were found for personal and social resources F (4, 426) = 2.83, p < .05. Male participants who had been homeless < 6 months had significantly higher scores on social connectedness than did male participants who were homeless > 1 year. Univariate analysis of variance (ANOVA) indicated that both boys and girls who had been homeless > 1 year had greater AIDS knowledge, F (1, 441) = 7.91, p < .01, reported significantly more sexual risk‐taking behaviors, F (1, 396) = 9.93, p < .05, and engaged in fewer safe‐sex behaviors, F (1, 396) = 12.05, p < .05, than did those who had been homeless < 6 months. Univariate ANOVA indicated that female participants had significantly lower levels of perceived health status, F (1, 429) = 12.08, p < .01, significantly greater sexual self‐care behaviors, F (1, 396) = 16.29, p < .01, and significantly higher levels of assertive communication F (1, 396) = 4.03, p < .05 than did male participants, regardless of duration of homelessness.

Conclusions:

The duration of homelessness and gender has both direct and interaction effects on cognitive‐perceptual and behavioral outcomes associated with sexual health.

Clinical Relevance:

Nurses and other healthcare providers working with homeless youth recognize the need to develop brief interventions that address health‐risk behaviors. Findings from this study indicate that gender‐specific interventions should be provided to youth soon after they become homeless.
Testing a Bioecological Model to Examine Social Support in Postpartum Adolescents
Authors: Logsdon M. Cynthia , Hertweck Paige , Ziegler Craig , Pinto‐Foltz Melissa
Published: May 2008

Purpose:

The purpose was twofold and included examining a bioecological model as a framework to describe social support in postpartum adolescents. The second purpose was to determine the relationship between a comprehensive view of the context of social support and symptoms of depression.

Design:

Cross‐sectional design with convenience sampling (n= 85) of adolescents at 4–6 weeks postpartum, recruited from two community hospitals.

Methods:

Approval was received from the university's IRB (institutional review board), each recruitment site, the adolescent mothers, and their parents or guardians. Data were collected by a research assistant during home visits using a battery of self‐report instruments to measure macro, meso, and microsystems of social support. Demographics, exposure to community violence (macrosystem), social support, social network (mesosystem), and perceived stress, mastery, and self‐esteem (microsystem) were predictor variables. Depressive symptoms were measured by using the Center for Epidemiologic Studies of Depression (CES‐D) Scale.

Findings:

Variables from each system were significant predictors of depressive symptoms but perceived stress was the strongest predictor. Many postpartum adolescents reported that they had been victims of violence. Significant symptoms of depression were identified in 37% of the postpartum adolescents.

Conclusions:

Context is important to consider in comparing international studies of social support. Researchers and clinicians should investigate variables associated with the low incidence of treatment for depressive symptoms in postpartum adolescents.

Clinical Relevance:

Feelings of high self‐esteem and mastery should be fostered in nursing interventions with postpartum adolescents and routine screening for symptoms of depression should be considered in relevant healthcare settings.
Maternal Factors Associated With Child Behavior
Authors: Hall Lynne A. , Rayens Mary Kay , Peden Ann R.
Published: May 2008

Background:

Knowledge of the relative contributions of risk factors in predicting young children's behavior problems may provide insights for the development of preventive interventions.

Objective:

The purpose of this cross‐sectional study was to identify maternal predictors of children's internalizing and externalizing behaviors in a volunteer sample of 205 low‐income, single mothers with children between 2 and 6 years of age.

Method:

Data were collected on chronic stressors, self‐esteem, negative thinking, depressive symptoms, and child behavior during in‐home interviews with the mothers.

Results:

Mothers' reports of internalizing and externalizing behaviors did not differ by sex or race of the child. Chronic stressors and depressive symptoms, in addition to control variables, explained 27% of the variability in internalizing behavior while these two variables accounted for 21% of the variability in externalizing behavior. For both internalizing and externalizing behavior, chronic stressors exerted the largest total effects. The effects of self‐esteem and negative thinking were indirect, with the latter playing a stronger role. The indirect effect of negative thinking on child behavior was exerted through depressive symptoms, while self‐esteem was linked with child behavior through both negative thinking and depressive symptoms.

Conclusions:

Decreasing mothers' negative thinking, a variable amenable to intervention, may not only decrease a mother's depressive symptoms but also improve her perception of the child's behavior.

Clinical Relevance:

Decreasing mothers' negative thinking may provide a way to reduce their depressive symptoms and result in fewer behavior problems among their young children. Nurses working in primary care and community‐based settings are in key positions to address this problem and improve the mental health of low‐income mothers and positively affect the behavior of their children.
Relative Contribution of Intrapersonal and Partner Factors to Contraceptive Behavior Among Taiwanese Female Adolescents
Authors: Wang Ruey‐Hsia , Chiou Chii‐Jun
Published: May 2008

Purpose:

To explore the relative contribution of intrapersonal factors (demographic data, sexual history, and self‐efficacy for contraception) and partner factors (perceptions of support from sexual partners for contraception, and relationship power) to contraceptive behaviors among sexually active female adolescents in Taiwan.

Design:

A cross‐sectional design. Female adolescents who have had a steady male sexual partner in the past 3 months (N= 375) were recruited as participants.

Methods:

Questionnaires including demographic data, sexual history, contraceptive behavior, self‐efficacy for contraception, perceptions of support from sexual partner for contraception, and perceptions of relationship power were submitted anonymously for this study.

Findings:

Participants who had their first sexual experience at less than 14 years of age and were from one‐parent families had the least comprehensive contraceptive behavior than did other participants. Number of steady sexual partners was significantly negatively correlated with contraceptive behavior. Self‐efficacy, perceptions of support from sexual partner for contraception, and relationship power all were positively correlated with contraceptive behavior. The important explanatory variables of contraceptive behavior were self‐efficacy, age of first sexual intercourse, intervals between sexual intercourse, and perceptions of support from sexual partner for contraception. These accounted for 39.1% of variance in contraceptive behavior.

Conclusions:

Intrapersonal factors (self‐efficacy, age of first sexual intercourse, and intervals between sexual intercourse) were more important than were partner factors (perceptions of support from sexual partners for contraception and relationship power) in influencing contraceptive behavior among sexually active female adolescents in Taiwan.

Clinical Relevance:

Intervention to increase contraceptive behavior among female adolescents should be focused more on intrapersonal factors than on partner factors.
Maternal Worries, Home Safety Behaviors, and Perceived Difficulties
Authors: Hendrickson Sherry Garrett
Published: May 2008

Purpose:

The aim of the study was to explore the worries, safety behaviors, and perceived difficulties in keeping children safe at home in a purposive sample of low‐income, predominantly non‐English speaking mothers as a foundation for later nursing interventions.

Design:

This study was a qualitative, descriptive design with content analysis to identify maternal concerns, behaviors, and perceptions of home safety as part of a larger study.

Methods:

Eighty‐two mothers, 64% of whom were monolingual Spanish‐speakers, responded in writing to three semistructured interview questions. When mothers were unable to read and write the researcher wrote the responses, then read the content aloud for verification. A standardized probe for each question was posed to obtain richer responses. Data management included use of the software program NUD*IST and coding analyses following the Miles and Huberman guidelines (1994). Interpretations were translated into English for this report.

Findings:

The major worries were falling, health, kidnapping, and being hit by a car. The leading maternal behaviors were coded as being physically, verbally, and environmentally preventive. Mothers said that it was their role to provide safety, and that this role could be wearisome, such that constant supervision was difficult.

Conclusions:

Low‐income mothers described their worries for their 1 to 4 year‐old children, explored their behaviors for preventing injury, and discussed what made keeping children from harm difficult. Understanding how mothers keep children safe, the barriers to home safety, and effective safety behaviors are important to the health of children.

Clinical Relevance:

The clinical relevance of this study includes building trust as clinicians plan assessment, intervention and evaluation of home safety to encourage dialog about concerns, safety behaviors, and barriers to keeping children from injury.
The Effect of High Nursing Surveillance on Hospital Cost
Authors: Shever Leah L. , Titler Marita G. , Kerr Peg , Qin Rui , Kim Taikyoung , Picone Debra M.
Published: May 2008

Purpose

: The purpose of this study was to determine the cost of one nursing treatment, surveillance, for older, hospitalized adults at risk for falling.

Design

: An observational study using information from data repositories at one Midwestern tertiary hospital. The inclusion criteria included patients age >60 years, admitted to the hospital between July 1, 1998 and June 31, 2002, at risk for falls or received the nursing treatment of fall prevention.

Methods

: Data came from clinical and administrative data repositories that included Nursing Interventions Classification (NIC). The nursing treatment of interest was surveillance and total hospital cost associated with surveillance was the dependent variable. Propensity‐score analysis and generalized estimating equations (GEE) were used as methods to analyze the data. Independent variables related to patient characteristics, clinical conditions, nurse staffing, medical treatments, pharmaceutical treatments, and other nursing treatments were controlled for statistically.

Findings

: The total median cost per hospitalization was $9,274 for this sample. The median cost was different (p = 0.050) for patients who received high versus low surveillance. High surveillance delivery cost $191 more per hospitalization than did low surveillance delivery.

Conclusion

: Propensity scores were applied to determine the cost of surveillance among hospitalized adults at risk for falls in this observational study. The findings show the effect of high surveillance delivery on total hospital cost compared to low surveillance delivery and provides an example of a useful method of determining cost of nursing care rather than including it in the room rate. More studies are needed to determine the effects of nursing treatments on cost and other patient outcomes in order for nurses to provide cost‐effective care. Propensity scores were a useful method for determining the effect of nursing surveillance on hospital cost in this observational study.

Clinical Relevance

: The results of this study along with possible clinical benefits would indicate that frequent nursing surveillance is important and might support the need for additional nursing staff to deliver frequent surveillance.
Advanced and Specialist Nursing Practice: Attitudes of Nurses and Physicians in Israel
Authors: Brodsky Eithan , Van Dijk Dina
Published: May 2008

Background

: With the introduction of new and advanced nursing roles, the nursing profession is undergoing dynamic change. Realizing changes will be easier to accomplish if the nursing community and other healthcare professionals welcome the process. Recently the nursing staff mix in Israel has been undergoing a transformation: encouraging registered nurses to enhance their status by acquiring academic degrees and advanced professional training, and initiating the adoption of new nursing roles.

Objective

: Our goal is to evaluate Israeli nurses' and physicians' attitudes to the introduction of new nursing roles and to expanding the scope of nursing practice.

Methods

: Two hundred and fifteen nurses and 110 physicians from three large general hospitals and 15 community clinics filled in a questionnaire.

Findings

: In general the majority of the nurses supported expansion of nursing practice, and such expansion did not cause significant opposition among physicians. However when the task affected patients' health, physicians were less willing to permit nurses to perform skills previously their responsibility alone. In addition, using multiple logistic regressions, support of the expansion of nursing practice was significantly higher among nurses in management or training positions, and among academically accredited nurses. Support for expanded roles was prominent among hospital physicians, graduates from Israeli schools of medicine, and less‐tenured physicians.

Conclusions

: We suggest that confirmation by various groups of physicians and nurses of standardized definitions of the new boundaries in the scope of nursing practice roles could successfully promote development of new roles and facilitate integration of the Israeli healthcare system into the global context of change.

Clinical Relevance

: Inter‐ and intra‐professional collaboration, agreement, and understanding regarding advanced nursing practice roles and their introduction into the healthcare system might improve the relationship between healthcare professions and ultimately increase quality of care and patient satisfaction.
Creating Cross‐Disciplinary Research Alliances to Advance Nursing Science
Authors: Loeb Susan J. , Penrod Janice , Kolanowski Ann , Hupcey Judith E. , Haidet Kim Kopenhaver , Fick Donna M. , McGonigle Dee , Yu Fang
Published: May 2008

Purpose:

To demonstrate the utility of a developmental approach to building and sustaining cross‐disciplinary research alliances.

Organizing Construct:

Cross‐disciplinary collaborations offer great promise for advancing an evolving program of research. Funding agencies' commitment to interdisciplinary work further heightens these collaborations. Nurse researchers, however, are not necessarily equipped with the knowledge and skills needed to strategically and successfully build and maintain cross‐disciplinary collaborations.

Methods:

Successful strategies for forging, extending, and sustaining alliances are organized using a developmental approach and illustrated by exemplars.

Findings:

The initial phase of forging alliances is focused on creating a limited network to support relatively clear‐cut research goals. The cohesive cross‐disciplinary team is subsequently extended beyond the initial team to strategically address broader research goals. As the team matures, emphasis shifts toward sustaining the team through shared leadership that more actively focuses on the development of the field than the development of individual programs of research.

Conclusions:

The advancement of nursing science requires nurse researchers to rethink the developmental phases of building appropriate research teams. Strategic approaches for forging, extending, and sustaining cross‐disciplinary alliances position nurse researchers as leaders in innovative cross‐disciplinary research. The development of cross‐disciplinary teams supports translational research and, by extension, the science that undergirds practice.

Clinical Relevance:

Research that reflects cross‐disciplinary perspectives is particularly well suited to addressing the complex health issues encountered by patients, families, and communities.
Effects of Rare‐Earth (RE) Intergranular Adsorption on the Phase Transformation, Microstructure Evolution, and Mechanical Properties in Silicon Nitride with RE2O3+MgO Additives: RE=La, Gd, and Lu
Authors: Becher Paul F. , Painter Gayle S. , Shibata Naoya , Waters Shirley B. , Lin Hua‐Tay
Published: May 2008

Silicon nitride powders most often consist primarily of the α phase, which transforms into the β phase during the densification and microstructural evolution of Si3N4 ceramics. The temperature at which the transformation initiates in the presence of a combination of MgO and RE2O3 densification additives is found to decrease with increasing atomic number of the rare earth (RE). This trend coincides with the predicted and observed decrease in the affinity of the RE to segregate to and absorb on the prism planes of hexagonal prism‐shaped β grains with an increase in the atomic number of the RE. When RE adsorption is diminished, Si (and N) attachment on the smooth prism planes is enhanced, which increases diametrical growth rates, normally reaction‐rate limited by an attachment mechanism. Combined with the typically fast [0001] growth, it is this augmented grain growth that contributes toward the initiation of the α–β transformation at lower temperatures. With the enhanced transformation, observations reveal an increase in the number of β grains growing in the early stages of densification. On the other hand, increased RE adsorption leads to greater growth anisotropy, resulting in the formation of higher aspect ratio grains. Thus, Lu2O3 generates larger diameter, yet elongated, reinforcing grains, while La2O3 results in reinforcing grains of a higher aspect ratio. The Gd2O3 additive transformation and microstructural characteristics lie intermediate to those of the lanthanide end‐member elements. Despite these differences, a substantial fraction of large reinforcing grains were found for each additive composition. As a result, the mechanical properties of the resultant ceramics are similar with flexure strengths in excess of 1 GPa, fracture toughness values >10 MPa·m1/2 at room temperature, and excellent strength retention (>800 MPa) at 1200°C.
Precision Material Condition Assessments
Authors: HARRIS MICHAEL W. , TRIPPEL ALBERT A.
Published: May 2008

One of the key elements for cost effective and efficient maintenance of today's Navy is the use of material condition assessments as part of the overall Navy's Condition‐Based Maintenance (CBM) philosophy. Through the use of material condition assessments, maintenance managers are able to detect, mitigate, and prevent potential costly and operationally debilitating equipment or systems failures. All Type Commanders (TYCOMs) use CBM assessments to help manage maintenance. This has been accomplished for CNSF N432 by the consolidated visit process, which has an established track record of proven success and is continuing to evolve with new technology and emerging processes, especially in view of the need to “do more with less.” One of the advances made in the material condition assessment process is the increased ability to accurately target problem maintenance objects for assessment. Much like the improvements made in missile technology, whereby the detection and seeker accuracy have evolved to permit pinpoint targeting (thus allowing warheads to become smaller and overall less costly), the improved use of maintenance history data and engineered risk priority business rules allows the material condition assessment process to zero in on problem maintenance objects. Modern missiles can now zoom in on specific buildings as designated targets and no longer need to be as destructive as in the past in order to achieve desired results, thus saving the cost and necessity for larger missiles and warheads. Likewise, today's precision material condition assessments can zoom in on those components within systems that are causing failures and not expend time, effort, and funding on collateral assessments for non‐problem items. A process tool currently being used to provide the precision targeting for material condition assessments is the Maintenance Assessment Index (MAI). This paper will review the background of the MAI, the process by which precision material condition assessments are determined, and how that information is integrated with the consolidated visit process: Hull, Mechanical, and Electrical Readiness Assessment. Success of the MAI is measured by increasing the look‐to‐find and find‐to‐fix ratios executed during the visits. Good systems and components fall off the radar screen, while bad actors are specifically targeted. This paper will also cover the consolidated visit process from agenda building to task loading from the Integrated Class Maintenance Plan, from the use of work order management tools to metrics collection and measures analysis. The ability to adjust the targeting criteria of the material condition assessment has become a powerful weapon for the TYCOM's battle to accomplish more maintenance with fewer resources and yet ensure a high state of material readiness for the fleet.
Aggressive NK cell leukaemia after splenectomy: association with CD95‐resistant memory T‐cell proliferation and recalcitrant clinical course of haemophagocytic syndrome
Authors: Suzuki Shinsuke , Uozumi Kimiharu , Utsunomiya Atae , Ishitsuka Kenji , Masamoto Izumi , Owatari Satsuki , Makino Torahiko , White Yohann , Arima Naomichi
Published: May 2008

We describe a 44‐yr‐old Japanese woman with persistent polyclonal T‐cell proliferation and recalcitrant clinical course of haemophagocytic syndrome (HPS). T cells bearing αβ T‐cell receptors (TCR) expressed increased amounts of CD95 and of CD45RO, which are phenotypically memory T cells. The TCR repertoire was broad and diverse. Regardless of CD95 expression, these cells were resistant to CD95‐mediated apoptosis. Aggressive natural killer cell leukaemia (ANKL) without an association with Epstein–Barr virus was detected 1 month after therapeutic splenectomy that followed 3 yr of immunosuppressive therapy against HPS. The immunophenotype of these leukaemia cells was CD56, CD16dim, CD7, CD45RA and they expressed some CD2, CD8 and HLA‐DR. Moreover, hyperdiploid clones with complex chromosomal abnormalities were also detected. Latent NK‐cell malignancy seemed to cause the CD95‐resistant memory T‐cell proliferation and splenectomy resulted in overt ANKL progression. There should be careful consideration of the risks versus benefits of splenectomy in HPS, in light of the possibility of fatal leukaemia/lymphoma progression.
Serum BAFF predicts prognosis better than APRIL in diffuse large B‐cell lymphoma patients treated with rituximab plus CHOP chemotherapy
Authors: Kim Seok Jin , Lee Seung Jin , Choi In Young , Park Yong , Choi Chul Won , Kim In Sun , Yu Woosung , Hwang Hee Sang , Kim Byung Soo
Published: May 2008

Objectives:  B‐cell activating factor of the tumor necrosis factor family (BAFF) and a proliferation‐inducing ligand (APRIL) regulate survival and proliferation of B cells. Thus the association of elevated serum levels of BAFF and APRIL with worse prognosis has been suggested in B‐cell lymphoid malignancies. However, the prognostic relevance of BAFF and APRIL is unknown in patients treated with rituximab, a monoclonal antibody targeting B‐cell depletion.

Methods:  We measured serum levels of BAFF and APRIL by enzyme‐linked immunosorbent assay in 66 patients newly diagnosed as diffuse large B‐cell lymphoma (DLBCL). All patients were treated with rituximab‐CHOP chemotherapy.

Results:  The mean (±standard deviation) serum level of BAFF (1 970.21 ± 1 979.45 pg/mL) was higher in DLBCL than in controls (861.03 ± 194.92 pg/mL, Mann–Whitney U‐test, P < 0.001). When the patients were dichotomized into high and low BAFF group based on the median value (1 258.00 pg/mL), high BAFF group had less numbers of complete responders to rituximab‐CHOP, and more relapses or progression after or during treatment. In multivariate analysis, serum BAFF was an independent prognostic factor for overall survival and progression‐free survival (P < 0.05). Although serum levels of APRIL was also higher than controls (10.60 ± 19.08 ng/mL vs. 1.10 ± 0.30 ng/mL, P = 0.023), it failed to show prognostic significance.

Conclusions:  Serum BAFF may be a useful indicator predicting prognosis in DLBCL patients treated with rituximab‐containing chemotherapy.