bluuebunny/crossref_metadata_2025 huggingface dataset:
Co‐Doping of Air Plasma‐Sprayed Yttria‐ and Ceria‐Stabilized Zirconia for Thermal Barrier Applications
Authors: Chen Zun , Trice Rodney , Wang Hsin , Porter Wally , Howe Jane , Besser Matthew , Sordelet Daniel
Published: May 2005

Co‐dopants of either Yb3+ or Ca2+ were incorporated into 7.6 mol% YO1.5–ZrO2 (7.6YSZ) and 12 mol% CeO2–ZrO2 (12CeSZ) coatings by infiltrating porous spray‐dried powders with salt solutions containing the appropriate co‐dopant species prior to plasma spraying. Co‐dopant concentration was varied from 2 to 5 mol%. Using a combination of transmission electron microscopy and energy‐dispersive analysis, no secondary phase or Yb3+ segregation was detected at the grain boundary of either as‐sprayed 2Yb/7.6YSZ or 2Yb/12CeSZ coatings. Dilatometer measurements showed that 2 mol% Yb3+ co‐doped 7.6YSZ and 12CeSZ coatings shrank ∼0.6% during a 5 h soak at 1400°C, approximately the same contraction as the baseline coatings (i.e. not co‐doped). X‐ray diffraction results show that the as‐sprayed 7.6YSZ, 2Ca/7.6YSZ, and 2Yb/7.6YSZ coatings comprised of non‐transformable, non‐equilibrium composition tetragonal ZrO2 (identified presently as t′‐ZrO2), while the 5Ca/7.6YSZ coating was a non‐equilibrium composition of cubic ZrO2. After a heat treatment of 100 h at 1200°C, the 2Yb/7.6YSZ coating was completely t′‐ZrO2, while the baseline and Ca2+ co‐doped 7.6YSZ coatings showed evidence of partitioning. Therefore, it appears that co‐doping of 7.6YSZ with 2 mol% Yb3+ increases the stability of t′‐ZrO2, whereas co‐doping with 2 mol% Ca2+ decreases the stability of t′‐ZrO2. The volume fraction of m‐ZrO2 in the baseline 12CeSZ coatings was estimated to be 88% after a 100 h heat treatment at 1200°C. 2 mol% Yb3+ or Ca2+ co‐doping limited the tetragonal to monoclinic phase transformation in 12CeSZ, with only 37% and 43% monoclinic phase observed, respectively, after a 100 h heat treatment at 1200°C; this was an improvement over the baseline 12CeSZ coating. As‐sprayed 2Yb/7.6YSZ and 2Yb/12CeSZ coatings had slightly lower thermal conductivity than their baseline counterparts in the as‐sprayed condition; after 100 h at 1200°C, their conductivity increased to that of the baseline coatings.
Hydrothermal Soft Chemical Synthesis and Particle Morphology Control of BaTiO3in Surfactant Solutions
Authors: Feng Qi , Hirasawa Manabu , Kajiyoshi Koji , Yanagisawa Kazumichi
Published: May 2005

Barium titanate (BaTiO3) particles with book‐like and spherical morphology were prepared by using a hydrothermal soft chemical process in the presence of a cationic surfactant. A layered titanate of H1.07Ti1.73O4with a lepidocrocite‐like structure and plate‐like particle morphology was used as the precursor. The layered titanate was hydrothermally treated in a Ba(OH)2–(HTMA‐OH) (n‐hexadecyltrimethylammonium hydroxide) solution or a Ba(OH)2–(HTMA‐Br) (n‐hexadecyltrimethylammonium bromide) solution in a temperature range of 80°–250°C to prepare BaTiO3. The intercalation reaction of HTMA+with the layered titanate promotes the structural transformation reaction from the layered titanates to BaTiO3, while it inhibits the structural transformation reaction to anatase under the hydrothermal conditions. The particle morphology of BaTiO3prepared by this method dramatically changes with changing reaction conditions. HTMA+plays an important role in changing particle morphology in the hydrothermal soft chemical process.
Strength and Notch Sensitivity of Porous‐Matrix Oxide Composites
Authors: Mattoni Michael A. , Zok Frank W.
Published: May 2005

The effects of matrix strength on the notched and unnotched tensile properties of a family of porous‐matrix oxide composites are examined both experimentally and theoretically. Experiments are performed on three composites, distinguished from one another by the amount of binding alumina within the matrix. Increases in alumina concentration produce elevations in unnotched tensile and shear strengths, but the benefits are offset by an increase in notch sensitivity. The degree of notch sensitivity is rationalized on the basis of a model that accounts for interactions between notch tip tensile and shear bands. The model predictions are cast in terms of the ratio of the notch length to a characteristic bridging length scale. These results, in turn, form the basis for a simple analytical formula for notched strength, accounting for effects of elastic anisotropy and finite sample size. The utility of this formula in predicting notched strength is assessed. Issues associated with bridging law shapes and bridging length scales are addressed. The effect of alumina concentration on notch sensitivity is discussed in terms of its influence on the bridging length scale, dictated by the interplay between the unnotched tensile strength, the longitudinal Young's modulus, the degree of in‐plane elastic anisotropy, and the fracture energy. The net result is a decreasing bridging length scale and hence increasing notch sensitivity as the matrix is strengthened with alumina.
Lath‐like Structure of β‐Tricalcium Phosphate in Orthopedic Implants
Authors: Dai Honglian , Li Shipu , Leng Yang
Published: May 2005

The lath‐like β‐tricalcium phosphate (β‐TCP) in the sintered porous β‐TCP implants was revealed by transmission electron microscope (TEM). Samples of sintered porous β‐TCP implants were extracted from rabbit tibia after implanted for 1–6 months. Although the majority of sintered β‐TCP particles are in a granular shape, the lath‐like structures of implants are observed occasionally. The length of laths is on the order of 1 μm, while the thickness of laths is on the order of 10 nm. The X‐ray energy dispersive spectroscopy and the electron diffraction indicate that the lath‐like material is β‐TCP with its rhombohedral () plane parallel to the longitudinal direction of laths. High resolution TEM imaging also confirms the finding of electron diffraction. This abnormal morphology of β‐TCP have raised our attention, even though its formation mechanism and effects on osseointegration is not yet certain.
Suppression of Sulfate Attack on a Stabilized Soil
Authors: Wang Lan , Roy Amitava , Seals Roger K. , Byerly Zachary
Published: May 2005

A soil containing calcium sulfates was stabilized at 40°C, with ample moisture, by cementitious mixtures producing a range of calcium hydroxide upon hydration. Maximum expansion occurred when the stabilizing agent was lime, whereas a mixture containing portland cement, Class C fly ash, and an amorphous silica stopped the expansion. X‐ray diffraction peak width and scanning electron microscopy (SEM) based image analysis showed that maximum expansion correlated with crystallization of colloidal ettringite. Ettringite was seen by SEM within an hour of mixing the soil with lime. Colloidal ettringite was not observed when portland cement, with supplementary cementing materials, was used for stabilization.
Experimental Assessment of Plasticity of Nanocrystalline 1.7 mol% Yttria Tetragonal Zirconia Polycrystals
Authors: Gutiérrez‐Mora Felipe , Gómez‐García Diego , Jiménez‐Melendo Manuel , Domínguez‐Rodríguez Arturo , Chaim Rachman
Published: May 2005

High temperature mechanical behavior of nanocrystalline 1.7 mol% (3 wt%) yttria tetragonal zirconia polycrystals (nc‐YTZP) was characterized by compression creep tests. The hot isostatically pressed nc‐YTZP with mean grain size of 120 nm was subjected to grain growth to obtain grain sizes in the range of 120–310 nm. Direct measurements of the creep parameters were performed in the temperature range 1150°–1300°C and stress range 5–400 MPa. The strain rates at 1150°C ranged between 2 × 10−7 and 9 × 10−5 s−1 when increasing the stress from 15 to 400 MPa. Values of the stress exponent, n=2.0±0.3, and the activation energy, Q=630±40 kJ/mol, were obtained for all test conditions. A value of the grain size exponent, p=1.5±0.3, was obtained at 1150°C in the stress range studied. Detailed microstructural observations revealed the absence of glassy phase at the grain boundaries. The creep parameters were compared with those from the literature, and the results were discussed in terms of the model recently developed by the authors, with a reasonable agreement.
Intragranular Particle Residual Stress Strengthening of Al2O3–SiC Nanocomposites
Authors: Sun Xudong , Li Ji‐Guang , Guo Shiwen , Xiu Zhimeng , Duan Kai , Hu Xiao Zhi
Published: May 2005

Al2O3/SiC ceramic nanocomposites were fabricated from nanocrystalline Al2O3 (10 nm in diameter) and SiC (15 nm in diameter) powders, and a theoretical model of intragranular particle residual stress strengthening was investigated. The SiC nanoparticles in the Al2O3 grains create a normal compressive stress at the grain boundaries and a tangential tensile stress in the Al2O3 grains, resulting in the “strengthening” of the grain boundaries and “weakening” of the grains. The model gives a good explanation of the experimental results of the authors and others which are difficult to be explained by the existing strengthening models, i.e. the maximum strength is normally achieved at about 5 vol% of SiC particles in the Al2O3–SiC ceramic nanocomposites. According to the model, there exists an optimum amount of SiC for strengthening, below which the grain boundaries are not fully “strengthened” and the fracture is mainly intergranular, above which the grains are “weakened” too much and the fracture is mainly transgranular, and at which the fracture is a mixture of intergranular and transgranular.
Crystallinity, Crystalline Quality, and Microstructural Ordering in Boron Nitride Fibers
Authors: Bernard Samuel , Chassagneux Fernand , Berthet Marie‐Paule , Cornu David , Miele Philippe
Published: May 2005

A qualitative and quantitative analysis of the microtexture/microstructure in several experimental boron nitride fibers was investigated by X‐ray diffraction and electron microscopy according to their mechanical properties. Young's modulus was controlled by grain orientation. The disordered microstructure of low modulus fibers consisted of amorphous regions and nanometer‐sized crystallites arranged in a wide range of orientation. In contrast, high modulus samples showed a coarse‐grained microtexture in which crystallites were ordered in a meso‐hexagonal arrangement along the fiber‐axis. Cracks were easily propagated as crystallinity increased, leading to decreased failure strain. The strength‐microstructure relationship was obscured by the fiber porosity and defects.
A Phase Diagram for Epitaxial PbZr1−xTixO3 Thin Films at the Bulk Morphotropic Boundary Composition
Authors: Choudhury Samrat , Li Yulan , Chen Long‐Qing
Published: May 2005

A phase diagram of temperature versus strain was constructed for a (001)‐oriented PbZr1−xTixO3 epitaxial single crystal thin film near the bulk morphotropic boundary composition (x=0.47) on an (001)‐oriented cubic substrate. The phase‐field approach is employed. It is shown that a mixture of distorted rhombohedral, orthorhombic, and tetragonal phases exists under small values of strain, i.e., close to the in‐plane clamped boundary condition. This result contradicts thermodynamic calculations assuming a single‐domain state that predicted a single distorted rhombohedral phase under similar strains. Furthermore, it is demonstrated that under a large tensile strain current phase‐field simulations showed a tetragonal phase with a1/a2 twin structures as the stable state whereas thermodynamic calculations predicted an orthorhombic phase.
Low‐Temperature, Single Step, Reactive Sintering of Lead Magnesium Niobate Using Mg(OH)2‐Coated Nb2O5 Powders
Authors: Gu Huiming , Shih Wan Y. , Shih Wei‐Heng
Published: May 2005

A low‐temperature, single step, reactive sintering method for Pb(Mg1/3Nb2/3)O3 (PMN) and PMN–PbTiO3 (PMN–PT) processing was developed based on the coating of Mg(OH)2 on Nb2O5. This method simplified the processing of PMN and PMN–PT to a single step of heat‐treatment and decreased the sintering temperature to 1000°C. It was found that the pyrochlore phase formation reaction at 500°C reduced the particle size to 130 nm. The overlap of the pyrochlor‐perovskite phase transformation between 700° and 900°C and the densification process between 800° and 1000°C improved the sintering process. These two factors were the major reasons of the low temperature sintering.
Interfacial Energy in Phase‐Separated Glasses from Emulsion Rheology
Authors: Wondraczek Lothar , Deubener Joachim , Pozo Helena del , Habeck Andreas
Published: May 2005

Classical theories of emulsion rheology yield information on the deformation of a liquid drop dispersed into another liquid matrix phase. By connecting the deformation and relaxation, respectively, and the capillary number of the dispersed phase, interfacial energy can be estimated. This was applied to demixing borosilicate and lead borate glasses, which are known to exhibit significant form anisotropy after elongation. Interfacial energies in these two systems were calculated based on graphical data of prior isothermal elongation experiments. The method is discussed in terms of experimental difficulties. It might provide an alternative way to overcome the obvious lack of information on interfacial energies in glasses.
Effect of Oxygen Segregation at Grain Boundaries on Deformation of B, C‐Doped Silicon Carbides at Elevated Temperatures
Authors: Ohtsuka Shigehiro , Shinoda Yutaka , Akatsu Takashi , Wakai Fumihiro
Published: May 2005

The effect of oxygen segregation at grain boundaries on the deformation of 1 wt% boron (B)‐ and carbon (C)‐doped β‐silicon carbide (B, C‐doped SiC) was investigated by compression testing at 2073 K. We studied the deformation of sinter‐forged B, C‐doped SiC (sinter‐forged SiC), which contained the minimum amount (0.07 wt%) of oxygen as an impurity, and that of hot isostatically pressed B, C‐doped SiC (HIPed SiC), which contained 1 wt% oxygen. Oxygen was detected at grain boundary in HIPed SiC by energy‐dispersive X‐ray spectroscopy, but it was not detected in sinter‐forged SiC. The strain rate of sinter‐forged SiC was one order of magnitude lower than that of HIPed SiC at the same grain size. The grain growth rate of sinter‐forged SiC was lower than that of HIPed SiC also. These results suggest that the oxygen segregation at grain boundaries, together with boron segregation, promoted the grain‐boundary diffusion in B, C‐doped SiC. But, the oxygen segregation without boron was less effective in promoting deformation than the boron segregation without oxygen.
Hollow Al2O3 Microspheres Derived from Al/AlOOH·nH2O Core‐Shell Particles
Authors: Kou Huamin , Wang Jing , Pan Yubai , Guo Jingkun
Published: May 2005

Hollow Al2O3 spheres with ∼2 μm in diameter and ∼200 nm in wall thickness were prepared successfully via the calcination of the Al/AlOOH·nH2O core‐shell particles, prepared by wet‐chemical method using commercial microscale aluminum powders as raw materials, at 900°–1100°C in air. X‐ray powder diffraction, differential scanning calorimetric analysis, scanning electron microscopy, and transmission electron microscopy were used to characterize the obtained samples, and the possible formation mechanism was discussed. These hollow Al2O3 microspheres may have promising applications in insulators, lightweight fillers, and catalyst carriers because of their unique hollow structure.
Solvothermal Synthesis of Tungsten Oxide Nanorod/Nanowire/Nanosheet
Authors: Choi Hong Goo , Jung Young Hwa , Kim Do Kyung
Published: May 2005

A simple process enables to synthesize tungsten oxide with various nanomorphologies, i.e. nanorods, nanowires, and nanosheets. The tungsten hexachloride (WCl6) was used as a raw material and the tungsten oxide nanoparticles were obtained by solvothermal treatment with solvents, i.e., ethanol, mixed solvent (ethanol+water), and water, at 200°C for 10 h. The various crystalline phases of tungsten oxide, such as monoclinic W18O49 nanorods, hexagonal WO3 platelets, and monoclinic WO3 nanosheets, were synthesized by simply changing the composition of the solvent. The oxygen, which was contained in water, played an important role in the final tungsten oxide phase. Especially, W18O49 nanorods grew to nanowires as the concentration of WCl6 was decreased. Using this simple process, it will be possible to control the crystalline phase and morphologies of nanostructured tungsten oxide system.
Stress Distributions in Thin Bilayer Discs Subjected to Ball‐On‐Ring Tests
Authors: Hsueh C. H. , Lance M. J. , Ferber M. K.
Published: May 2005

Ball‐on‐ring tests have been used extensively to measure the biaxial strength of brittle materials. However, the tests and analyses are limited to materials of uniform properties. An analytical model is developed in the present study to analyze thin bilayer discs subjected to ball‐on‐ring tests. It is found that closed‐form solutions for bilayer discs can be obtained from existing solutions for monolayer discs by replacing the position of the neutral surface and the flexural rigidity of monolayers with those of bilayers. To validate the analytical solutions for bilayers, ball‐on‐ring tests are performed on a thin Al2O3 scale grown on an oxide dispersion‐strengthened FeCrAl alloy disc and photo‐stimulated luminescence spectroscopy is used to measure the stress distributions in the Al2O3 layer. In this case, the stress‐induced peak shift of the R lines emitted by the Al2O3 scale is used to determine the average stress through the scale thickness. Good agreement between predictions and measurements is obtained.
Nurse Practitioners' Perceptions of Their Caring Behaviors
Authors: Brunton Byrle , Beaman Margaret
Published: May 2005

PURPOSE

To explore nurse practitioners' (NPs) perceptions of their own caring behaviors, the relationship between sociodemographic variables, environmental factors, and NP's perceptions of their caring behaviors.

DATA SOURCES

A mailed survey to a systematic random sample of 200 members of an Illinois NP group.

CONCLUSIONS

The top ten caring behaviors in rank order were appreciating the patient as a human being, showing respect for the patient, being sensitive to the patient, talking with the patient, treating patient information confidentially, treating the patient as an individual, encouraging the patient to call with problems, being honest with the patient, and listening attentively to the patient.

IMPLICATIONS FOR PRACTICE

The quality of instruction in the biomedical aspect of nursing education is relatively easily assessed. Caring is nurses' hidden work that may go unrecognized except when the caring behaviors are missed by the patients or their families.
The Distribution of Advanced Practice Nurses in Arkansas: Gaps in the Care of Rural Underserved Populations
Authors: Kippenbrock Thomas , Stacy Annette , Tester Karen , Richey Roger
Published: May 2005

PURPOSE

To examine the relationships between advanced practice nurses' (APN) practice sites and economic factors, racial and ethnic characteristics of the populations they serve, and the likelihood of APNs practicing in underserved areas.

DATA SOURCES

Retrospective analysis of U. S. census data and records supplied by the Arkansas State Board of Nursing.

CONCLUSIONS

Nurse practitioners (NPs) were the only APN group with equal distribution in rural or urban areas. Overall, APNs and NPs were more likely to practice in counties with higher rates of poverty and lower education levels.

IMPLICATIONS FOR PRACTICE

More effort needs to be made in recruiting and retaining APNs in rural and underserved areas.
Factors Contributing to the Quality of End‐of‐Life Care
Authors: Gabany Jennifer M.
Published: May 2005

PURPOSE

To examine the factors influencing healthcare for the elderly and the terminally ill in modern health care.

DATA SOURCES

Selected articles, Internet sources, and legal sources.

CONCLUSION

Despite increasing use of advance directives, patients are not given adequate information at an appropriate time to make informed decisions. Even when advance directives are in place, they may not be honored.

IMPLICATIONS FOR PRACTICE

Among the most critical areas to consider in improving end‐of‐life care are encouraging patients to make known their wishes, respecting patients' concerns about quality of life, and promoting continuity and skill in end‐of‐life care.
Periodontal Disease: Diagnosis and Management
Authors: Ridgeway Elaine Embrack
Published: May 2005

Approximately 50% of all adults in the United States have some form of gingivitis, and 80% have experienced some degree of periodontitis. Despite the use of fluoride, a critical element in the prevention of periodontal disease, many children and adults still suffer needlessly from this “silent” destroyer of the gum tissue and its underlying bone structures. This article highlights the prevalence, pathophysiology, classifications, health risk factors and clinical management of clients with periodontal diseases. Regardless of the health care setting, the advanced practice nurse plays a critical role in the prevention, early diagnosis and intervention of periodontal disease.
Tobacco Cessation Intervention in a Nurse Practitioner Managed Clinic
Authors: Reeve Kathleen , Calabro Karen , Adams‐McNeill Jeanette
Published: May 2005

Tobacco cessation counseling by health care professionals has been associated with increased tobacco cessation rates. In this study we compare the effectiveness of two smoking cessation approaches administered by nurse practitioners – a stepped care approach (n = 34) and a routine care approach (n = 41), using a pre‐ and post‐test control group study design. Additionally, this study was guided by the “stages of change” construct of the transtheoretical model. Study results indicated that nurse practitioners delivered consistent office‐based advice about tobacco use. In addition, nurse practitioner smoking cessation interventions contributed to positive shifts in stage of change for smoking cessation.
Professionalism and the Nurse‐Midwife Practitioner: An Exploratory Study
Authors: Hampton Dorothee L. , Hampton Gerald M.
Published: May 2005

This article reports the findings of an exploratory study on the level of professionalism among certified‐nurse midwives (CNMs). Using a five dimensional scale to measure professionalism, our research examined the level of professionalism among CNMs. It explored the relationship between organizational reward structures, level of education, and professionalism. The results show that CNMs exhibit a high degree of professionalism in the practice of nurse‐midwifery. The findings also support the notion of a causal relationship between reward structures, education levels and CNM professionalism.
The Pleasure of Your Company: Attitudes and Opinions of Preceptors Toward Nurse Practitioner Preceptees
Authors: Gibson Sandra E. , Hauri Claudia
Published: May 2005

PURPOSE:

To survey the attitudes and opinions of preceptors about their experiences with nurse practitioner stu‐dents.

DATA SOURCES:

Original research using a mailed questionnaire designed by the researchers to 196 physician and nurse practitioner preceptors (23% response rate).

CONCLUSIONS:

Preceptors desired faculty support and feedback, wanted involvement in shaping the curriculum, and had strong opinions about the precepting experience.

IMPLICATIONS FOR PRACTICE:

The attitudes and opinions of preceptors are extremely important to the availability of a qualified and motivated pool of preceptors, the clinical growth of the stu‐dents, the quality of the student's learning experience, and the survival of nurse practitioner programs.
Advances in the Treatment of Hepatitis C: Combination Antiviral Therapy With Interferon alfa‐2b and Ribavirin
Authors: Benson Laura , Birkel Alice , Caldwell Linda , Stafford‐Fox Valerie , Casarico Beverley
Published: May 2005

PURPOSE:

To provide nurse practitioners with the information to manage patients with chronic hepatitis C (HCV) receiving a new combination drug therapy containing ribavirin and interferon alfa‐2b.

DATA SOURCES:

Reviews of clinical trial results including large multicenter trials, Centers for Disease Control and Prevention documents, data from the drug manufacturer.

CONCLUSION:

This new therapy offers the potential for HCV remission or complete cure of the HCV infection. Although virologic responses are markedly improved with combination therapy, the side effects associated with combination therapy warrant regular patient monitoring, management, and medical intervention when clinically indicated.

IMPLICATIONS FOR PRACTICE:

Combination therapy does not significantly worsen the side effects associated with mono‐therapy, which are predictable, manageable, and reversible. However, proper patient education, symptom management, vigilance for serious side effects, and monitoring of hematologic parameters are critical to patient outcome.
Primary Care Provider's Guide to Cardiology
Authors: Maddox Margie
Published: May 2005

Primary Care Provider's Guide to Cardiology G.N. Levine & D.L. Mann (Eds.) (2000)

Dying: A Book of Comfort P. McNees (1996)

A Pocket Manual of Differential Diagnosis (4th ed.) S.N. Adler, D.B. Gasbaria & D. Adler‐Klein (Eds) (2000)

A Clinician's Guide to Tuberculosis M.D. Iseman (2000)
Nurse Practitioner Student Prescriptive Patterns
Authors: Fontana Susan A. , Devine Elizabeth C. , Kelber Sheryl K.
Published: May 2005

As employment of nurse practitioners (NPs) increases in health care systems, there is a need to have current data on their prescribing practices and patterns, and to implement a system for updating such data. This study reports prescriptive data based upon 10,421 primary care visits conducted by 55 family NP students over a 15‐month period in 1997 and 1998. Numbers of over‐the‐counter drugs taken regularly, prescription drugs currently prescribed and prescription drugs prescribed or refilled at the visit were recorded in addition to types of drugs, compliance issues, diagnoses rendered and socio‐demographic information. Individual student data were aggregated and analyzed using Epi Info (Epidimiology Program Office of the Centers for Disease Control) and SPSS‐PC®. Results identified that: 1) the majority of patient visits involved the prescription of 1‐2 drugs (88%); 2) major compliance issues included financial concerns, knowledge deficits, and complexity/demands of treatment; 3) commonly rendered diagnoses at drug visits for chronic conditions were hypertension and diabetes; for acute conditions, otitis sinusitis and upper respiratory infections; 4) anti‐microbial agents, drugs used for relief of pain, and cardiovascular drugs account for 60% of drug mentions; and 5) the numbers of drugs prescribed or refilled at visits were similar by type of preceptor, except fewer single drugs were prescribed or refilled at visits supervised by nurse preceptors. Findings are discussed relative to deepening the understanding of advanced practice nursing education and the prescribing practices of NP students and their preceptors.
coping Strategies of Rural Families of Critically Ill Patients
Authors: Hunsucker Sharon , Flannery Jeanne , Frank Deborah
Published: May 2005

This study explored the coping strategies of families of critically ill patients in a rural Southern Appalachian setting. A convenience sample of 30 family members of 22 critically ill patients in two rural hospitals completed the Jaloweic Coping Scale. The five most frequently used coping methods were helping, thinking positively, worrying about the problem, trying to find out more about the problem and trying to handle things one step at a time. The five most effective coping strategies were talking the problem over with friends, praying, thinking about the good things in life, trying to handle things one step at a time and trying to see the good side of the situation. Findings contradicted many of the more “negative” descriptions of Appalachian people in the literature. Similarities outweighed differences when comparing the coping styles of rural and urban populations. Findings suggest that coping strategies must be considered for positive outcomes in the delivery of care to such a rural population.
Diagnosing Appendicitis Across the Life Span
Authors: Gauf Christine L.
Published: May 2005

Arriving at a definitive diagnosis of acute appendicitis (AA) requires an understanding of the various presenting signs and symptoms of all ages and genders across the life span. Primary care providers must also be aware of the pertinent laboratory tests and imaging procedures that will assist in providing useful information toward making an accurate diagnosis of AA. Utilizing an in‐depth review of the literature, this article delineates the presenting signs and symptoms of AA from children to adults to elders. It also delineates which laboratory and imaging techniques should be used for each age group as effective adjuncts in diagnosing AA.
The A, B, C's of Bone Building in Adolescence
Authors: Durst Eugenia S.
Published: May 2005

The majority of treatment for osteoporosis has focused on secondary and tertiary strategies that attempt to preserve acquired adult bone mass. However, the occurrence of osteoporosis and its related physical and economic sequelae continue to escalate, resulting in devastating morbidity and mortality in later adulthood because of bone fractures. Mounting evidence continues to support primary intervention strategies that target adolescents during skeletal maturation as effective in building bone mass reserves with the power to resist the threat of osteoporotic fractures. Nurse practitioners need to exercise their expertise as primary care providers by teaching adolescents and their families the A, B, Cs of bone building with calcium, vitamin D and exercise.
Creating a “Health Connection” Between STD Services and Primary Care
Authors: Brian Donna L. , Pond Jane B.
Published: May 2005

Women's health nurse practitioners may find their practice includes men who present for treatment of sexually transmitted diseases (STD). In seven months, the women's healthnurse practitioner at Temple Health Connection treated 70 African‐American males for STDs. Seventeen males (24%) were diagnosed with hypertension. Nine of these patients returned for follow‐up care with a primary care adult nurse practitioner. Our experience shows it is important to combine STD treatment with accessible primary health care.
Increasing the Knowledge Base of Asthmatics and Their Families Through Asthma Clubs Along the Southwest Border
Authors: Alexander Jackie , Divin‐Cosgrove Chris , Faner Maria Luisa , O'Connell Michael
Published: May 2005

This study focused on behavior modification and enhancement of knowledge concerning home asthma management. The intervention focused on asthma awareness, severity assessment, medication use, and development of management plans while building a support group. The quasi‐experimental design utilized various tools to evaluate knowledge, behavior modification, and self‐care management. A 25% increase in knowledge and a 13% decrease in emergency department visits was identified over the 12‐month period of the study.
Hereditary Hemochromatosis: Should Clinicians Screen for this Common Disease?
Authors: Russell Linda C.
Published: May 2005

Hereditary hemochromatosis is a serious condition of abnormal iron metabolism that is often missed until complications involving multiple organ systems occur. It is an autosomal recessive condition primarily affecting Caucasians of Western European origin. This article discusses the pathophysiology, diagnosis, and management of this condition. Questions related to population screening are examined and recommendations made for a cost‐effective screening program.
Integration of Spirituality into Health Care Practice by Nurse Practitioners
Authors: Treloar Linda L.
Published: May 2005

Although conceptualizations of mind, body, and spirit are ancient, spiritual aspects have not been readily integrated into health care. Western medicine's mechanistic model, with its “fix‐broken‐parts” paradigm, focuses on the physical body, with occasional consideration given to emotional and mental aspects. One's view of self in relation to a Supreme Being, and one's existence and purpose for life is central to health at all levels, e.g., spiritual, physical, emotional, and cognitive. The purpose of this article is to describe the role that nurse practitioners can and should take with patients and their families in integrating spirituality into health care practice.
A PERSONAL ACCOUNT OF A MEDICAL MISSION
Authors: Christman Mark S.
Published: May 2005

The author participated in a medical mission to the Philippines while he was a student in a family nurse practitioner program. This first person account of his two weeks in the Philippines details his impressions of the country, experiences with poverty, and the challenges of working with limited resources.
Syringomyelia: An Expanding Problem
Authors: Yuras Sherry
Published: May 2005

Syringomyelia, a central cavitation of the spinal cord, was once thought to be a rare disorder. Associated with congenital malformations as well as trauma and tumors, a syringomyelia can cause a variety of sensory complaints, including parasthesias, changes in temperature recognition, and pain. Other symptoms may range from gastrointestinal problems to shoulder arthropathy. Left unchecked, a syringomyelia can expand and lead to permanent disability. The nurse practitioner should be suspicious of the presence of a syrinx in patients who have otherwise unexplained sensory deficits that follow cervical or thoracic dermatomes.
American College of Radiology Appropriateness Criteria
Authors: Goolsby Mary Jo
Published: May 2005

The Clinical Practice Guideline (CPG) series provides an overview of one CPG each month. The overview includes a brief summary of the guideline's content, as well as the identification of some factors by which the author has critiqued it. The first article in the series reviewed the steps of CPG critique. Subsequent columns have described CPGs related to viral upper respiratory illnesses, tobacco dependence, menopause and perimenopause, and musculoskeletal evaluation. The document described in this month's clinical practice guideline column is actually a set of recommendations ranking the appropriateness of specific radiologie imaging or therapeutic options for particular conditions or presentations. The American College of Radiology Appropriateness Criteria provides a very valuable resource when ordering diagnostic imaging procedures.
Providing Wholistic Health Care for the Elderly: Utilization of the Shuler Nurse Practitioner Practice Model
Authors: Shuler Pamela A. , Huebscher Roxana , Hallock Judith
Published: May 2005

Purpose

To present an application of The Shuler Nurse Practitioner Practice Model with elderly patients through use of a gerontological wholistic assessment and the utilization of the model in developing a treatment plan and evaluating patient outcomes.

Data Sources

Selected literature from nursing and medicine, including natural, alternative, and complementary (NAC) therapies, as well as the authors' personal experiences.

Conclusions

Providing health care services to the elderly involves recognition of not only physical ail‐ments, but also an awareness of how functional status, psychological condition, social support, environmental conditions and cultural, as well as spiritual beliefs, shape the total health care needs of this vulnerable group.

Implications for Practice

Nurse practitioners who work with the aged could benefit from a theoretically based, wholistic assessment guide. Treatment plans that include NAC therapies and healing strategies should be considered. Outcome evaluations should reflect adherence to the elders' preferences regarding quality and end‐of‐life issues.
Strategies for Working with Elderly Clients: A Qualitative Analysis of Elderly Client/Nurse Practitioner Communication
Authors: Kaakinen Joanna , Shapiro Elayne , Gayle Barbara Mae
Published: May 2005

Purpose

To describe communication between nurse practitioners (NPs) and elderly clients.

Data Sources

A qualitative study using a focus group composed of 6 NPs and in‐depth interviews of an additional 6 NPs who provide care to elderly clients in a variety of settings.

Conclusions

The NPs described a framework of critical thinking, termed hypervigilance, which they enter before and during an interaction with an elderly client. Specific communication strategies were identified that increased the likelihood of compliance with or adherence to treatment regimens for elderly clients.

Implications for Practice

Hypervigilance is descriptive of actively working to merge nursing practice with traditional medical primary care practice. This finding raises the issue of the difference in practice between physicians and NPs in regards to communication with clients.
Ascariasis
Authors: Roberts Amy , Kemp Charles
Published: May 2005

This series is based on the Infectious Diseases section of the web site Refugee Health ∼ Immigrant Health, available on the World Wide Web at http://www.baylor.edu/~Charles_Kemp/Refugee_Health.htm The site was developed through a contract with the Texas Department of Health as part of an ongoing effort to improve the health of refugees and immigrants.
A Motivational Intervention to Improve Adherence to Treatment of Chronic Disease
Authors: Konkle‐Parker Deborah J.
Published: May 2005

Purpose

To describe an approach to intervention, based on Motivational Interviewing (MI) and the Transtheoretical Model (TTM) of Change that allows the health care provider to support medication adherence in a client‐centered fashion.

Data Sources

Review of selected research‐based and theoretical articles on MI, TTM, and medication compliance issues.

Conclusions

Adherence is a complex phenomenon that requires a personalized intervention. The response must focus on clients' readiness to adhere, their sense of self‐efficacy in taking medicines in all circumstances, and their personal pros and cons related to adherence.

Implications for Practice

Adherence to complex medication regimens is important to long‐term treatment of chronic diseases, such as HIV disease. Adherence in HIV is particularly critical to adequately suppress viral replication as well as to prevent opportunistic infections.
Hypertension Outcomes In an Urban Nurse‐Managed Center
Authors: Benkert Ramona , Buchholz Susan , Poole Michelle
Published: May 2005

Purpose

To assess the quality of hypertension (HTN) care in an urban nurse‐managed center (NMC) by chart audits of insured and uninsured (N= 52) African Americans who were managed by nurse practitioners.

Data Sources

A chart audit form was developed by the authors that merged Health Plan Employer Data and Information Set (HEDIS) criteria with the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC VI) criteria.

Conclusions

There was near comparable hypertension control among the two groups. No difference was found in systolic blood pressure (BP) control; however, the uninsured group had a slightly greater average diastolic BP compared with the insured group. There was no significant difference in the number of HTN medications or the number of risk factors. A significant difference was found in the number of NP visits per year between the two groups; the uninsured group averaged 3.2 more visits per year.
The Role of Computer‐Assisted Simulation in Nurse Practitioner Education
Authors: Goolsby Mary Jo
Published: May 2005

Purpose

To develop a better understanding of the role of computer‐assisted simulations (CAS) in nurse practitioner (NP) education by observing 4 pairs of students complete a CAS case.

Data Sources

Qualitative observational study of 8 students performing in a computer laboratory and a series of post‐observation interviews. Observations were recorded, refined, coded, and quantified based on the theoretical frame‐work of ecological psychology.

Conclusions

Each pair of students established their own “per‐sonalities” for the completion of the task. Misinterpretation of information was common and the absence of a live patient interaction affected the reasoning process of the students. The students demonstrated the ability to develop a perspective on the case based on previous nursing experience. Students generally obtained adequate data on which to base differential/final diagnoses. Observations provided information regarding strengths and weaknesses of students and methods used to solve scenarios.

Implications for Practice

All students agreed that the CAS scenarios were realistic, useful learning experiences, and that the knowledge gained would be transferable to real clinical situations. Such experiences provide useful experience with terminology, sequencing of the examination, and decision‐making.
Treating Tobacco Use and Dependence
Authors: Goolsby Mary Jo
Published: May 2005

This month, the Clinical Practice Guideline (CPG) column reviews the recently published guideline, Treating Tobacco Use and Dependence. This set of recommendations is available in a quick reference format and a more comprehensive clinician's guide that includes detailed information on the methodology and references used to develop the guidelines. Both are available in electronic and hard copy versions through a variety of sources, including the National Guidelines Clearinghouse, the Centers for Disease Control and Prevention, and the National Cancer Institute.
Prescribing for Seniors: It's a Balancing Act
Authors: Schafer Sandra L.
Published: May 2005

PURPOSE

To present a rational approach to prescribing for seniors, balancing the need for and number of medications.

DATA SOURCES

Selected evidence‐based reviews and research articles and the author's own experience.

CONCLUSIONS

Whenever possible, alternatives to medication therapy should be considered as the initial treatment of choice; however, medications should be prescribed when indicated and not withheld due to a patient's age. Reducing the number of medications reduces the risk for adverse drug reactions and drug‐to‐drug inter‐actions. IMPLICATIONS FOR PRACTICE Careful review of an older patient's medication list prior to initiating new therapy is necessary. Follow‐up care to review the efficacy and monitor any potential side effects is crucial. Timely discontinuation of a drug when therapeutic usefulness is surpassed is equally important.
Postmenopausal Bleeding: A Practical Approach
Authors: McGregor Helen F.
Published: May 2005

PURPOSE

To provide nurse practitioners (NPs) with a practical approach for the management of postmenopausal bleeding in office settings.

DATA SOURCES

Selected scientific literature and the author's own experience.

CONCLUSIONS

Postmenopausal bleeding should be considered cancer until proven otherwise, despite the fact that abnormal pathology is found in only 15% of endometrial biopsies.

IMPLICATIONS FOR PRACTICE

Post menopausal bleeding can be safely evaluated and managed by NPs using aspiration endometrial biopsies and/or transvaginal ultrasound. Hospitalization for dilation and curettage under anaesthesia can often be avoided.
The Role of Human Papillomavirus in Screening for Cervical Cancer
Authors: Schumann Lorna , McFadden Susan E. , Schumann Lorna
Published: May 2005

PURPOSE

To review the options for effectively screening for cervical cancer, including human papilloma virus (HPV) identification, cytologic screening, colposcopy, or a combination approach. Current pathophysiology, diagnostic criteria, treatment approaches, and patient preparation and education related to cervical cancer screening and prevention are also included.

DATA SOURCES

Comprehensive review of current literature, including research and review articles.

CONCLUSION

Because the Papanicolau (Pap) smear is a screening tool, not a diagnostic tool, further studies must be done to identify the actual nature of discovered abnormalities. Of particular concern is the classification of atypical squamous cells of undetermined significance (ASCUS), which may simply indicate inflammation, or may be the first indicator of serious pathology. Following ASCUS Pap smears with HPV screening will allow for a clarification of the best approach to treatment. A screening algorithm supported by a review of the literature is proposed.

IMPLICATIONS FOR PRACTICE

Cervical cancer is a preventable disease caused by certain forms of HPV. Current screening protocols are based on the use of the Pap smear; and in areas where this test is routine and available, morbidity and mortality rates have dropped dramatically. Many women throughout the world and in underserved regions of the U. S. do not have adequate access to routine screening with Pap smear technology. As long as women continue to die needlessly of cervical cancer, more comprehensive and accessible screening methods must be explored. (Cutting the unnecessary worldwide and in the U. S.)
The Invisibility of Advanced Practice Nurses in Popular Magazines
Authors: Norwood Susan L.
Published: May 2005

PURPOSE

To determine the image portrayed in the media of nurses and particularly nurse practitioners (NPs) compared with other health care providers.

DATA SOURCES

An analysis of advertisements and articles in popular magazines aimed at female, male, and gender‐neutral audiences was conducted between 12/99 and 06/00. Relationships between target audience and content of advertisements and articles, as well as portrayal of health care providers were also explored.

CONCLUSIONS

A review of 100 consecutive advertisements for health‐related products and 96 consecutive health‐related articles in popular magazines revealed that the media continues to overwhelmingly depict and promote physicians as the source of health care and health‐related advice.

IMPLICATIONS FOR PRACTICE

Because when there are few references to a group, such as NPs, it is reasonable to assume group members have little influence, standing, and authority, NPs should be concerned about the implications of these findings. Strategies for increasing the visibility of NPs as credible and valuable members of the health care team are shared.
Teaching Spirituality to Nurse Practitioner Students: The Importance of the Interconnection of Mind, Body, and Spirit
Authors: Maddox Margie
Published: May 2005

SpirituaLism is dormant, not dead, Let us hope. How to revive it, to rekindle it into life, is the great question – Florence Nightingale

PURPOSE

To describe the author's experience in locating and implementing a spiritual assessment tool in teaching a first semester clinical nurse prac‐titioner (NP) course.

DATA SOURCES

Selected articles and responses of NP students to the use of the tool.

CONCLUSIONS

A spiritual assessment is an important component of a comprehensive health assessment. The use of a formal structured protocol provides a framework for beginning students to become comfortable with sprirituality and spiritual assessments and to begin to recognize spiritual distress in clients.

IMPLICATIONS FOR PRACTICE

The protocol used in the course is very extensive and might not be practical in a busy practice setting. An alternative, 4‐point assessment is provided.
Nurse Practitioner Peer Review: Process and Evaluation
Authors: Sheahan Sharon L. , Simpson Cinda , Rayens Mary K.
Published: May 2005

PURPOSE

To describe the initiation and evaluation of a nurse practitioner (NP) peer review program for a group of 15 NPs practicing at a Veteran's Affairs Medical Center.

DATA SOURCES

Using a standardized review form, 15 NPs performed a peer review on a total of 163 medical records; each review was re‐reviewed by 2 researchers who were also NPs. To determine the congruency of the reviews among the 15 NPs, the data were analyzed with Intraclass correlations (ICC) and ANOVA.

CONCLUSIONS

A relatively low ICC (r= 0.37) was found for the 15 NPs. The ANOVA indicated that there were significant differences among the NPs (F= 11.92, p < .0001).

IMPLICATIONS FOR PRACTICE

The outcome of a peer review process depends upon the motivation and values of the NPs, practice sites, and standardization of the format, as well as the degree of collective participation. Peer review can reveal charting deficiencies as well as identify topics for continuing education and risk management programs.