bluuebunny/crossref_metadata_2025 huggingface dataset:
ORIGINAL ARTICLE: Follicular Fluid Levels of Interleukin‐10 and Interferon‐gamma do not Predict Outcome of Assisted Reproductive Technologies
Authors: Cerkiene Zivile , Eidukaite Audrone , Usoniene Audrone
Published: August 2010

Problem  Follicular fluid (FF) and surrounding tissue contains various lymphocytes that synthesize different cytokines. The other sources of cytokines are ovarian somatic cells. FF provides microenvironment for the oocyte and contains immunological factors for the regulation of its development. Changes in expression and concentrations of certain cytokines can influence oocyte and embryo quality, resulting in a reduced ability to implant. Some data shows that follicular environment depends on infertility indication. The purpose of our study was to investigate whether cytokines interleukin‐10 (IL‐10) and interferon‐γ (IFN‐γ) are released in the human FF and also to evaluate impact of those cytokines on fertilization rate, cleavage rate, embryo quality, and pregnancy rate.

Methods of study  Couples treated by assisted reproductive technologies were selected for this study. A total of 121 patients participated in the study. Until cytokine detection samples of FF were stored at −20°C. In vitro fertilization or intracytoplasmic sperm injection procedure was used depending on the indication. After 72 hr, on the day of transfer, embryo morphology was evaluated. Embryo transfer based on embryo morphology was performed. Commercial enzyme‐linked immunosorbent assay kit from Diaclone, France was used for the quantitative determination of human IL‐10 and IFN‐γ concentrations in FF. Analysis of the results was performed using spss 12.0.

Results  One hundred and twenty‐one FF samples were tested for IL‐10 and IFN‐γ. IFN‐γ and IL‐10 were detected in 14 (11.6%) and 108 (89.3%) FF samples, respectively (range 0.9–31.1 pg/mL for IFN‐γ and 0.7–10.8 pg/mL for IL‐10). There was no significant correlation between infertility indication, fertilization rate, cleavage rate, and concentrations of the follicular cytokines. Similarly, IL‐10 concentrations did not differ significantly in different age groups and did not alter pregnancy rate.

Conclusion  Our study showed that IFN‐γ and IL‐10 are not suitable markers in predicting outcome of assisted reproductive technologies.
REVIEW ARTICLE: Mucosal Innate Immunity as a Determinant of HIV Susceptibility
Authors: Iqbal Shehzad M. , Kaul Rupert
Published: August 2010

Most human immunodeficiency virus (HIV) is acquired during sex, across a mucosal membrane. Despite many advances in our understanding of HIV pathogenesis, the initial events during mucosal transmission have been poorly characterized, and a better understanding of these events will probably be a key to the development of successful microbicide(s) and/or a preventative HIV vaccine. While a vast majority of mucosal HIV exposures do not result in productive infection, implying that innate mucosal immune defenses are highly protective, failure of these mucosal defenses resulted in over 3 million new HIV infections in 2006. We review recent findings regarding HIV mucosal immunopathogenesis, emphasizing the importance of innate immunity in natural protection from infection, and examine how natural or induced perturbations in the mucosal innate system may underpin HIV transmission. Given the great challenges to the development of HIV microbicides and vaccines, identification and enhancement of ‘natural’ innate immune defenses present attractive avenues for development of safe, non‐toxic microbicides.
ORIGINAL ARTICLE: Prenatal Priming of Cord Blood T Lymphocytes by Microbiota in the Maternal Vagina
Authors: Stencel‐Gabriel Krystyna , Gabriel Iwona , Wiczkowski Andrzej , Paul Marek , Olejek Anita
Published: August 2010

Problem  In the vagina of women at the reproductive age, more than 170 strains of bacteria and yeasts are found. The effect of vaginal flora on neonatal T cells is yet to be investigated.

Method of study  We analyzed CD45RA and CD45RO expression on neonatal CD4+ T cells and cytokine production in CBMC cultures (interferon‐γ (IFN‐γ ), interleukin‐4 (IL‐4) and IL‐12) related to vaginal bacteria isolated from a maternal vagina. We collected vaginal swabs from 36 women at the first stage of the delivery and cord blood from their newborns. IFN‐γ, IL‐4, and IL‐12 in stimulated CBMC were measured and the expression of CD45RA/CD45RO on CD4+ T cells was assessed.

Results  We noted the difference in CD45RO CD4+ expression and IL‐12 levels between the newborns whose mothers were or were not colonized with Lactobacillus in the vagina (newborns whose mothers were colonized with Lactobacillus: CD45RO‐10%±3; IL‐12‐0.2 pg/mL ± 0.05; newborns whose mothers were not colonized with Lactobacillus: CD45RO‐6%±3; IL‐12‐2.0 pg/mL ± 0.7).

Conclusion  Our results may indicate that lactobacilli in maternal vagina influence the development of neonatal immune system. Yet, more research is needed using specified bacterial antigens.
ORIGINAL ARTICLE: The Role of TSP‐1 on Decidual Macrophages Involved in the Susceptibility to Unexplained Recurrent Spontaneous Abortion
Authors: Jin Yan , Wang Xipeng , Xiao Yunshang , Lv Caijun , Ding Chuanwei , Lin Qide
Published: August 2010

Problem  To investigate the role of TSP‐1 on decidual macrophages (DMΦ) in unexplained recurrent spontaneous abortion (RSA).

Method of study  A total of 20 women undergoing artificial abortion in the first trimester and 10 patients with RSA were selected. (i) The expression of TSP‐1 mRNA in deciduas was detected by real‐time polymerase chain reaction; (ii) Flow cytometry was used to detect the percentage of positive TSP‐1, CD36, CD47 markers on macrophages. (iii) Cytokine expression was measured by enzyme‐linked immunosorbent spot‐forming (ELISPOT) cell assay.

Results  (i) The expression of TSP‐1 mRNA on DMΦ in RSA was significantly decreased (P < 0.05). (ii) The increased expression of CD36 (P < 0.01) and the decreased expression of TSP1 (P < 0.01) were found on DMΦ of RSA. No different CD47 expression level on DMΦ was observed between two groups. (iii)The expression of IL‐10 in DMΦ of RSA patients was decreased significantly compared with that of controls (P < 0.05). When adding TSP1 into culture medium, there was no change in IFN‐γ expression, but increased IL‐10 (P < 0.05) expression in DMΦ of RSA patients was observed. The expression of IL‐10 was decreased significantly in DMΦ from controls when adding anti‐TSP‐1 antibody to culture medium (P < 0.05).

Conclusion  TSP‐1 on DMΦ could influence IL‐10 expression as Th2 cytokines. The abnormal expression of TSP‐1 could make some women undergo pregnancy loss.
Reliability of the SNAP (score of neonatal acute p00hysiology) data collection in mechanically ventilated term babies in New South Wales, Australia
Authors: Sutton L , Bajuk B , Berry G , Sayer GP , Eagles BL , Henderson‐Smart DJ
Published: August 2010

The aim of this population‐based, case‐control, cohort study was to report inter‐rater reliability between the New South Wales Neonatal Intensive Care Unit Data Collection (NICUS) audit nurses' collection of SNAP (OS) and a research nurse's SNAP data as the audit SNAP (AS). The study was carried out in Sydney and four large rural/urban health areas in New South Wales (NSW), Australia. The subjects—182 singleton term infants with no major congenital anomalies—were admitted to a tertiary neonatal intensive care unit (NICU) for mechanical ventilation. SNAP data were collected on the 182 case infants, born between 1 January and 31 December 1996, by clinical audit officers in the nine tertiary NICUs in NSW. The research officer conducted an audit of the original SNAP score on all infants. The data were examined using Pearson's correlation coefficient, weighted kappa, a plot of difference in SNAP against mean SNAP and Wilcoxon's signed rank sum test. Pearson's correlation coefficient between the OS and AS data was 0.80. Median (interquartile range) SNAP was 13 (9,19) for the OS and 14 (10,20) for the AS. Weighted kappa was highest for highest heart rate, paO2, temperature (°C), oxygenation index, haematocrit, platelet count, lowest serum sodium, lowest blood glucose and seizure. In 17 (9%) infants, OS and AS differed by ≥10, 14 because of an original data collection error, 1 data entry error, 1 audit error and 1 for both data collection and data entry errors.

Conclusion: If SNAP is to be incorporated into any routine NICU data collection, it should be audited regularly on a sample of records. It is important to standardize and adhere to strict definitions for parameters before the collection of SNAP data.
Continuous gastric drip versus intravenous fluids in low birthweight infants
Authors: Becerra M , Cifuentes J , Saldías MI , Gálvez MC , Fernández P , Aguila A
Published: August 2010

This multicentre randomized study compared a continuous gastric drip (CGD) with intravenous (i.v.) fluid administration. Healthy newborns with birthweight from 1501 to 2000 g whose physician ordered i.v. fluids were randomized before the 2nd hour of life to CGD or i.v. fluids. The major outcome variable was the need for an i.v. line in the CGD group. Serum glucose was measured at 30 min, 1 h and every 6 h thereafter. Serum sodium and potassium were measured at least once during the first 72 h of life. Enteral feedings, feeding intolerance, number of venous lines and i.v. line‐related complications were recorded until the interruption of CGD or the i.v. line. Twenty‐nine infants were randomized to each group. The two groups were comparable in terms of birthweight and gestational age. Ten percent (3/29) of the infants randomized to the CGD group required i.v. fluids and 90% of them received electrolytes and glucose through an orogastric tube. The incidence of hypoglycaemia, hyponatraemia and episodes of feeding intolerance did not differ between the groups.

Conclusion: Fluid administration by CGD reduces the need for i.v. lines without increasing the risk of complications.
Plasma guanosine3′,5′‐cyclic monophosphate and severity of peri/intraventricular haemorrhage in the preterm newborn
Authors: van Bel F , Valk L , Uiterwaal CSPM , Egberts J , Krediet TG
Published: August 2010

A poorly controlled cerebral circulation, caused by excessive production of nitric oxide, has been suggested as predisposing to peri/intraventricular haemorrhage (PIVH) in the immature neonate. It is hypothesized that a relation exists between plasma cyclic GMP (cGMP) as an effector of endogenous vasodilatory nitric oxide production and severity of PIVH. In 83 consecutively admitted preterm neonates, nitric oxide production was assessed by measuring plasma cGMP at 0, 24, 48, 72 and 168 h of age. Simultaneously, cranial ultrasound investigations were performed and haemodynamic parameters registered. The investigations showed that 60 neonates (72%) had no PIVH; 18 neonates (22%) had mild to moderate PIVH; and 5 neonates (6%) had severe PIVH. At 48 and 72 h of age, cGMP levels of infants with severe PIVH were significantly higher than those of infants with no or only mild PIVH, whereas at 72 and at 168 h, infants with moderate PIVHs had significantly higher cyclic cGMP levels than infants without PIVH. Finally, at 168 h of age infants with mild PIVH also had higher cyclic cGMP values than those of infants without PIVH. Maximal cGMP values preceded the final extension of PIVH in moderate and severe PIVHs. Blood pressure support was necessary significantly more often in infants with moderate and severe PIVH. A logistic regression model revealed that cGMP was significantly associated with PIVH, irrespective of gestational age, mean arterial pressure or severity of infant respiratory distress syndrome.

Conclusion: Increased cGMP levels are associated with the development of PIVH. It is suggested that vasodilatory nitric oxide‐induced impairment of cerebral autoregulation plays a role here.
Changes in cerebral, renal and mesenteric blood flow velocity during continuous and bolus infusion of indomethacin
Authors: Christmann V , Liem KD , Semmekrot BA , van de Bor M
Published: August 2010

Vasoconstriction induced by bolus injection of indomethacin reduces organ perfusion and has been related to the well‐known side effects of indomethacin given for closure of the patent ductus arteriosus (PDA). The aim of the study was to compare the changes in cerebral, renal and mesenteric blood flow velocities after continuous infusion versus bolus injection of indomethacin for closure of the PDA. Thirty‐two preterm infants (range 26–35 wk gestational age) with PDA were randomly assigned to receive the same amount of indomethacin either as three bolus injections (n= 14) or as a continuous infusion (n= 18) over 36 h. Blood flow velocities were measured in the internal carotid, right renal and superior mesenteric arteries at baseline and serially at 10, 30, 60 and 120 min and 12, 24, 36 and 48 h after the start of indomethacin treatment. There were no differences in blood flow velocities between both groups at baseline. During continuous infusion of indomethacin there was no significant change in the cerebral, renal and mesenteric blood flow velocities, whereas the flow velocities in the infants receiving bolus injections decreased significantly during the first 2 h after indomethacin administration in all arteries measured. There was a transient, but significant reduction in urine output after bolus injection of indomethacin.

Conclusion: In contrast to bolus injections, decrease of organ blood flow and impairment of urine output do not accompany continuous infusion of indomethacin over 36 h.
Late onset of right Bochdalek's hernia with strangulation of the omentum
Authors: Shimizu T , Hira S , Hirooka S , Yonekura T , Tamai H
Published: August 2010

We report a case of bloody pleural effusion and infarction of the greater omentum caused by a non‐traumatic diaphragmatic hernia with a late presentation. A 15‐y‐old boy with Down's syndrome developed abdominal pain and vomiting, as well as an elevated serum level of C‐reactive protein. Chest roentgenograms showed a right‐sided pleural effusion and computed tomography revealed a right diaphragmatic hernia. Barium enema confirmed the diagnosis. An operation revealed a right Bochdalek's hernia with strangulation of the greater omentum in the right pleural cavity.

Conclusion: Diaphragmatic hernia should be considered in patients with pleural effusion, abdominal pain and vomiting.
Preoperative cranial ultrasound findings in infants with major congenital heart disease
Authors: TE PAS ARJAN B. , VAN WEZEL‐MEIJLER GERDA , BÖKENKAMP‐GRAMANN REGINA , WALTHER FRANS J.
Published: August 2010

Background: Advances in diagnostic testing and surgical techniques have resulted in reduced mortality in neonates with congenital heart disease (CHD) and a major concern for neurological morbidity in the presence of preoperative neurological injury. Objectives: To determine the incidence and nature of preoperative cerebral ultrasound abnormalities in neonates with major CHD and to examine the relationship between cerebral abnormalities and the type of CHD.

Methods: Retrospective study; inclusion criteria: (1) neonates with major CHD admitted to the NICU over a 3‐y period, (2) gestational age > 35 wk, (3) documented preoperative cranial ultrasound available; exclusion criteria: (1) small for gestational age, (2) other congenital anomalies and/or chromosomal abnormalities, (3) a 5‐min Apgar score < 7, (4) congenital infection. Cranial ultrasounds (CUS) were reviewed without knowledge of the cardiac defect. CHDs were categorized.

Results: Fifty of 108 neonates with CHD met the inclusion criteria. Twenty‐one patients (42%) had abnormalities on CUS. Thirteen of these (26%) had widened ventricular and/or subarachnoid spaces, three (6%) lenticulostriate vasculopathy, one (2%) calcification in the basal nuclei, and four (8%) had acute ischaemic changes. Cerebral abnormalities occurred more frequendy in patients with coarctation or hypoplastic left heart syndrome (HLHS) than transposition of the great arteries (TGA) (63% vs 14%; n.s.).

Conclusion: There is a high incidence of preoperative cerebral ultrasound abnormalities in this group of neonates with major CHD.
Developmental delay at 12 months in children born extremely preterm
Authors: LANDO ANE , KLAMER ANJA , JONSBO FINN , WEISS JANNE , GREISEN GORM
Published: August 2010

Aim: To evaluate the feasibility and validity of a structured telephone interview to assess the development of children born extremely preterm.

Methods: The parents of 88 children born with a gestational age below 28 wk admitted to the neonatal intensive care unit (NICU) at Rigshospitalet, Copenhagen, were interviewed by telephone when their child was 1 y of age, corrected for preterm birth. A fully structured questionnaire on psychomotor function was used (Revised Prescreening Developmental Questionnaire (R‐PDQ)). The parents of 30 children born at term without complications were interviewed for comparison. The interview was conducted by NICU staff. To validate the R‐PDQ, parents of 22 children in the preterm group and parents of 19 children in the reference group conducted an Ages and Stages Questionnaire (ASQ) when their children had reached the age of 3–3 y.

Results: The R‐PDQ was easy to use by staff and well accepted by parents. The mean score in the preterm group was 14.9 ± 3.9 vs 17.7 ± 2.7 in the term group (p < 0.001). Three children had developmental scores below ‐2 SD. The R‐PDQ score was associated with the ASQ score 2 y later.

Conclusion: A structured questionnaire administrated by telephone is an alternative and usable tool for assessing neuro‐developmental deficit in children born extremely preterm. The mean developmental delay in the preterm group compared to the term group (about‐1 SD) was close to expectations.
Tourette syndrome and other tic disorders in a total population of children: Clinical assessment and background
Authors: KHALIFA NAJAH , VON KNORRING ANNE‐LIIS
Published: August 2010

Aim: To describe the symptoms, onset, heredity, pre‐/perinatal events and socio‐economic status in Tourette syndrome (TS) and other tic disorders.

Methods: From a total population of 4479 children, 25 (0.6%) with TS, 58 (1.3%) with chronic motor/vocal tics (CMVT) and 214 (4.8%) with transient tics (TT) in the last year were found. A three‐stage procedure was used: tic screening, telephone interview and clinical assessment. The TS group was compared with 25 children with TT and 25 controls without tics.

Results: The mean age of the first symptoms of TS was significantly lower than the onset of CMVT. All except one with TS had contact with medical services. The tics of children with TS were significantly more severe than the tics of others. Younger age of onset of TS indicated more severe tics. Parents and siblings of children with TS had an increased prevalence of tic disorders, obsessive‐compulsive behaviour (OCD), attention‐deficit/hyperactivity disorder (ADHD) and depression. Eighty per cent had a first‐degree relative with a psychiatric disorder. A non‐significant increase with regards to reduced optimality score in the pre‐, peri‐ or neonatal periods was found in children with TS compared to controls. No differences were found concerning socio‐economic status.

Conclusion: Almost all children from a total population with TS have sought help from medical services. An increased prevalence of tics, OCD, depression or ADHD was found in the parents/siblings of children with TS, which draws attention to the importance of thorough investigation of family members.
Sphingosine 1‐phosphate in neural signalling and function
Authors: Milstien Sheldon , Gude David , Spiegel Sarah
Published: August 2010

Complex sphingolipids are particularly enriched in the central nervous system. Although they were long considered to be structural components of membranes, in the last decades it has become apparent that they have other important functions. More recently, attention has been given to the sphingolipid metabolites ceramide, sphingosine and sphingosine 1‐phosphate (S1P), which have been implicated in the regulation of many aspects of neuronal proliferation, differentiation, survival and apoptosis. Dysregulation of the relative levels of these bioactive sphingolipid metabolites may have implications for a wide array of neurodegenerative disorders and neural malformations. In this paper, we will focus on studies from our laboratory over the past few years using cultured neurons to examine the roles of the sphingolipid metabolite S1P in neuronal survival and differentiation.

Conclusion: Identification of potential intracellular targets of S1P remains a crucial objective for attaining a better understanding of the potent role this molecule plays in regulating cell fate.
Vascular effects of sphingolipids
Authors: Michel Martin C , Mulders Arthur CM , Jongsma Maikel , Alewijnse Astrid E , Peters Stephan LM
Published: August 2010

The sphingomyelin metabolites ceramide, sphingosine 1‐phosphate (S1P) and sphingosylphosphorylcholine (SPC) are emerging modulators of vascular tone. While ceramide appears to act primarily intracellularly, S1P and SPC appear to mainly work via specific receptors, although those for SPC have not yet been defined unequivocally. Each of the sphingomyelin metabolites can induce both vasoconstriction and vasodilatation and, in some cases – ceramide on the one hand, and S1P and SPC on the other hand – have opposite effects on vascular tone. The differences in effects between vessels may relate to the relative roles of endothelial and smooth muscle cells in mediating them, as well as to the distinct expression patterns of S1P receptors among vascular beds and among endothelial and smooth muscle cells. Recent evidence suggests that vascular tone is not only modulated by sphingomyelin metabolites which are exogenously added or reach the vessel wall via the bloodstream but also by those formed locally by cells in the vessel wall. Such local formation can be induced by known vasoactive agents such as angiotensin II and may serve a signalling function.

Conclusion: We conclude that sphingomyelin metabolites are important endogenous modulators of vascular function, which may contribute to the pathophysiology of some diseases and be targets for therapeutic interventions.
Optimization of concomitant medication in Fabry cardiomyopathy
Authors: Close Lydia , Elliott Perry
Published: August 2010

We describe a male patient with Fabry disease and use this case study to illustrate the importance of a detailed cardiovascular evaluation and the role of supportive therapy in routine management of the disease. The major areas of discussion include the management of exertional chest pain, progressive heart failure and the diagnosis and treatment of atrial and ventricular arrhythmia.

Conclusion: In the era of enzyme replacement therapy, conventional pharmacological and device‐based therapies remain central to the management of cardiovascular symptoms and the prevention of complications, such as arrhythmia and stroke.
Reduced basal salivary cortisol in children with asthma and allergic rhinitis
Authors: Bakkeheim E , Mowinckel P , Carlsen KH , Burney P , Lødrup Carlsen KC
Published: August 2010

Aim:  Reduced basal cortisol is reported in allergic disease. We investigated if basal salivary cortisol levels were reduced in children with asthma or allergic rhinitis, controlling for inhaled corticosteroids (ICS) use.

Methods:  Morning and evening saliva of asthmatic children aged 7–12 years (n = 50) and that of controls (n = 52) were sampled. A total of 19 asthmatics and four controls had allergic rhinitis. Healthy children were controls without rhinitis. Of all, 14 asthmatic children used low, and 12 used moderate or high doses of ICS. Cortisol was analysed by radioimmunoassay.

Results:  Morning salivary cortisol median (95% CI) was lower in asthmatics (8.7 (7.1, 9.7)) compared with that in controls (10.4 (9.6, 11.8); p = 0.006), which was similar for evening cortisol levels. Regression analyses demonstrated that asthmatics using moderate or high doses of ICS had reduced morning salivary cortisol adjusted (for age and gender) odds ratio (aOR) (95% CI) (0.54 (0.37, 0.80); p = 0.002) and reduced evening cortisol aOR (0.09 (0.01, 0.6); p = 0.02) compared with that in healthy children. Asthmatics with rhinitis on no or low doses of ICS had reduced morning cortisol aOR (0.73 (0.56, 0.96); p = 0.02) compared with that in healthy children.

Conclusion:  Asthmatic children on moderate or high doses of inhaled corticosteroids had reduced salivary cortisol, but co‐morbidity of asthma and rhinitis was also associated with reduced cortisol levels.
Are we getting the best from breastfeeding?
Authors: Walshaw C Anne
Published: August 2010

Different breastfeeding methods (traditional/scheduled, demand or baby‐led) influence lactation physiology by either supporting or interfering with the let‐down reflex, by an autocrine effect in the breast, and indirectly via infant appetite. Postnatal breast morphological changes and neonatal osmoregulation are also susceptible to breastfeeding method. Feed length is important: short feeds from both breasts (employed in traditional methods) optimize breast morphological changes and neonatal osmoregulation, condition the let‐down reflex, limit autocrine inhibition, stimulate the infant’s appetite and are associated with a plentiful supply of milk. However, the limited evidence available on prolonged feeds and those from only one breast (both often seen with the baby‐led method), suggests interference with lactation because of a compromised let‐down reflex and autocrine inhibition, resulting in a reduced milk supply.

Conclusion: Regular short feeds from both breasts encourage a plentiful milk supply and successful breastfeeding: these are best reflected by a modified traditional breastfeeding method.
Ambidextrous Scholarship: A Review Essay
Authors: Mackler Stephanie
Published: August 2010

This essay reviews three recent works in the field of philosophy of education, each of which brings the work of a major philosophical thinker to bear on contemporary topics within education: Michael Peters, ed., Heidegger, Education, and Modernity; Randall Curren, Aristotle on the Necessity of Public Education; and Mordechai Gordon, ed., Hannah Arendt and Education. I argue that these works are representative of a current trend in educational philosophers' ideas, including their political, social, and ethical philosophy. This approach to philosophy of education differs in significant ways from past approaches, in which the connection between philosophy and education was conceived narrowly. In the works under consideration here, education is not understood as an isolated field that is connected to philosophy only through a concerted effort; rather, education is understood as a presence within the broad constellation of philosophical questions. These books therefore not only shed light on educational matters, but they also demonstrate an elegant way to bring together theory and practice, mind and body, philosophy and education.
WHOSE DEVELOPMENT? SALVAGING THE CONCEPT OF DEVELOPMENT WITHIN A SOCIOCULTURAL APPROACH TO EDUCATION
Authors: Matusov Eugene , DePalma Renée , Drye Stephanie
Published: August 2010

Abstract The concept of development is currently under revision in education and psychology. In this essay, Eugene Matusov, Renée DePalma, and Stephanie Drye examine a traditional notion of development and provide an alternative sociocultural view. As educators working within a sociocultural approach to learning, development, and education, the authors see psychological phenomena as rooted in participation in sociocultural activities, practices, and communities. They critique how the traditional notion of development essentializes this process, assuming development to be independent of the observer. Using a case where a child of color develops a “sitting disability” within the institutional context of schooling, they illustrate the need for introducing a sociocultural notion of development, arguing that development is a social construction emerging in communities of practice and that it is necessary to consider the role of the observer in both defining and guiding this process in a professional discourse of cases.
Nurse Practitioners: A Comparison of Rural‐Urban Practice Patterns and Willingness to Serve in Underserved Areas
Authors: Martin Kenneth E.
Published: August 2010

PURPOSE

To determine nurse practitioners' (NPs) practice patterns and willingness to practice in underserved areas in both rural and urban settings in a largely rural state.

DATA SOURCES

A census of all NPs holding a Pennsylvania license and providing addresses in Pennsylvania or one of the contiguous states was conducted in 1996. The ZIP codes of practice sites were matched with 1990 census data.

CONCLUSIONS

Nurse practitioners in rural areas are more likely than their urban counterparts to provide primary care in primary care practice settings, they see more patients per week, and they are more likely to be the principal provider of care for a higher percentage of their patients. Experience with managed care contracts is greater for urban NP's as is their willingness to practice in urban underserved areas. Rural NP's were more willing to practice in rural underserved areas than their urban counterparts.

IMPLICATIONS FOR PRACTICE

Access to primary care continues to be a concern in rural areas. The increasing market penetration of managed care and the deficit of primary care providers in rural environments may lead to increased opportunities for NPs in the rural health care delivery system.
Ohio APNs: Lead Poisoning Knowledge and Practices
Authors: Choate Devan W. , Polivka Barbara J.
Published: August 2010

PURPOSE

To determine lead poisoning knowledge and practices of Ohio's advanced practice nurses (APNs).

DATA SOURCES

Original research conducted by mailed survey sent to all APNs registered in Ohio (N= 1448). The response rate was 72%. APNs from nine specialties and 70% of counties responded.

CONCLUSIONS

Respondents correctly answered approximately 80% of the questions. Knowledge gaps in primary prevention strategies were noted. Of APNs serving pregnant women and/or children <6 years, 57% screen for lead poisoning and 16% report no one provides lead education.

IMPLICATIONS FOR PRACTICE

Lead poisoning is a preventable health problem. Education of APN students and preceptors needed in the areas of primary lead poisoning prevention issues and practice protocols. Results from this study can help focus educational efforts and outreach programs.
Training of Nurse Practitioners and Physician Assistants to Perform Screening Flexible Sigmoidoscopy
Authors: Horton Kimberlee , Reffel Angela , Rosen Karen , Farraye Francis A.
Published: August 2010

Purpose

To describe the colorectal cancer‐screening program at Harvard Vanguard Medical Associates, a large multispecialty medical group, in which nurse practitioners (NPs) and physician assistants (PAs) perform screening flexible sigmoidoscopies.

Data Sources

Scientific literature, consensus statements and guidelines, and the protocol utilized to train NPs and PAs to perform flexible sigmoi‐doscopy. Data from 9,500 screening proce‐dures are presented.

Conclusions

In comparison with gastroenterologists, trained NP and PA endoscopists perform screening flexible sigmoidoscopy with similar accuracy and safety but at lower cost.

Implications for Practice

Screening flexible sigmoidoscopy performed by NPs and PAs may increase the availability and lower the cost of flexible sigmoidoscopy for colorectal cancer screening.
Men And Family Planning: What Is Their Future Role?
Authors: Fortunati Lorraine Neeley , Floerchinger‐Franks Ginger
Published: August 2010

Purpose

To describe men's desired involvement in family planning and to determine the services desired by potential male clients.

Data Sources

Using a self‐administered questionnaire, this study surveyed male partners of family planning clients and men attending sexually transmitted disease (STD) clinics at an urban health department. Perceived health concerns, contraceptive attitudes and practices, and desired involvement in family planning currently and in the future were targeted.

Conclusions

Respondents reported desiring involvement in family planning decisions, although reported behaviors often conflicted with this desire. Routine physical examinations and receipt of health information were perceived to be important, while “male only” clinics were not. Respondents were willing to attend partners' family planning appointments if asked and were willing to help pay for the chosen contraceptive. Provision of vasectomy services was perceived as important. Prevention of cancer, STDs, and impotence were the three highest health concerns reported.

Implications for Practice

Men want to be partners in family planning and will access services if available. Current political and social policies are demanding more personal responsibility for the outcome of unintended pregnancies. In response to political and social demands, Title X family planning clinics are refocusing services to include men.
Beyond Sexual Assessment: Lessons Learned from Couples Post Radical Prostatectomy
Authors: Monturo Cheryl A. , Rogers Patricia D. , Coleman Meghan , Robinson Joanne P. , Pickett Mary
Published: August 2010

Purpose

To share selected experiences of advanced practice nurses (APNs) who implemented a home‐based nursing protocol related to psychosexual function for couples following radical surgery for prostate cancer.

Data Sources

Selected research‐based articles, the PLISSIT Model for sexual rehabilitation counseling, and the authors' experiences.

Conclusions

Five lessons related to communicating about sexuality and intimacy were synthesized from the experience, including examining knowledge and selfawareness regularly, using a structured interview guide to facilitate the process, developing a trusting relationship with the couple, attending to verbal and nonverbal cues, and providing information about the full range of sexual expression.

Implications for Practice

Include an assessment of sexual health as an integral part of a general health assessment. Patients do not generally volunteer information about their sexual concerns unless the subject is introduced by the APN.
The Effect of Age, Gender, Risk Level and Glycosylated Hemoglobin in Predicting Foot Amputation in HMO Patients with Diabetes
Authors: Watts Sharon A. , Daly Barbara , Anthony Mary , McDonald Patricia , Khoury Allan , Dahar Wendy
Published: August 2010

Purpose

To determine if age, gender, risk level and glucosylated hemoglobin could predict foot amputations in HMO patients with diabetes.

Data Sources

A retrospective chart review of a non‐random sample of 27 patients with amputation and 110 randomly selected patients without amputation during the same time period. Chi‐square, t‐tests and logistic regression were used to analyze the data.

Conclusions

There was no significant difference between the group with amputation and those without amputation in age or gender. However, there was a significant difference between the two groups in the risk stratification (p=.005) and glycosylated hemoglobin levels (p=.058).

Implications for Practice

Nurse practitioners can effectively screen for amputation risk factors and closely monitor glycosylated hemoglobin levels of diabetic patients to reduce the incidence of vascular complications and related lower extremity amputation.
Use of PSA Measurement in Practice
Authors: Goolsby Mary Jo
Published: August 2010

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. This month, the column describes a CPG titled: Prostate‐Specific Antigen (PSA) Best Practice Policy, from the American Urological Association (AUA). As prostate cancer is the leading cause of cancer deaths among U.S. men, this set of recommendations should have wide application.
Chronic Obstructive Pulmonary Disease
Authors: Goolsby Mary Jo
Published: August 2010

Each month the Journal of the American Academy of Nurse Practitioners' clinical practice guideline (CPG) column reviews a different set of clinical recommendations. It is important that those in practice be aware of guidelines applicable to the needs of their patients and judge the available guidelines. This month, the CPG addresses the fourth major cause of morbidity and mortality in the United States: COPD. This article addresses the need to identify persons at risk in order to minimize avoidable risk factors, as well as how to diagnose and manage the various stages of the disease.

Readers are encouraged to suggest specific CPGs for future columns or to request that the editor search for and summarize a CPG addressing a common health problem. Readers are also invited to submit a manuscript reviewing CPGs that they find helpful in their area of practice.
Prevention in the Inpatient Setting
Authors: Kelley Carol Genet , Daly Barbara J.
Published: August 2010

Purpose

To review the literature on and describe approaches to implementing health promotion and disease prevention practices in the inpatient setting.

Data sources

Comprehensive review of nursing and medical literature, clinical practice guidelines, and U.S. government documents.

Conclusions

Preventive screening has been shown to reduce morbidity and mortality from many diseases. Health promotion and disease prevention activities form the foundation of practice for many nurse practitioners (NPs). As increasing numbers of NPs begin to practice in the acute care setting, it is important they incorporate prevention into the inpatient setting.

Implications for practice

Because there are many barriers that impact appropriate preventive screening, health care providers must take advantage of every patient encounter including those in the inpatient setting. Although it may not be feasible to actually perform certain screening exams while a patient is hospitalized, it is feasible in many cases to take a few minutes to review recommended preventive screening.
Infectious Diseases: Filariasis—Bancroftian filariasis, Malayan filariasis, Loiasis (loa loa), Onchocerciasis (river blindness)
Authors: Kemp Charles , Roberts Amy
Published: August 2010

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.
College Students' Attitudes and Beliefs about the Consequences of Smoking: Development and Normative Scores of a New Scale
Authors: Budd Geri M. , Preston Deborah Bray
Published: August 2010

Purpose

To develop an instrument that could be used to assist young adults to determine their perceived consequences about cigarette smoking. The new instrument consisted of 27 items measuring attitudes about smoking selected from the literature and evaluated by experts.

Data Sources

The instrument was administered to a convenience sample of 172 undergraduate college students. Psychometric assessment using an exploratory factor analysis revealed four factors (subscales) that explained 48.1% of the variance. These were labeled attitudes and beliefs about smoking related to emotional benefits, health hazards, self‐confidence, and body image.

Conclusions

Statistically significant differences between mean scores of smokers and nonsmokers were found on attitudes and beliefs about the benefits of smoking related to emotional benefits, self‐con‐fidence, and body image; smokers' answers indicated that they perceived these as positive consequences of their smoking behavior.

Implications for Practice

The newly constructed instrument may be a useful assessment of college students' reasons for smoking. This approach offers new hope for successful cessation counseling and for smoking prevention programs. Currently anti‐smoking methods emphasize the health hazards of cigarette smoking and have not been sufficient in reducing the rate of smoking in the young adult population. Some young people may use smoking as a strategy for dealing with stressful situations, weight control, and lack of self‐confidence. Thus, smoking cessation programs should also include strategies to use in place of smoking during periods when stress and lack of self‐confidence are high.
Evaluating and Applying Clinical Practice Guidelines
Authors: Goolsby Mary Jo
Published: August 2010

Clinical practice guidelines (CPG) hold great potential for providing a summary of large volumes of clinical evidence and a related set of practical recommendations. Nurse practitioners should become aware of the range of available CPGs and methods by which they can be evaluated for use. Appropriate evaluation of CPGs should include their overall reliability and validity, as well as their applicability in specific situations. This article provides an overview of an appropriate evaluation method and serves as an introduction to future columns presenting individual CPGs.
Reducing Needle‐Stick Injuries with the Use of 2‐Octyl Cyanoacrylates for Laceration Repair
Authors: Gordon Catherine A.
Published: August 2010

PURPOSE

To describe the effectiveness of 2‐octyl cyanoacrylates (2‐OCA) for repair of lacerations, reduction of needle‐stick injuries to health care providers, patient satisfaction, and overall cost reduction.

DATA SOURCES

A descriptive study of typical lacerations (N=38) presenting to a suburban urgent care center.

CONCLUSIONS

Wound approximation was complete (92.1%); with no erythema, drainage, or warmth (100%) and patients were satisfied (87%) and preferred 2‐OCA (91%). No needle stick injuries occurred (100%) to providers or ancillary staff.

IMPLICATIONS FOR PRACTICE

2‐Octyl cyanoacrylates tissue adhesive effectively closes and heals wounds without infection, pain, or erythema. Health care providers can prevent the risk of blood and body fluid exposure from needle‐stick injuries through the use of 2‐OCA tissue adhesive.
Promoting Health in Older Adults: A Four‐Year Analysis
Authors: Resnick Barbara
Published: August 2010

PURPOSE

The purpose of this study was to consider the influence of selected health promotion and disease prevention interventions in elderly residents of a continuing care retirement community (CCRC) over a four‐year period by comparing actual health promotion practices of the residents.

DATA SOURCES

Original research using a descriptive design, face‐to‐face interviews of residents (N=176‐200), chart reviews, and administration of a minimental state exam (MMSE) and health survey administered annually.

CONCLUSIONS

In each year the mean age of the residents was at least 85, the majority were female, Caucasian, and unmarried. With the exception of checking stools for occult blood, there was a statistically significant change in all health promotion behaviors over the four‐year period. The most significant change was in the area of exercise behavior, which increased from 24% of the residents participating in regular exercise in year one to 61% by year four.

IMPLICATIONS FOR PRACTICE

The purpose of health promotion and disease prevention in older adults is to reduce the potential years of life lost in premature mortality and ensure better quality of remaining life. In addition to regularly scheduled interventions (group education, on‐site administration of pneumonia and flu vaccines, on‐site exercise room and walking group), individualized counseling regarding the pros and cons of health‐promotion activities was provided to help residents make an educated decision about engaging in these activities. These interventions can be used to help facilitate participation in health promotion activities as appropriate and desired for each older adult.
Inhalational Anthrax: Threat, Clinical Presentation, and Treatment
Authors: Schumann Lorna , Henry Leslie
Published: August 2010

PURPOSE

To provide nurse practitioners (NPs) with a basic understanding of clinical presentation, transmission, diagnosis, pharmacological treatment, and post‐exposure prophylaxis of inhalational anthrax.

DATA SOURCES

Selected research and clinical articles and government guidelines.

CONCLUSIONS

Inhalational anthrax has an incubation period of 1 to 6 days and is very difficult to diagnose early. The chest radiograph consistently reveals a widened mediastinum and pleural effusion without infiltrates. Mortality for inhalational anthrax is high, despite aggressive treatment after onset of symptoms. Delays in diagnosis contribute to the high mortality rate.

IMPLICATIONS FOR PRACTICE

The potential use of aerosolized anthrax as a biological warfare weapon has renewed interest in inhalational anthrax. Primary care providers are cornerstones in the defense against biological weapons because they may be the first to recognize and report suspicious cases.
Clinical Practice Guideline: Screening and Diagnosing Autism
Authors: Goolsby Mary Jo , Blackwell James
Published: August 2010

The clinical practice guideline (CPG) reviewed in this month's column concerns the screening and diagnosis of autism. Autism is the third most common developmental disability and affects more than 1 in 500 children, or nearly 400,000 people in the United States, in some form. Primary care providers of children, including pediatric nurse practitioners (PNPs) and family nurse practitioners (FNPs), should reasonably expect to care for at least one child with autism (CWA). The American Academy of Neurology (AAN) has therefore developed guidelines to help healthcare providers facilitate the early identification of children with autism.
Worth Their Weight in Gold: The Role of Clinical Coordinator in a Family Nurse Practitioner Program
Authors: Sobralske Mary , Naegele Lisa M.
Published: August 2010

Purpose

To identify key functions and responsibilities of the role of clinical coordinator in a family nurse practitioner (FNP) program.

Data Sources

Recent articles, research, and interviews with other faculty serving as clinical coordinators in FNP programs at five other universities.

Conclusions

Clinical coordinators are extremely valuable members of the NP education team; they are worth their weight in gold. They support NP programs by assisting in the coordination of student‐oriented placement and needs‐based clinical activities, in the recruitment and retention of preceptors and clinical agencies, and in providing updated information related to various student resources.

Implications for Practice

It is important that this complex and valuable role be better understood and appreciated by university administrators and other faculty. Clinical coordination in a distance learning program can take up to three fourths release time for a faculty. The role of the clinical coordinator is diverse, not easily learned, and requires proficiency in academic advising, administration, and clinical supervision.
Management of a Patient with Post‐polio Syndrome
Authors: Halbritter LCDR Terry
Published: August 2010

Purpose

To describe the current understanding of the management of patients with post‐polio syn‐drome (PPS) and relate the research to a case study.

Data Sources

Standard neurology textbooks, current review and research articles, and a case study.

Conclusions

More than 15 years following a diagnosis of poliomyelitis, a new onset of weakness, fatigue, joint pain, decreased endurance, muscle atrophy, gait disturbance, respiratory and swallowing problems, cold intolerance, and difficulties with activities of daily living might indicate a neurologic disorder called PPS.

Implications for Practice

Non‐post‐polio causes of weakness, fatigue or pain must be excluded before making a diag‐nosis of PPS. Approaches to management vary depending on the symptoms and level of disability. Reducing physical and emotional stress, energy conservation, adequate rest, modification of work and home environments, joint protection, and the use of orthoses, adaptive equipment, or mobility aids can reduce fatigue and preserve function.