bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychological well‐being of orphans in Dar El Salaam, Tanzania
Authors: Makame V , Ani C , Grantham‐McGregor S
Published: August 2010

Forty‐one orphans whose fathers and/or mothers had died from AIDS, and were living in the poor suburbs of Dar Es Salaam, Tanzania, were compared with 41 matched non‐orphans from the same neighbourhoods. The subjects were given an arithmetic test and a semi‐structured questionnaire concerning any internalizing problems, their attendance at school and their experiences of punishment, reward and hunger. The scale of internalizing problems comprised 21 items adapted from the Rand Mental Health and Beck Depression Inventories concerning mood, pessimism, somatic symptoms, sense of failure, anxiety, positive affect and emotional ties. Most orphans lived with aunts and uncles. Compared with non‐orphans, they were significantly less likely to be in school but those who did attend school had similar arithmetic scores. Significantly more orphans went to bed hungry. Orphans had markedly increased internalizing problems compared with non‐orphans (p < 0.0001) and 34% reported they had contemplated suicide in the past year. Multiple regression analysis indicated that the independent predictors of internalizing problem scores were sex (females higher than males), going to bed hungry, no reward for good behaviour, not currently attending school, as well as being an orphan.

Conclusion: The orphans not only had unmet basic needs, but also had markedly increased internalizing problems, thus their long‐term mental health would be in jeopardy. There is an urgent need to expand and improve current intervention programmes not only to meet the basic needs but also to include psychosocial support, counselling services for the orphans, and training for their carers and teachers.
French adolescent attitudes towards informal care for physical and emotional or relational problems
Authors: Pommier J , Billot L , Mouchtouris A , Deschamps J‐P , Romero MI , Zubarew T
Published: August 2010

The objective of this study was to determine adolescents' attitudes concerning the use of self‐care and traditional medicines. A self‐administered anonymous questionnaire with open‐ended questions was completed by 543 adolescents aged 15–19 y. The results showed that the most frequent self‐care activity for general health problems, in more than three‐quarters of them, was self‐medication; 14% of them resorted to minor home treatment such as taking care of wounds, bandaging or massages. Instructions for use were mentioned by 69% of adolescents as a way of choosing self‐prescribed drugs. Natural medicines were used by 32% of the girls and 23% of the boys, mainly herbal teas or plant‐based medicines, followed by homoeopathy. Self‐care for emotional and relational problems mainly involved thinking about the problem and questioning themselves about their own behaviour or about the way they are. They also mentioned activities such as sports, going out, listening to music, watching television, and trying to think about something else by keeping themselves occupied. Natural medicines were used by 19% of the girls and 13% of the boys. Plant‐based medicines or herbal teas were used most often, followed by drugs or alcohol, with homoeopathy in third place.

Conclusion: Self‐care and alternative medicines were used by adolescents in this study for physical as well as for emotional or relational problems. Their use did not reflect dissatisfaction with physicians and hospital treatment or an objection to formal services, but rather was a choice of these approaches for their own specific characteristics. They were also viewed as being less harmful than conventional treatment.
Screening for duct‐dependent congenital heart disease with pulse oximetry: A critical evaluation of strategies to maximize sensitivity
Authors: GRANELLI ANNE DE‐WAHL , MELLANDER MATS , SUNNEGÅRDH JAN , & KENNETH SANDBERG , ÖSTMAN‐SMITH INGEGERD
Published: August 2010

Aim: To evaluate the feasibility of detecting duct‐dependent congenital heart disease before hospital discharge by using pulse oximetry. Design: Case‐control study. Setting: A supra‐regional referral centre for paediatric cardiac surgery in Sweden. Patients: 200 normal term newborns with echocardiographically normal hearts (median age 1.0 d) and 66 infants with critical congenital heart disease (CCHD; median age 3 d).

Methods: Pulse oximetry was performed in the right hand and one foot using a new‐generation pulse oximeter (NGoxi) and a conventional‐technology oximeter (CToxi).

Results: With the NGoxi, normal newborns showed a median postductal saturation of 99% (range 94–100%); intra‐observer variability showed a mean difference of 0% (SD 1.3%), and inter‐observer variability was 0% (SD 1.5%). The CToxi recorded a significantly greater proportion of postductal values below 95% (41% vs 1%) in the normal newborns compared with NGoxi (p < 0.0001). The CCHD group showed a median postductal saturation of 90% (45–99%) with the NGoxi. Analysis of distributions suggested a screening cut‐off of < 95%; however, this still gave 7/66 false‐negative patients, all with aortic arch obstruction. Best sensitivity was obtained by adding one further criterion: saturation of < 95% in both hand and foot or a difference of > ± 3% between hand and foot. These combined criteria gave a sensitivity of 98.5%, specificity of 96.0%, positive predictive value of 89.0% and negative predictive value of 99.5%.

Conclusion: Systematic screening for CCHD with high accuracy requires a new‐generation oximeter, and comparison of saturation values from the right hand and one foot substantially improves the detection of CCHD.
Glycosylation of therapeutic proteins in different production systems
Authors: Werner Rolf G , Kopp Kristina , Schlueter Michael
Published: August 2010

Glycosylation plays an important role in a number of therapeutic proteins, including monoclonal antibodies. The enzymatic activity of a therapeutic protein is mainly determined by the protein structure, whereas the pharmacokinetics, pharmacodistribution, solubility, stability, enhancement of effector function and receptor binding are all influenced by the carbohydrate moiety.

Hyperglycosylated proteins show increased serum half‐life, are less sensitive to proteolysis and more heat‐stable compared with the non‐glycosylated forms. Molecular engineering of the TNK‐tissue plasminogen activator molecule results in a more complex type of glycosylation and increases the half‐life of the protein, which allows a single bolus injection at a lower dose for the treatment of acute myocardial infarction.

Antibody‐dependent cell cytotoxicity (ADCC) is determined partially by the specific N‐glycosylation of the Fc domain of the monoclonal antibody. Specific glycoforms of monoclonal antibodies, which interact solely with the FcγRIIIa receptor of natural killer cells, result in superior ADCC compared with heterogeneous glycoforms that interact with different Fc receptors. This demonstrates that glycoengineering for directed glycosylation of therapeutic proteins can improve the therapeutic effect.

While the amino acid sequence of the therapeutic protein is determined by the nucleotide sequence of the inserted gene, glycosylation depends on the glycosylating enzymes in the endoplasmatic reticulum and the Golgi apparatus of the eukaryotic host cell. In addition, the glycosylation of the therapeutic protein is affected by the culture medium used, the efficiency of protein expression and the physiological status of the host cell.

Conclusion: For a given protein, changes in the type of host cell, composition of the culture media and fermentation conditions during process development will most likely result in changes in the site occupation and heterogeneity of glycosylation. This, of course, can influence the therapeutic profile. Therefore, the early selection of the host cell and selection of upstream parameters are key in the process development of a product.
Pathogenic mechanisms in lysosomal disease: a reappraisal of the role of the lysosome
Authors: Walkley Steven U
Published: August 2010

The view that lysosomes simply represent end organelles in the serial degradation of polymeric molecules derived from the cell surface and its interior has led to major misconceptions about the nature of lysosomal storage diseases and the pathogenic cascades that characterize them. Accordingly, lysosomal storage bodies are often considered ‘inert’, inducing cell dysfunction and death primarily through mechanical overcrowding of normal organelles or by other non‐specific means leading to generalized cytotoxicity. However, modern studies of lysosomes and their component proteins provide evidence to support a far greater role for these organelles in cell metabolism. In intimate association with endosomal, autophagosomal and related vesicular systems, the greater lysosomal system can be conceptualized as a vital recycling centre that serves as a central metabolic coordinator, influencing literally every aspect of the cell, from signal transduction to regulation of gene expression.

Conclusion: This broader view of the role of lysosomes in cells not only provides insight into how single gene defects impacting on lysosomal function can result in the plethora of complex cellular transformations characteristic of these diseases, but also suggests new and innovative therapies that may hold considerable promise for ameliorating disease progression.
Quantification of brain tissue alterations in Fabry disease using diffusion‐tensor imaging
Authors: Fellgiebel Andreas , Albrecht Juliane , Dellani Paulo R , Schermuly Ingrid , Stoeter Peter , Müller Matthias J
Published: August 2010

Central nervous system involvement is a major burden in Fabry disease. Conventional cranial magnetic resonance imaging (MRI) shows micro‐ and macroangiopathic changes such as severe and progressive white matter lesions (WMLs) at an early age on T2‐ and fluid‐attenuated inversion recovery‐weighted images, increased signal intensity in the pulvinar on T1‐weighted MRI, as well as tortuosity and dilatation of the larger vessels (dolicho‐ectasia). Using diffusion tensor imaging (DTI), a new structural MRI‐technique that measures water diffusion characteristics, we showed marked brain tissue alterations in Fabry disease predominantly in the periventricular white matter. Even patients with few WMLs had significantly elevated brain tissue diffusivity.

Conclusion: DTI is more sensitive in detecting brain tissue changes in Fabry disease than conventional MRI. DTI measurements could provide appropriate surrogate parameters with which to monitor the natural history of structural brain involvement and potential effects of therapy (such as enzyme replacement) in Fabry disease.
Animal models for mucopolysaccharidosis disorders and their clinical relevance
Authors: Haskins Mark E
Published: August 2010

Progress in understanding how a particular genotype produces the phenotype of an inborn error of metabolism, such as a mucopolysaccharidosis, in human patients has been facilitated by the study of animals with mutations in the orthologous genes. These are not just animal models, but true orthologues of the human genetic disease, with defects involving the same evolutionarily conserved genes and the same molecular, biochemical, and anatomic lesions as in human patients. These animals are often domestic species because of the individual medical attention paid to them, particularly dogs and cats. In addition, naturally occurring mouse models have also been found in breeding colonies. Within the last several decades, advances in molecular biology have allowed the production of knockout mouse models of human genetic disease, including the lysosomal storage diseases. The ability to use both inbred strains of a small, prolific species together with larger out‐bred animals found because of their disease phenotype provides a powerful combination with which to investigate pathogenesis, develop approaches to therapy, and define biomarkers to evaluate therapeutic success. This has been true for the inborn errors of metabolism and, in particular, the mucopolysaccharidoses.

Conclusion: Animal models of human genetic disease continue to play an important role in understanding the molecular and physiological consequences of lysosomal storage diseases and to provide an opportunity to evaluate the efficacy and safety of therapeutic interventions.
Mucopolysaccharidosis type II: an update on mutation spectrum
Authors: Froissart Roseline , Da Silva Isabel Moreira , Maire Irène
Published: August 2010

Mucopolysaccharidosis type II (MPS II; Hunter disease) is caused by deficiency of the enzyme iduronate‐2‐sulphatase (IDS) and patients present with a wide range of clinical signs and symptoms. The level of activity of IDS, however, does not allow prediction of phenotype. In our study of unrelated individuals with MPS II, alterations in the IDS gene could be identified in all 155 patients. Investigations in families in which the occurrence of MPS II was sporadic revealed mosaicism in the mothers of a small number of patients and a high frequency of de novo mutations occurring preferentially during male meiosis. Mutations identified in our patients include 27 large alterations and 128 small gene alterations (96 different alterations). These data further confirm the extreme heterogeneity of IDS gene alterations, as more than 330 have been reported to date. This genetic heterogeneity may explain the high degree of clinical heterogeneity in MPS II. Therefore, attempts have been made to establish genotype–phenotype correlations in order to provide an indication of the likely prognosis and a basis on which to evaluate treatment. To date, some progress has been made in predicting the clinical phenotype from the genotype although it remains difficult in a few individual cases. However, as the crystallographic 3D structure of IDS is yet to be determined, evaluation of the impact of mutations on IDS activity is often time consuming. Furthermore, if a given mutation is recurrent, some patients carrying the same change may present with different phenotypes, suggesting that factors other than the IDS gene (e.g. other genes, environmental factors) can modulate the clinical phenotype.

Conclusion: Although genotype–phenotype correlations may be difficult to establish, they will be of increasing importance for choosing the most appropriate therapy for an individual patient, as new therapeutic strategies may be targeted according to phenotype.
Equality and Merit: A Merit‐Based Argument for Equity Policies in Higher Education
Authors: Simpson Evan , Wendling Karen
Published: August 2010

We assume, for the sake of argument, that the sole purpose of colleges and universities is the advancement of knowledge through teaching and research, and that academic merit, as defined by each discipline, ought to be the only relevant criterion in admissions and hiring decisions. Even on this restrictive set of assumptions, we argue that hiring and admitting women and people of color is sometimes the best way for colleges and universities to advance knowledge. We then address two objections to our argument, that race and sex are no more relevant than being left‐ or right‐handed, and that the epistemic attributes we ascribe to women and people of color belong to people as individuals, not as members of certain groups. We conclude that academic merit and social justice are mutually compatible.
Bridging the Divides: The Need for a Pragmatic Semiotics of Teacher Knowledge Research
Authors: Rosiek Jerry , Atkinson Becky
Published: August 2010

In this essay, we consider four approaches to research on teacher knowledge: the scholarship of teaching, action research and teacher research, narrative inquiry, and critical‐cultural teacher research. Similarities and differences among these four approaches are highlighted. The most salient difference lies in the way each approach identifies different discourses as sources of distortion in teacher knowledge research. Although some divergence within a field of study can be a valuable source of debate and dialogue, we believe the differences identified here risk dividing the field of teacher knowledge research in unproductive ways. What is needed, we propose, is a semiotic theory that acknowledges the way teacher knowledge is irreducibly mediated by multiple discourses while preserving a commitment to the idea that individual teachers’ experiences can be a source of novel and useful knowledge. We examine two semiotic theories — French poststructuralism and Charles Sanders Peirce's pragmatic semiotics — and critically assess how they might facilitate more constructive dialogue among differing conceptions of teachers’ knowledge research.
MORALIZED PSYCHOLOGY OR PSYCHOLOGIZED MORALITY? ETHICS AND PSYCHOLOGY IN RECENT THEORIZING ABOUT MORAL AND CHARACTER EDUCATION
Authors: Carr David
Published: August 2010

Abstract Moral philosophy seems well placed to claim the key role in theorizing about moral education. Indeed, moral philosophers have from antiquity had much to say about psychological and other processes of moral formation. Given this history, it may seem ironic that much systematic latter‐day theorizing about moral education has been social scientific, and that some of the major trends in the field have been led by empirical or other psychologists. Moreover, while acknowledging the influence of such major past philosophers as Plato, Aristotle, and Kant on the primary modern movements of cognitive developmentalism, care ethics, and character education, some recent social scientists have called for the development of a “psychologized morality” in the interests of an even more leading role for psychological research in the theory of moral formation. In this essay, David Carr surveys and critically evaluates these trends in theorizing moral education.
WHAT IS THE VALUE OF PUBLIC SCHOOL ACCOUNTABILITY?
Authors: Gunzenhauser Michael G. , Hyde Andrea M.
Published: August 2010

Abstract In this review essay, Michael Gunzenhauser and Andrea Hyde consider three recent edited collections that address the potential value of public school accountability policy: Kenneth Sirotnik’s Holding Accountability Accountable: What Ought to Matter in Public Education; Martin Carnoy, Richard Elmore, and Leslie Santee Siskin’s The New Accountability: High Schools and High‐Stakes Testing; and Linda Skrla and James Scheurich’s Educational Equity and Accountability: Paradigms, Policies, and Politics. Taken together, the texts provide a snapshot of current scholarly discourse about the phenomenon of accountability policy and provide educators with conceptual tools for analyzing and responding to accountability pressures. While these conceptual distinctions help advance scholarly discourse on accountability, ultimately the texts demonstrate the conceptual poverty of accountability policy for guiding educational improvement. Gunzenhauser and Hyde argue that current state accountability systems are not likely to encourage the broad, systemic capacity building that these three volumes describe as fundamental to achieving the requirements of federal policies.
On the efficiency of legume supernodulating mutants
Authors: Novák K.
Published: August 2010

The supernodulating mutants of legumes lack the internal regulation of the number of symbiotic root nodules that harbour N2‐fixing nodule bacteria. On one hand, these mutants represent an efficient tool for dramatic increase in the degree of rhizobial symbiosis development. The trait of released nodulation is often associated with the desirable resistance of nodule initiation and functioning to the inhibition by ambient nitrate. On the other hand, the more intense and stable atmospheric nitrogen fixation of supernodulated plants is devalued by plant growth depression that results from the disproportion between the photosynthetic capacity of the shoot and the catabolic demands of symbiotic nodules. The deleterious effects of excessive nodulation can be neutralised or alleviated by a breeding strategy aimed at creating an ideotype of N2‐fixing legume. The growth depression can be diminished by the reduction in the nodule number typical for supernodulators, that is, 6–10‐fold of the wild type, to the level found permissive for the particular crop. This shift should be accompanied with breeding aimed at the increased photosynthetic capacity of the shoot. Forage varieties of legumes represent a reserve of high photosynthetic and shoot growth capacity, thanks to a long‐term breeding history for green biomass accumulation. Moreover, the deleterious effects of supernodulation are less perceived after introgression into the background of forage varieties in view of different criteria in their evaluation, such as nitrogen accumulation and biomass production per crop area unit. The growth of supernodulators can be further corrected by breeding for auxiliary traits such as long‐vine shoot architecture, a longer vegetation period and late flowering. The same strategy is applicable to the compensation for inherent pleiotropic changes in plant development, which are often associated with primarily symbiotic mutations. Supporting evidence for the efficiency of the described approach has already been reported.
Structural diversity of NADPH diaphorase‐reactive enteral networks in Stylommatophora (Gastropoda, Pulmonata)
Authors: Röszer Tamás , Jenei Zsolt , Serfözö Zoltán , Czimmerer Zsolt , Bánfalvi Gáspár
Published: August 2010

Abstract. In this work we investigated the involvement of putative nitric oxide (NO)‐forming neurons in enteric plexuses of stylommatophoran gastropods. The nitric oxide synthase (NOS)‐containing cells were detected by NADPH diaphorase (NADPHd) histochemistry in the entreral nervous systems of several stylommatophoran species (Achatinacea: Achatina fulica, Helicacea: Cepaea hortensis, Cepaea nemoralis, Discus rotundatus, Helicella obvia, Helix lucorum, Helix lutescens, Monachoides umbrosa, Trichia hispida, Zebrina detrita, Succineacea: Succinea putris, Vertiliginacea: Clausilia dubia, Zonitacea: Arion ater, Arion subfuscus, Limax maximus). We detected the NO synthesis of isolated midintestinal segments by Griess's quantification of nitrite, one end product of NO. Effects of the NOS substrate L‐arginine and the NOS inhibitor Nω‐nitro‐L‐arginine (NOARG) were also tested on nitrite production. We found NADPHd‐reactive neurons and extrinsic nerves with NADPHd‐stained fibers within the myenteric and submucosal networks of the midintestine of investigated members of Helicacea, Succineacea, and Vertiliginacea families. These networks innervated the midintestinal musculature and several nerve cells of the myenteric and submucosal plexi. In investigated members of Achatinacea and Zonitacea, NADPHd‐stained networks were not detectable within the digestive tract. Administration of 1 mM L‐arginine elevated, whereas 2 mM of NOARG diminished, the nitrite levels of the NADPHd‐stained networks containing midintestine in C. nemoralis and H. lucorum. Enteral NADPHd staining was not detected in A. ater and L. maximus, and the nitrite production was not affected by L‐arginine. Our results indicate a possible, but evolutionarily not conserved, NO‐mediated enteral transmission in stylommatophoran gastropods.
Nemesis reconsidered
Authors: Melott Adrian L. , Bambach Richard K.
Published: August 2010

The hypothesis of a companion object (Nemesis) orbiting the Sun was motivated by the claim of a terrestrial extinction periodicity, thought to be mediated by comet showers. The orbit of a distant companion to the Sun is expected to be perturbed by the Galactic tidal field and encounters with passing stars, which will induce variation in the period. We examine the evidence for the previously proposed periodicity, using two modern, greatly improved paleontological data sets of fossil biodiversity. We find that there is a narrow peak at 27 Myr in the cross-spectrum of extinction intensity time series between these independent data sets. This periodicity extends over a time period nearly twice that for which it was originally noted. An excess of extinction events is associated with this periodicity at 99 per cent confidence. In this sense we confirm the originally noted feature in the time series for extinction. However, we find that it displays extremely regular timing for about 0.5 Gyr. The regularity of the timing compared with earlier calculations of orbital perturbation would seem to exclude the Nemesis hypothesis as a causal factor.
A Critical Review Of Current Nursing Faculty Practice
Authors: Sawyer Meghan J. , Alexander Ivy M. , Gordon Lisa , Juszczak Linda J. , Gilliss Catherine
Published: August 2010

PURPOSE

To critically examine the current literature on nursing faculty practice, using the National Organization of Nurse Practitioner Faculties (NONPF) Guidelines for Evaluation of Faculty Practice, and to examine faculty practice models' strengths, weaknesses, and barriers.

DATA SOURCES

Thirty‐five articles describing models of faculty practice were identified through an exhaustive search on CINAHL and Medline. Two NONPF monographs on nursing faculty practice were used as guidelines for the critical review.

CONCLUSIONS

Faculty practice has become an integral component of faculty‐role expectations at many schools of nursing. Workload, especially without adequate compensation, remains a hindrance to practice. The value of faculty practice time and expertise has not been sufficiently demonstrated. Integration of practitioner, educator and researcher roles remains extremely difficult and sometimes elusive.
Trauma Risks and Prevention Strategies for Snowboarders
Authors: McDonah Margaret R.
Published: August 2010

PURPOSE

To provide primary care providers with current information about the risk of injury and trauma prevention measures for snowboarders.

DATA SOURCES

Selected research articles and Internet sources

CONCLUSIONS

Beginners are at increased risk for snowboarding injuries. Lower extremity injuries have been reduced in recent years by the introduction of the hybrid boot for beginners. Little has been done to reduce the significant impact of head injuries and wrist fractures to snowboarders.

IMPLICATIONS FOR PRACTICE

Snowboarders comprise approximately 25%‐37% of the population on ski slopes. Recommending the use of helmets and wrist guard protection to snowboarding patients is a useful trauma prevention measure. The high rate of injury to the beginner and young snow‐boarder makes a particularly strong argument for these safety recommendations to this patient population.
Meeting National Tobacco Challenges: Recommendations for Smoking Cessation Groups
Authors: Schumann Lorna , Andrews Jeannette , Heath Janie , Harrell Lori , Forbes Mary
Published: August 2010

PURPOSE

To review the literature on model smoking cessation programs and provide an overview of the practice guidelines for intensive smoking cessation groups.

DATA SOURCES

Selected evidence‐based literature and AHCPR/AHRQ clinical practice guidelines.

CONCLUSIONS

Smoking is the leading cause of preventable death in our global society and is expected to kill more people than any other disease within 20 years. Data support that most smokers want to quit and are more likely to succeed with a combination of behavioral and pharmacological support.

IMPLICATIONS FOR PRACTICE

Smoking cessation must be a priority in the delivery of patient care. Intensive interventions are more effective than brief interventions and should be available for all smokers.
Management of Chronic Hepatitis C
Authors: Goolsby Mary Jo , Blackwell James
Published: August 2010

One purpose of the Clinical Practice Guideline column is to increase the awareness of the broad availability of existing guidelines and recommendations on various health topics. The hepatitis C virus (HCV) currently accounts for 20% to 40% of acute viral hepatitis, 60% to 80% of chronic hepatitis, and 20% to 30% of cirrhosis, end‐stage liver disease, and liver cancer. Nearly four million Americans are currently infected with hepatitis C. Nurse practitioners should be aware of the recommendations regarding the diagnosis, management, and monitoring of the dis ease. This column summarizes the content of two NIH documents regarding the care of patients with hepatitis C: Management of Hepatitis C: NIH Consensus Statement (NIH, 1997) and Chronic Hepatitis C: Current Disease Management (NIDDK, 2000).

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.
Unintentional Injuries in the Young Adult Male
Authors: Stiglets Carley
Published: August 2010

Purpose

To review the primary causes of unintentional deaths in young adult males and suggest strate‐gies for educating young men about reducing risks for accidental death.

Data Sources

Selected scientific literature and Internet sources.

Conclusions

Unintentional deaths are the fifth leading cause of death in all age groups, after heart dis‐ease, cancer, stroke, and chronic obstructive pulmonary disease. Accidental death is the leading cause of death in males 1 to 44 years of age. Motor vehicle crashes, drowning, gunshot wounds, and occupational fatalities are among the leading injuries that contribute to the unanticipated death of the young adult male.

Implications for Practice

The ability to make sound decisions is a devel‐opmental process that is not achieved until later in adolescence or early adulthood. Nurse practitioners must assess the adolescent devel‐opmentally to provide appropriate guidance and assistance with behavior change.
A Review of Antiphospholipid Antibody Syndrome
Authors: Schumann Lorna , Olmstead Jill
Published: August 2010

Purpose

To review the pathophysiology, clinical presen‐tation, and management options for antiphos‐pholipid antibody syndrome (APS), a poten‐tially life‐threatening coagulation disorder.

Data Sources

Selected scientific literature, consensus guide‐lines, and expert opinion.

Conclusions

Clinical features that should alert the clinician to consider APS include recurrent fetal loss, arterial or venous thrombosis, thrombocytope‐nia and livedo reticularis. One should be sus‐picious of this diagnosis in a younger patient, one with an autoimmune disease, or family history of autoimmune disease. To confirm the diagnosis one needs both clinical and laborato‐ry abnormalities.

Implications for Practice

The signs and symptoms of APS are varied and could be confused with many disorders. The primary care provider needs to be aware of this syndrome in order to include it in the differ‐ential diagnosis and appropriately recognize and refer the patient in a timely manner.
Wait Time and Satisfaction with Care and Service at a Nurse Practitioner Managed Clinic
Authors: Cole Frank L. , Mackey Thomas A. , Lindenberg Julie
Published: August 2010

Purpose

To examine the relationships among the various times patients wait for health care and patient satisfaction with nurse practitioner (NP) care and the service component of care in a NP developed and managed clinic.

Data Sources

Fortyseven patients (78% response rate) responded anonymously to a 15‐item questionnaire that measured satisfaction with NP care and an additional 15 items that measured satisfaction with the service component of care. Actual clock times were recorded on a flow sheet that corresponded to the system of care at this clinic.

Conclusions

Using Pearson Product‐Moment Correlation, there were no statistically significant relationships among various wait times and the measures of satisfaction.

Implications for Practice

Patient satisfaction with NP care is an important indicator of quality of care. Although satisfaction was not related to wait times, NPs must be respectful of the amount of time that patients wait for health care.
BOOK REVIEW
Authors: Silverman Shelley
Published: August 2010

The Outsider: A Journey into My Father's Struggle with Madness Nathaniel Lachenmeyer (2000)
AACE Hyperandrogenism Guidelines
Authors: Goolsby Mary Jo
Published: August 2010

The problems associated with hyperandrogenism are not uncommon in primary care settings. In fact, polycystic ovary syndrome, a common cause of androgen excess, exists in 5% to 10% of women during their reproductive years, with onset typically in adolescence. The subject of this column is the AACE's Hyperandrogenism Guidelines, which review the evaluation and treatment of the disorders causing androgenic excess.

Readers are encouraged to submit ideas and manuscripts for future CPG columns. The column editor can be contacted at: mjgoolsby@home.com or mgoolsby@uh.org.
Assessing Diagnostic Accuracy and Tympanocentesis Skills by Nurse Practitioners in Management of Otitis Media
Authors: Sorrento Ann , Pichichero Michael E.
Published: August 2010

Purpose

To assess healthcare provider accuracy in rec‐ognizing the physical examination findings of acute otitis media (AOM) and otitis media with effusion (OME) and technical compe‐tence in performing tympanocentesis using a simulation model.

Data Sources

A descriptive study of 1,271 pediatricians and 206 nurse practitioners (NPs) who viewed 9 dif‐ferent video‐recorded pneumatic otoscopic examinations of tympanic membranes (TMs) during a continuing medical education (CME) course. Diagnostic differentiation of AOM, OME and normal was ascertained. A mannequin model of a one‐two year old child was used to assess technical proficiency of performing tympa‐nocentesis on artificial tympanic membranes.

Conclusions

Overall, the average correct diagnosis by all healthcare providers was 46% (range=25% to 71%); by pediatricians it was 50% (25% to 71%) and by NPs 42% (25% to 68%). Pediatricians and NPs correctly recognized the absence of normality 86% to 99% and 68% to 99% of the time; they over‐diagnosed AOM in 7% to 58% (average 27%) and 10% to 65% of examinations (average 31%), respectively. Performance of tympanocentesis was optimal‐ly performed by 73% of NPs.

Implications for Practice

The distinction between AOM and OME is important for antibiotic management deci‐sions; tympanocentesis may be useful in diag‐nosis of AOM in selected patients. Healthcare providers may misdiagnose AOM and OME with some frequency. Nurse pactitioners and pediatricians have the skills to be trained in the tympanocentesis procedure. Interactive CME courses with simulation technology may enhance skills and lead to a willingness to change and improve diagnostic accuracy and treatment paradigms.
Evaluating Acute Musculoskeletal Complaints
Authors: Goolsby Mary Jo
Published: August 2010

Clinical practice guidelines (CPG) are now widely available summarizing large amounts of scientific evidence and providing specific recommendations for the evaluation, diagnosis, and management of varied health problems. In order to take advantage of the available CPGs in clinical practice, providers must be aware of their existence and be able to critique them for scientific merit and relevance to specific clinical settings. This ongoing series is designed to provide a brief review of a different CPG each month. This month, the CPG reviewed addresses the evaluation of an extremely common set of complaints: musculoskeletal symptoms. The document emphasizes the importance of a thorough history and physical for these presentations and indicates when specific diagnostic studies and/or consultations are warranted.
Individualizing Care of Hepatitis B in Older Adults and Asians
Authors: Fu Helen N. C.
Published: August 2010

Purpose

To review the pathophysiology of hepatitis B virus (HBV) as it relates to special groups such as older adults and Asian populations and to stratify preventive services relative to these particular populations.

Data Sources

Selected scientific literature and practice guidelines.

Conclusions

The HBV is one of the most common causes of viral hepatitis. Acute infection is mostly self‐limiting with nonspecific symptoms. Chronic infection is characterized by persistent serum levels of Hepatitis B surface antigen (HBsAg) for more than six months.

Implications for Practice

Chronic HBV is a major risk factor for hepa‐tocellular carcinoma. Special populations, such as older adults with decreased immune response and Asians from places with high endemic HBV infection, are at particularly high risk for progression of HBV infection to chronic states and serious liver damage.
Lyme Disease
Authors: Schumann Lorna , Wright Donna
Published: August 2010

Purpose

To review the presentation, treatment, and prevention of Lyme disease in primary care.

Data Sources

Selected articles from the scientific literature and the Centers for Disease Control.

Conclusions

Lyme disease is a tick‐borne, multisystem inflammatory disease with worldwide distribution caused by the spirochete Borrelia burgdor‐feri. Lyme disease is initially characterized by a spreading, annular erythema migrans skin rash and can disseminate to the musculoskeletal, neurologic, or cardiovascular system. Stages of the disease present with varying clinical mani‐festations.

Implications for Practice

Treatment of Lyme disease with appropriate antimicrobial therapy should be prompt in order to avoid debilitating outcomes. Awareness of the many presentations of Lyme disease in endemic areas may facilitate a timely diagnosis and appropriate treatment.
Primary Care Providers' Views of Precepting Nurse Practitioner Students
Authors: Lyon Debra E. , Peach JoAnne
Published: August 2010

Purpose

To explore perceived barriers to and facilitators of precepting as viewed by experienced community‐based preceptors.

Data Sources

Twenty‐four nurse practitioner and physician preceptors participated in a 20‐minute telephone interview, using a semi‐structured format. The interviews were audio‐taped and transcribed. Constant comparative analysis was used to organize the preceptors' responses into thematic categories.

Conclusions

Overall, most preceptors were satisfied with the precepting experience; however, many preceptors cited increasing difficulty with teaching students in primary care sites due various organizational constraints such as the imperative to increase productivity. Good communication with school of nursing faculty was cited as the key factor to continued willingness to precept.

Implications for Practice

Understanding factors that are important for preceptors continuing in their clinical teaching role is important for schools of nursing, especially given the increasing time‐limitations that many providers face due to social and economic changes in health‐care delivery.
Congestive Heart Failure: Understanding the Pathophysiology and Management
Authors: Fletcher Lynn , Thomas Debera
Published: August 2010

Purpose

To explain key concepts involved in the development and management of congestive heart failure (CHF). An overview of medications commonly used in the treatment of CHF is also presented.

Data Sources

Selected clinical articles, major research studies, and clinical guidelines.

Conclusions

The prevalence of CHF continues to increase and in the United States alone accounts for more than two million outpatient clinic visits per year at a cost of more than $10 billion annually. With the growing number of people over age 65, coupled with the advances in medical technology, primary care providers are treating many more patients with CHF.

Implications for Practice

A thorough understanding of the pathophysiology, especially the compensatory neurohormonal systems and ventricular remodeling that are the hallmarks of CHF, is essential for consistent application of the principles of management of this complex condition. Multidisciplinary approaches led by advanced practice nurses have excellent outcomes and improve the quality of life of patients with CHF.
Infectious Diseases: Echinococcosis (Hydatid Disease)
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.
Peyronie's Disease: Assessment and Treatment
Authors: Schumann Lorna , Reesor Linda E.
Published: August 2010

Purpose

To describe the assessment, diagnosis, appropriate testing, and available treatment options for Peyronie's disease.

Data sources

Selected articles from the medical literature, standard textbooks and online resources.

Conclusions

Clinical hallmarks of the disease include palpable, fibrotic plaques, temporary painful, penile curvature during erection and decreased rigidity of the penis.

Implications for practice

Treatment options range from watchful waiting to surgery. Several promising medications, including vitamin E, are being investigated.
Urinary Tract Infection
Authors: Goolsby Mary Jo
Published: August 2010

Clinical Practice Guidelines (CPG) are widely available and published by many sources. CPGs hold great potential for application in practice. The best summarize a large amount of clinical and scientific evidence on a particular topic, in a format that informs practice. This series provides a monthly review of one of the many available CPGs. The CPG reviewed in this month's column provides recommendations for a very common problem: urinary tract infection in women. It is expected that this CPG will have broad application.

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.
Primary Care Assessment and Management of Sleep Disorders
Authors: Schumann Lorna , Elliott Ann Christy
Published: August 2010

Purpose

To review the functions of sleep and describe an appropriate sleep assessment for the identification of sleep disorders for nurse practitioners (NP) in primary care. Guidelines for management and referral are included.

Data Sources

Selected scientific literature, national consensus guidelines, and the author's experience.

Conclusions

The incidence of sleep deprivation in the United States is generally unacknowledged by the public as well as health care professionals. Unfortunately, the catastrophic and debilitating consequences that result from alterations in sleep are usually noted after significant physical and emotional damage have occurred.

Implications for Practice

An assessment of sleep hygiene and the physical, emotional, or lifestyle changes that alter sleep patterns should be a part of the NP's routine encounter with patients. Referral is indicated for suspicion of obstructive sleep apnea, narcolepsy, restless leg syndrome, complex motor activity, or if the condition fails to respond to therapeutic management.
A Review of Current Weight Management: Research and Recommendations
Authors: Davis Robert B. , Turner Lori W.
Published: August 2010

PURPOSE

To review current research and recommendations on weight loss and weight control and provide suggestions for health care providers who furnish weight management counseling.

DATA SOURCES

Scientific publications, clinical guidelines, and government sources

CONCLUSIONS

Research reaffirms the long‐held understanding that weight loss can be accomplished only through a reduction in the number of calories consumed and an increase in exercise. Weight maintenance requires life‐long behavioral change combining moderate exercise, lower fat intake, increased fruit and vegetable consumption, as well as social support. Fad diets and medications are not the answer to long‐term weight maintenance.

IMPLICATIONS FOR PRACTICE

The essential components of a weight loss or weight management program include: calorie reduction of 300–500 calories per day, appropriate exercise, variety in food choices, increased consumption of grains, fruits, and vegetables, and reduction of fat to no more than 30% of daily calories. Clients should be referred to dietitian and exercise consultants as needed.
Polycystic Ovary Syndrome: Implications for the Advanced Practice Nurse in Primary Care
Authors: Markle Mary Elizabeth
Published: August 2010

PURPOSE

To discuss the diagnosis and management of polycystic ovary syndrome (PCOS) by the advanced practice nurse in primary care.

DATA SOURCES

Selected research and clinical articles.

CONCLUSIONS

The disorder is an endocrinopathy characterized by chronic anovulation, resulting in multiple ovarian cysts. Recent research suggests a genetic etiology and a close association with obesity. Patients often present with hyperan‐drogenism, irregular menses, and infertility. Management is directed at the alleviation of individual symptoms.

IMPLICATIONS FOR PRACTICE

If left untreated, cardiovascular disease, abnormal insulin metabolism, and ovarian and endometrial cancers may develop.
Smoking Cessation Interventions for Pregnant Women to Prevent Low Birth Weight: What Does the Evidence Show?
Authors: Messecar Deborah C.
Published: August 2010

PURPOSE

To review the epidemiology of smoking cessation and low birth weight (LBW), the use of meta‐analysis and cost‐benefit analysis in analyzing this problem, and the financial considerations of institutionalizing smoking cessation interventions. Recommendations for clinicians caring for smoking pregnant women and suggestions for implementing the recommended strategies for smoking cessation programs are included.

DATA SOURCES

Comprehensive review of smoking and low birth weight (LBW) outcomes, cost‐effective‐ness, and tobacco use and dependence literature; clinical practice guidelines, and a widely cited meta‐analysis on smoking cessation.

CONCLUSIONS

Research has shown that smoking is a significant factor in LBW outcomes and that cessation is especially critical for pregnant women.

IMPLICATIONS FOR PRACTICE

Careful evaluation of the intervention research is required before designing local interventions to ensure the most effective measures are utilized.
A Community Needs Assessment for a SANE Program Using Neuman's Model
Authors: Melton Linda , Secrest Janet , Chien Anne , Andersen Barbara
Published: August 2010

PURPOSE

To present guidelines for a community needs assessment for a Sexual Assault Nurse Examiner (SANE) program using Neuman's Systems Model. The guidelines provide advanced practice nurses with a holistic, systematic means to conduct an assessment prior to the implementation of a SANE program and facilitate collaborative work with other disciplines and agencies.

DATA SOURCES

Selected research‐based articles on sexual assault, classic texts and writings on Neuman's Systems Model, and community assessment models and programs.

CONCLUSIONS

Sexual assault is a problem faced by almost every community. A thorough community assessment is an important first step in establishing programs that adequately meet a com‐munity's needs. Guidelines for conducting such an assessment related to implementation of a SANE program are rare, and guidelines using a nursing model were not found in the literature.

IMPLICATIONS FOR PRACTICE

One program that has been successful in meeting community needs is the SANE program. A concise and organized assessment guide can reduce the necessary time and money allocated for a community assessment and can provide a basis for evaluation and research.
Infectious Diseases of Refugees and Immigrants: Giardiasis (Giardia lamblia)
Authors: Roberts Amy , Kemp Charles
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.