bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of a Modified Ambulance Night Shift System on Fatigue and Physiological Function among Ambulance Paramedics
Authors: Takeyama Hidemaro , Itani Toru , Tachi Norihide , Sakamura Osamu , Murata Kensaburo , Inoue Tatsuki , Takanishi Toshimasa , Suzumura Hatsuko , Niwa Sayuri
Published: June 2009

Effects of a Modified Ambulance Night Shift System on Fatigue and Physiological Function among Ambulance Paramedics: Hidemaro Takeyama, et al. Faculty of Human Wellness, Department of Registered Dietitians, Tokaigakuen University

Objectives

In the present study, we modified a night shift system for an ambulance service so that ambulance paramedics were assured of taking a nap, and examined the effects of this new system on the fatigue and physiological function of ambulance paramedics.

Methods

Ten ambulance paramedics at a fire station in the center of a large city in Japan voluntarily enrolled as subjects in this field study. They worked a 24‐h shift system. There were two teams of 5 ambulance paramedics in the fire station. Three ambulance paramedics per shift usually provided the emergency services. In the traditional system, the ambulance paramedics had to deal with all emergency calls throughout a 24‐h shift (T‐shift). In the modified system, 2 ambulance paramedics were allotted time for naps in the 21:00–3:00 (C‐shift) or 3:00–8:30 (Bshift) shift by the addition of another a firefighter (Dshift).

Results

There were fewer emergency dispatches and nap time was longer in the B‐ and Cshifts than in the T‐shift. Parasympathetic nerve activities during naps in B‐ and C‐shifts were higher than in the T‐shift. The results of critical flicker fusion frequency and 3‐choice reaction time in the B‐shift at 7:30 tended to be higher and shorter than that in Tshift.

Conclusions

The results of this study suggest that the modified night shift which ensured time for ambulance paramedics to take long, restful power naps alleviated subjective fatigue, and improved physiological function which are often adversely affected by night workload.
Self‐reported Health among Employees in Relation to Sex Segregation at Work Sites
Authors: Svedberg Pia , Bildt Carina , Lindelöw Malin , Alexanderson Kristina
Published: June 2009

Self‐reported Health among Employees in Relation to Sex Segregation at Work Sites: Pia Svedberg, et al. Section of Personal Injury Prevention, Department of Clinical Neuroscience, Karolinska Institutet, Sweden

Objectives

Despite the high level of sex segregation of the labour market in Sweden and other countries, there is little knowledge on the association between sex segregation and ill‐health. The aim of this study was to study associations between self‐reported ill‐health among women and men and the level of numerical sex segregation at their work sites and psychosocial work conditions.

Methods

A cross‐sectional questionnaire study was conducted among 10,000 employed persons in the County of Östergötland, Sweden. The questionnaire covered the level of numerical sex segregation at the work site, work organisation and conditions, ill‐health, and demography. The proportions of individuals at sex‐integrated and sex‐segregated work sites reporting frequent ill‐health symptoms were calculated and compared using Chi‐square test statistics. Prevalence's of physical and psychosocial work aspects were calculated. Logistic regression models were used to assess the associations between sex segregation and other aspects of the work situation and health.

Results

Among the men, 69% worked at male‐dominated work sites, 16% at female‐dominated, and 15% at sex‐integrated work sites. Among the women, the equivalent rates were 8%, 75%, and 17%, respectively. Sex segregation was associated with all self‐reported ill‐health symptoms among the men, also when controlling for possible confounders. Other variables that were associated with self‐reported illhealth symptoms were demands at work, negative expectations, and sickness presence.

Conclusions

The present study generates sufficient findings to suggest that the link between sex segregation at work sites and ill‐health is an important area that merits further attention.
Review Paper: Emerging vertical‐alignment liquid‐crystal technology associated with surface modification using UV‐curable monomer
Authors: Lee Seung Hee , Kim Sung Min , Wu Shin‐Tson
Published: June 2009

Abstract— The recent development of polymer‐induced pretilt angle in multi‐domain vertical‐alignment liquid‐crystal (LC) structures is reviewed. To create a small but well‐defined pretilt angle, ∼0.1 wt.% of a photo‐curable monomer was mixed in an LC host and a bias voltage was applied to reorient the LC directors within each domain. The monomers are polymerized near the substrate surfaces by UV exposure. The formed polymer layers change the surface pretilt angle of the LC from 90° to about 89° with a defined azimuthal orientation. Consequently, within each domain the LC reorientation direction responding to the external field is well‐defined which leads to faster rise time and higher transmittance. This new technology overcomes the long standing problems of conventional MVA devices and is therefore expected to play a dominant role in the future.
Kidney Function and Estimated Vascular Risk in Patients with Primary Dyslipidemia
Authors: Tziomalos Konstantinos , Ganotakis Emmanuel S , Gazi Irene F , Nair Devaki R , Mikhailidis Dimitri P
Published: June 2009

Background:

Chronic kidney disease (CKD) is associated with increased vascular risk. Some studies suggested that considering markers of CKD might improve the predictive accuracy of the Framingham risk equation.

Aim:

To evaluate the links between kidney function and risk stratification in patients with primary dyslipidemia.

Methods:

Dyslipidemic patients (n = 156; 83 men) who were non-smokers, did not have diabetes mellitus or evident vascular disease and were not on lipid-lowering or antihypertensive agents were recruited. Creatinine clearance (CrCl) was estimated using the Cockcroft-Gault equation. Estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease (MDRD) equation. We estimated vascular risk using the Framingham equation.

Results:

In both men and women, there was a significant negative correlation between estimated Framingham risk and both eGFR and CrCl (p < 0.001 for all correlations). When men were divided according to creatinine tertiles, there were no significant differences in any parameter between groups. When men were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined (p<0.001 for all trends). When women were divided according to creatinine tertiles, all estimated Framingham risks except for stroke significantly increased as creatinine levels increased. When women were divided according to either eGFR or CrCl tertiles, all estimated Framingham risks significantly increased as renal function declined.

Conclusions:

Estimated vascular risk increases as renal function declines. The possibility that incorporating kidney function in the Framingham equation will improve risk stratification requires further evaluation.
America's Socialism for the Rich
Authors: Stiglitz Joseph E.
Published: June 2009

We cannot afford to continue on the current path and let banks do as they please regardless of the risks for taxpayers and the economy, according to Joseph Stiglitz.
Reasons for an outstanding plant diversity in the tropical Andes of Southern Ecuador
Authors: Richter Michael , Diertl Karl-Heinz , Emck Paul , Peters Thorsten , Beck Erwin
Published: June 2009

Long-term field studies in the scope of a multidisciplinary project in southern Ecuador revealed extraordinary high species numbers of many organismic groups. This article discusses reasons for the outstanding vascular plant diversity using a hierarchical scale-oriented top-down approach (Grüninger 2005), from the global scale to the local microscale. The global scale explains general (paleo-) ecological factors valid for most parts of the humid tropics, addressing various hypotheses and theories, such as the "greater effective evolutionary time", constant input of "accidentals", the "seasonal variability hypothesis", the "intermediate disturbance hypothesis", and the impact of soil fertility. The macroscale focuses on the Andes in northwestern South America. The tropical Andes are characterised by many taxa of restricted range which is particularly true for the Amotape-Huancabamba region, i.e. the so called Andean Depression, which is effective as discrete phytogeographic transition as well as barrier zone. Interdigitation of northern and southern flora elements, habitat fragmentation, geological and landscape history, and a high speciation rate due to rapid genetic radiation of some taxa contribute to a high degree of diversification. The mesoscale deals with the special environmental features of the eastern mountain range, the Cordillera Real and surrounding areas in southern Ecuador. Various climatic characteristics, the orographic heterogeneity, the geologic and edaphic conditions as well as human impact are the most prominent factors augmenting plant species diversity. On microscale, prevailing regimes of disturbance and environmental stresses, the orographic basement, as well as the general role on the various mountain chains are considered. Here, micro-habitats e.g. niches for epiphytes, effects of micro-relief patterns, and successions after small-sized disturbance events are screened. Direct effects of human impact are addressed and a perspective of possible effects of climate change on plant diversity is presented.
Titration Calorimetry Standards and the Precision of Isothermal Titration Calorimetry Data
Authors: Baranauskienė Lina , Petrikaitė Vilma , Matulienė Jurgita , Matulis Daumantas
Published: June 2009

Current Isothermal Titration Calorimetry (ITC) data in the literature have relatively high errors in the measured enthalpies of protein-ligand binding reactions. There is a need for universal validation standards for titration calorimeters. Several inorganic salt co-precipitation and buffer protonation reactions have been suggested as possible enthalpy standards. The performances of several commercial calorimeters, including the VP-ITC, ITC200, and Nano ITC-III, were validated using these suggested standard reactions.
Yeast Two-Hybrid, a Powerful Tool for Systems Biology
Authors: Brückner Anna , Polge Cécile , Lentze Nicolas , Auerbach Daniel , Schlattner Uwe
Published: June 2009

A key property of complex biological systems is the presence of interaction networks formed by its different components, primarily proteins. These are crucial for all levels of cellular function, including architecture, metabolism and signalling, as well as the availability of cellular energy. Very stable, but also rather transient and dynamic protein-protein interactions generate new system properties at the level of multiprotein complexes, cellular compartments or the entire cell. Thus, interactomics is expected to largely contribute to emerging fields like systems biology or systems bioenergetics. The more recent technological development of high-throughput methods for interactomics research will dramatically increase our knowledge of protein interaction networks. The two most frequently used methods are yeast two-hybrid (Y2H) screening, a well established genetic in vivo approach, and affinity purification of complexes followed by mass spectrometry analysis, an emerging biochemical in vitro technique. So far, a majority of published interactions have been detected using an Y2H screen. However, with the massive application of this method, also some limitations have become apparent. This review provides an overview on available yeast two-hybrid methods, in particular focusing on more recent approaches. These allow detection of protein interactions in their native environment, as e.g. in the cytosol or bound to a membrane, by using cytosolic signalling cascades or split protein constructs. Strengths and weaknesses of these genetic methods are discussed and some guidelines for verification of detected protein-protein interactions are provided.
Synthesis and Characterization of Photo-Responsive Carbosilane Dendrimers
Authors: Koyama Tetsuo , Hatano Ken , Matsuoka Koji , Esumi Yasuaki , Terunuma Daiyo
Published: June 2009

Preparation of photo-responsive carbosilane dendrimers bearing 4-phenylazo-benzonitrile units on their molecular surface has been accomplished, and their both photo and thermal behaviors have also been characterized. These functional dendrimers suggest that the apparent molecular sizes of the cis-isomers are smaller than those of the corresponding trans-isomers, since the molecular diameter of these dendrimers would be shorter on the basis of trans→cis photo-isomerization of azobenzene.
Le naufrage de la marine marchande française au XXe siecle
Authors: Berneron-Couvenhes Marie-Françoise
Published: June 2009

Résumé L’étroite association des armateurs, des navigants et des pouvoirs publics a permis à la marine marchande française de surmonter les deux guerres mondiales mais a accentué les rigidités de cette branche et compromis sa capacité d’évolution. Le surcoût du pavillon français n’a pas été compensé par les innovations technologiques des années 1960 tandis que l’insuffisante concentration de l’armement a freiné les adaptations commerciales. Les chocs pétroliers de 1973 et 1979 l’ont précipité dans une crise sans précédent : en 2000, elle ne contrôle plus directement que 1 % du tonnage mondial. Son recul affaiblit la compétitivité du commerce extérieur français et des activités portuaires, et pose la question du rôle de l’État, qui s’est désengagé de ce secteur coûteux au cours des années 1990, tout en affirmant la nécessité du maintien d’un pavillon tricolore.
L'analyse d'une crise : les Moulins du Bazacle, une étude de cas moderne ?
Authors: Saboly Michèle
Published: June 2009

Résumé L’existence des crises et les efforts des gestionnaires pour les résoudre n’ont pas attendu que se constituent des courants de recherche sur le phénomène des crises et leur gestion. Un document datant de 1872, le rapport d’une commission destiné aux actionnaires d’une société toulousaine, formule les bases d’un véritable diagnostic et propose des solutions aux problèmes identifiés. La compréhension que ces analystes ont de la situation peut être retracée par la grille de lecture fournie par les travaux récents sur les crises.
La déroute de l'électronique grand public allemande dans les années soixante-dix
Authors: Klein François
Published: June 2009

Résumé L’électronique grand public allemande a su se mettre en prise sur un des marchés les plus porteurs de l’Allemagne de l’époque du miracle et conquérir une part importante du marché mondial aux dépens des constructeurs américains, jusque-là en position dominante. Cette industrie a connu son apogée industriel et commercial vers 1960. Mais, à partir de 1965, la situation s’est retournée brutalement. L’industrie japonaise a, à son tour, commencé à élargir sa part du marché mondial, refoulant progressivement sa rivale allemande sur quelques créneaux limités et causant la ruine de la plupart des entreprises de la branche en Allemagne. Erreurs de stratégie, inégalité des conditions du marché intérieur et moindre capacité à maîtriser des techniques nouvelles expliquent la tragique destinée de l’électronique grand public allemande.
Objet et acteurs de recherche
Authors: Dalle-Nazébi Sophie
Published: June 2009

Cet article porte sur les formes d’implication d’acteurs dits non scientifiques dans la recherche, et sur l’émergence de nouvelles expertises, à travers le cas des recherches linguistiques sur les langues des signes. Nous exposons en quoi les grands registres de participation de locuteurs sourds relèvent d’activités de médiations culturelle et linguistique. Nous analysons ensuite comment se déclinent les tâches et responsabilités endossées par ces personnes au sein d’un laboratoire de linguistique spécialisé dans l’analyse de la Langue des Signes Québécoise. Cet article, qui s’appuie sur une analyse ethnographique de ces activités scientifiques, montre la montée en expertise des locuteurs impliqués dans ces recherches. Il invite à une articulation des études sur la science, les formes d’actions collectives et l’émergence de nouvelles expertises, et évoque le caractère central d’une analyse des pratiques – même routinières – d’inscription et de communication scientifiques.
La science dans les pays non hégémoniques
Authors: Losego Philippe , Arvanitis Rigas
Published: June 2009

Que signifie pays non hégémonique ? Ce dossier devait effectivement traiter des savoirs dans les pays « en développement ». Cependant, il s’efforce d’échapper à l’énumération convenue des stigmates (pauvreté, illettrisme, épidémies, faiblesse des investissements et des infrastructures, etc.) car ces pays ne sont pas nécessairement « pauvres » mais sont dominés dans la division internationale du travail scientifique faute d’instruments financiers capables d’influer sur les grandes tendances de la production de savoir dans le monde. Il porte sur des pays contraints par les échanges internationaux mais disposant de marges de manœuvre pour élaborer une politique à l’échelle nationale. Il montre que si la globalisation des échanges rend cette politique difficile, elle donne aussi une nouvelle légitimité. On assiste à une reprise en main de l’appareil scientifique par l’État au nom même de la mondialisation pour élaborer leurs propres politiques de R&D.
Le psychosoma en tant que paradigme et méthode d'investigation
Authors: Fine Alain
Published: June 2009

Résumé L’auteur procède à une lecture attentive, parfois critique de L’Investigation psychosomatique. Il soumet à évaluation quelques éléments considérés comme fondamentaux et primordiaux dans l’introduction de l’ouvrage, tant au plan de la recherche qu’à celui de la clinique au niveau des éléments clés de l’introduction. Enfin il se confronte aux commentaires du cas de Gisèle W.
Organisation psychique et affection somatique : pour introduire la discussion
Authors: L’Heureux-Le Beuf Diane
Published: June 2009

Résumé Le psychosomaticien d’aujourd’hui ne pourrait faire l’économie de la théorisation novatrice de Pierre Marty. L’observation de Madame Gisèle W. est exemplaire d’une investigation psychosomatique. Cependant, on peut regretter l’absence d’importance apportée au rêve et à ses associations dans la discussion. Nous en retirerions beaucoup d’enseignements sur son organisation psychique.
La puberté sans adolescence
Authors: Brusset Bernard
Published: June 2009

Résumé Bien des aspects cliniques dans la première investigation du cas de Gisèle témoignent d’une continuité génétique depuis l’enfance dans l’absence des transformations de l’adolescence. Il en résulte une forme de pathologie du caractère encouragée sinon déterminée par une forme de contrat narcissique avec les parents et le groupe familial. Un tel cas conduit à une interrogation sur les rapports entre sexualité infantile et sexualité adulte et sur les modèles psychosomatiques de la puberté et de l’adolescence.
Le premier entretien
Authors: Cournut-Janin Monique , Rueff-Escoubès Claire , Jean-Strochlic Christine
Published: June 2009

Résumé M. Cournut-Janin nous montre avec clarté les points communs et les différences entre l’investigation psychosomatique et une consultation devant plusieurs assistants au Centre Jean-Favreau. Celle-ci est toujours suivie, quelques jours après, d’une seconde rencontre, individuelle cette fois, avec le même psychanalyste. Par ailleurs, M. Cournut-Janin donne sa compréhension personnelle du cas « Gisèle ».
Le prédicant, hérétique et séditieux. De l'édit de Compiègne (1557) à l'édit de janvier (1562)
Authors: Durot Éric
Published: June 2009

RÉSUMÉ La figure du prédicant telle qu’elle apparaît pour le pouvoir royal est définie clairement à partir de l’édit de Compiègne. Elle révèle un " singulier collectif " qui devient le principal vecteur des idées hérétiques et des scandales, un responsable d’actes de séditions et un individu sous les ordres des pasteurs de Genève. La construction de cette image repose sur la figure traditionnelle du faux prophète, largement remodelée par le contexte des années de genèse de la Réforme française. Entre 1557 et 1560, le " prédicant " traduit l’interprétation de la crise religieuse – et politique – du pouvoir royal, il envahit son champ de l’imaginaire et de son action politique, il est au cœur de tous les édits, répressifs comme d’apaisement. En 1561, après ce qui semble être un apogée de cette figure paradigmatique, la régence de Catherine de Médicis cherche à imposer une politique de concorde qui recompose la figure du prêcheur hétérodoxe, qui peut désormais être aussi un prédicateur catholique exclusiviste. Et, par l’édit de janvier 1562, elle promeut des prédicants calvinistes au statut de ministres de la Religion.
Guerres de religion ou guerres ethniques ? Les conflits religieux en Irlande, 1500-1650
Authors: O' Hannracháin Tadhg
Published: June 2009

RÉSUMÉ Cet article traite de l’évolution des conflits religieux dans l’Irlande moderne, à partir de 1500 environ, jusqu’à la fin de l’Interrègne en 1660. Au début de la période, l’Irlande était extrêmement divisée d’un point de vue politique. D’un point de vue religieux, le monde de la chrétienté irlandaise était assez différent du modèle du catholicisme de la fin du Moyen ge. La Réforme en Irlande eut des origines presque entièrement étrangères. Le protestantisme attira peu de fidèles parmi la population irlandaise gaélique ou dans la communauté anglaise pré-élisabéthaine. Cet article souligne que la raison principale en fut la co ïncidence entre le changement religieux et l’édification de l’État Tudor en Irlande. Au début de l’époque Stuart, l’État anglais avait conquis toute l’île, mais l’Église d’État était extraordinairement impopulaire. Cependant, entre 1580 et 1641, une authentique identité protestante apparut en Irlande à la suite d’une immigration anglaise et écossaise à grande échelle. Favorisées par le gouvernement, ces populations connurent un succès économique rapide et s’arrogèrent le monopole de la détention des offices. L’église d’État, cependant, ne rencontrait qu’une audience limitée. La conquête de l’Irlande par les régicides victorieux de la seconde guerre civile déboucha sur un nombre élevé de victimes, une diminution massive de la propriété catholique et la destruction des élites urbaines catholiques. Considérés ensemble, ces événements des années 1640 et 1650 devaient avoir une influence décisive sur la nature des identités confessionnelles au cours des siècles suivants. La mémoire des attaques surprises des Catholiques contre les Protestants en 1641 forma la base d’une insistance aiguë sur la nécessité de réduire la puissance et la propriété catholiques. Du côté catholique, les rudes épreuves des années 1650 devinrent centrales dans une conscience de persécution et de pertes subies, sur fond religieux. En Irlande, les différences religieuses se sont greffées sur des antagonismes ethniques et coloniaux ajoutant aux divisions confessionnelles une profondeur et une complexité généralement absentes du reste de l’Europe.
A Consideration of Contemporary Factors Influencing Professional Development in Health Research
Authors: Cleary Michelle L. , Walter Garry , Horsfall Jan , Matheson Sandra
Published: June 2009

Numerous contemporary factors, including issues pertaining to continuing education and professional development, influence nursing careers in all areas of health research. This article provides an overview of international trends, practices, and questions that impinge on nurse educators and health researchers. These factors include the status of randomized controlled trials, the influence of evidence-based practice, gaps between research results and patient requirements, and the relationships between available evidence and clinical decision making. Added to this research and evidence environment are government concerns about the relevance and usefulness of health research. Finally, the questions an individual career researcher may ask, specifically regarding specialization versus a broad research agenda, are considered.

J Contin Educ Nurs
2009;40(6):273–279.
The Nature of Evidence in Teaching Practice
Authors: Patterson Barbara
Published: June 2009

A common thread in the educational literature is the recognition that teaching methods are appropriate for learners and that educators use the most effective teaching approaches. Unfortunately, the literature lacks a clear description of the evidence on which nurse educators base their teaching. Using a qualitative descriptive design, this study surveyed 14 nurse educators about the nature of the evidence they use in their teaching practices. Participants derived evidence from multiple sources and noted limited use of empirical research as a basis for teaching. An important consideration as to whether participants would modify their teaching was evaluation of that evidence. In addition, there were barriers and facilitators to the use of evidence. Based on the findings, a pluralistic view of evidence rather than any single source appears to be a preferable approach given the rapidly changing, dynamic nature of teaching practice and the nursing student population.
Concept-Based Learning Activities Using the Clinical Judgment Model as a Foundation for Clinical Learning
Authors: Nielsen Ann
Published: June 2009

Several forces are influencing clinical education in the early 21st century. The clinical environment is changing as both patient acuity and patient-to-nurse staffing ratios increase. In many communities, the number of nursing students exceeds the number of clinical placements available. As nursing education moves forward, it is worthwhile to look more closely at how education occurs in the clinical environment regarding student progression from novice to more advanced levels of practice and how best to support development of student clinical judgment. Concept-based learning activities, first described by Heims and Boyd, are used to assist students in examining and addressing fundamental aspects (i.e., concepts) of pediatric patient and family care. The Clinical Judgment Model has been incorporated into concept-based learning activities as a framework to guide student thinking about the concepts.
Practicum and Clinical Experiences: Postpracticum Students' Views
Authors: Ralph Edwin , Walker Keith , Wimmer Randolph
Published: June 2009

The clinical or practicum component of preservice undergraduate education across all disciplines typically is rated by prebaccalaureate students as the most important phase of their entire professional preparation. This study collected e-mail survey responses from 63 post-practicum nursing students who had just completed their culminating fourth-year clinical course. Students identified the most positive and the most negative aspects of that final practicum experience. These responses were compared with those reported by postpracticum students from the disciplines of engineering and teacher education. The cross-disciplinary similarity of these data related to postpracticum students' perceptions of this experiential learning phase of their preservice professional training was noted. The student voice provides a critical dimension to the program-enhancement process for all professional disciplines, and practicum organizers across the disciplines should value such student input and collaborate to improve the clinical phase of preservice education for all professions.
Promoting Skill Building and Confidence in Freshman Nursing Students with a “Skills-a-Thon”
Authors: Roberts Susan T. , Vignato Julie A. , Moore Joan L. , Madden Carol A.
Published: June 2009

Freshman nursing students returning for their second semester after summer break benefited by reviewing previously learned clinical skills presented in a Skills-a-Thon. Skills stations were established and facilitated by faculty and senior students. Senior students were first trained in mentoring and specific steps in skills competencies. Freshman students demonstrated skills in various mock clinical situations including catheter insertion, sterile dressings, medications, and physical assessment. The strategy reinforced learning and provided an opportunity for students to experience risk-free skills performance among peers. Freshman students gained proficiency and appreciated guidance by senior students without the pressures of testing. Seniors benefited from a condensed version of the program to review their own skills prior to the event. Responses were positive, with students reporting improved performance and confidence with hands-on application in a non threatening environment. Nursing faculty observed improvement in skill performance and competence, and plan to offer future events.
An Integrated Mental Health Clinical Rotation
Authors: Roberts Kay T. , Robinson Karen M. , Stewart Christopher , Smith Felicia
Published: June 2009

The most common site for accessing mental health care is the primary care setting. Yet, primary care nurses are not adequately prepared to treat the complex mental health needs of these patients. Similarly, providers in segregated mental health sites do not adequately address physical health needs. New educational models are needed to better prepare nursing graduates to provide holistic care. The integrated mental health model, which colocates mental health specialists in primary care sites, is designed to do this. This article describes key curricular elements of a successful interprofessional clinical rotation within an integrated mental health team that included the use of case studies, a standardized mental health screening instrument, a quality improvement process, and a patient satisfaction questionnaire. Family nurse practitioner and psychiatric mental health nurse practitioner students learned to collaborate with each other and with other members of the interprofessional team to provide holistic care.
Turning Simulation into Reality: Increasing Student Competence and Confidence
Authors: Wagner Debra , Bear Mary , Sander Jane
Published: June 2009

Clinical experiences are an essential part of nursing education as students learn technical skills, build on critical thinking skills, and hone skills in patient teaching. To build competence and confidence in each of these skill areas, an innovative clinical experience for senior students enrolled in women's health nursing was developed to provide nursing care and independent discharge teaching for postpartum mothers. Faculty facilitated this clinical experience by designing a simulation laboratory for students to practice their maternal self-care teaching and infant care skills prior to beginning their clinical rotation. In the hospital, students spent a day independently prioritizing new mothers' need for education and teaching new mothers to care for themselves and their newborns. Students reported confidence in teaching maternal self-care and newborn care, and satisfaction with this unique clinical experience. This approach may assist students in transferring skills learned in simulation laboratories to clinical practice.
Dissociated Vertical Deviation and Inferior Oblique Overaction
Authors: Strominger Mitchell B. , Rogers Gary L. , Wagner Rudolph S.
Published: June 2009

Nelson: We’re going to discuss how to manage dissociated vertical deviation (DVD) and an inferior oblique overaction. I’d like to begin by discussing briefly how each of us measures this condition and then we can discuss how we manage it. Dr. Wagner?
A Neuroectodermal Hypothesis of the Cause and Relationship of Myopia in Retinopathy of Prematurity
Authors: Beri Sarita , Malhotra Mridula , Dhawan Anuradha , Garg Rajiv , Jain Rajesh , D’souza Pamela
Published: June 2009

Purpose:
To analyze the oculometric parameters in preterm infants with and without retinopathy of prematurity (ROP) and to observe the effect of presence of ROP on development of myopia.

Methods:
A prospective study of preterm infants screened for ROP. Examination included fundus examination, cycloplegic refraction, and biometric measurements at three visits.

Results:
A total of 42 preterm infants were divided into two groups: preterm infants with ROP and preterm infants without ROP. Preterm infants with ROP who had myopia showed increased lens thickness with similar anterior segment lengths compared to preterm infants without ROP and preterm infants with ROP who did not have myopia.

Conclusion:
Increased lens thickness in the absence of anterior segment arrest seems to be the major contributing factor for myopia in ROP. This change may be associated with altered neuroectodermal development in ROP.
Congenital Eyelid Colobomas in 51 Patients
Authors: Grover Ashok Kumar , Chaudhuri Zia , Malik Sarmi , Bageja Shaloo , Menon Vikas
Published: June 2009

Purpose:
To review the clinical observations in the management of congenital eyelid coloboma.

Methods:
Fifty-one cases of congenital eyelid colobomas including the functional and cosmetic rehabilitation of patients who were treated over a period of 18 years with an average follow-up of 4.7 years were retrospectively reviewed.

Results:
Thirty-eight patients had an upper eyelid coloboma and 13 patients had a lower eyelid coloboma. Systemic associations included Goldenhar syndrome and Treacher–Collins–Franceschetti syndrome. Twenty-two patients with upper eyelid colobomas underwent surgery by direct apposition, eyelid sharing procedures, or a lateral rotation flap. Lower eyelid colobomas were repaired in 4 patients.

Conclusion:
Gratifying cosmetic and functional results could be achieved in all 26 patients who underwent surgery.
Cerulean (“Blue-Dot”) Cataract
Authors: Ghadfan Faisal E. , Al-Mesfer Saleh , Khan Arif O.
Published: June 2009

The Images in Pediatric Ophthalmology column is a 1-page photo essay showing encounters in the field of pediatric ophthalmology.
Categorizing the Safety of Medications During Pregnancy and Lactation
Authors: Howland Robert H.
Published: June 2009

When physicians and nurses see patients, they must be able to understand and discuss how drugs are labeled with regard to pregnancy and lactation. This article describes the current and proposed U.S. Food and Drug Administration (FDA) classification system for pregnancy and lactation labeling. Using data from animal and human studies, the FDA currently classifies drug safety into five categories; however, there is no current standard FDA classification system to categorize risk for lactation. Because the current labeling category system has been criticized, the FDA has proposed a revision of the system. The proposed change to the labeling system would provide more detailed, comprehensible, and practical information about the use and effects of drugs during pregnancy and lactation.
Promoting Culturally Sensitive ADHD Services for Women: An Individual Example and a Call to Action
Authors: Waite Roberta , Ivey Nicole
Published: June 2009

Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous chronic behavioral disorder characterized by developmentally inappropriate levels of inattention, motor activity, and impulsiveness. Currently, most literature and research focuses on Caucasian males. Data on women with ADHD, specifically African American women, has to a great extent been absent from the literature and research. Research indicates that undiagnosed and untreated ADHD among women often causes psychological and academic impairments, low self-esteem, impaired social relationships, and general demoralization. In addition, women with ADHD have limited ability to be consistent parents, are less able to manage their jobs and households, and are at a higher risk for divorce and single parenting. Given these implications, undiagnosed and untreated ADHD poses not only a personal tragedy but also a serious public health concern. The purpose of this article is to provide a research overview of adult ADHD and to share a reflective life journey of an African American woman who was diagnosed with ADHD as an adult.
Suicide Risk Assessment: 6 Steps to a Better Instrument
Authors: Hermes Brenda , Deakin Kathy , Lee Kathy , Robinson Sherry
Published: June 2009

Recent research indicates that commonly used instruments to assess suicidal ideation identify patients at chronic risk for suicide but do not identify those who are at acute (imminent) risk for suicide while hospitalized. Items to measure anxiety and agitation, identified as more appropriate risk factors, should be incorporated into suicide risk assessments. The purpose of this article was to develop an evidence-based imminent suicide risk instrument for an inpatient psychiatric unit. The Iowa Model of Evidence-Based Practice to Promote Quality Care guided development. Two validated instruments, the Hamilton Anxiety Scale (to measure anxiety) and the Behavioral Activity Rating Scale (to measure agitation) were applied to 75 patients to help create an evidence-based instrument, which should more accurately identify hospitalized patients at risk for imminent suicide.
A Comparative Study of Non-Chopping Rotation and Axial Rotation Versus Quick Chop Phacoemulsification Techniques
Authors: Zeng Mingbing , Liu Xialin , Zhang Xinyu , Xia Yuanlin , Liu Yuhua , Yuan Zhaohui , Liu Yizhi
Published: June 2009

Background and Objective:

The authors describe the non-chopping rotation and axial rotation phacoemulsification techniques and compare them with the quick chop technique in terms of efficacy and safety.

Patients and Methods:

A prospective, randomized, comparative study of 654 eyes of patients with cataracts who underwent phacoemulsification and intraocular lens implantation was conducted. Patients were randomly assigned to three groups according to phacoemulsification technique and were subdivided into four groups according to nuclear density.

Results:

For grade 1 and 2 nuclei, non-chopping rotation and axial rotation techniques outperformed the quick chop technique in ultrasound time, cumulative dissipated energy, best-corrected visual acuity, central corneal thickness, and endothelial cell loss. For grade 3 nuclei, the axial rotation technique did best according to the same terms. For grade 4 nuclei, the two rotation techniques were less efficient for lens removal.

Conclusion:

The non-chopping rotation and axial rotation phacoemulsification techniques are advisable for removal of soft to medium-hard nuclei. For hard nuclei, chopping techniques are more successful.

[Ophthalmic Surg Lasers Imaging 2009;40:222–231.]
Clinical Factors Associated With Floppy Iris Signs: A Prospective Study From Two Centers
Authors: Altan-Yaycioglu Rana , Gedik Sansal , Pelit Aysel , Akova Yonca A. , Akman Ahmet
Published: June 2009

Background and Objective:

To evaluate the relationship of intraoperative floppy iris syndrome with pseudoexfoliation, diabetes mellitus, hypertension, and alpha-1 adrenergic blocker (A1AB) use.

Patients and Methods:

Five hundred patients were included in this prospective study. Intraoperative adverse events, such as pupillary constriction, iris billowing, and iris prolapse from the wound, were noted. Multinomial regression analysis was used to evaluate the relationship of intraoperative floppy iris syndrome with pseudoexfoliation, diabetes mellitus, hypertension, pupil diameter, and A1AB use.

Results:

Pupil constriction was significantly associated with pseudoexfoliation (
P
< .001). Diabetes mellitus was associated with pupil constriction and iris billowing (
P
= .005 and .003, respectively). Hypertension was associated with pupil constriction (
P
= .021). Intraoperative floppy iris syndrome was strongly associated with A1AB use and male gender (
P
< .001 and .039, respectively).

Conclusion:

Intraoperative floppy iris syndrome was observed in 2.8% of patients and was strongly related to A1AB use, particularly in smaller pupil diameters. Pseudoexfoliation, diabetes mellitus, and hypertension were not associated with intraoperative floppy iris syndrome.

[Ophthalmic Surg Lasers Imaging 2009;40:232–238.]
Comparison of Spectral Domain Optical Coherence Tomography and Color Photographic Imaging of the Optic Nerve Head in Management of Glaucoma
Authors: Kotera Yuriko , Yasuno Yoshiaki , Hangai Masanori , Inoue Ryo , Makita Shuichi , Nakanishi Hideo , Yamanari Masahiro , Yoshimura Nagahisa
Published: June 2009

Background and Objective:

Spectral domain optical coherence tomography (SD-OCT) allows three-dimensional imaging of the optic disc. The objective of this study was to compare optic disc and cup margins between fundus photographs and SD-OCT.

Patients and Methods:

Eighteen eyes with glaucoma were examined by a custom-built SD-OCT. OCT fundus images were used to register fundus photographs and SD-OCT volume.

Results:

Disc margins on fundus photographs corresponded to termination of the highly reflective straight line that represented the retinal pigment epithelium (RPE) or the highly reflective curved line that connected to the RPE on the OCT B-scan images at 99.3% of the positions along the disc edges. Cup margins on fundus photographs corresponded at 73.6% of the positions to the interior border of the hyporeflective regions on the OCT fundus images.

Conclusions:

Excellent to fair correspondence in the determination of disc and cup margins between fundus photographs and SD-OCT images was shown.

[Ophthalmic Surg Lasers Imaging 2009;40:255–263.]
Spectral Domain High-Definition Optical Coherence Tomography in Patients Undergoing Epiretinal Membrane Surgery
Authors: Falkner-Radler Christiane I. , Glittenberg Carl , Binder Susanne
Published: June 2009

Background and Objective:

To evaluate possible advantages of spectral domain optical coherence tomography (SD-OCT) in epiretinal membranes.

Patients and Methods:

Patients with idiopathic epiretinal membranes (ERMs) were examined before and after vitreoretinal surgery. Cirrus SD high-definition (HD)-OCT was compared with Stratus time domain OCT to find correlations with visual acuity (VA) and metamorphopsia.

Results:

Five consecutive patients were enrolled. With Cirrus HD-OCT, it was possible to differentiate between the ERM and the retinal surface in all patients. In areas where the ERM was adherent, this differentiation was severely limited with Stratus OCT. We found no significant correlations between Cirrus OCT and Stratus OCT for retinal thickness and VA. However, we found a relationship between metamorphopsia and topographic maps of the internal limiting membrane.

Conclusion:

Cirrus HD-OCT improved the preoperative evaluation of ERMs, offered a topographic reconstruction of the vitreomacular interface, and improved identification of retinal structures.

[Ophthalmic Surg Lasers Imaging 2009;40:270–276.]
Retinal Angiomatous Proliferation: Morphological Changes Assessed by Stratus and Cirrus OCT
Authors: Krebs Ilse , Glittenberg Carl , Hagen Stefan , Haas Paulina , Binder Susanne
Published: June 2009

Background and Objective:

Spectral domain optical coherence tomography (SD-OCT) should be used to examine lesions containing retinal angiomatous proliferation (RAP) to achieve a better understanding of the origin of this pathology.

Patients and Methods:

In this prospective, observational case series, patients with RAP underwent retinal thickness imaging with Stratus OCT and cube 200 × 200 imaging with Cirrus OCT.

Results:

A total of 12 eyes from 11 patients were included in the study. Of these, eight eyes had stage III RAP and four eyes had stage II RAP. Cirrus OCT detected the hyperreflective area corresponding to the neovascularization in all 12 eyes and Stratus OCT detected this pathology in 10 of the 12 eyes. All stage III lesions contained a retinal pigment epithelial break, which was more visible in the 200 × 200 scans obtained from Cirrus OCT compared with six radial scan lines obtained from Stratus OCT.

Conclusion:

Cirrus OCT had considerable advantages compared with Stratus OCT, particularly in investigation of juxtafoveal pathology.

[Ophthalmic Surg Lasers Imaging 2009;40:285–289.]
Bilateral Developmental Glaucoma Associated With Optic Disc Pit and Uveal Effusion
Authors: Ichhpujani Parul , Ramasubramanian Aparna , Pandav Surinder , Kaushik Sushmita
Published: June 2009

This report describes the association of developmental glaucoma with bilateral optic disc pits and uveal effusion. A case of developmental glaucoma (isolated trabeculodysgenesis) presented with bilateral optic disc pits and uveal effusion detected on ultrasound biomicroscopy. Uveal effusion and optic disc pits could be associated with bilateral developmental glaucoma. The constellation of symptoms reported here have not been previously described in the literature and thus merit exploration.
[Ophthalmic Surg Lasers Imaging 2009;40:290–292.]
Progression of Macular Ischemia Following Intravitreal Bevacizumab
Authors: Sabet-Peyman E. Jason , Heussen Florian M. A. , Thorne Jennifer E. , Casparis Heather , Patel Sayjal J. , Do Diana V.
Published: June 2009

A 37-year-old woman with bilateral obliterative retinal vasculitis and macular ischemia received intravitreal bevacizumab for rapidly progressive neovascularization of the optic disc and vitreous hemorrhage in the left eye. One week after treatment, she presented with central scotoma and fluorescein angiography revealed increased parafoveal capillary dropout and progressive macular ischemia in the treated eye.
[Ophthalmic Surg Lasers Imaging 2009;40:316–318.]
Spectral Domain Optical Coherence Tomography in a Patient With Adult-Onset Vitelliform Dystrophy Treated With Intravitreal Bevacizumab
Authors: Lee Joo Yong , Lim Jongyoon , Chung Hyewon , Kim June-gone , Yoon Young Hee
Published: June 2009

A patient with adult-onset vitelliform dystrophy received intravitreal injections of bevacizumab in one eye. During 4 months of follow-up, spectral domain optical coherence tomography (SD-OCT) showed a progressive decrease of yellowish deposits and complete resolution of subretinal fluid at the last follow-up. Despite the good anatomic outcome, the patient reported a mild decrease in visual acuity and persistent metamorphopsia. The clinical course and the correlation between the fundus findings and the morphologic information from SD-OCT data are described.
[Ophthalmic Surg Lasers Imaging 2009;40:319–321.]
Spectral Domain Optical Coherence Tomography of Combined Hamartoma of the Retina and Retinal Pigment Epithelium
Authors: Huot Christopher S. , Desai Komal B. , Shah Vinay A.
Published: June 2009

A 17-year-old girl presented with slow, progressive, painless visual deterioration in the left eye. Fundus examination and fluorescein angiography findings were consistent with combined hamartoma of the retina and retinal pigment epithelium. Spectral domain optical coherence tomography (SD-OCT) displayed a preretinal membrane, retinal disorganization, and thickened retina drawn into folds. Partial posterior vitreous detachment was noted. The higher-resolution scans delineated the transition between the tumor and normal retina. The higher resolution of SD-OCT allows detailed observation of the vitreoretinal interface abnormalities and retinal disorganization present in combined hamartomas of the retina and retinal pigment epithelium and aids in the differential diagnosis and management of pigmented fundus lesions.
[Ophthalmic Surg Lasers Imaging 2009;40:322–324.]
Intravitreal Bimanual Surgery for Residual Lens Fragments and Displaced Crystalline Lenses
Authors: Yata Koichiro , Tanikawa Atsuhiro , Hori Kazumasa , Nakamura Akira , Yamada Hideki , Horiguchi Masayuki
Published: June 2009

The authors have developed a new technique for removing large and hard lens fragments or crystalline lenses with hard nuclei dislocated into the vitreous cavity using an optic fiber-free intravitreal surgical system (OFFISS). The OFFISS visualizes the fundus without a fiberoptic and facilitates the bimanual technique. The lens materials are stabilized with one hand and the fragmatome to emulsify the lens fragments is controlled with the other. The lens fragments or subluxated crystalline lenses can be removed through 20-gauge incisions. This technique was used in 14 cases and was found to be safe and not invasive.
[Ophthalmic Surg Lasers Imaging 2009;40:331–335.]