bluuebunny/crossref_metadata_2025 huggingface dataset:
High‐precision geothermobarometry across the High Himalayan metamorphic sequence, Langtang Valley, Nepal
Authors: Fraser G. , Worley B. , Sandiford M.
Published: March 2003

One of the long recognized features of Himalayan geology is the apparent inversion of metamorphic sequences, as evidenced in both metamorphic parageneses and thermobarometric data. With the aid of an extended thermobarometric dataset from the Langtang Valley section of the Higher Himalayan Crystallines, it can be demonstrated that the relatively large uncertainties associated with traditional thermobarometric techniques severely limit the tectonic interpretation of metamorphic gradients across the Himalayas. We apply the recently developed ΔPT  approach, which significantly improves the precision to which pressure and temperature differences between samples may be calculated. High‐precision thermobarometric data reveal an isothermal, rather than inverted, temperature array at Langtang, while the pressure data suggest significant structural complexity, with the Higher Himalayan Crystallines in the Langtang section comprising two distinct, possibly duplicated sequences, each having experienced considerable structural attenuation following metamorphism.
High‐T, low‐P metamorphism in the Palaeoproterozoic Halls Creek Orogen, northern Australia: the middle crustal response to a mantle‐related transient thermal pulse
Authors: Bodorkos S. , Sandiford M. , Oliver N. H. S. , Cawood P. A.
Published: March 2003

High‐T, low‐P metamorphic rocks of the Palaeoproterozoic central Halls Creek Orogen in northern Australia are characterised by low radiogenic heat production, high upper crustal thermal gradients (locally exceeding 40 °C km−1) sustained for over 30 Myr, and a large number of layered mafic‐ultramafic intrusions with mantle‐related geochemical signatures. In order to account for this combination of geological and thermal characteristics, we model the middle crustal response to a transient mantle‐related heat pulse resulting from a temporary reduction in the thickness of the mantle lithosphere. This mechanism has the potential to raise mid‐crustal temperatures by 150–400 °C within 10–20 Myr following initiation of the mantle temperature anomaly, via conductive dissipation through the crust. The magnitude and timing of maximum temperatures attained depend strongly on the proximity, duration and lateral extent of the thermal anomaly in the mantle lithosphere, and decrease sharply in response to anomalies that are seated deeper than 50–60 km, maintained for <5 Myr in duration and/or have half‐widths <100 km. Maximum temperatures are also intimately linked to the thermal properties of the model crust, primarily due to their influence on the steady‐state (background) thermal gradient. The amplitudes of temperature increases in the crust are principally a function of depth, and are broadly independent of crustal thermal parameters.

 Mid‐crustal felsic and mafic plutonism is a predictable consequence of perturbed thermal regimes in the mantle and the lowermost crust, and the advection of voluminous magmas has the potential to raise temperatures in the middle crust very quickly. Although pluton‐related thermal signatures significantly dissipate within <10 Myr (even for very large, high‐temperature intrusive bodies), the interaction of pluton‐ and mantle‐related thermal effects has the potential to maintain host rock temperatures in excess of 400–450 °C for up to 30 Myr in some parts of the mid‐crust. The numerical models presented here support the notion that transient mantle‐related heat sources have the capacity to contribute significantly to the thermal budget of metamorphism in high‐T, low‐P metamorphic belts, especially in those characterised by low surface heat flow, very high peak metamorphic geothermal gradients and abundant mafic intrusions.
Polyphase zircon in ultrahigh‐temperature granulites (Rogaland, SW Norway): constraints for Pb diffusion in zircon
Authors: Möller A. , O'Brien P. J. , Kennedy A. , Kröner A.
Published: March 2003

SHRIMP U–Pb ages have been obtained for zircon in granitic gneisses from the aureole of the Rogaland anorthosite–norite intrusive complex, both from the ultrahigh temperature (UHT; >900 °C pigeonite‐in) zone and from outside the hypersthene‐in isograd. Magmatic and metamorphic segments of composite zircon were characterised on the basis of electron backscattered electron and cathodoluminescence images plus trace element analysis. A sample from outside the UHT zone has magmatic cores with an age of 1034 ± 7 Ma (2σ, n = 8) and 1052 ± 5 Ma (1σ, n = 1) overgrown by M1 metamorphic rims giving ages between 1020 ± 7 and 1007 ± 5 Ma. In contrast, samples from the UHT zone exhibit four major age groups: (1) magmatic cores yielding ages over 1500 Ma (2) magmatic cores giving ages of 1034 ± 13 Ma (2σ, n = 4) and 1056 ± 10 Ma (1σ, n = 1) (3) metamorphic overgrowths ranging in age between 1017 ± 6 Ma and 992 ± 7 Ma (1σ) corresponding to the regional M1 Sveconorwegian granulite facies metamorphism, and (4) overgrowths corresponding to M2 UHT contact metamorphism giving values of 922 ± 14 Ma (2σ, n = 6). Recrystallized areas in zircon from both areas define a further age group at 974 ± 13 Ma (2σ, n = 4). This study presents the first evidence from Rogaland for new growth of zircon resulting from UHT contact metamorphism. More importantly, it shows the survival of magmatic and regional metamorphic zircon relics in rocks that experienced a thermal overprint of c. 950 °C for at least 1 Myr. Magmatic and different metamorphic zones in the same zircon are sharply bounded and preserve original crystallization age information, a result inconsistent with some experimental data on Pb diffusion in zircon which predict measurable Pb diffusion under such conditions. The implication is that resetting of zircon ages by diffusion during M2 was negligible in these dry granulite facies rocks. Imaging and Th/U–Y systematics indicate that the main processes affecting zircon were dissolution‐reprecipitation in a closed system and solid‐state recrystallization during and soon after M1.
Petrogenetic significance of orthopyroxene‐free garnet + clinopyroxene + plagioclase ± quartz‐bearing metabasites with respect to the amphibolite and granulite facies
Authors: Pattison D. R. M.
Published: March 2003

Orthopyroxene‐free garnet + clinopyroxene + plagioclase ± quartz‐bearing mineral assemblages represent the paragenetic link between plagioclase‐free eclogite facies metabasites and orthopyroxene‐bearing granulite facies metabasites. Although these assemblages are most commonly developed under P–T conditions consistent with high pressure granulite facies, they sometimes occur at lower grade in the amphibolite facies. Thus, these assemblages are characteristic but not definitive of high pressure granulite facies. Compositional factors favouring their development at amphibolite grade include Fe‐rich mineral compositions, Ca‐rich garnet and plagioclase, and Ti‐poor hornblende. The generalized reaction that accounts for the prograde development of garnet + clinopyroxene + plagioclase ± quartz from a hornblende + plagioclase + quartz‐bearing (amphibolite) precursor is Hbl + Pl + Qtz=Grt + Cpx + liquid or vapour, depending on whether the reaction occurs above or below the solidus. There are significant discrepancies between experimental and natural constraints on the P–T conditions of orthopyroxene‐free garnet + clinopyroxene + plagioclase ± quartz‐bearing mineral assemblages and therefore on the P–T position of this reaction. Semi‐quantitative thermodynamic modelling of this reaction is hampered by the lack of a melt model and gives results that are only moderately successful in rationalizing the natural and experimental data.
Strategy for Maximizing the Use of Arteriovenous Fistulae
Authors: Beathard Gerald A.
Published: March 2003

Increasing the use of arteriovenous fistulae in dialysis patients requires a specific strategy. In order to properly select patients for an arteriovenous fistula (AVF), it is essential that the nephrologist become knowledgeable about the subject and that an organized approach be followed. Both the arterial and venous systems must be evaluated. Evaluation of medical history, general physical examination, specific physical examination related to the vasculature of the extremity, vein mapping and duplex ultrasound studies are all important. It is very important to assess the size of the vessels involved. Although a newly created AVF should be allowed to fully mature prior to use, failure to develop should be evaluated early. Many cases of early failure can be successfully salvaged. Even if the patient has an arteriovenous graft, they should be evaluated at the time of every graft failure for the possibilities of creating a secondary AVF.
Coordination of Care in Disease Management: Opportunities and Financial Issues
Authors: Mosley Coleman
Published: March 2003

Patients with end‐stage renal disease (ESRD) and pre‐ESRD require higher utilization of health care resources. Current reimbursement modalities contribute to the fragmentation of care, and inadequate financial information obscures the fiscal impact disease management's coordination of care can have for this population. Ignoring the extreme costs of the first 3 months of hemodialysis underestimates costs by as much as 16%. Potential areas of coordination and the financial benefits are discussed.

In each venue of the care settings of a patient with chronic renal failure (CRF) they may receive excellent service. Too often there is not optimal coordination of care between these venues, and in fact the fragmentation of care can cause unnecessary wear and tear on the patient, and increases the overall expense to a health care system. Understanding sources of fragmentation, reimbursement effects, and potential corrections will enhance the patient's voyage through the system. This article provides some examples of the discoordination that presently exists and financial implications especially during the transition onto dialysis.

In patients with end‐stage renal disease (ESRD), each arena of care has criteria established to quantitate quality. None of the settings, whether it is the dialysis unit, the hospital, the skilled nursing facility, or the physician's office, exists in the absence of regulations. These may be state or federal, National Council on Quality Assurance (NCQA), Health Plan Employer Data and Information Set (HEDIS), water standards, Occupational Safety and Health Administration (OSHA), fire codes, physician peer review, Medicare billing, Health Care Finance Administration (HCFA), the ESRD networks, credentialing, health maintenance organization (HMO) insurance requirements, pharmacy benefits and formularies, safe harbors, “antikickback,” or National Kidney Foundation Dialysis Outcomes Quality Initiative (NKF‐DOQI) guidelines. For all the providers of care, the other critical component is the ability to have adequate income to stay in business, and make a profit. Each becomes very astute at working within the confines of the regulatory restrictions to provide good care. However, the continuity of care cannot be the overwhelming issue for many of the providers. The only person that is involved in every arena is the patient. The only provider that currently crosses over most arenas is the nephrologist. But the other element that exists in each arena is a payer.
Quantitative Characterization of Hemodialyzer Solute and Water Transport
Authors: Clark William R.
Published: March 2003

Clinicians are frequently faced with the task of selecting a hemodialyzer for a dialysis‐dependent patient. Several quantitative dialyzer parameters, such as clearance, sieving coefficients, and ultrafiltration coefficient, are routinely used in this selection process. However, the quantitative basis and exact meaning of these indices are often unclear or misinterpreted. The purpose of this article is to provide a detailed description of several of these parameters with the hope that this information will enable clinicians to make dialyzer selection from a more quantitative perspective.
Dialysis‐Related Amyloidosis: Pathogenesis Focusing on AGE Modification
Authors: Niwa Toshimitsu
Published: March 2003

Dialysis‐related amyloidosis (DRA) is a serious complication in long‐term dialysis patients, and presents with carpal tunnel syndrome, cystic bone lesions, destructive spondylarthropathy, diffuse arthritis and periarthritis, systemic organ involvement, and dialysis‐related spinal canal stenosis (DSCS). Recently a new concept of DSCS has been proposed that includes both destructive spondylarthropathy and myeloradiculopathy induced by extradural thickness. β2‐microglobulin (β2M) amyloid was demonstrated to be modified with advanced glycation end products (AGEs) such as imidazolone, Nε‐(carboxymethyl)lysine (CML), and pentosidine. Imidazolone is a reaction product of arginine residue in proteins with 3‐deoxyglucosone (3‐DG), which is markedly accumulated in uremic serum. Imidazolone is generated under nonoxidative conditions, while CML and pentosidine are formed by oxidative processes. Immunoelectron microscopy demonstrated that AGEs were localized not only in dialysis amyloid but also in nonamyloid collagenous structures, supporting the hypothesis that AGE modification of collagen might have pathogenic relevance in the deposition of β2M on collagen. Serum levels of AGEs are increased in uremic patients. The dimeric form of β2M in the dialysate and urine of uremic patients is more susceptible to imidazolone modification as observed in dialysis amyloid. However, the major component of dialysis amyloid is a native form of β2M, while AGE‐modified β2M and truncated β2M are the minor components. Thus I propose that 3‐DG and the other dicarbonyl compounds accumulating in uremic serum promote the modification of β2M with AGEs mainly after deposition of β2M as amyloid. For the prevention and treatment of DRA, β2M should be efficiently eliminated from circulating blood by kidney transplantation, hemodialysis, or hemodiafiltration using high‐flux membranes and an adsorbent (Lixelle) column.
Significance of Distribution Volume in Dialysis Quantification
Authors: Sternby Jan
Published: March 2003

The urea distribution volume is in several ways an important parameter in the treatment of end‐stage renal disease (ESRD) patients. It has a major impact on the relative dose of dialysis treatment as measured by Kt/V. It is also important in the assessment of fluid status, which has a direct influence on blood pressure. Nevertheless, urea distribution volume is usually not measured on a regular basis, probably because it has been perceived as a relatively complicated measurement. With the arrival of on‐line monitors for dialysate urea this situation has improved radically. In this article a number of volume determination methods are discussed, including some new methods based on on‐line dialysate urea monitoring, which are shown to perform well in comparison to reference methods.
Clinical Experience with Continuous Flow and Flow‐Through Peritoneal Dialysis
Authors: Amerling Richard , DeSimone Luca , Inciong‐Reyes Rosa , Pangilinan Amy , Folden Tom , Ronco Claudio , Gotch Frank A. , Levin Nathan
Published: March 2003

Concern over the inherent inefficiency of solute removal by conventional peritoneal dialysis (PD) has led to renewed interest in continuous flow PD (CFPD). We present clinical data from two experiences with CFPD. In the first, two catheters were used to recirculate a fixed intraperitoneal volume through an external circuit comprised of a standard hemodialysis system. The second patient had a dual‐lumen PD catheter and was studied during two sessions of flow‐through PD (FTPD) using sterile PD solution. Urea clearances with both techniques were around 30 ml/min, which is consistent with data reported in the literature. Significant streaming of dialysate from port to port within the peritoneal cavity limited clearances. CFPD offers a potentially safe and effective alternative to daily or nightly home hemodialysis.
Catheter Performance
Authors: Depner Thomas A.
Published: March 2003

Venous catheters differ from peripheral arteriovenous (AV) access devices in many important ways. This discussion focuses on their performance as a conduit for blood flow between the patient and the dialyzer and on how catheter function is both limited and enhanced relative to the more common peripheral accesses. Catheter flow is limited by the high resistance inherent in the extended length of venous catheters relative to dialysis needles, but the high rate of flow in central veins also diminishes the opportunity for access recirculation. Cardiopulmonary recirculation is absent in patients with catheter access unless the patient also has a peripheral access. In the latter case, the same detrimental effect on urea clearance is seen regardless of which access device is used. Flow‐dependent recirculation through circuits other than the peripheral AV access reduces the efficiency of dialysis (regardless of the type of access, catheter, or peripheral AV device used) across both catheters and peripheral AV devices. The insdie diameter of the catheter plays a sensitive role in determining catheter resistance to flow. Slight increases in diameter under the same pressure head are associated with large increases in flow. Negative pressure at the catheter inflow port generated by the blood pump is magnified relative to peripheral devices, predisposing to partial collapse of the pump tubing segment and erroneous blood flow readings by the pump motor speed indicator. Setting a limit on prepump negative pressure can minimize this error. Future applications of dialysis may require lower pump speeds, which would allow more liberal use of catheter access if their potential for infection and clotting can be reduced.
Utilizing a Disease Management Approach to Improve ESRD Patient Outcomes
Authors: Anand Shaan , Nissenson Allen R.
Published: March 2003

In this era of processes and systems to improve quality, disease management is one methodology to improve care delivery and outcomes for patients with chronic kidney disease (CKD). In most disease management systems a senior renal nurse coordinates all aspects of the patient's care and ensures that the prescribed and necessary care is delivered for both CKD‐related and comorbid conditions. The nurse also continually monitors outcomes on quality indicators and key performance measures. These outcome data are then aggregated and analyzed, are compared with local and national benchmarks, and drive the continuous quality improvement (CQI) process. Such a system attempts to centralize the currently fragmented care delivery system, continually improve patient outcomes, and conserve scarce economic resources. Early data suggest a disease management approach may improve both the morbidity and mortality of CKD patients.
Alternative Medicine and Nephrology Series Editor: Naomi V. Dahl: Herbs, Menopause, and Dialysis
Authors: Roemheld‐Hamm Beatrix , Dahl Naomi V.
Published: March 2003

Women with chronic kidney disease (CKD) are at increased risk for menstrual disorders, early menopause, and osteoporosis, and rarely discuss gynecologic and reproductive issues with their nephrologist. Various complementary and alternative medicine (CAM) products are of interest to women with end‐stage renal disease (ESRD) who have these disorders. However, very little is known about the specifics of using herbal medicines in patients on chronic dialysis, resulting in numerous problems when patients and providers try to ascertain the safety and efficacy of these products. This article reviews evidence regarding the safety and efficacy of black cohosh, ginseng, chastetree, dong quai, evening primrose oil, soy products, and the so‐called natural hormones. Pharmacologic parameters important to evaluating the quality of botanical products are discussed, along with recommendations and information resources.
Withholding and Withdrawal of Dialysis in the Elderly
Authors: Lowance David C.
Published: March 2003

The awareness that many patients eligible for dialysis may live lives in which the burdens of treatment outweigh the benefits has led the renal community to establish guidelines to assist the health care team in advising patients of the potential outcomes of living with or without dialysis. The guidelines published have been personal, consensual, and evidence based. They share in common the principles of shared decision making and informed consent. Only the patient or his surrogate should make the decision regarding initiation or cessation of dialysis.
Blood Pressure Control in Dialysis Patients
Authors: Fishbane Steven A. , Scribner Belding H.
Published: March 2003

Hypertension is present in most patients on hemodialysis, and evidence suggests that it is not well controlled. In this review we discuss the pathogenesis of hypertension in these patients and the reasons that short‐duration, intermittent hemodialysis makes blood pressure treatment especially difficult. We provide suggestions for targeting volume management as a basis for optimal hypertension treatment.
Imaging in the Dialysis Patient: Contrast Agents in Patients on Dialysis
Authors: Dawson Peter
Published: March 2003

Contrast media are used to enhance the structural and functional information that is provided by imaging methods. They are used particularly in conventional radiographic (X‐ray) investigations, but are also used in magnetic resonance imaging (MRI) and increasingly in ultrasound (US). The water‐soluble, iodinated, intravascular radiographic agents are commonly used, and in large doses. They are excreted almost exclusively by the kidney and may have nephrotoxic effects. The use of these agents in patients with renal impairment may potentially be problematic. In this article the chemical composition and pharmacokinetics of these contrast agents are reviewed, as are their potentially toxic effects on the heart, neural tissues, kidney, and endothelium. Their safety for use in the patient with end‐stage renal disease (ESRD) and those on dialysis is discussed. This aspect is also addressed briefly for the contrast agents used to augment MRI and US.
Special Article: The Study of Treatment for Renal Insufficiency: Data and Evaluation (STRIDE), a National Registry of Chronic Kidney Disease
Authors: Rao Madhumathi , Kausz Annamaria T. , Mitchell Don , Ratican Sari Heller , Lin Francie , Burrows‐Hudson Sally , Port Fritz , Pereira Brian J. G.
Published: March 2003

Optimization of care in patients with chronic kidney disease (CKD) could be the key to improved clinical and economic outcomes, both during the phase of CKD as well as in patients with end‐stage renal disease (ESRD). CKD is a major public health problem that has been insufficiently studied. There is little published information on outcomes among CKD patients, specifically, data on mortality, morbidity, and quality of life. Indeed, recent efforts by the National Kidney Foundation (NKF) have served to define the classification, evaluation, and approach to management of CKD in practice. The Study of Treatment for Renal Insufficiency: Data and Evaluation (STRIDE) registry is an initiative to study CKD patients in nephrology practices across the country. It is a prospective observational study whose objective is to profile demographic and clinical variables, practice patterns, comorbid conditions, quality of life, and outcomes in a nationally based sample of CKD patients. This article details the design, methodology, and process of enrollment into the registry.
Editorials: The ADEMEX Study and Its Implications for Peritoneal Dialysis Adequacy
Authors: Burkart John M.
Published: March 2003

In an attempt to improve patient outcomes in peritoneal dialysis (PD), national organizations (such as the National Kidney Foundation Dialysis Outcomes Quality Initiative [NKF‐DOQI] process) have formulated clinical practice guidelines based on clinical evidence available at the time of development. For “adequacy” of PD it was acknowledged that there was no prospective randomized interventional clinical trial that evaluated the effect of an increase in peritoneal clearance on outcome. The ADEMEX study is the first such study designed to do this. It was well done and adequately powered for the primary analysis. The study findings indicate that over the range of solute clearances studied, an increase in peritoneal clearance is not associated with an incremental improvement in patient outcome. However, it is noted that the cause of dropout was different between groups, with more dropout for “uremia” in the control group. There are also some limitations in the generalizability of the results. First, the exclusion criteria were likely to exclude patients who were small in body size or were high transporters, patients with the highest relative risk of death. Second, although there was an increase in small solute clearance between control and intervention groups, there was not likely to be an increase in clearance of other potential uremic solutes such as middle molecules. Third, the study did not examine outcomes for patients on cycler therapy. Nevertheless it was a provocative, well‐run clinical study which does have implications for clinical practice. It confirms that one prescription does not fit all patients, that many patients below current NKF‐DOQI targets for small solute clearance are likely to be adequately dialyzed, and provides evidence‐based clinical information for national societies to consider when preparing for the next revision of their guidelines.
Prevention Strategies Other Than Male Condoms Employed by Low‐Income Women to Prevent HIV Infection
Authors: Crosby Richard A. , Yarber William L. , Meyerson Beth
Published: March 2003

This study sought to determine HIV prevention strategies other than male condom use employed by low‐income women who have sex with men (WSM) and to identify variables that predict use of these strategies. A cross‐sectional survey of nearly 4,000 women receiving Women, Infants, and Children (WIC) benefits in 21 Missouri counties was conducted. The response rate was 58%, with 2,256 completed questionnaires returned. Women were asked to indicate one or more of nine methods they had ever used to prevent HIV infection. Women were also asked about their use of male condoms, preference for male condoms versus female condoms, and which partner usually made decisions about STD/HIV prevention. Of the 2,256 questionnaires returned, 1,325 WSM indicated use of at least one HIV prevention strategy other than condom use. Strategies were: being tested for HIV (68.2%), partner being tested for HIV (44.1%), asking partner about his sex history (41.1%), using oral contraceptives (18.8%), asking him if he has HIV (13.7%), douching (11.8%), withdrawal (9.4%), and having anal or oral sex (6.6%). Common predictors of these strategies were race, education, history of STD, condom use, and marital status. Basic misunderstandings about HIV prevention are common in specified subpopulations of low‐income women. HIV prevention programs for low‐income WSM should capitalize on women's efforts to prevent HIV by designing programs to help women replace ineffective prevention strategies with effective prevention strategies.
Feria de Salud: Implementation and Evaluation of a Communitywide Health Fair
Authors: Hecker Emily Jill
Published: March 2003

Evaluating the effectiveness of community interventions is a major responsibility for community health nurses (CHNs). Without evidence of the effectiveness of interventions, their impact on the health status of populations or communities cannot be determined. This article presents the planning, implementation, and evaluation processes of a communitywide health fair. This fair was held in a suburban community of approximately 12,000 individuals, located 20 kilometers outside of Mexico City. The health fair was one component of a collaborative project aimed at addressing the overall health needs of the community. Emphasis is on the development and utilization of measurable objectives in evaluating both processes and outcomes of the health fair. Green and Kreuter's (1991) PRECEDE‐PROCEED program planning model provided direction for program planning and evaluation. The findings of process, impact, and outcome evaluation are described, providing both qualitative and quantitative measures of program effectiveness. These findings provide direction for program replication and modification. Recommendations address the utility of theory‐based assessment, program planning, and evaluation, the importance of formative evaluation, and the need for cultural sensitivity in community health program planning.
Occupational Health Nurses' Work and Expertise in Finland: Occupational Health Nurses' Perspective
Authors: Naumanen‐Tuomela Paula
Published: March 2003

The purpose of this study was to describe Finnish occupational health nurses' (OHNs) work in terms of its contents, characteristics, necessities, meanings, development areas, changes, and expertise. The data were gathered via essays handwritten by OHNs (n= 20). Qualitative content analysis revealed that occupational health nursing practice included work with individuals, work communities, and various collaborative partners, office tasks, and other duties. Responses about OHNs' work were classified as characteristics of OHNs and of their work with advantages as well as disadvantages. The work of OHNs requires a multidisciplinary knowledge basis, professional skills, certain personal characteristics, and other features. These should be maintained and developed through continual education. The outcomes of OHNs' work were better health and healthier habits for employers, higher productivity for employers and occupational health care units, and health care savings for society. The most significant change that has occurred over the last 20 years was the move from an individual and medicine orientation toward a focus on the work community and on nursing. Expert OHNs were expected to be competent and multiskilled professionals who apply multidisciplinary knowledge in practice. This study brought out the need for further study with a focus on the client's perspective.
Mapping the Future of Environmental Health and Nursing: Strategies for Integrating National Competencies into Nursing Practice
Authors: Larsson Laura S. , Butterfield Patricia
Published: March 2003

Nurses are increasingly the primary contact for clients concerned about health problems related to their environment. In response to the need for nursing expertise in the field of environmental health, the Institute of Medicine (IOM), Agency for Toxic Substances and Disease Registry (ATSDR), and National Institute of Nursing Research (NINR) have designed core competencies for the nursing profession. The IOM competencies focus on four areas: (1) knowledge and concepts; (2) assessment and referral; advocacy, ethics, and risk communication; and (4) legislation and regulation. The competencies establish a baseline of knowledge and awareness in order for nurses to prevent and minimize health problems associated with exposure to environmental agents. To address the known difficulties of incorporating new priorities into established practice, nurses attending an environmental health short course participated in a nominal group process focusing on the question, “What specific actions can we take to bring environmental health into the mainstream of nursing practice?” This exercise was designed to bring the concepts of the national initiatives (IOM, NINR, ATSDR) to the awareness of individual nurses involved in the direct delivery of care. Results include 38 action items nurses identified as improving awareness and utilization of environmental health principles. The top five ideas were: (1) get environmental health listed as a requirement or competency in undergraduate nursing education; (2) improve working relationships with interdepartmental persons—a team approach; (3) strategically place students in essential organizations such as NIOSH, ATSDR, or CDC; (4) educate nurse educators; and (5) create environmental health awards in nursing. The 38 original ideas were also reorganized into a five‐tiered conceptual model. The concepts of this model include: (1) developing partnerships; (2) strengthening publications; (3) enhancing continuing education; (4) updating nursing practice; and (5) strengthening schools of nursing. The model serves as a road map for action in building environmental health capacity within mainstream nursing.
Community‐Based Senior Health Promotion Program Using a Collaborative Practice Model: The Escalante Health Partnerships
Authors: Nuñez Diane E. , Armbruster Charlotte , Phillips Wayne T. , Gale Betty J.
Published: March 2003

Abstract Recent research demonstrates that, although the risk of disease and disability clearly increases with age, poor health need not be an inevitable consequence of aging. A healthy lifestyle is more influential than genetic factors in assisting older adults avoid the decline and deterioration traditionally associated with aging. Many effective strategies for reducing disease and disability are widely underused. The Escalante Health Partnerships is a community‐based, nurse‐managed health promotion and chronic disease care management program for community‐residing older adults. The program base supports a multidisciplinary, collaborative practice model, which has responded to the health needs of members of a community at high risk of having or developing chronic conditions. Preliminary comparisons of the health status of program participants with national norms demonstrate that these seniors report better general health, performance of roles, and social functioning, with the strongest correlations occurring between general health and vitality and between general health and role‐physical. In addition, these participants have 4.2 doctor visits per year, in comparison with 7.1 office visits for a national comparison group and 1.6 hospital days per year, in comparison with 2.1 hospital days in the same referenced population. This collaborative partnership is a model that can be replicated cost‐effectively in other communities.
Elastin Gene Deletions in Williams Syndrome Patients Result in Altered Deposition of Elastic Fibers in Skin and a Subclinical Dermal Phenotype
Authors: Urbán Zsolt , Peyrol Simone , Plauchu Henri , Zabot Marie‐Therese , Lebwohl Mark , Schilling Kurt , Green Martin , Boyd Charles D. , Csiszár Katalin
Published: March 2003

Abstract: Williams syndrome (WS) is a complex developmental disorder with multisystem involvement known to be the result of a microdeletion in the q11.23 region of chromosome 7. This deletion involves several genes, including the elastin gene. Although elastic fibers are important constituents of skin, little is known about the skin phenotype in WS patients. We have therefore studied the skin of four WS patients in which we've shown the deletion of one copy of the elastin gene. Physical examination and indirect immunofluorescent microscopy of elastin did not detect any major phenotypic or morphologic changes in the skin. We were able, however, to show subtle textural changes in skin and, by electron microscopy, that the amorphous component of elastic fibers in WS patients was consistently reduced when compared to normal controls. These findings indicate that deletion of one copy of the elastin gene results in reduced deposition of elastin in dermal elastic fibers, an altered elastic fiber ultrastructure, and a subclinical dermal phenotype in the children and young adult patients analyzed in this study.
Chemical Burn Caused by Topical Vinegar Application in a Newborn Infant
Authors: Korkmaz Ayşe , Şahiner Ümit , Yurdakök Murat
Published: March 2003

Abstract: Although there is increasing interest in “alternative medicine,” including nontraditional and homeopathic remedies, all around the world, they are not always safe and beneficial and may have adverse effects. We report a chemical burn caused by vinegar applied topically to lower body temperature in a febrile newborn and discuss briefly chemical skin burns caused by organic acids.
Granuloma Gluteale Infantum: A Case Report
Authors: De Zeeuw Raymond , Van Praag Marinus C. G. , Oranje Arnold P.
Published: March 2003

Abstract: Granuloma gluteale infantum is a benign disorder with the clinical appearance of “granulomatous” nodules involving the diaper area. It is an uncommon disorder considered a complication of primary irritant diaper dermatitis. A 6‐month‐old boy with reddish‐purple oval nodules located on the right inguinal fold and right buttock diagnosed as granuloma gluteale infantum is presented. A contributing factor in our patient could be a primary irritant dermatitis or a preexisting candidial infection. The name granuloma gluteale infantum is a misnomer since no granulomas are found in these lesions.
The Natural History of Sensitizations to Food and Aeroallergens in Atopic Dermatitis: A 4‐Year Follow‐Up
Authors: Patrizi Annalisa , Guerrini Valentina , Ricci Giampaolo , Neri Iria , Specchia Fernando , Masi Massimo
Published: March 2003

Abstract: The natural history of atopic dermatitis (AD) is variable. Generally the dermatitis disappears during the first years of life, but it is often followed by the appearance of allergic respiratory diseases (ARDs). Our aim was to establish the risk factors for developing an ARD in children with AD. We followed up for 4 years 78 children (51 boys, 27 girls) with mild (26%), moderate (48%), and severe (26%) AD (clinical score proposed by Rajka and Langeland). In all the patients IgE serum levels were checked and skin prick tests (SPTs) were performed at the first examination. The SPTs were repeated in 68 children at the end of the study. The children with severe AD had significantly higher IgE serum levels than those with mild or moderate AD. SPTs at the first observation were positive in 47% of cases, mostly in patients with severe AD, with a prevalence of food allergens, particularly in younger patients. At the second observation, SPTs were positive in 65% of cases, including 100% of children with severe AD. Inhalants were the most common allergens. An ARD appeared in 38% of all patients: in 75% of those with severe AD and in 54% of those with a positive first SPT. Allergic screening should be carried out at an early age, especially in severe AD, since SPT positivity to food allergens, associated with severe clinical AD symptoms and a high IgE serum level, identifies those children ages 0–3 years at high risk of development of ARD.
Duodenal Atresia, Biliary Atresia, and Intestinal Infarct in Truncal Aplasia Cutis Congenita
Authors: Lane Whitney , Zanol Karen
Published: March 2003

Abstract: A newborn boy with aplasia cutis congenita had biliary atresia, distal duodenal atresia, and a severe infarct of the intestine resulting in complete absence of the entire midgut. The boy died due to biliary atresia and severe short gut syndrome approximately 3 weeks after birth. While the association of duodenal atresia with aplasia cutis congenita has been described, the findings of biliary atresia and midgut atresia in association with aplasia cutis congenita have not been described previously.
Direct Comparison of Skin Physiology in Children and Adults with Bioengineering Methods
Authors: Fluhr J. W. , Pfisterer S. , Gloor M.
Published: March 2003

Abstract: The aim of the study was to investigate whether the physiologic skin parameters of transepidermal water loss (TEWL), stratum corneum hydration (capacitance and conductance), dynamic stratum corneum hydration parameters (hygroscopicity and water‐holding capacity), skin color (a* and L* axes; chromameter), cutaneous blood perfusion [laser Doppler flowmetry (LDF)], and pH value differ between a sample of 44 children [C] (average age 3.5 years) and a directly comparable sample of 44 adults (their parents) [P] (average age 34.6 years). The results can be described as follows: TEWL C: 6.2 g/m2/h, P: 5.4 g/m2/h; stratum corneum hydration, capacitance C: 75.4 AU, P: 76.1 AU; conductance C: 27.1 μS, P: 19.2 μS; hygroscopicity C: 129.0 AU, P: 132.7 AU; water‐holding capacity: C: 127.7 AU, P: 127.6 AU; redness (a*) C: 7.31, P: 8.21; lightness (L*) C: 67.63, P: 66.36; LDF (%) C: 24.6, P: 18.7; pH value C: 4.91, P: 5.07. In comparison to the skin of the adult sample we investigated (the parents of the 44 children), the skin of the small child can be characterized in the following way: it has a significantly lower hygroscopicity, a lighter (higher L* values) and less red color (lower a* values), and an increased cutaneous blood perfusion (LDF).
Coexistent Linear Scleroderma and Juvenile Systemic Lupus Erythematosus
Authors: Majeed Mahmoud , Al‐Mayouf Sulaiman M. , Al‐Sabban Essam , Bahabri Sultan
Published: March 2003

Abstract: We describe a girl who initially presented with linear scleroderma. Five and a half years later she developed systemic lupus erythematosus (SLE). Previous descriptions of the coexistence of linear scleroderma and SLE in childhood are reviewed.
Juvenile Xanthogranuloma on the Sole
Authors: Whittam L. R. , Higgins E. H.
Published: March 2003

Abstract: Juvenile xanthogranulomas are benign, typically self‐limiting tumors that most commonly occur on the head and trunk. We report one such tumor with an atypical clinical appearance, occurring at an unusual site, the sole of the foot.
An Unusual Presentation of Immunodeficiency with Hyper‐IgM
Authors: Uğuz Ayşen , Yilmaz Ertan , Çiftçioğlu M. Akif , Yeğin Olcay
Published: March 2003

Abstract: Hyper‐IgM syndrome is a rare immunodeficiency disease characterized by markedly decreased serum IgG, IgA, and IgE levels but normal or elevated IgM levels. The most common clinical signs are infections, cirrhosis, arthritis, malignancies, and mucosal ulcers. Approximately two‐thirds of patients have chronic neutropenia associated with oral and perirectal ulcers. We report a 14‐month‐old girl with hyper‐IgM syndrome who has recurrent cutaneous ulcers restricted to the diaper area.
Skin Barrier, Hydration, and pH of the Skin of Infants Under 2 Years of Age
Authors: Giusti Francesca , Martella Alessandro , Bertoni Laura , Seidenari Stefania
Published: March 2003

Abstract: The goal of this study was to instrumentally evaluate the skin of healthy infants and to compare it to adult skin. A total of 70 infants, 45 girls and 25 boys, ages 8–24 months, and 30 healthy women were studied by means of transepidermal water loss (TEWL), capacitance, and pH measurements at two different skin sites, the volar forearm and the buttocks. No significant differences in TEWL were found between infants and adults, either on the buttocks or on the volar forearm. On the contrary, capacitance values were higher in infants. Their skin also appeared less acid than that of adults, with high statistical significance. No TEWL, capacitance, or pH variations were observed in infants according to sex and age. On the basis of the above data, the skin of infants 8–24 months of age shows functional signs of immaturity. This may lead to an increased permeability and a reduced capacity for defense against chemical and microbial aggression.
Childhood Psoriasis: A Clinical Review of 1262 Cases
Authors: Morris Anne , Rogers Maureen , Fischer Gayle , Williams Katrina
Published: March 2003

Abstract: Our aim was to describe the types of psoriasis seen in a large series of patients presenting to a tertiary referral pediatric dermatology department using a classification system combining conventional terminology and additional categories based on the site and characteristics of the rash. A total of 1262 patients seen consecutively in the dermatology department of the Royal Alexandra Hospital for Children, Sydney, Australia, between 1981 and 1995 are described and classified according to the pattern of psoriasis at the time of presentation. Additional information recorded included family history, facial involvement, and history of a psoriatic type of diaper rash in infancy. The ages of the children ranged from 1 month to 15 years. There was an equal gender distribution and a high rate of positive family history at 71%. Twenty‐six percent of children had a history of a psoriatic diaper rash and facial involvement occurred in 38% of children. Plaque psoriasis was the most common type overall, affecting 430 patients (34%). Three hundred forty‐five children were less than 2 years of age, and this is the largest series of children with psoriasis in this age group presented to date. An entity defined by us as psoriatic diaper rash with dissemination was the most common type of psoriasis in the less than 2‐year age group, affecting 155 (45%) patients. This large series offers information on the manifestations of psoriasis in childhood, but is particularly useful in examining the previously less well‐described infant age group. The classification used is proposed as a practical way to describe psoriasis in children, particularly with respect to future descriptive studies.
Unusual Clinical Presentation in Two Cases of Multiple Sulfatase Deficiency
Authors: Blanco‐Aguirre M. E. , Kofman‐Alfaro S. H. , Rivera‐Vega M. R. , Medina C. , Valdes‐Flores M. , Rizzo W. B. , Cuevas‐Covarrubias S. A.
Published: March 2003

Multiple sulfatase deficiency (MSD) is an inborn error of metabolism that combines the clinical features of late infantile metachromatic leukodystrophy and mucopolysaccharidosis. The characteristic biochemical abnormality is a reduction in the activities of several sulfatases, with consequent tissue accumulation of sulfatides, sulfated glycosaminoglycans, sphingolipids, and steroid sulfates. In this study we present two unusual cases of MSD with variable enzymatic deficiency of arylsulfatases A, B, and C. Both patients had ichthyosis, broad thumbs and index fingers, an unusually slow progression of the neurologic symptoms, and lacked the hepatosplenomegaly that is typical of MSD. Olivopontocerebellar atrophy was present and one patient had a large retrocerebellar cyst. Mucopolysaccharides were not detected in the urine from either subject. Leukocyte arylsulfatase A activity in patient 1 was 0.46 nmol/mg protein/hr and in patient 2 was 0.0 nmol/mg protein/hr (normal 0.7–5.0 nmol/mg protein/hr). Leukocyte arylsulfatase B activity in patient 1 was 24 nmol/mg protein/hr and in patient 2 was 22 nmol/mg protein/hr (normal 115–226 nmol/mg protein/hr). Leukocyte arylsulfatase C in patient 1 was 0.30 pmol/mg protein/hr and in patient 2 was 0.28 pmol/mg protein/hr (normal 0.84 pmol/mg protein/hr). In conclusion, these two patients with MSD had mild clinical presentations not previously reported and variable enzymatic deficiency of arylsulfatases A, B, and C.
Aplasia Cutis Congenita in Surviving Co‐twins: Four Unrelated Cases
Authors: Cambiaghi Stefano , Schiera Alberto , Tasin Laura , Gelmetti Carlo
Published: March 2003

Four unrelated patients born from twin pregnancies and showing extracranial aplasia cutis congenita are reported. All the patients lost their co‐twins during the first half of the pregnancy. Two of the patients had the characteristic truncal and symmetrical type of aplasia cutis associated with fetus papyraceus and placental abnormalities. The presence of multiple hepatic hematomas in one of them gives further credit to a “vascular disruption” as the possible pathogenetic mechanism of the disorder. The two other patients were born with symmetrical aplasia cutis at the extensory aspects of both knees, which presumably represents a milder expression of the former defect. Thus the so‐called aplasia cutis with fetus papyraceus shows heterogeneity in localization, extension, presence of extracutaneous abnormalities, and possible association with fetus papyraceus at birth. To include all the patients affected by this peculiar type of aplasia cutis congenita, the designation of aplasia cutis with extracranial symmetrical involvement is proposed.
Pyogenic Granuloma of the Penile Shaft Following Circumcision
Authors: Naimer Sody A. , Cohen A. , Vardy D.
Published: March 2003

Pyogenic granuloma is a benign vascular, inflammatory proliferation that appears following minor trauma in children. The exact pathogenesis of pyogenic granuloma is unknown, but its formation is closely related to minor trauma, chronic irritation, and hormonal influences. We present a unique case of a pyogenic granuloma that appeared in an infant following circumcision.