bluuebunny/crossref_metadata_2025 huggingface dataset:
Nurse‐Managed Primary Care: Outcomes of a Faculty Practice Network
Authors: Edwards Joellen B. , Oppewal Sonda , Logan Carol Lee
Published: May 2005

Purpose

To describe selected outcomes of nurse‐managed primary care in a large faculty practice network (FPN) and to use guidelines proposed by the National Organization of Nurse Practitioner Faculties (NONPF) to evaluate those outcomes.

Data Sources

Mission and goals, nursing control, fiscal stability, health care outcomes, and faculty role integration were examined.

Conclusions

Outcomes show that the FPN directly supports the mission and goals of the East Tennessee State University College of Nursing and is managed by nurse faculty members. The FPN uses earned revenue, grants, and contracts to maintain fiscal stability. Patients are highly satisfied with services, and external and internal audits find the quality of care to be excellent. Students are educated in the centers. Faculty members publish and present research and other scholarly work derived from the FPN.

Implications for Practice

This model demonstrates that faculty practice can work, can meet the evaluation components of guidelines of a major national organization, and can contribute to the improvement of health for vulnerable populations.
Management of Hyperbilirubinemia in the Healthy Term Newborn
Authors: Goolsby Mary Jo , Blackwell James T.
Published: May 2005

This month's clinical practice guideline review is on hyperbilirubinemia in healthy term newborns. Due to the large number of newborns that experience clinical jaundice each year in the United States and the controversy that continues to surround the treatment of hyperbilirubinemia in healthy newborns, this guideline should be of great interest to nurse practitioners that treat this population.
Benefits of Swim Training for Children and Adolescents with Asthma
Authors: Rosimini Cherri
Published: May 2005

PURPOSE

To r eview scientific evidence related to the benefits of swimming and present an evidence‐based approach to prescribing swim training for children and adolescents with asthma.

DATA SOURCES

Extensive literature review of all research that has been done on swim training in asthmatic children and adolescents, using the databases CINAHL, Medline, and ProQuest.

CONCLUSIONS

When swimming is compared to other sports in the scientific literature, it has been found to have a lower asthmogenicity. It has also been shown to decrease the severity of asthma symptoms. Swimming may be an effective nonpharma‐cological intervention for the child or adolescent with asthma.

IMPLICATIONS FOR PRACTICE

Research findings are summarized regarding the benefits of swim training on children and adolescents with asthma, and a stepped three‐level approach to swim prescription is outlined along with safety recommendations.
Hispanic Women's Experience With “el Cambio de Vida”
Authors: Longworth Judith C. D.
Published: May 2005

Purpose

To examine the factors that influence Hispanic women's decisions to initiate or not initiate hormone replacement therapy (HRT) during menopause to manage symptoms or to prevent longer‐term conditions.

Data Sources

A descriptive study of 51 Hispanic women who completed the Spanish version of the Menopausal Decision‐Making Questionnaire (S‐MDMQ) to describe their experience with and perceptions about menopause.

Conclusions

Most of the low‐income Hispanic women in this study would elect not to take HRT; however, they do use exercise, diet, vitamins, and other self‐care activities to manage symptoms of menopause. Hispanic women were eager to discuss how to manage their health care during perimenopause and menopause with one another and their health care providers.

Implications for Practice

Nurse practitioners need to understand factors that might influence Hispanic women's decisions regarding management of menopausal symptoms, including the use of HRT, and to be able to assist women in making an individ‐ualized personal treatment choice that is culturally acceptable.
Management of Molecular‐Targeted Therapy for Chronic Myelogenous Leukemia
Authors: Ault Patricia , Kaled Suzan , Rios Mary Beth
Published: May 2005

Purpose

To provide primary care providers with guidelines on the evaluation and manage‐ment of treatment for patients with chronic myelogenous leukemia (CML) with emphasis on the molecular‐targeted therapy imatinib mesylate.

Data Sources

Research‐based articles in the medical literature, review articles, and clinical practice guidelines.

Conclusions

CML is a clonal stem cell disorder causing 5,000 new cases annually. Research on mol‐eculartargeted therapy confirms that specific protein kinases have broad conse‐quences for the development of future drugs to treat CML. The most recent discovery is a new compound, imatinib mesylate, which has become commercially available. Currently, the standard of care for CML is this agent. This therapy has changed management strategies for treatment of patients with the diagnosis of CML.

Implications for Practice

Long‐term observations and evaluations are needed for final determination of treatment effectiveness; thus, primary care providers will follow patients with CML in the community. Unforeseen toxicity may surface, requiring accurate assessment and evalua‐tion. Primary care providers will be actively involved with providing symptom management for these patients.
Predictors of Nurse Practitioners’ Autonomy: Effects of Organizational, Ethical, and Market Characteristics
Authors: Ulrich Connie , Soeken Karen , Miller Nancy
Published: May 2005

Purpose

To identify the predictors of autonomy of nurse practitioners (NPs) affiliated directly and/or indirectly with managed‐care systems (e.g., HMOs).

Data Sources

A mailed survey sent to a stratified random sample of 254 NPs certified and licensed to practice in the state of Maryland. The measures consisted of selected organizational char‐acteristics; market factors of HMO penetration and percentage of client population enrolled in managed care; and factors of ethical concern, such as ethical ideology, ethics education, and autonomy. The County Surveyor Database was used to assess market penetration in the state.

Conclusions

Although NPs were ethically concerned about their autonomy in a managed‐care environment (70.2%), actual autonomy scores were high. The higher the percentage of HMO penetration, percentage of client population enrolled in managed care, and perceived ethi‐cal concern, the lower the perceived autonomy of NPs.

Implications for Practice

Findings may be used for future research to address the complexity of variables that influence the autonomous practice of NPs.
Promoting Lifestyle Change in the Prevention and Management of Type 2 Diabetes
Authors: Whittemore Robin , Bak Patricia S. , Melkus Gail D'Eramo , Grey Margaret
Published: May 2005

Purpose

To present the theoretical background for lifestyle change interventions in the prevention and management of type 2 diabetes and to provide pragmatic strategies for advanced practice nurses (APNs) to incorporate such interventions into their practices.

Data Sources

Selected scientific literature and the Internet.

Conclusions

There is an epidemic of obesity and type 2 diabetes among adults in the United States. Preventing or managing these health conditions requires significant lifestyle changes by individuals.

Implications for Practice

APNs are in a key role to deliver lifestyle change interventions, particularly in the primary care setting. Strategies to assist APNs with lifestyle change counseling include (a) assessment, (b) mutual decision making, (c) referral to education programs, (d) individualized treatment goals, (e) strategies to assist with problem solving, (f) continuing support and encouragement, (g) relapse prevention, and (h) ongoing follow‐up.
Treatment Options for Patients With the Metabolic Syndrome
Authors: Berra Kathy
Published: May 2005

Purpose

To review clinical and laboratory findings that will enhance nurse practitioner (NP) recognition of the metabolic syndrome and to increase awareness of recent treatment guidelines and treatment options.

Data Sources

Professional association practice guidelines, government documents, original research articles, and journal articles.

Conclusions

The metabolic syndrome is a prevalent condition characterized by a cluster of lipid and nonlipid abnormalities, including atherogenic dyslipidemia, elevated fasting blood glucose, hypertension, and abdominal obesity. Many persons with this syndrome are also insulin resistant. Prompt recognition and treatment of the metabolic syndrome can prevent or delay the development of type 2 diabetes and coronary heart disease. Clinical guidelines recommend treating the metabolic syndrome as a secondary target of lipid‐lowering therapy after addressing the primary target, low‐density lipoprotein cholesterol.

Implications for Practice

NPs are in an instrumental position to manage treatment for patients with the metabolic syndrome by (a) evaluating risk factors, including abdominal obesity, physical inactivity, atherogenic dyslipidemia, hypertension, and elevated fasting blood glucose; (b) assisting in the modification of lifestyle factors such as diet and exercise; (c) implementing pharmacological therapy when needed; and (d) providing psychosocial support to encourage therapeutic adherence.
Preadmission Characteristics of Advanced Practice Nursing Students
Authors: Crosby Frances E. , Dunn Joan Dolce , Fallacaro Michael D. , Jozwiak‐Shields Connie , Maclsaac Ann Marie
Published: May 2005

Purpose

To determine the nature of prerequisite experiences of applicants to nurse practitioner (NP) and certified registered nurse anesthetist (CRNA) programs that faculty believe are necessary for success in graduate nursing programs.

Data Sources

An exploratory descriptive study based on findings from four focus groups of faculty from four different universities and a written survey mailed to program or admissions directors of a random sample of 50% of the 295 credentialed NP or CRNA programs in the United States.

Conclusions

Themes from the focus groups revealed 20 personal characteristics, 14 professional character‐istics, and 9 clinical skills, all of which were used to create a survey instrument. A 33% response rate was achieved (n = 48). Personal characteristics were considered most important, professional characteristics and clinical skills moderately important, and kinds of clinical experience of lesser importance. Length of desired experience ranged from 0 to 5 years, most often 2 years. The most important characteristic under personal was “ethical;” under professional, “clinically competent;” under clin‐ical, “interpersonal communication;” and under clinical experience, “to work in a setting with MD‐RN interaction.”0
Comparison of Quality‐of‐Hypertension‐Care Indicators for Groups Treated by Physician Versus Groups Treated by Physician‐Nurse Team
Authors: Scisney‐Matlock Margaret , Makos Gail , Saunders Tracy , Jackson Frances , Steigerwalt Susan
Published: May 2005

Purpose

To determine whether the type of health care provider (i.e., physician versus physician‐nurse team) affected the quality of hypertension care given to two groups of randomly selected adult women.

Data Sources

Three indicators measured the quality of hypertension care: blood pressure control level, knowledge of hypertension, and discussion about blood pressure medications with the health care provider(s). Blood pressure readings were taken with a 24‐hr ambulatory blood pressure monitor, and demographic data from survey results taken at orientation and researchercollected data on posttreatment knowledge of hypertension and cognitive representations of hypertension were gathered. Chi‐square and t tests were used to analyze the data.

Conclusions

The group whose care was managed by a physiciannurse team demonstrated lower means for 24‐hr systolic blood pressure and diastolic blood pressure (systolic: M = 132, SD = 14.9; diastolic: M = 75, SD = 11.3) than the group whose care was managed only by one or more physicians (systolic: M = 136, SD = 13.4; diastolic: M = 79, SD = 11.24). Also, the group whose care was managed by a physician‐nurse team revealed significantly higher scores for discussion of blood pressure medication than the group whose care was managed only by one or more physicians. There were no group differences for knowledge of hypertension.

Implications for Practice

Nurses qualified to assist with meeting the needs of hypertension clients in primary care settings can positively affect clients’ knowledge about blood pressure medication and—perhaps as a result of this knowledge—how well the clients control their blood pressure.
Approaches to Breast Cancer Screening Among Nurse Practitioners
Authors: Lawvere Silvana , Mahoney Martin C. , Symons Andrew B. , Englert Jessica J. , Klein Susan B. , Mirand Amy L.
Published: May 2005

Purpose

To determine nurse practitioners’ (NPs’) knowledge and reported practices regarding breast cancer screening in a climate of conflicting guidelines.

Data Source

A descriptive, cross‐sectional survey design was used to examine approaches to cancer screening among NPs in western New York.

Conclusions

Among the 175 NP respondents, agreement with the accepted answer for the individual breast cancer—screening items ranged from 51% to 80%; responses did not vary by age group or gender. Overall, 54% demonstrated agreement with three or more of four breast cancer—screening items.

Implications for Practice

These findings suggest the need to implement educational interventions as one means of decreasing variation in breast cancer screening among NPs. Also, the development and endorsement of a single set of evidence‐based breast cancer—screening guidelines would promote adoption of a single screening recommendation.
The Acute, Nontraumatic Scrotum: Assessment, Diagnosis, and Management
Authors: Cole Frank L. , Vogler Robert
Published: May 2005

Purpose

This article reviews the acute, nontraumatic scrotal conditions of testicular torsion, torsion of an epididymal or testicular appendage, and epididymitis in order to assist the nurse practitioner (NP) with arriving at a diagnosis. Primary and emergency care management are presented.

Data Sources

Selected published literature in refereed journals and the authors’ clinical experiences.

Conclusions

Signs and symptoms of testicular pathologies can overlap, making diagnosis problematic. However, key features can raise the NP's index of suspicion for a particular diagnosis and can assist in selecting the most appropriate management strategy.

Implications for Practice

Although these conditions are rarely fatal, they may carry a risk of morbidity in the form of testicular necrosis, infarction, or atrophy with concomitant infertility. Any patient with scrotal or testicular pain should be presumed to have testicular torsion until proven otherwise, as this condition carries a high degree of morbidity. The information gained through a thorough history and physical examination can assist in arriving at the proper diagnosis.
Bone Mineral Density in Adolescent Women Using Depot Medroxyprogesterone Acetate
Authors: Busen Nancy H.
Published: May 2005

Purpose

To present current data on bone mineral density (BMD) in adolescent women using the long‐acting contraceptive depot medroxyprogesterone acetate (DMPA) and also to discuss the importance of developing maximal bone mass during adolescence to offset bone demineralization later in life.

Data Sources

Research‐based articles in the medical literature, review articles, and recommendations from the American Academy of Pediatrics and the National Osteoporosis Foundation.

Conclusions

Osteoporosis is a preventable disease that affects millions of Americans, particularly older women. Factors influencing the attainment and maintenance of peak bone mass during childhood and adolescence affect the future risk of fractures. Although longitudinal studies conducted on adolescent women using DMPA are very limited, findings suggest that adolescents are losing bone density during a time of expected bone accretion.

Implications for Practice

Clinicians must consider all the risks and benefits when prescribing contraceptives to adolescents. By themselves, the findings related to BMD and DMPA use by adolescents are not sufficient to limit the use of DMPA as a contraceptive method. However, clinicians must take into account the addition of other modifying factors associated with BMD that may contribute to overall bone loss in adolescent females. More prospective data on the long‐term use of DMPA by adolescents are needed to determine DMPA's effect on bone loss and to determine if bone loss is transient in adolescents.
Acupuncture and Acupressure for the Management of Chemotherapy‐Induced Nausea and Vomiting
Authors: Collins Kimberly B. , Thomas Debera J.
Published: May 2005

Purpose

To examine the formal and informal health care beliefs, behaviors, and practices of nurse practitioners (NPs).

Data Sources

A self‐administered questionnaire with primarily closed‐ended format was distributed over a 3‐day period to a convenience sample of 321 NPs attending a national NP conference.

Conclusions

The overall health status and health practices of NPs were found to be fairly good, but there was room for improvement, particularly with regard to nutrition, health responsibility, physical activity, and stress management.

Implications for Practice

Respondents were more likely to self‐diagnose and self‐treat minor illnesses and largely received their primary health care from physicians. The majority of NPs indicated a willingness to receive health care from an NP; however, the nonavailability of NPs restricted this option.
A Proposal for a Code of Ethics for Nurse Practitioners
Authors: Peterson Moya , Potter Robert Lyman
Published: May 2005

Purpose

To review established codes for health care professionals and standards of practice for the nurse practitioner (NP) and to utilize these codes and standards, general ethical themes, and a new ethical triangle to propose an ethical code for NPs.

Data Sources

Reviews of three generally accepted ethical themes (deontological, teleological, and areteological), the ethical triangle by Potter, the American Academy of Nurse Practitioners (AANP) standards of practice for NPs, and codes of ethics from the American Nurses Association (ANA) and the American Medical Association (AMA).

Conclusions

A proposal for a code of ethics for NPs is presented. This code was determined by basic ethical themes and established codes for nursing, formulated by the ANA, and for physicians, formulated by the AMA. The proposal was also developed in consideration of the AANP standards of practice for NPs.

Implications for Practice

The role of the NP is unique in its ethical demands. The authors believe that the expanded practice of NPs presents ethical concerns that are not addressed by the ANA code and yet are relevant to nursing and therefore different than the ethical concerns of physicians. This proposal attempts to broaden NPs’ perspective of the role that ethics should hold in their professional lives.
Health Promotion Attitudes and Practices of Texas Nurse Practitioners
Authors: Reeve Kathleen , Byrd Theresa , Quill Beth E.
Published: May 2005

Purpose

The Purpose of this descriptive cross‐sectional survey was to examine the health promotion attitudes and practices of Texas nurse practitioners (NPs).

Data Sources

Original research utilizing the Health Promotion Practices of Nurse Practitioners Instrument developed by the researcher and completed 442 Texas NPs.

Conclusions

Overall, Texas NPs have positive attitudes toward health promotion and are supportive of health promotion practices. However, the findings this study indicate that improvement can made in the adoption of certain health promotion practices.

Implications for Practice

The growing number of NPs providing care patients can significantly impact public health through consistent health promotion in clinical practice.
Prospective Analysis of Presenting Symptoms Among 265 Patients With Radiographie Evidence of Chiari Malformation Type I With or Without Syringomyelia
Authors: Mueller Diane M. , Oro’ John J.
Published: May 2005

Objective

To characterize the presenting symptoms among persons with radiographic evidence of Chiari malformation (CM) type I in an effort to help the primary care provider determine accurate diagnosis and treatment.

Methods

The symptoms of CM can often be vague and ambiguous, leading to misdiagnosis. Patients who had radiographic evidence of CM with or without syringomyelia were prospectively studied. The detailed symptom data were collected from patient reports at initial examination to determine if there was a pattern of symptoms typically attributable to the CM.

Results

Analysis of presenting symptoms among 265 patients demonstrated a distinct pattern of symptom constellation. This study reports a prospective analysis of presenting symptoms among 265 patients with radiographic evidence of CM with or without syringomyelia and defines a common presentation pattern. Recognition of typical symptoms attributable to CM can result in appropriate diagnostic workup, accurate diagnosis, and timely treatment, leading to improved patient outcomes.
Caught in the Middle: Experiences of Tobacco‐Dependent Nurse Practitioners
Authors: Heath Janie , Andrews Jeannette , Kelley Frances J. , Sorrell Jeanne
Published: May 2005

Purpose

To explore how tobacco‐dependent nurse practitioners (NPs) describe their experiences with health promotion and disease prevention practices with patients who smoke.

Data Sources

Twelve NPs who completed a graduate level NP program of study participated in face‐to‐face interviews and/or online chat room interviews.

Conclusions

Participants’ responses revealed three themes relevant to their experience as tobacco‐dependent clinicians with health promotion responsibilities. These themes centered around (a) living as an insider in the world of tobacco addiction, (b) having the outside‐in view of living with a tobacco addiction, and (c) being caught in the middle of a tobacco addiction.

Implications for Practice

All of the tobacco‐dependent participants described limited smoking‐cessation interventions with their patients. A barrier to implementation of more aggressive interventions, perhaps, is the provider's own tobacco addiction. With increasing evidence that tobacco‐dependent health care professionals are not adequately intervening with tobacco‐dependent patients, effective strategies are needed to assist and/or support not only tobaccodependent patients but providers as well.
Atopic Dermatitis: An Overview for the Nurse Practitioner
Authors: Mack Susan
Published: May 2005

Purpose

To provide the primary care provider (PCP) with a review of the clinical presentation, aggravating factors, and basic options for treatment of atopic dermatitis (AD).

Data Sources

Selected scientific literature and clinical experiences of the author.

Conclusions

AD is a common, chronic skin condition that is frequently seen in both children and adults. Although AD can be challenging to treat, a number of therapeutic options exist to help alleviate the pruritus and rash that accompany the disorder.

Implications for Practice

The PCP can manage AD in most patients by prescribing avoidance measures, good skin care, antihistamines, and conservative topical medications. Patients with more severe disease may require aggressive therapies such as phototherapy, balneo‐phototherapy, or systemic agents.
Evidence for Practice: Oral Contraception and Risk of Cervical Cancer
Authors: Bertram Cathy Cramer
Published: May 2005

Purpose

The issue of continued oral contraceptive use among women with abnormal Pap smears may be controversial due to reported evidence of an increased risk of cervical cancer among long term oral contraceptive users. This article reviews the evidence concerning oral contraception and cervical cancer risk. The role of Human Papilloma virus (HPV)and proposed mechanisms for the development of cervical cancer are explained.Evidence from World Health Organization (WHO) studies and additional research evidence are discussed.Implications for clinical practice are included.

Data Sources

WHO commissioned studies, additional relevant studies searchable from an EBSCO database, and texts that describe the natural history of HPV.

Conclusions

Epidemiological studies and biomedical research suggest a role for steroid hormones, such as oral contraceptives, in facilitating the action of HPV. However, a majority of HPV infections resolve spontaneously, despite widespread use of oral contraception. Oral contraception does not appear to increase incident HPV infection or persistence of HPV infection. The benefits of oral contraceptives appear to outweigh the risks associated with HPV facilitation.

Implications for Practice

NPs inform patients of abnormal Pap smears, manage the clinical care of women at risk of cervical cancer, and provide educational counseling regarding contraceptive choices. Ethical considerations include clear disclosure of potential risk. However, a risk‐benefit analysis supports continued use of oral contraception among women who have abnormal Pap smears but also have access to clinical surveillance.
Adolescent Obesity: Current Trends in Identification and Management
Authors: Hagarty M. Anette , Schmidt Cynthia , Bernaix Laura , Clement Jacquelyn M.
Published: May 2005

Purpose

To discuss the prevalence, identification, and clinical manifestations of adolescent obesity for the advanced practice nurse in primary care.

Data Sources

Selected research and clinical articles.

Conclusions

Adolescent obesity has been historically attributed to inappropriate diet and exercise; however, recent research also attributes adolescent obesity to genetic factors and metabolic dysfunction. If left untreated, adolescent obesity may result in the metabolic complications of dyslipidemia, hypertension, cardiovascular disease, and early onset of type 2 diabetes.

Implications for Practice

Practitioners should focus on using the new body mass index (BMI) national guidelines for early identification of obesity. Essential to the management of this condition are education, parental involvement, behavior modification, and psychological support.
Testicular Complaints and the Young Man
Authors: Mullen Barbara Ann
Published: May 2005

Purpose

To review the common causes, diagnostic procedures, treatment options, education, and follow‐up care for testicular complaints in the young man between the ages of 15 and 40 and to provide a case study that illustrates diagnostic concerns.

Data Sources

Current literature published in journals and textbooks.

Conclusions

A testicular mass has multiple possible etiologies. The mnemonic “TESTICLE” can help the practitioner to remember all the differential diagnoses. Treatment is based upon history and diagnostic findings.

Implications for Practice

An untreated testicular mass can lead to many adverse outcomes, including infertility and death. It is imperative that the nurse practitioner be up‐to‐date on differential diagnoses, evaluation, and treatment of a testicular complaint.
Transformation in Family Nurse Practitioner Students’ Attitudes Toward Homeless Individuals After Participation in a Homeless Outreach Clinic
Authors: Dela Cruz Felicitas A. , Brehm Constance , Harris Jeanne
Published: May 2005

Purpose

To use a retrospective pre/post self‐assessment survey to determine the attitudes of family nurse practitioner (FNP) students toward homeless individuals before and after partici‐pating in a homeless outreach clinic (HOC) and to elicit, through focus groups, their per‐spectives on the homeless population after their HOC participation.

Data Sources

A mixed‐methods study using focus group tapes and transcripts of 15 FNP students who were divided into two separate focus groups as well as three completed survey measures: Demographic Data Form, Attitudes Toward Homelessness Inventory, and HOC Attendance Form.

Conclusions

Overall, the FNP students revealed no stigma‐tizing attitudes toward homeless people prior to their HOC participation, but a significant positive change in their attitudes occurred after the experience. There were significant mean differences in 6 out of the 11 scale items and in the overall total mean scores after the HOC experience (p=. 013). The focus groups revealed the transformation of the students' attitudes toward homeless individuals after their HOC participation, supporting and illu‐minating the survey findings.

Implications for Practice

The study findings underscore the importance of including the care of homeless patients in FNP educational programs. Such exposure provides FNP students with an opportunity to develop the social responsibility to care for all segments of society, especially homeless people, in keeping with nursing's social contract as a helping profession.
Perception and Use of Herbals Among Students and Their Practitioners in a University Setting
Authors: Ambrose Evelyn T. , Samuels Sandra
Published: May 2005

Purpose

To determine the extent of herbal use among students at Rutgers, the State University of New Jersey, and to examine the campus health services practitioners' attitudes toward herbals.

Data Sources

An exploratory study of a nonrandom sampling of 1,754 students and 40 practitioners. The student t test and chi‐square comparisons were used to analyze the data.

Conclusions

Over half of the students surveyed were using herbals, primarily for relief of physical symptoms, prevention of illness, and improvement of general well‐being. Many students lacked accurate or sufficient information about herbals and were not seeking medical guidance. Although the practitioners asked students about herbal use and sometimes even encouraged it, 75% noted the need for additional professional education about herbals.

Implications for Practice

Practitioners in the college health setting need to be cognizant of students' self‐medication with herbals and need to have the knowledge to guide students appropriately.
Stress Urinary Incontinence in Women
Authors: Gray Mikel
Published: May 2005

Purpose

To review and synthesize existing knowledge about the epidemiology, pathophysiology, evaluation, and management of stress urinary incontinence in women.

Data Source

Selected scientific literature.

Conclusions

Stress urinary incontinence is more than merely a symptom. Instead, it is a clinically relevant disease with adverse psychosocial and physical consequences. Evaluation begins with active screening and is followed by individualized assessment when urinary leakage is detected.

Implications for Practice

Traditional treatment modalities, including pelvic muscle rehabilitation, focus on behavioral strategies to reduce urine loss, and surgical correction of anatomic defects is completed in selected cases. Pharmacotherapeutic options have been limited, but one compound is undergoing clinical trials to determine whether it is a safe and effective alternative for the treatment of stress urinary incontinence.
Preventing head and neck injury: Table 1
Authors: McIntosh A S , McCrory P
Published: May 2005

A wide range of head and neck injury risks are present in sport, including catastrophic injury. The literature since 1980 on prevention of head and neck injury in sport was reviewed, focusing on catastrophic and brain injury and identifying the range of injury prevention methods in use. There have been few formal evaluations of injury prevention methods. Approaches that are considered, or have been proven, to be successful in preventing injury include: modification of the baseball; implementation of helmet standards in ice hockey and American football and increased wearing rates; use of full faceguards in ice hockey; changes in rules associated with body contact; implementation of rules to reduce the impact forces in rugby scrums. Helmets and other devices have been shown to reduce the risk of severe head and facial injury, but current designs appear to make little difference to rates of concussion. Research methods involving epidemiological, medical, and human factors are required in combination with biomechanical and technological approaches to reduce further injury risks in sport.
Research approaches to describe the mechanisms of injuries in sport: limitations and possibilities
Authors: Krosshaug T , Andersen T E , Olsen O-E O , Myklebust G , Bahr R
Published: May 2005

A number of different methodological approaches have been used to describe the inciting event for sports injuries. These include interviews of injured athletes, analysis of video recordings of actual injuries, clinical studies (clinical findings of joint damage are studied to understand the injury mechanism, mainly through plain radiography, magnetic resonance imaging, arthroscopy, and computed tomography scans), in vivo studies (ligament strain or forces are measured to understand ligament loading patterns), cadaver studies, mathematical modelling and simulation of injury situations, and measurement/estimation from “close to injury” situations. In rare cases, injuries have even occurred during biomechanical experiments. This review describes each research approach and assesses its strengths and weaknesses in contributing to the understanding and prevention of sports injuries.
Evaluation of a two dimensional analysis method as a screening and evaluation tool for anterior cruciate ligament injury
Authors: McLean S G , Walker K , Ford K R , Myer G D , Hewett T E , van den Bogert A J
Published: May 2005

Background:Increased knee valgus predicts the risk of anterior cruciate ligament (ACL) injury, particularly in women. Reducing injury rates thus relies on detecting and continually evaluating people with relatively large valgus motions.

Objectives:To examine the potential of a two dimensional (2D) video analysis method for screening for excessive valgus.

Methods:Ten female and 10 male National Collegiate Athletic Association basketball players had three dimensional (3D) knee valgus and two dimensional (2D) frontal plane knee angle quantified during side step, side jump, and shuttle run tasks. 3D valgus was quantified from external marker coordinates using standard techniques, and 2D data were obtained from both the frontal plane projections of these coordinates (2D-Mot) and manual digitisation of digital video footage (2D-Cam). A root mean square (RMS) error was calculated between 2D-Mot and 2D-Cam data to evaluate the reliability of the latter. Correlations between 2D-Cam and 3D data (intersubject and intrasubject) were also conducted, and regression slope andr2values obtained.

Results:2D-Cam and 2D-Mot data were consistent for side step (RMS  =  1.7°) and side jump (RMS  =  1.5°) movements. Between subjects, 2D-Cam and 3D data correlated well for the side step (r2 =  0.58) and side jump (r2 =  0.64). Within subjects, 2D-Cam and 3D data correlated moderately for the side step (r2 =  0.25 (0.19)) and side jump (r2 =  0.36 (0.27)).

Conclusions:The 2D-Cam method can be used to screen for excessive valgus in elite basketball players, particularly for movements occurring primarily in the frontal plane. This method may also be a useful training evaluation tool when large reductions in dynamic valgus motions are required.
Environmental inequality and circulatory disease mortality gradients
Authors: Finkelstein Murray M , Jerrett Michael , Sears Malcolm R
Published: May 2005

Study objective:Studies in Europe and North America have reported that living in a disadvantaged neighbourhood is associated with an increased incidence of coronary heart disease. The aim of this study was to test the hypotheses that exposure to traffic and air pollution might account for some of the socioeconomic differences in mortality rates in a city where residents are covered by universal health insurance.

Design:Cohort mortality study. Individual postal codes used to derive: (1) socioeconomic status from census data; (2) mean air pollution levels from interpolation between governmental monitoring stations; (3) proximity to traffic from the geographical information system. Analysis conducted with Cox proportional hazards models.

Setting:Hamilton Census Metropolitan Area, Ontario, Canada, on the western tip of Lake Ontario (population about 480 000).

Participants:5228 people, aged 40 years or more, identified from register of lung function laboratory at an academic respirology clinic between 1985 and 1999.

Main results:Circulatory disease (cardiovascular and stroke) mortality rates were related to measures of neighbourhood deprivation. Circulatory disease mortality rates were also associated with indices of long term ambient pollution at the subjects’ residences (relative risk 1.06, 1.00 to 1.13) and with proximity to traffic (relative risk 1.40, 1.08 to 1.81). Subjects in more deprived neighbourhoods had greater exposure to ambient particulate and gaseous pollutants and to traffic.

Conclusions:At least some of the observed social gradients in circulatory mortality arise from inequalities in environmental exposure to background and traffic air pollutants.
Social dynamics of health inequalities: a growth curve analysis of aging and self assessed health in the British household panel survey 1991–2001
Authors: Sacker Amanda , Clarke Paul , Wiggins Richard D , Bartley Mel
Published: May 2005

Objectives:To study how social inequalities change as people age, this paper presents a growth curve model of self assessed health, which accommodates changes in occupational class and individual health with age.

Design:Nationally representative interview based longitudinal survey of adults in Great Britain.

Setting:Representative members of private households of Great Britain in 1991.

Participants:Survey respondents (n = 6705), aged 21–59 years in 1991 and followed up annually until 2001.

Main outcome measure:Self assessed health.

Results:On average, self assessed health declines slowly from early adulthood to retirement age. No significant class differences in health were observed at age 21. Health inequalities emerged later in life with the gap between mean levels of self assessed health of those in managerial and professional occupations and routine occupations widening approaching retirement. Individual variability in health trajectories increased between ages 40 and 59 years so that this widening of mean differences between occupational classes was not significant. When the analysis is confined to people whose occupational class remained constant over time, a far greater difference in health trajectories between occupational classes was seen.

Conclusions:The understanding of social inequalities in health at the population level is enriched by an analysis of individual variation in age related declines by social position.
Structural behavior of alternative low floor height system using structural "tee," half precast concrete, and horizontal stud
Authors: Ju Young K , Kim Sang-Dae
Published: May 2005

Conventional composite construction consisting of steel beams and concrete slabs has been widely used throughout the world. When compared with a concrete flat-slab structure, however, the reduced beam height is a significant problem and is particularly important in a city where land prices are higher because a height reduction of 15 cm per storey can lead to a 750 cm reduction in the total height for a 50 storey building (equivalent to two storeys). In this paper a newly developed composite beam, the technical, economical, and convenient (TEC) beam, is proposed and experimentally investigated using a series of monotonic loading tests. The results show that the capacity of the proposed system is in agreement with design code predictions, and the system demonstrates a reliable composite behavior between steel beam and concrete slab.Key words: composite beam, steel structure, monotonic loading, flexural capacity.
Regional seismic risk in British Columbia — damage and loss distribution in Victoria and Vancouver
Authors: Onur Tuna , Ventura Carlos E , Finn W.D Liam
Published: May 2005

This paper presents the results of regional seismic risk assessment studies that were carried out for two cities in southwestern British Columbia, Vancouver and Victoria. Ground shaking intensity in the area was obtained using the seismic source zones delineated by the Geological Survey of Canada for a probability level of 10% chance of exceedance in 50 years. Building inventories were compiled by aggregating data from sidewalk surveys as well as municipal databases. Modified Mercalli intensity-based damage matrices that relate the level of ground shaking to the amount of damage expected in different types of structures were used to estimate damage to structural and non-structural components of buildings. Estimated damage and loss distributions were mapped on a block-by-block basis. The historic sections of the cities were estimated to have damage levels between 10% and 30% of the replacement cost, while in the rest of the cities the estimated damage was generally in the 5% to 10% range. The results show the estimated economic loss distribution is considerably different from the damage distribution. Although the older neighbourhoods of the cities are expected to suffer highest amount of damage, the highest amount of economic loss is estimated to occur in areas with concentration of concrete high-rise buildings.Key words: seismic hazard, seismic risk, vulnerability, earthquake, damage, loss, probability, modified Mercalli intensity.
Regional seismic risk in British Columbia — classification of buildings and development of damage probability functions
Authors: Ventura Carlos E , Finn W.D Liam , Onur Tuna , Blanquera Ardel , Rezai Mahmoud
Published: May 2005

Regional seismic risk estimations are needed in southwestern British Columbia, since it is one of the most seismically active and highly populated regions in Canada. Regional estimations typically involve a large number of buildings, which makes it necessary to establish a building classification system, where the average response to earthquake shaking is assumed to be similar within each building class. In this study, buildings in British Columbia were divided into 31 classes based on their material, lateral load bearing system, height, use, and age. A damage probability matrix (DPM) was then developed for each building class which describes the probability of being in a certain damage level (i.e., light, moderate, heavy, etc.) given the ground shaking intensity. Next, a probability distribution function was fit to the discrete probability values at each intensity level. The products of this study, the building classification system, the DPMs, and the probability distribution functions will allow regional damage and loss estimations in the area.Key words: seismic risk, vulnerability, building classification, structural system, building response, damage, probability.
Comparative evaluation of mass transfer of oxygen in three activated sludge processes operating under uniform conditions
Authors: Mahendraker Venkatram , Mavinic Donald S , Hall Kenneth J
Published: May 2005

This investigation was conducted in three laboratory-scale activated sludge processes, namely, the conventional completely mixed activated sludge process (CMAS), the modified Ludzack-Ettinger process (MLE), and the University of Cape Town (UCT) process. These systems were operated under controlled conditions by feeding a uniform influent at a single 10-d solids retention time (SRT). The oxygen transfer parameters (KLaf, α, OTRf, and OTEf) determined indicated that the alpha (α) and oxygen transfer efficiency (OTEf) in processes where the enhanced biological phosphorus removal (EBPR) mechanism was active were higher than in the conventional completely mixed activated sludge (CMAS) process, where such a mechanism was absent. Thus, presenting a clear evidence of improved oxygen utilization in activated sludge processes containing unaerated, anoxic, and anaerobic selector zones. Key words: biological nutrient removal, completely mixed activated sludge process, oxygen uptake rate, oxygen transfer efficiency.
Examination of discrete and counfounding effects of water quality parameters during the inactivation of MS2 phages and Bacillus subtilis spores with chlorine dioxide
Authors: Barbeau Benoit , Huffman Debra , Mysore Chandra , Desjardins Raymond , Clément Bernard , Prévost Michèle
Published: May 2005

The role of water quality (pH, temperature, turbidity, and natural organic matter (NOM)) on the efficacy of chlorine dioxide to inactivate Bacillus subtilis spores and MS2 phages was investigated in synthetic waters. Modelling the curves describing tailing inactivation with a parallel Chick-Watson model proved to be a valid approach. The formation of aggregates was exacerbated when using chlorine dioxide as opposed to free chlorine. The origin of these aggregates lies in the interactions of chlorine dioxide with the water matrix and the microorganisms. Higher temperature and higher turbidity were dominant factors in predicting spores tailing, while decreasing the pH from 8.5 to 6.5 was responsible for increasing the fraction of MS2 aggregates from 0.06% to 9.0% (138-fold). The resistance of aggregates were, on average, 18–21 times higher than for single organisms. The addition of dissolved organic carbon significantly (p < 0.01) improved inactivation with chlorine dioxide. Turbidity (5 NTU) did not significantly hinder MS2 inactivation, but it increased the concentration–time (Ct) 1-log of B. subtilis spores from 386 to 600 mg·min·L–1. Key words: drinking water, disinfection, spores, MS2 coliphages, chlorine dioxide, water quality, turbidity, natural organic matter.
Environmental, geotechnical, and hydraulic behaviour of a cellulose-rich by-product used as alternative cover material
Authors: Panarotto Cláudia Teixeira , Cabral Alexandre Rodrigues , Lefebvre Guy
Published: May 2005

Deinking by-product (DBP), a cellulose-rich by-product produced in the early stages of the paper recycling process, has been used as alternative material for the construction of cover systems for municipal waste disposal facilities and acid-producing mine residues. Because of the high organic content of this material, covers constructed with it are susceptible to biodegradation and, thus, to changes in their properties with time. With the goal of identifying the biodegradation parameters that could influence the long-term behaviour of DBP covers, an experimental laboratory program was developed and a series of 15 samples of DBP were monitored in biodegradation tests for 400 d. Periods of intermittent water percolation allowed for collection of leachate. The evolution of gas and leachate production was monitored in terms of quality and quantity. According to the results obtained, the hydraulic and geomechanical properties of importance for a cover do not seem to be adversely affected by the level of biodegradation of the DBP or by mass loss. Key words: cover systems, deinking by-products, biodegradation, mass loss by gas production, mass loss by leaching.
Parameters affecting the thickness of bentonite cake in cutoff wall construction: case study and physical modeling
Authors: Soroush Abbas , Soroush Mohammad
Published: May 2005

Concrete cutoff walls are usually constructed using a panel-by-panel technique in which primary panels are constructed with space between them and then secondary panels are constructed and inserted in the spaces. A small thickness of residual bentonite cake from the slurry used during excavation usually remains in the construction joints between adjacent primary and secondary panels. The thickness of such bentonite-filled joints should be minimized in terms of the performance of the cutoff wall in controlling seepage. This research experimentally evaluated the effects of a number of design and construction parameters on the thickness of the bentonite cake using data from a case study (the cutoff wall of Karkheh Dam). A physical model test was developed and a number of tests were conducted. The test results showed that parameters such as age of the primary panels, cement content of the slurry, quantity of additives in the slurry, and circulation versus noncirculation of the slurry are responsible for the thickness of the bentonite cake. The results are presented and analyzed.Key words: cutoff wall, plastic concrete, bentonite slurry, bentonite cake, physical model.