bluuebunny/crossref_metadata_2025 huggingface dataset:
Fall Prevention Practices in Adult Medical-Surgical Nursing Units Described by Nurse Managers
Authors: Shever Leah L. , Titler Marita G. , Mackin Melissa Lehan , Kueny Angela
Published: October 2010

The purpose of this article was to describe nursing practices (e.g., assessment, interventions) around fall prevention, as perceived by nurse managers in adult, medical-surgical nursing units. One hundred forty nurse managers from 51 hospitals from across the United States participated. Descriptive frequencies are used to describe nurse manager responses. The most commonly used fall risk assessment tool was the Morse Fall Risk Assessment Tool (40%). The most common fall prevention interventions included bed alarms (90%), rounds (70%), sitters (68%), and relocating the patient closer to the nurses’ station (56%). Twenty-nine percent of nurse managers identified physical restraints as an intervention to prevent falls whereas only 10% mentioned ambulation. No nurse manager identified that RN hours per patient-day were adjusted to prevent falls or fall-related injuries. More work is needed to build systems that ensure evidence-based nursing interventions are consistently applied in acute care.
Evidence-Based Practice Day: An Innovative Educational Opportunity
Authors: Bromirski Bridget H. , Cody Jean Lemieux , Coppin Karen , Hewson Karen , Richardson Barbara
Published: October 2010

To maximize patient outcomes, the latest research and practice updates must be disseminated across the patient care continuum to include all members of the nursing team. The Clinical Research Council (CRC) recognized the need to bridge the gap between nursing research and practice, using evidence to decrease variation in practice. To meet this challenge, a Magnet-designated, rural community hospital developed an innovative educational program. This article describes Evidence-Based Practice (EBP) day, an interactive learning environment that engages nursing staff and strengthens their understanding of the science that guides practice. Topics for inclusion were selected based on staff requests, current research, quality improvement data, and institutional priorities. Evidence was provided in a format that supported rapid implementation into practice. Key components of the program included a clinical scenario, internal and external data, nursing interventions, patient outcomes (nursing-sensitive and organizational), and regulatory requirement updates.
Risk Behaviors Among Adolescent Girls in an HIV Prevention Trial
Authors: Morrison-Beedy Dianne , Carey Michael P. , Crean Hugh F. , Jones Sheryl H.
Published: October 2010

Adolescent girls remain vulnerable to HIV and other sexually transmitted infections. Understanding their sexual and substance use behaviors is essential to designing effective interventions to reduce their risk. In this study, baseline data were analyzed from 738 adolescent girls ages 15 to 19 years in Rochester, New York. Data on sexual behavior and substance use (lifetime, past 3 months, and most recent sexual experience) were collected. Nearly one half of recent vaginal (42%) and anal (45%) sex acts were not condom protected; 39% had a prior sexually transmitted infection (STI) and 12% were currently infected with an STI. Approximately one third (31%) of girls had more than one sex partner in the past 3 months. Girls with multiple partners reported that their recent sexual experiences were more likely to involve drug and alcohol use by themselves and partners. Adolescent girls, particularly those with multiple sexual partners, continue to report high-risk sexual behaviors and need focused risk-reduction interventions.
Implementing and Sustaining Evidence-Based Nursing Practice to Reduce Pediatric Cardiopulmonary Arrest
Authors: Randhawa Simmy , Roberts-Turner Renee' , Woronick Karen , DuVal Jennifer
Published: October 2010

Rapid response teams (RRTs) improve outcomes for patients through early escalation of care. However, subtle signs of clinical deterioration in children may not be consistently recognized by the bedside acute care nurse and therefore the RRT may not be activated. The Pediatric Early Warning Score (PEWS), an evidence-based tool, provides nurses with a mechanism for early detection using quantitative data. We describe our process and outcomes of implementing and sustaining the use of PEWS at the unit and organizational level using the Plan—Do—Check—Act methodology for performance improvement. Our outcome data indicate that cardiopulmonary arrests were reduced by 31% at the pilot unit level and subsequently 23.4% at the organizational level. Data also suggest that bedside nurses effectively escalated patient care needs without activating RRTs (19.4% reduction in RRT activations after PEWS implementation). Strategies to sustain the positive outcomes of PEWS at the unit and organizational levels are also described.
Open aortic arch surgery: how to reduce air embolism risk during antegrade cerebral perfusion
Authors: Lentini Salvatore , Gaeta Roberto
Published: October 2010

Antegrade cerebral perfusion (ACP) is used widely, with the aim of obtaining cerebral protection during open aortic arch surgery. ACP is considered by many to be the reason for improvements in the clinical outcome of this type of surgery. However, perioperative cerebral complications may still occur. Cerebral complications during ACP are considered to be due mainly to embolic events rather than hypoperfusion. We believe that many of the embolic events during ACP may be due to air embolism rather than to vessel manipulation only. To reduce the risk of air embolism during ACP, we propose an easy technique, with the suggested steps to be followed in an exact sequence.
The effect of oxygenator mechanical characteristics on energy transfer during clinical cardiopulmonary bypass
Authors: Ganushchak YM , Reesink KD , Weerwind PW , Maessen JG
Published: October 2010

The hollow-fibre oxygenator is a key component of any extracorporeal circuit used to provide cardiopulmonary bypass (CPB) during open-heart surgery. Since the oxygenator is placed downstream of the pump, the energy losses over it have a direct impact on the quality of pulsatile pressure and flow waveforms. The objective of this study was to describe the effects of hydrodynamic characteristics of the oxygenator on energy transfer during pulsatile, normothermic CPB. Twenty-three adult patients scheduled for coronary bypass surgery were divided randomly into two groups, using either an oxygenator (Group 1) with a relatively high-resistance and low-compliance (2079 ± 148 dyn.s.cm-5 and 0.00348 ± 0.00071 ml.mmHg-1, respectively) or an oxygenator (Group 2) with a relatively low-resistance and high-compliance (884 ± 464 dyn.s.cm-5 and 0.01325 ± 0.00161 ml .mmHg-1, respectively). During perfusion, pre- and post-oxygenator pressures, radial artery pressure, and blood flow were recorded simultaneously.

A 32% decline of mean pressure was observed in Group 1 and a 16% decline in Group 2 (p<0.0001). Another decrease by approximately 73% in mean pressure in the rest of the perfusion system was noted in both groups. The mean radial artery pressure did not differ between the groups (74 ± 6 mmHg in Group 1 and 73 ± 6 mmHg in Group 2, p=0.608). Although lower total energy transfer indices were noticed through the low-resistance oxygenator (Group 2), both oxygenators showed a decrease of the generated pump oscillatory energy of approximately 50%. Despite the differences in resistance and compliance of the hollow-fibre oxygenators used, both oxygenators cause a comparable loss of generated oscillatory energy. Exclusion of the oxygenator downstream of the pulsatile pump would improve energy transfer during CPB.
Can a 12-Step Program Work in Methadone Maintenance Treatment?
Authors: Ronel Natti , Gueta Keren , Abramsohn Yali , Caspi Nir , Adelson Miriam
Published: October 2010

Three consecutive, professionally led (as opposed to self-help) groups following the 12-step program (TSP) were integrated into a methadone maintenance treatment (MMT) program that included 32 heroin-addicted individuals in recovery. This report describes our experience in meeting the challenges that arose and our conclusions regarding the therapeutic potential of this integration. A professional therapeutic staff guided the groups. In-depth interviews of 10 participants and the reflections of the group leaders provided data for learning about the groups’ experience. Initially the participants rejected the concepts of Step 1, powerlessness and unmanageability of life. The assimilation of Step 4 (defining character defect) also aroused some resistance. The participants eventually adopted the pragmatic aspects of TSP, including its terminology. The establishment of a common language of recovery helped to create group coherence and a sense of belonging, and helped to meet the needs of those who felt stigmatized by both the nonaddicted and addicted population undergoing nonmethadone recovery. TSP could be adapted to various aspects of daily life, produced a sense of self-efficacy, and stimulated motivation for change. Therapeutic implications are discussed.
An investigation on the dynamic behavior and thermal properties of MWCNTs/FRP laminate composites
Authors: Mao Sheng Chang
Published: October 2010

The synergetic effect of multi-walled carbon nanotubes (MWCNTs), carbon fiber (CF), and glass fiber (GF) on the static and dynamic mechanical and thermal properties of MWCNTs/epoxy (EP), carbon fiber reinforced polymer (CFRP), and glass fiber reinforced polymer (GFRP)/EP composites were studied. Impact, tensile, and flexural strengths and fatigue cycles of MWCNTs/EP, MWCNTs/CFRP/EP, MWCNTs/GFRP/EP were increased with an increase of MWCNTs content in the epoxy resins. The impact strength of MWCNTs/EP composite is increased dramatically from 4.8 J/M (neat resin) to 12.2 J/M (increased 154.1%) by adding 2.0 phr MWCNTs in the composites. The tensile strength of MWCNTs/CFRP/EP was enhanced from 580.1 MPa (CFRP/EP) to 781.4 MPa (increased 34.7%) by adding 0.5 phr MWCNTs. In addition, the flexural strength of MWCNTs/GFRP/EP was increased from 244.1 MPa (GFRP/EP) to 298.1 MPa (increased 22.16%) by adding 0.75 phr MWCNTs. The fatigue cycles of MWCNTs/GFRP/EP were increased from 959 cycles (GFRP/EP) to 3232 cycles (increased 237%) by adding 2.0 phr MWCNTs. The coefficient of thermal expansion (CTE) of MWCNTs/CFRP/EP was decreased significantly by adding 2.0 phr MWCNTs. The CTE of GFRP/EP had a value of 65.5 ppm/°C by adding 2.0 phr MWCNTs and was lower than that of CFRP/EP.
Landfill sustainability and aftercare completion criteria
Authors: Scharff Heijo , van Zomeren André , van der Sloot Hans A
Published: October 2010

Although many countries are increasing their efforts to recycle and to re-use waste materials, landfilling will still be needed in order to dispose of wastes which cannot be recycled or treated in other ways. Since landfills will most probably be present for a long time, measures will have to be taken to reduce their (long-term) emissions. The European Commission has delegated the competent authorities to decide to end aftercare and several member states have provided regulations for this purpose. However, there is currently no guidance for long-term risk assessment to support an aftercare completion procedure for landfills. The aim of this study is to provide examples of current regulations and to demonstrate an alternative approach for a quantitative risk assessment of landfill leachate. The presented modelling approach clearly demonstrates the added value of site specific risk assessments of the long-term emissions from landfills and might provide a basis for application when the acceptance criteria for landfill will be revisited in the future. In addition, the modelling approach can be used as one of the toolboxes to perform assessments of the long-term emissions from landfill leachates and might help the competent authorities to decide whether the remaining emission potential is acceptable or not. Moreover, the results imply that local environmental conditions contribute to the acceptability of landfill emissions and are important factors in choosing a landfill location.
Idiopathic Intracranial Hypertension and Facial Palsy: Case Report and Review of the Literature
Authors: Tzoufi Meropi , Makis Alexandros , Grammeniatis Vasilios , Nakou Iliada , Exarchakos Georgios , Asproudis Ioannis , Zikou Anastasia , Argyropoulou Maria , Siamopoulou-Mavridou Antigone
Published: October 2010

We present the case of an 11-year-old obese girl who presented with idiopathic intracranial hypertension affecting first the lateral abducens nerve. She received acetazolamide, but 5 days later she developed lateral, peripheral facial palsy. Imaging evaluation was normal, which primarily excluded cerebral venous thrombosis and sustained the initial diagnosis. Despite some complicating factors (obesity, elevated intracranial pressure), prednisolone was administered for a short-term period to counteract the facial palsy. Ophthalmological residuals resolved within almost 1.5 months, while facial palsy receded after 4 months. Peripheral facial palsy is an extremely rare, but not unknown condition in idiopathic intracranial hypertension. As a symptom, it should be investigated thoroughly, primarily to exclude cerebral venous sinus thrombosis, before it can be attributed to idiopathic intracranial hypertension. As far as treatment is concerned, corticosteroids can be added to the initial treatment with acetazolamide, without worsening already elevated intracranial hypertension or ophthalmologic findings.
Inattention, Hyperactivity, Impulsivity—Epidemiology and Correlations: A Nationwide Greek Study From Birth to 18 Years
Authors: Palili Alexandra , Kolaitis Gerasimos , Vassi Ippolyti , Veltsista Alexandra , Bakoula Chryssa , Gika Artemis
Published: October 2010

We examined the prevalence of inattention, hyperactivity, and impulsivity (attention-deficit hyperactivity disorder [ADHD]-like symptoms) at 7 and 18 years in a Greek birth cohort, and associated factors. Information was derived from a representative sample of 2695 Greek individuals followed-up from birth to18 years through 3 questionnaire surveys (1983, 1990, 2001). At 7 years, the prevalence of hyperactivity was 7%, inattention 9.5%, and impulsivity 7% for all children, while a significant decrease was observed at 18 years. Adverse perinatal factors, poor academic performance, fights or quarrels with peers, comorbidity, and a higher frequency of physical punishment and accidents during childhood were found to be associated with ADHD-like symptoms at 7 years. Factors identified to be related with these symptoms at 18 years included male gender, maternal stress, smoking during pregnancy, physical punishment, and psychological problems in childhood. These longitudinal findings provide significant information for health and educational planning in Greece and other countries.
Congenital Hypotonia in a Child With a De Novo 22q13 Monosomy and 2pter Duplication: A Clinical and Molecular Genetic Study
Authors: Trabacca Antonio , Losito Luciana , De Rinaldis Marta , Gennaro Leonarda
Published: October 2010

The authors describe a 5-year-old girl with a neurological phenotype of 22q13 deletion syndrome (neonatal and persisting hypotonia, developmental delay, absence of language, decreased perception of pain) and minor dysmorphisms. Subtelomeric fluorescent in situ hybridization tests revealed de novo 22q13 monosomy and 2pter duplication. Numerous genetic and neurologic disorders of childhood are characterized by congenital hypotonia. This muscle tone disorder is often one of the symptoms that a neurologist is asked to evaluate. Recent advances in genetic testing can help provide a specific diagnosis for children with this symptom. Subtelomeric deletions are a category of disorders of which hypotonia can be a prominent feature. Deletions of chromosome 22q13 are some of the most commonly observed terminal deletions in humans, whereas duplications of chromosome 2p25.2 are very rare, and little is known about the phenotypic effect of these duplications. To the best of the authors’ knowledge, this association has never been described before.
Longitudinal Hand Function in Rett Syndrome
Authors: Downs Jennepher , Bebbington Ami , Kaufmann Walter E. , Leonard Helen
Published: October 2010

Loss of hand function is a core feature of Rett syndrome. This article describes longitudinal hand function at 3 time points for 72 subjects participating in the Australian Rett Syndrome Database. Approximately 40% of subjects with some grasping abilities lost skill over the 3- to 4-year period between video assessments. In these subjects, a decrease in hand function was seen less frequently in girls 13 to 19 years old than in those younger than 8 years, in subjects with some mobility compared with those who were wheelchair bound, and in those who had previously been able to finger feed. Relationships with the magnitude of change reflected these findings. Change in hand function did not vary with clinical severity. The results for all subjects were similar to results obtained when analysis was restricted to those with a pathogenic mutation. Variability in the longitudinal course of hand function in Rett syndrome was observed.
Burgeoning Democracy or Threatening Security? The Ambiguous Voice of the American Press on Taiwan’s Independence
Authors: Tang Zhilin
Published: October 2010

This study is a framing analysis of the coverage of the issue of Taiwan independence by the leading US newspaper – the New York Times. The identified major themes and meaning system illustrate how a politically sensitive issue on foreign soil is culturally translated into the mainstream American press: American elite press coverage of Taiwan’s independence is packaged with the significant cultural symbols of democracy and freedom, marked by the threat from communism as well as surrounded by the rhetoric of social order and peace. The engendered ambiguity is argued to transcend partisan rifts, renew the dominant values and maintain the credibility of American politics.
Exploring the Factors That Influence Functional Performance Among Nursing Home Residents
Authors: Sabol Valerie K. , Resnick Barbara , Galik Elizabeth , Gruber-Baldini Ann L. , Morton Patricia Gonce , Hicks Gregory E.
Published: October 2010

Objective: To promote healthy aging in older nursing home (NH) residents, it is important to identify factors that impact functional performance. Using the Disablement Process Model, it was hypothesized that variables from all levels of the model would significantly impact the ability of a NH resident to get up from a chair. Method: A stepwise multiple logistic regression model was used to test the impact of sociodemographic, physiologic, physical, psychosocial, and environmental factors on chair rise. Results: Analysis indicated that three factors, strength, gait, and self-efficacy, were significantly associated with chair-rise ability and together explained approximately 64% of the variance and successfully classified 88.4% of the chair-rise cases. Discussion: These findings indicate that identifying physical and psychosocial variables early in the disablement process will help health care providers tailor medical and restorative care interventions that may help older adults maintain the ability to chair rise.
Nanotechnology risk assessment from a waste management perspective: Are the current tools adequate?
Authors: Musee Ndeke
Published: October 2010

The burgeoning nanotechnology industry is rapidly generating new forms of waste streams generically referred herein as nanowastes. However, little is known about the fate and behavior of these waste streams and their impacts thereof in different ecological systems despite their increasingly widespread dispersion into the environment through production, distribution, handling, and nanomaterials (NMs) incorporation into bulk products processes. In this paper, risk assessment of nanotechnology from a waste management perspective was examined to elucidate potential new forms of challenges nanowastes may likely pose to the current legislative and waste management systems. This was through the identification of several knowledge gaps that merit urgent attention in order to increase our collective understanding of managing nanowastes safely, responsibly, and sustainably. The paper presents the identified gaps and consequently proposes a qualitative risk assessment of nanowastes to address some of the current challenges. The applicability of the proposed model is illustrated through several examples. In addition, the first nanowastes classification protocol presented in this article show that a given nanomaterial may result in generating nanowaste streams of different forms with variant hazard levels ranging from benign to extremely being hazardous waste streams — a dramatic phenomenon from the conventional waste streams due to macroscale chemicals. The study shows that it is in the early days to draw broad generic classification of different nanowastes, and each stream may require their risk profile be assessed on a case-by-case basis. We conclude by presenting several recommendations on what needs to be done in dealing with nanowastes as means of avoiding unintended long-term consequences of nanotechnology.
The efficacy of high doses of vitamin C in patients with paraquat poisoning
Authors: Jeong Mi Moon  , Byeong Jo Chun
Published: October 2010

Paraquat (PQ) poisoning is an extremely difficult condition to manage clinically because of the lack of effective treatments. The purpose of this study was to assess the effect of high doses of vitamin C in combination with anti-inflammatory and immunosuppressant therapy in patients with PQ poisoning. The medical records of 134 patients who presented to the emergency department within 24 hours after PQ poisoning were reviewed retrospectively. The 57 patients presented between January 2004 and September 2005 were group 1; they received pulse therapy, which included cyclophosphamide and methylprednisolone, followed by the administration of dexamethasone over 2 weeks. The 77 patients that presented between October 2005 and January 2008 were group 2; they received the above-mentioned therapy and high-dose vitamin C for 2 weeks. There was no difference in the distribution of baseline variables between the 2 groups. However, group 2 showed a significant reduction in acute kidney injury related to PQ. Furthermore, a multivariate logistic regression analysis showed that the addition of vitamin C to the treatment was significantly associated with an increased survival of the patients. Larger trials will be needed to verify the effect of high-dose vitamin C on survival in patients with PQ poisoning.
Preservation of newspapers: Theoretical approaches and practical achievements
Authors: Hasenay Damir , Krtalić Maja
Published: October 2010

The preservation of newspapers is the main topic of this paper. A theoretical overview of newspaper preservation is given, with an emphasis on the importance of a systematic and comprehensive approach. Efficient newspaper preservation implies understanding the meaning of preservation in general, as well as understanding specific approaches, methods and techniques that are included in newspaper preservation concepts. A project-oriented organization of newspaper preservation is explained by showing some examples of good practice in the field. The paper also aims to show approaches to preservation of Croatian newspapers, to outline major developments and to put Croatian initiatives into the general context of managing newspaper preservation.
Diffuse edema and bilateral massive pleural effusion as the presentation of systemic lupus erythematosus
Authors: Aslan M , Bicak U , Dogan DG , Dogan M , Yakinci C
Published: October 2010

A rare case of systemic lupus erythematosus (SLE), with massive bilateral pleural effusions and generalized edema as the first manifestations, is reported. The patient was a previously healthy 13-year-old boy. He presented with a history of fever, lack of appetite, gradually increasing fatigue, cough, diffuse edema, and moderate dyspnea. He responded well to corticosteroids with resolution of the pleural effusions, and edema. SLE should always be kept in mind in cases of massive pleural effusions and/or diffuse edema, even in the absence of other clinical manifestations of the disease.
Recognizing the Centrality of Emotion in Diversity Courses: Commentary on “Gender in the Management Education Classroom”
Authors: Spelman Duncan
Published: October 2010

This commentary adds to the analysis and recommendations presented in “Gender in the Management Education Classroom” concerning a very challenging incident focused on powerful gender/diversity dynamics. It discusses the centrality of emotion in students’ experiences of diversity discussions and calls for teachers to explicitly help students develop the capacity to interact in emotional situations about challenging intercultural issues with people from other identity groups. Developing such a capacity includes both intrapersonal and interpersonal components. A key intrapersonal piece is students’ looking at themselves, particularly their cultural identities, and how those identities can be threatened during diversity discussions. Interpersonal skills for dealing with such moments include adopting a learning stance, advocacy and inquiry, and investigating deeply how the other person constructs reality. Teachers’ own emotions are also an important element of the diversity classroom, because of both their potential impact on teaching behavior and the opportunity to model intercultural effectiveness for students.
Native American Values and Management Education: Envisioning an Inclusive Virtuous Circle
Authors: Verbos Amy Klemm , Gladstone Joe S. , Kennedy Deanna M.
Published: October 2010

Circles are symbols of interconnectedness. Behavioral circles can be vicious or virtuous. Many American Indians are caught in a vicious circle of exclusion from the purported benefits of Westernization, entrapment in its negative elements, and the ongoing undermining of their culture and thus their identities. Yet Native Americans, along with many indigenous peoples the world over, are holding fast to traditional values. Indigenous knowledge systems include spiritual orientations that, in the face of the social and environmental issues facing humanity, may provide an alternative set of values for generating life-enhancing business behavior. The authors introduce management educators to Native American values generally and specifically to four traditional Lakota values: bravery, generosity, fortitude, and wisdom. Management education might move toward to an inclusive, virtuous circle through respect for Native American values as an equally valid alternative to dominant management values.
Evolving plastic neural networks with novelty search
Authors: Risi Sebastian , Hughes Charles E , Stanley Kenneth O
Published: October 2010

Biological brains can adapt and learn from past experience. Yet neuroevolution, that is, automatically creating artificial neural networks (ANNs) through evolutionary algorithms, has sometimes focused on static ANNs that cannot change their weights during their lifetime. A profound problem with evolving adaptive systems is that learning to learn is highly deceptive. Because it is easier at first to improve fitness without evolving the ability to learn, evolution is likely to exploit domain-dependent static (i.e., nonadaptive) heuristics. This article analyzes this inherent deceptiveness in a variety of different dynamic, reward-based learning tasks, and proposes a way to escape the deceptive trap of static policies based on the novelty search algorithm. The main idea in novelty search is to abandon objective-based fitness and instead simply search only for novel behavior, which avoids deception entirely. A series of experiments and an in-depth analysis show how behaviors that could potentially serve as a stepping stone to finding adaptive solutions are discovered by novelty search yet are missed by fitness-based search. The conclusion is that novelty search has the potential to foster the emergence of adaptive behavior in reward-based learning tasks, thereby opening a new direction for research in evolving plastic ANNs.
Positive assortment for peer review
Authors: Aktipis C Athena , Thompson-Schill Sharon L
Published: October 2010

We suggest that the introduction of positive assortment (the pairing of individuals with similar characteristics) to the peer review process would increase the speed of reviewing, improve the quality of reviews, and decrease the burden on reviewers. In assortative reviewing, each reviewer is given a score based on speed of reviewing, the usefulness of the review, the rate of reviewing, or any other priority of the journal editor. Authors submitting manuscripts are then paired with reviewers who have similar scores to themselves. This is a no-cost solution that aligns reviewers’ incentives by accounting for the benefits provided to the scientific community and returning them in kind. This assortative reviewing system can promote rapid, high quality, and high volume reviewing at a benefit to the scientific community at no financial cost.
Slow Wave Activity During Sleep: Functional and Therapeutic Implications
Authors: Greene Robert W. , Frank Marcos G.
Published: October 2010

Electroencephalographic slow-wave activity (EEG SWA) is an electrophysiological signature of slow (0.5 to 4.0 Hz), synchronized, oscillatory neocortical activity. In healthy individuals, EEG SWA is maximally expressed during non-rapid-eye-movement (non-REM) sleep, and intensifies as a function of prior wake duration. Many of the cellular and network mechanisms generating EEG SWA have been identified, but a number of questions remain unanswered. For example, although EEG SWA is a marker of sleep need, its precise relationship with sleep homeostasis and its roles in the brain are unknown. In this review, the authors discuss their current understanding of the neural mechanisms and possible functions of EEG SWA.
Citing and Building on Meta-Analytic Findings
Authors: Carlson Kevin D. , Ji Fiona Xiaoying
Published: October 2010

Meta-analysis is commonly used to quantitatively review research findings in the social sciences. This article looks at what happens next, after a meta-analysis is published. The authors examine how meta-analytic findings are cited in subsequent studies and whether the citing authors take full advantage of the information meta-analyses provide. A review of 1,489 citations to meta-analyses in 319 empirical studies published in three journals over two decades indicates that the frequency of citing meta-analyses is accelerating. An analysis of citing practices indicates that authors use data for a variety of purposes in subsequent research studies. However, the citing studies often underreported important aspects of meta-analytic data, and additional opportunities exist to build on the data provided by meta-analytic reviews.
Doctor in the lead: balancing between two worlds
Authors: Witman Yolande , Smid Gerhard A.C. , Meurs Pauline L. , Willems Dick L.
Published: October 2010

The article examines the leadership of department heads in a university hospital in day-to-day practice. These ‘doctors in the lead’ bridge the medical and the management world in the hospital organization.They are better able to influence their colleagues’ clinical activities than a non-medical manager. This is, however not a trouble-free task. The concepts of Pierre Bourdieu—habitus, field and capital—guide the analysis of empirical material. The medical habitus influences the questions and dilemmas department heads face, as well as the ways in which they can exert influence on their colleagues. ‘Janus-faced’ they look at the medical and the management world with their two different logics. Sometimes they display managerial behaviour, but the medical habitus remains their second nature. Based on these findings we argue that the formal hierarchy of the hospital organization should be brought more in line with the informal professional hierarchy.
Lower levels of glutathione in the brains of secondary progressive multiple sclerosis patients measured by 1H magnetic resonance chemical shift imaging at 3 T
Authors: Choi I-Y , Lee S-P , Denney DR , Lynch SG
Published: October 2010

Background: Disability levels for patients with secondary progressive multiple sclerosis (SPMS) often worsen despite a stable MRI T2 lesion burden. The presence of oxidative stress in the absence of measurable inflammation could help explain this phenomenon. In this study, the assessment of an in vivo marker of oxidative stress, cerebral glutathione (GSH), using magnetic resonance chemical shift imaging (CSI) is described, and GSH levels were compared in patients with SPMS and healthy controls.

Objective: To assess whether GSH, a key antioxidant in the brain, is lower in the SPMS patients compared to matched controls.

Methods: Seventeen patients with SPMS (Expanded Disability Status Scale = 4.0–7.0; length of MS diagnosis = 19.4 ± 7 years) and 17 age- and gender-matched healthy controls were studied. GSH levels were measured in the fronto-parietal regions of the brain using a specially designed magnetic resonance spectroscopy technique, CSI of GSH, at 3T.

Results: The levels of GSH were lower for SPMS patients than for controls, the largest reduction (18.5%) being in the frontal region ( p = 0.001).

Conclusion: The lower GSH levels in these patients indicate the presence of oxidative stress in SPMS. This process could be at least partially responsible for ongoing functional decline in SPMS.
Enhancing adoptive parenting: A randomized controlled trial
Authors: Rushton Alan , Monck Elizabeth , Leese Morven , McCrone Paul , Sharac Jessica
Published: October 2010

The aim was to conduct a pragmatic randomized controlled trial (RCT) to evaluate two parenting programmes designed for adopters of children late placed from care. Adoptive parents, with children between 3 and 8 years who were screened to have serious behavioural problems early in the placement, participated in home-based, manualized, parenting programmes delivered by trained and supervised family social workers. The adopters who agreed to join the study were randomly allocated to one of two parenting interventions or to a “services as usual” group. Baseline, immediate post-intervention and six-month follow-ups were assessed using questionnaires and adopter interviews. No cases were lost to follow-up at any point and satisfaction was high with both parenting interventions. At the six-month follow-up, a significant difference ( p < 0.007) was found for “satisfaction with parenting” in favour of the intervention group (Effect Size d = 0.7). Negative parenting approaches were reduced in the intervention group. However, no significant differences in child problems were found between the intervention groups and control group, adjusting for baseline scores. Costs analysis showed that a relatively modest investment in post-adoption support would be well spent in improving adopters’ satisfaction with parenting in the intervention group compared to the routine service group.
The cross-informant concordance and concurrent validity of the Borderline Personality Features Scale for Children in a community sample of boys
Authors: Sharp Carla , Mosko Orion , Chang Bonny , Ha Carolyn
Published: October 2010

The Borderline Personality Disorder Features Scale for Children (BPFSC) is currently the only dimensional measure specifically developed to assess borderline features in children and adolescents. Few studies have investigated this measure for its concurrent validity and concordance between youth self-report and parent-report versions. To this end, the current study had two aims: (1) to investigate the cross-informant concordance (youth self-report vs. parent-report) of the BPFSC; and (2) to examine the concurrent validity of the BPFSC by showing that youth scoring high on the BPFSC also show poor clinical and psychosocial functioning, as measured by a standard Axis I scale. A community sample ( N = 171) of boys between the ages of 8 and 18 completed the BPFSC and a self-report measure of Axis I psychopathology. Parents completed a newly developed parent-report version of the BPFSC (BPFSP) and a standard measure of Axis I psychopathology to index clinical and psychosocial functioning. Findings confirmed expectations. Modest concordance between parent- and self-report ratings were found. In addition, youth with borderline features showed poorer clinical and psychosocial functioning in all domains, especially where externalizing problems were concerned. Concurrent validity and modest parent—child concordance were demonstrated for the BPFSC. The BPFSC and BPFSP show promise as dimensional measures to assess borderline features in boys. However, a criterion validity study is needed before the measure can be used.
The “Spirit of New Orleans”: Translating a model of intervention with maltreated children and their families for the Glasgow context
Authors: Minnis Helen , Bryce Graham , Phin Louise , Wilson Phil
Published: October 2010

Children in care have higher rates of mental health problems than the general population and placement instability contributes to this. Children are both most vulnerable to the effects of poor quality care and most responsive to treatment in the early weeks and months of life yet, in the UK, permanency decisions are generally not in place until around the age of four. We aimed to understand the components of an innovative system for assessing and intervening with maltreated children and their families developed in New Orleans and to consider how it might be implemented in Glasgow, UK. During and after a visit to New Orleans by a team of Glasgow practitioners, eight key interviews and meetings with New Orleans and Glasgow staff were audio-recorded. Qualitative analysis of verbatim transcripts identified key themes. Themes highlighted shared aspects of the context and attitudes of the two teams, identified gaps in the Glasgow service and steps that would be needed to implement a version of the New Orleans model in Glasgow. Our discussions with the New Orleans team have highlighted concrete steps we can take, in Glasgow, to make better decision-making for vulnerable children a reality.
Some reflections on the use of psychiatric diagnosis in the looked after or “in care” child population
Authors: DeJong Margaret
Published: October 2010

The current classification system, DSM-IV, inadequately captures the range and type of psychopathology seen in the “in care” population of children. A combination of pre-natal influences, early interpersonal trauma involving the primary caregiving relationship, disturbed and disrupted attachment relationships and other significant losses and adverse environmental effects produce a complex constellation of symptoms and a pervasive impact on development that is difficult to categorize. The challenges facing DSM-V are illustrated, highlighting unresolved topics such as quasi-autism, reactive attachment disorder and complex trauma.
A national study of the impact of outpatient mental health services for children in long-term foster care
Authors: Bellamy Jennifer L. , Gopalan Geetha , Traube Dorian E.
Published: October 2010

Despite the tremendous mental health need evidenced by children in foster care and high rates of use of mental health services among children in foster care, little is known about the impact of outpatient mental health services on the behavioral health of this population. This study utilizes data from the National Survey of Child and Adolescent Well-being (NSCAW), the first nationally representative study of child welfare in the United States. A subsample of 439 children who have experienced long-term foster care were included in this study. These data were used to estimate the impact of outpatient mental health services on the externalizing and internalizing behavior problems of children in long-term foster care. A propensity score matching model was employed to produce a robust estimate of the treatment effect. Results indicate that children who have experienced long-term foster care do not benefit from the receipt of outpatient mental health services. Study results are discussed in the context of earlier research on the quality of mental health services for children in foster care.
Review: Do deficits in cardiac care influence high mortality rates in schizophrenia? A systematic review and pooled analysis
Authors: Mitchell Alex J , Lord Oliver
Published: October 2010

We have previously documented inequalities in the quality of medical care provided to those with mental ill health but the implications for mortality are unclear. We aimed to test whether disparities in medical treatment of cardiovascular conditions, specifically receipt of medical procedures and receipt of prescribed medication, are linked with elevated rates of mortality in people with schizophrenia and severe mental illness. We undertook a systematic review of studies that examined medical procedures and a pooled analysis of prescribed medication in those with and without comorbid mental illness, focusing on those which recruited individuals with schizophrenia and measured mortality as an outcome. From 17 studies of treatment adequacy in cardiovascular conditions, eight examined cardiac procedures and nine examined adequacy of prescribed cardiac medication. Six of eight studies examining the adequacy of cardiac procedures found lower than average provision of medical care and two studies found no difference. Meta-analytic pooling of nine medication studies showed lower than average rates of prescribing evident for the following individual classes of medication; angiotensin converting enzyme inhibitors (n = 6, aOR = 0.779, 95% CI = 0.638—0.950, p = 0.0137), beta-blockers (n = 9, aOR = 0.844, 95% CI = 0.690—1.03, p = 0.1036) and statins (n = 5, aOR = 0.604, 95% CI = 0.408—0.89, p = 0.0117). No inequality was evident for aspirin (n = 7, aOR = 0.986, 95% CI = 0.7955—1.02, p = 0.382). Interestingly higher than expected prescribing was found for older non-statin cholesterol-lowering agents (n = 4, aOR = 1.55, 95% CI = 1.04—2.32, p = 0.0312). A search for outcomes in this sample revealed ten studies linking poor quality of care and possible effects on mortality in specialist settings. In half of the studies there was significantly higher mortality in those with mental ill health compared with controls but there was inadequate data to confirm a causative link. Nevertheless, indirect evidence supports the observation that deficits in quality of care are contributing to higher than expected mortality in those with severe mental illness (SMI) and schizophrenia. The quality of medical treatment provided to those with cardiac conditions and comorbid schizophrenia is often suboptimal and may be linked with avoidable excess mortality. Every effort should be made to deliver high-quality medical care to people with severe mental illness.
Review: Mortality trends in the general population: the importance of cardiorespiratory fitness
Authors: Lee Duck-chul , Artero Enrique G , Xuemei Sui  , Blair Steven N
Published: October 2010

Cardiorespiratory fitness (CRF) is not only an objective measure of habitual physical activity, but also a useful diagnostic and prognostic health indicator for patients in clinical settings. Although compelling evidence has shown that CRF is a strong and independent predictor of all-cause and cardiovascular disease mortality, the importance of CRF is often overlooked from a clinical perspective compared with other risk factors such as hypertension, diabetes, smoking, or obesity. Several prospective studies indicate that CRF is at least as important as the traditional risk factors, and is often more strongly associated with mortality. In addition, previous studies report that CRF appears to attenuate the increased risk of death associated with obesity. Most individuals can improve their CRF through regular physical activity. Several biological mechanisms suggest that CRF improves insulin sensitivity, blood lipid profile, body composition, inflammation, and blood pressure. Based on the evidence, health professionals should encourage their patients to improve CRF through regular physical activity.
The paradox of premature mortality in schizophrenia: new research questions
Authors: Wildgust Hiram Joseph , Hodgson Richard , Beary Mike
Published: October 2010

The life expectancy of patients with schizophrenia is reduced by between 15 and 25 years. Those patients dying of natural causes die of the same diseases as in the general population. In 2009 the World Health Organization (WHO) identified underlying global risk factors for mortality in the general population. However, there is little evidence in the literature assessing their validity in those with schizophrenia. The WHO report on global health risks (2009) identifies hypertension, smoking, raised glucose, physical inactivity, overweight and obesity, and high cholesterol as the six leading global mortality risk factors. Currently, there are minimal data on the contribution to mortality that these risk factors make in schizophrenia, and their optimum management. Both short and long-term studies are needed to address these gaps. New research has raised important questions about risk balance with regards to ideal body mass, with some studies showing that being overweight is associated with lower all-cause mortality and lower suicide rates. Cardiorespiratory fitness is being recognized as a more powerful predictor of mortality than smoking, hypertension or diabetes in men. However, there are virtually no published data on assessment of fitness levels in schizophrenia. New studies have raised concerns about the quality of physical care for patients with schizophrenia, which is another important avenue of future research. A greater biological understanding of the relationship between these disorders and schizophrenia would inform clinical practice. Low birth weight has been associated with increased risk for schizophrenia, and it will be important to explore this risk factor for both physical and mental health outcomes.
Review: Are there modifiable risk factors which will reduce the excess mortality in schizophrenia?
Authors: Wildgust Hiram Joseph , Beary Mike
Published: October 2010

The 2009 World Health Organization report on global health risks identifies hypertension, smoking, raised glucose, physical inactivity, obesity and dyslipidaemia, in that order, as being the top six modifiable global mortality risk factors. Patients with schizophrenia have high levels of all these risk factors. There are a small number of studies showing that interventions can improve these, but prospective long-term studies are not available to show their impact on mortality. A number of studies are now supporting the view that patients with schizophrenia may be dying prematurely as they are not gaining access to or receiving the same medical care as the general population. The literature now suggests that low cardiorespiratory fitness and muscle strength are among the strongest predictors of all-cause mortality in the general population. Smoking is still one of the largest risk factors for premature all-cause mortality. The literature supports the thesis that lifestyle intervention programmes addressing exercise, smoking cessation and compliance with medication are likely to have significant impact on mortality in schizophrenia. It will be important to ensure that all patients with schizophrenia have advocates to ensure appropriate treatment and avoid prejudice, and to establish fitness standards in schizophrenia.