bluuebunny/crossref_metadata_2025 huggingface dataset:
Narrating knowledge: presupposition and background in Flannery O'Connor's fiction
Authors: Hardy Donald E.
Published: October 2007

Clausal presupposition in Flannery O'Connor's fiction is examined and shown to contribute stylistically to O'Connor's explorations of the fallibility of human knowledge. Marked presuppositional constructions - those in which the narrator and narratee do not share the background knowledge of the presupposition - are analysed as attempts on the part of the narrator to put into a shared gestalt background contested knowledge. These attempts have three main effects: (1) an ironic comment on false knowledge held by a character; (2) a displacement of knowledge from a character's awareness; (3) an empathetic response to a character's knowledge of mystery or destiny. A call is made to develop a typology of literary uses of marked presuppositional constructions making reference not only to the quality of knowledge among the narrator, narratee, and character(s), but also to the specific literary effect of marked presupposition, e.g. irony, narrative suspense, empathy. If it is true that marked presupposition is a fundamental characteristic of literary enjoyment (Kock, 1976), a typology of a narrator's use of contested presuppositions tells us much about a particular author's characteristic strategies of engaging a reader's interest. It is left an open question whether all authors whose narrators use contested presuppositions are as concerned as O'Connor was with the fallibility of human knowledge.
Gender and mediatized political discourse: a case study of press coverage of Margaret Beckett's campaign for the Labour leadership in 1994
Authors: Walsh Clare
Published: October 2007

Drawing upon the work of the philosopher Carole Pateman and the critical discourse analyst Norman Fairclough, this article will argue that fraternal networks operate within and between the institutional order of masculinist political discourse and the equally masculinist discourse of the print media, marginalizing female political actors. It will be argued further that the colonization of mediatized political discourse by market values has had a particularly detrimental effect on the representation of female politicians. A comparative analysis of press coverage of the three candidates in the 1994 British Labour leadership campaign reveals a distinct gender bias in the way in which they were treated. This is evident at the metadiscursive level in terms of patterns of discourse representation which suggest that the fraternity of media workers address an ideal reader who is gendered as male. The dominant metaphors and collocations used to describe Margaret Beckett's qualities as a potential party leader in both the national tabloids and broadsheets reveal the extent to which the genre of the political interview in particular, and news narratives in general, are premised on masculinist assumptions. There are, however, contradictory tendencies. For instance, much of the coverage addresses the issue of overt gender bias, while at the same time reproducing it in more covert forms. The case study needs to be seen in the broader context of systematic and sustained negative coverage in the media of feminist strategies aimed at challenging patriarchal practices in British party politics.
Playing hard to get: metaphor and representation in the discourse of car advertisements
Authors: Thornborrow Joanna
Published: October 2007

In this article I analyse some of the main semantic and metaphoric representations which underpin the discourse of car advertising in Britain. In particular, I focus on the use of male and female bodies as organizing metaphors which produce a gendered framework for advertising different types of cars. The discussion is based on adverts seen on roadside hoardings in the London area, in magazines, and on television at different periods over the past three years, and I use an analytic framework which is grounded in critical linguistic approaches to texts, situated within the context of current debates in feminist stylistics and critical discourse analysis (Fairclough, 1989, 1992; Mills, 1995; Stubbs, 1997; Toolan, 1997).
Crisis in German Decentralized Production
Authors: Herrigel Gary
Published: October 2007

This paper discusses the current crisis in the German industrial district of Baden Württemberg. Considered to be a flagship example of flexibility and international competitiveness for European manufacturing during the 1980s, producers in the district - both large and small - have fallen upon hard times in the 1990s. This paper suggests that the explanation for the crisis can not be traced either to high wages or low levels of productivity in the region. Rather, the problem con fronting the producers in Baden Württemberg- and by extension in German industry as a whole - is that they are being challenged by an alternative system of flexible manufacturing that is superior to their own. Rigidity in the system of production in Germany can be traced to institutional arrangements that were previously thought to be a source of strength: broad yet nonetheless specific skill categories and distinct, functional divisions within management. Successful adjustment in Germany today will have to involve profound self-reflection on and debate about the reform of some of the most taken-for-granted dimen sions of German industrial order.
Technology Parks and Regional Development in the Southern European Periphery
Authors: Peck Frank , Stone Ian , Esteban Marisol
Published: October 2007

Technology parks have been widely embraced as a mechanism for creating local high-technology com plexes in the context of regional development policy. Such policies are constructed on the basis that the creation of an appropriate infrastructure can induce cumulative development of technologically-related activities. In theory it is expected that the growth process will be characterized by a high degree of innovation, the application of locally-generated knowledge, flexible forms of organization and inter dependence between enterprises. Previous research has shown that there is considerable variability in the forms of development which occur on technology parks, and a debate has developed concerning the potential for the decentralization of high technology industry to peripheral locations. While many tech nology parks may not attain the ideal in terms of technological synergies, they can nonetheless produce significant regional development outcomes. This is demonstrated through a case study of the Andalucia Technology Park situated on the outskirts of the City of Milaga in the south of Spain. In this case, the high technology label has plainly acted as a magnet for public sector funding, which has been used to create the kind of modern customized infra structure demanded by inward investors. The initial 'cost-per-job' has undoubtedly been high, but the availability of financial support from the public sector suggests that expansions of existing projects and further inward investment are likely to occur. This interpretation of technology parks has important implications for our understanding of regional policy in the 1990s. Many technology parks, in reality, are used to produce what can be regarded as less ambitious but significant regional policy outcomes (i.e. job-creation through relocation and inward investment) and are perhaps more appropriately judged in those terms.
The Global Context
Authors: Dicken Peter , Öberg Sture
Published: October 2007

This paper aims to set processes of regional and urban restructuring in Europe in their global con text. We begin with an account of Europe's situation within the international population system, demon strating that wider issues have been and will con tinue to be significant. Then we consider Europe's position within the international division of labour, particularly its role in a global trading system and as a source of foreign direct investment. Finally we focus on the changing external policy environment, placing emphasis upon trade policy.
Endomyocardial Biopsy in Pediatric Oncology: Implications for Nursing
Authors: Fisher Lisa M.
Published: October 2007

At Pacific Presbyterian Medical Center endomyocardial biopsies are utilized in pediatric oncology patients to evaluate the degree of cardiotoxicity resulting from the anthracycline agents doxorubicin and daunorubicin. This article discusses the indications, technical aspects, potential risks and complications of endomyocardial biopsy in pediatric oncology patients. The nursing care of the pediatric patient and family, as well as age-specific teaching guidelines, are described.
The Effects of Group Therapy on Adolescents with Cancer
Authors: Heiney Sue P. , Ruffin Julian , Ettinger Robert S. , Ettinger Sandra
Published: October 2007

The value of group therapy for adolescents with cancer has not been well documented. This quasi-experimental and descriptive study was completed to determine the effects of participation in a support group on measures of psychosocial functioning of adolescents with cancer and to describe the process and content of such a group. Seven control and seven experimental subjects were tested prior to beginning the group and again following its completion. Descriptive data were obtained from a process log of the sessions and from participant evaluations. Descriptive findings suggest that the group may have had therapeutic value for the participants by helping them cope with such stresses as over-protective parents and isolation from peers. Empirical findings showed no significant differences on any measures of psychosocial functioning. Results of the study implied that adolescents with cancer may benefit from having a specific time to discuss concerns. However, further study is needed with a larger sample and improved methodology in order to support this finding empirically.
Ethical Issues Related to Research Involving Children
Authors: Lee Lily
Published: October 2007

With the advent of pediatric biomedical technology research in the past few decades, concern for the rights of children as research subjects is increasing. This article offers an orientation for pediatric nurses regarding the historical background of protection of children's rights, ethical principles, ethical issues of consent and risk versus benefit, and nursing implications relating to research involving children.
Dermatoglyphics and Acute Lymphocytic Leukemia in Children
Authors: Edelstein Joan , Amylon Michael , Walsh Jo Anne Berkman
Published: October 2007

Cellular features of acute lymphocytic leukemia (ALL) in children suggest that it originates in abnormal embryogenesis. Because palmar flexion creases develop in the embryo at the same time as the blood-forming cells, and because both arise from mesodermal tissue, insults to the embryo that may lead to leukemic changes in the blood-forming cells may also result in aberrant palmar crease patterns. This study investigated the relationship between aberrant palmar creases and ALL in children who developed leukemia at age 6 years or younger. Odds ratios and chi squares demonstrated significant differences in bilateral aberrant palmar creases between ALL children and relatives (P < .025). Differences were not explained by familial clustering of aberrant creases. These results support the theory that the insult occurred during pregnancy, probably in the first trimester. There were no significant differences in either bilateral or unilateral aberrant palmar creases between ALL children and their siblings. All children with bilateral aberrant creases had a higher incidence of central nervous system involvement (50%) than those without bilateral aberrant creases (6%). This may reflect a preleukemic change in utero before the time the blood-brain barrier has been established.
Informed Consent for Treatment of Childhood Cancer: Factors Affecting Parents' Decision Making
Authors: Ruccione Kathy , Kramer Robin F. , Moore Ida K. , Perin Gail
Published: October 2007

Both the treatment for childhood cancer and the legal requirements for gaining parents' consent to treatment have become increasingly complex. The purpose of the exploratory investigation reported here was to identify influential circumstances surrounding the consent process in the pediatric setting, to describe the relationship of parental anxiety to these factors, and to delineate related practice and research implications. Twenty-eight parents of children entered on one of four protocols for the treatment of newly diagnosed acute lymphoblastic leukemia at the Childrens Hospital Los Angeles and the University of California San Francisco were asked to complete two questionnaires within 48 hours after consenting to treatment: the State-Trait Anxiety Index and the Parent Informed Consent Questionnaire. Results of the study confirmed clinical experience that parents are given complex information and asked to make decisions about their child's life in a highly anxious state. Although participants were generally satisfied with the informed consent process 48 hours after signing a consent form, further research is needed to document how well parents understand and remember key information, as well as the influence of time, experience, and changes in state anxiety on their perceptions of the adequacy of the consent process. In current clinical practice, simple strategies can be applied to improve the informed consent process for families of children with cancer.
Comparing the Perception of Support by Parents of Children With Cancer and by Health Professionals
Authors: Williams Holly Ann
Published: October 2007

Childhood cancer is considered one of the greatest challenges a family can face. Some families cope well with it; others do not. The presence of social support, both perceived and actual, as well as the individuals with whom parents interact, may determine how well a family copes. The purpose of this pilot study was to describe how parents of children with cancer perceive support and the types of things parents found supportive while their child was hospitalized. Parents' perceptions of support were compared with those of the health professionals involved in the care of these children. The primary way the parents perceived support was any activity that met their affective needs. Health professionals faltered when asked to define support, but most said that it meant "being available." Caring and educational activities were the two ways the professionals could offer support to the families, yet parents rarely mentioned teaching as a supportive activity. Parents and health professionals defined aspects of support similarly, but there was minimal congruity between them in listing which people were considered supportive to the parents. In conclusion, health professionals and parents have similar ideas about what support is, but at best, the professionals' predictions concerning who is supportive in a given case appear random and may be biased. This study suggests that new ways of assessing support needs for these families are needed.
The Impact of Childhood Cancer on 50 Chinese Families
Authors: Martinson Ida M. , Su-Xiao-Yin  , Liang Yi-Hua
Published: October 2007

As part of a larger study, a descriptive study of the impact of childhood cancer on 50 Chinese families was conducted in Guangzhou (Canton) in the Guangdong Province of the Peoples' Republic of China. The parents of children whose cancer was newly diagnosed (n = 25) or undergoing treatment (n = 25) were interviewed in Chinese and their responses were then translated to English. The children ranged in age from 3 to 16 years and had a variety of cancer diagnoses. Parental occupations and incomes varied. The majority (42%) of the families only had the child with cancer. The duration of symptoms before the diagnosis ranged from 1 week to greater than 2 years. Thirty-five parents (70%) believed that their child knew very little or nothing about their disease. The children learned of their diagnosis in a variety of ways. The parents varied in their degree of openness regarding the child's diagnosis with relatives, friends, and colleagues. Some families had previous experience with a serious illness or death, but all identified cancer as the most frightening disease. Forty-one percent of the families felt they had not adjusted yet to the diagnosis. Few acknowledged the impact on siblings. Families also described their outlook on life and their fears of death. Seventy-six percent of the families were paying the total cost of their child's care themselves, and 14% of the total number of families reported major financial problems.
The Phenomenon of Hand Holding as a Coping Strategy in Adolescents Experiencing Treatment-Related Pain
Authors: Weekes DeLois P. , Kagan Sarah H. , James Kelly , Seboni Naomi
Published: October 2007

The purpose of this study was to understand the phenomenon of hand holding as a coping strategy used by adolescents to deal with treatment-related pain. The convenience sample consisted of 20 adolescents whose ages were 11 to 19 years: 10 had cancer and 10 had renal disease (this served as the comparison group). Using a descriptive design, a semistructured interview was conducted with each adolescent. To supplement and support interview data, structured observations were conducted as adolescents underwent painful treatments (eg, blood draws, shunt placement, peripheral chemotherapy, lumbar punctures, and bone marrow aspirations). Data were analyzed using descriptive statistics and qualitative analytic techniques similar to those delineated by Strauss and Corbin. The results of this study indicated that subjects in both the cancer and the renal disease group perceived hand holding to be a very effective coping strategy in ameliorating treatment-related pain. Overwhelmingly the patients preferred to hold their mother's hand. When the mother was unavailable, they preferred to hold a specific nurse's hand. Hand holding functioned to reduce tension associated with impending treatments, as a source of distraction, and as a source of security. Accordingly, adolescents' subjective experience of treatment-related pain was reduced when they felt more secure, less tense, and were distracted.
Orem's Theory Used as a Guide for the Nursing Care of an Eight-Year-Old Child with Leukemia
Authors: Foote Anne , Holcombe Judy , Piazza Dianne , Wright Penelope
Published: October 2007

Orem's general theory of nursing provides a framework for holistic pediatric oncology nursing. In this article, an overview of Orem's theory is provided. The theory is used to assess the self-care deficits of an 8-year-old boy who has been diagnosed with leukemia, the ability of the mother to meet the son's self-care demands, and the nursing system needed to assist the mother to meet her son's self-care demands. The theory is used to plan and evaluate the nursing care of this child. A comprehensive list of nursing diagnoses and a nursing care plan for two of these diagnoses are presented.
Life Change Events and Coping Behaviors in Families of Children With Cancer
Authors: Thoma Martha E. , Hockenberry-Eaton Marilyn , Kemp Virginia
Published: October 2007

This study investigated life change events and coping behaviors in families of children with cancer compared with those who have physically healthy children. The sample consisted of 21 families with a child with cancer and 17 families with physically healthy children. All the children in the study were 6 to 12 years of age. Parents from each group completed items from the Family Inventory of Life Events and Changes and the Family Crisis Oriented Evaluation Scales. These tools evaluate stressful life change events experienced by families within a 12-month period and coping behaviors used by families during difficult situations. Families with a child who has cancer experienced significantly more stressful life change events (t = 2.15, P = 0.04) than those with physically healthy children. There were no significant differences (t = 0.23, P = 0.82) in the coping behaviors that were used by the two groups. The results provided a clearer understanding of stressful life change events that impact families with a child with cancer.
Waiting and Not Knowing: The Diagnosis of Cancer in a Child
Authors: Clarke-Steffen Laura
Published: October 2007

A subset of data from a longitudinal grounded theory study was analyzed to describe the experience families have during the period immediately surrounding the time of diagnosis of cancer in a child. A convenience sample consisted of 40 members of seven families with a child who was recently diagnosed with cancer with a favorable prognosis. All family members 5 years of age and older participated. Data collection consisted of three tape-recorded, semistructured interviews with family members in the home. It was found that the ''waiting and not knowing" of this period was most distressing for family members. This period is further described and implications for nursing practice are discussed. Factors limiting generalizability of the findings include the small sample size, single site, and the short length of time families were followed.
The 1992 APON Delphi Study to Establish Research Priorities for Pediatric Oncology Nursing
Authors: Hinds Pamela S. , Quargnenti Alice , Olson Mary Sue , Gross Julie , Puckett Patty , Randall Elizabeth , Gattuso Jami S. , Wiedenhoffer Dawn
Published: October 2007

The Association of Pediatric Oncology Nurses (APON) recently sponsored a two-wave Delphi study to identify the most important research priorities for pediatric oncology nursing. Seventy-five research priorities were rated for importance by 227 APON members. The majority of these members were inpatient or ambulatory care nurses who had been in pediatric oncology more than 25 months. The top 10 research priorities were primarily about nursing procedures and psychosocial care needs of patients and families. The top priority was to "measure the quality of life and late effects of treatment in long-term survivors of childhood cancer." Study findings will be used to encourage researchers to conduct research on these priorities and to encourage funding organizations to support research related to these priorities.
The Measured Intensity of Work-Related Stressprs in Pediatric Oncology Nursing
Authors: Bond Debra Carlson
Published: October 2007

The purpose of this descriptive study was to measure the rated intensity of work-related stressors experienced by pediatric oncology nurses and to examine the reliability of a new instrument. The Stressor Scale for Pediatric Oncology Nurses (SSPON), a 50-item visual analogue instrument, was used to measure the intensity of those work-related stressors. A national sample (n = 92) of randomly selected members of the Association of Pediatric Oncology Nurses participated. Although most subjects had 2 or more years of pediatric oncology nursing experience (92%), the majority had greater than 5 years of experience (52%). Median scores on the SSPON indicated that the nurses sampled experienced a moderately high level of work stress. Scale items rated most stressful were "watching a patient suffer and not be able to do anything about it," "when a favorite patient dies," and "making mistakes:' Scale items rated least stressful were "when patients die at home rather than here at the hospital with us," "not feeling comfortable with my skills," and "when I can't answer a question about my patient." A comparison of total scale scores, using a t-test for independent samples, indicated that nurses with less than 5 years of pediatric oncology experience (n = 44) did not differ significantly from nurses with greater than 5 years of pediatric oncology experience (n = 48; t = 1.30, P = .199), in relation to intensity of work-related stress. Reliability was estimated using coefficient alpha. The total scale SSPON was found to be internally consistent (coefficient α = 0.93). However, the SSPON's six clusters need to be further refined, modified, and developed because of low coefficient alphas.
Fathers of Children With Cancer: A Descriptive Study of Their Stressors and Coping Strategies
Authors: Cayse Lisa Noelle
Published: October 2007

The purpose of this study was to identify the stressors and coping strategies of fathers with a child diagnosed with cancer. Differences in the fathers' stressors, feelings, and coping strategies by severity of their child's condition were also assessed. The Contingency Model of Long-Term Care was the framework for the study. The Parental Perception Inventory questionnaire was completed by 23 fathers. The fathers reported that their most common concern was their "child's future," followed by their "child's health." The most common coping strategy was "to pray," a strategy that was also reported as being the most helpful. The next most common strategies were "to get information," "look at options," and "to weigh choices." These strategies are problem-oriented which is consistent with the research findings of others. A one-way analysis of variance with planned comparisons was used to compare stressors, feelings, and coping strategies of the fathers by severity of their child's condition. No planned comparisons were statistically significant at the .05 level nor were any additional differences detected.
The Parent-Nurse Relationship from the Perspective of Parents of Children with Cancer
Authors: Howlett Nanna , Casey Linda
Published: October 2007

This commentary reflects the views of Mrs N. Howlett a pediatric oncology nurse practitioner, and Mrs Linda Casey, mother of 16-year-old Jeremy Casey who died from alveolar soft part sarcoma in 1992. Howlett and Casey had a parent-nurse relationship throughout the 13 months that Jeremy received treatment before his death. A brief history of Jeremy's care is followed by reflections from Howlett and Casey about their parent-nurse relationship. The kind of care they describe corresponds to what Romaniuk and Kristjanson have labeled "Caring Completely" and 'Working Together." Howlett agreed to initiate the interviews after she was identified by Casey in a separate study as a "From the Heart Caregiver." The telephone interviews occurred 2 years after Jeremy died. The quoted segments describe key moments which took place throughout the treatment period from the parent perspective. Interpretive comments by Howlett (NH) introduce or follow the parent's (LC) comments.
The Experience of South American Mothers Who Have a Child Being Treated for Malignancy in the United States
Authors: Crom Deborah B.
Published: October 2007

This phenomenological study examined the experience of South American mothers who brought their children to the United States for cancer treatment. Five mothers were interviewed twice about their subjective experiences. Data were analyzed using Colaizzi's method of phenomenology. Thirty-two significant statements were grouped into eight themes. The South American mothers brought their children to the United States in hopes of finding effective treatment, illustrating the major theme of our findings that no effort or sacrifice was too great to save their children's lives. The diagnosis of cancer had an overwhelming impact on the child and the family. This was made worse by the uncertainty of treatment outcome. Although the decision to come disrupted family life and caused economic and cultural hardship, it was uniformly believed to have been the right decision. The greatest challenges experienced by the mothers were language difficulties and the constant preoccupation with the child's illness. Through faith and a variety of coping strategies, these South American mothers succeeded in adapting. They transcended life disruption and focused on the critical goal of restoring their child's health. Central to their experience is that everything humanly possible be done to preserve the life of their child.
Parse's Theory of Human Becoming: An Alternative Guide to Nursing Practice for Pediatric Oncology Nurses
Authors: Melnechenko Karen L.
Published: October 2007

The Parse theory of human becoming guides nurses In their practice to focus on quality of life as it is described and lived. Parse's theory is presented here as an alternative approach for nursing practice in pediatric oncology. In this article, the human becoming theory is discussed and the practice dimensions and processes are described and illuminated with an example from nursing practice. © 1995 by Association of Pediatric Oncology Nurses.
Peak and Nadir Experiences and Their Consequences Described by Pediatric Oncology Nurses
Authors: Olson Mary Sue , Hinds Pamela S. , Euell Kerri , Quargnenti Alice , Milligan Mary , Foppiano Pheraby , Powell Brent
Published: October 2007

Pediatric oncology nurses experience role-related stressors, some of which are inherent to the speciality, and their consequences. Despite these difficulties, nurses continue in the specialty. One variable that helps to explain their continued commitment is "meaning," or what pediatric oncology nurses find to be most significant and satisfying in their roles. One technique for determining meaning in a role is to inquire about the peak (significant and positive) and nadir (significant and negative) role-related experiences and the consequences of both kinds of experiences. The purpose of this study was to identify the peak and nadir experiences of pediatric oncology nurses and the short- and long-term consequences of those experiences.

Using an interview format that consisted of four open-ended questions and a convenience sampling plan, five nurses interviewed 26 nurses from one pediatric cancer center and 38 nurses from a national sample. The interviewers completed an initial training session on interviewing and repeated that training two more times during data collection. Written or taped oral consent was obtained at the time of each interview. Using a content analytical technique (Krippendorff, 1980), four nurses independently coded each interview. Agreement ratings ranged from 75% to 100% per coded theme for an overall agreement level of 92%. Training for the coding process occurred initially and periodically throughout the analysis period.

Fifteen different themes for peak experiences were identified, the majority of which reflect the nurses' experience with patients dying, or with patients recovering and living normal lives, or with the close relationships that develop between nurses and patients. Multiple short- and long-term consequences were identified and included changes in (1) values (becoming less judgmental), (2) behaviors (giving more empathic care), and (3) perspective (accepting limitations of care). Twenty-three different nadir themes were identified. A shared characteristic of several of these themes is the nurses' regret over a perceived inadequacy in handling a situation. Another common element is witnessing patient suffering and feeling unable to adequately relieve the suffering or provide comfort to the patient. The short-term consequences of nadir experiences tend to be negative and include guilt, anger, or dread. The long-term consequences tend to be positive and similar to the long-term consequences of peak experiences.

Study findings indicate that pediatric oncology nurses do find meaning in their roles and that those who continue in the speciality are able to experience positive long-term consequences. Study findings will be used to develop a new scale to measure role-related meaning and to develop interventions designed to assist nurses in finding meaning in their roles even during particularly stressful periods.
The Meaning of Peak and Nadir Experiences of Pediatric Oncology Nurses: Secondary Analysis
Authors: Clarke-Steffen Laura
Published: October 2007

This article explores the meanings pediatric oncology nurses derive from their work role and describes the process by which nurses create meaning. This was a secondary analysis of data from a qualitative study that examines peak and nadir experiences and their consequences in pediatric oncology nurses. A semistructured interview was used to gather data from a sample of 26 nurses at a pediatric cancer treatment center. Interviews were tape-recorded and transcribed. Content analysis was used in the primary study to identify themes and characteristics of the peak and nadir experiences and their consequences. Constant comparative analysis revealed emerging categories of significant meaning for pediatric oncology nurses. These categories included relating to others; experiencing life, death and dying; being aware of self as nurse; and experiencing diminishing qualities of the nursing situation. Through a process of giving and receiving, the nurses were able to find fulfillment in giving care to children with cancer. (
The Importance of Family Functioning to Caregiver Adaptation in Mothers of Child Cancer Patients: Testing a Social Ecological Model
Authors: Shapiro Johanna , Perez Myriam , Warden M. James
Published: October 2007

This study was designed to investigate associations between family relationships, personal-psychological caregiver adaptation (ie, depressive symptomatology, sense of burden), and ability to function within the health care system (perceived doctor-parent relationship) in mothers of child cancer patients. Data were collected through a survey of a sample of 29 mothers whose children were diagnosed with some form of childhood cancer, mainly leukemia. Family functioning was positively related to both caregiver adaptation and doctor-parent relationship. Mothers who reported decreased maternal depression and burden were significantly more likely to report respectively improved spousal relationships and improved spousal communication. Mothers reporting more positive doctor-parent relationships also described themselves as having improved relationships with spouse and child, and improved spousal communication. Maternal well-being and doctor-parent relationship were not directly related. By suggesting that both intrapsychic and instrumental maternal adaptation are influenced by positive relationships in the family, this study provides support for the social ecological model of stress. The possibility that family factors exert a direct influence on both caregiver intrapsychic well-being and instrumental skills argues for the importance of their being carefully considered in any models evaluating caregiver adaptation.
Late Effects in Survivors of Bone Tumors Late Effects in Survivors of Bone Tumors
Authors: Mosher Revonda B. , McCarthy Barbara J.
Published: October 2007

Today more than 71 % of children with cancer are surviving their disease. This is because of improved treatment including aggressive combination therapy and better supportive care measures. The majority of patients with bone tumors are now being treated with surgery, chemotherapy, and radiation therapy, resulting in an increase in numbers of long-term survivors. This aggressive therapy, however, has increased the risk of developing late effects. This article reviews some of these late effects in survivors of bone tumors diagnosed in childhood or adolescence. Areas that are explored include cardiac, infections, second operations, second malignant neoplasms, renal, auditory, fertility, pulmonary, functional, and psychosocial outcomes. The need for long-term follow-up clinics is also addressed.
Room Service Improves Patient Food Intake and Satisfaction With Hospital Food
Authors: Williams Ruth , Virtue Karen , Adkins Alisa
Published: October 2007

Cancer therapy causes side effects that interfere with oral intake. Frequently, patients undergoing such therapy suffer from anorexia, nausea, vomiting, food aversions, dysgeusia, and xerostomia, all which adversely affect oral intake. Adequate nutrition intake is an important part of therapy for the cancer patient, especially when that patient is a child. Children who are well nourished are better able to withstand infection and tolerate therapy. Parents and staff at our hospital have worked diligently to improve patients' oral intake with limited success. Hence, a multidisciplinary team was organized to develop a new approach to food services that would improve patients' oral intake. The team initiated patient "room service," and patients were allowed to call the kitchen when they were ready to eat. The system works much like room service in a hotel. After the introduction of room service, patients' caloric intake improved significantly (P = .008), and protein intake increased by 18%. Patient satisfaction with hospital food service also improved; excellent ratings increased by as much as 35%. We conclude that room service is a viable alternative to traditional food services in the pediatric oncology setting and may be useful in other patient populations, such as maternity and general pediatrics.
Pediatric Blood Volumes: A One-Page Reference Guide
Authors: Smiley Jody , Reitan Jodie
Published: October 2007

At our institution, a multidisciplinary team met to work out a blood volume policy for our pediatric patients' laboratory testing. Because we are a cancer center, many of our patients are on protocols and/or are in the hospital for an extended period of time. These factors result in multiple blood draws. It is important to manage the volumes used so that we do not compromise the hematological status of our pediatric patients. The concerns of nurses and laboratory technologists were discussed and a three-tiered system was designed consisting of adult volumes, volumes for < 20-kg patients, and volumes for < 10-kg patients. Each tier consists of less blood than the one above it but the cost for such a procedure is increased. Time to conduct the draw, the cost of equipment to do the draw, and inflexibility to verify or add to the original order without resticking the patient increase at each tier. It is imperative to the overall quality of care for all patients that discretion is used when following these guidelines. When it is medically prudent to restrict the blood volumes taken from any patient, it should be done. However, when it is not medically necessary, the increased costs and potential decrease in the quality of laboratory service outweighs the desire to use smaller blood volumes.
A Review of the Literature on Resilience in the Adolescent With Cancer: Part II
Authors: Woodgate Roberta L.
Published: October 2007

Adolescents with cancer experience multiple stressors that may stem from both the illness and from normal developmental tasks. Some adolescents remain or become resilient even when faced with multiple challenges. An understanding of what contributes to resilience in the adolescent cancer experience is important in caring for adolescents with cancer and childhood cancer survivors. The purpose of this article is to provide a synthesis of the literature related to resilience in the adolescent cancer experience. Research recommendations based on theoretical and methodological limitations noted in the review are presented.
Be Careful What You Ask For
Authors: Sevier Brian , Ashcraft Catherine
Published: October 2007

Current educational reform efforts have called attention to the need for more male teachers, primarily in elementary education. Recent scholarship, however, has highlighted significant problems with some of the assumptions underlying these calls, arguing that if we are to incorporate male teachers in ways that truly challenge dominant discourses of masculinity, we must address questions such as why we need more male teachers and what masculinities these teachers will model. Importantly, research has shown that men do not question what it means to be a male teacher or a male role model. The authors seek to extend this research by inquiring into the confusion surrounding the concept and consequences of this confusion. The authors contend that the idea of a male role model needs questioning, the illusion of clarity it offers is potentially dangerous, and disrupting this idea could potentially rearticulate male participation in elementary teaching in more liberating ways.
Understanding Body Dissatisfaction in Gay and Heterosexual Men
Authors: McArdle Keri A. , Hill Melanie S.
Published: October 2007

This study examines differences in body dissatisfaction among gay and heterosexual men. Specifically, media, peer influence, and self-esteem are explored as potential variables in understanding these differences. Fifty-four Caucasian heterosexual males and eighty-two Caucasian gay males between the ages of eighteen and seventy-three participated in this study. The main findings of the current study are (a) gay men reported significantly more body dissatisfaction than heterosexual men; (b) significantly more men report a desire to lose weight than to gain weight, with gay men reporting a significantly smaller ideal weight than heterosexual men; (c) the magnitude of the relationship between self-esteem and body dissatisfaction was not significantly different for gay and heterosexual men; (d) media influence was more strongly related to body dissatisfaction and self-esteem for gay men than for heterosexual men; and (e) the magnitude of the relationship between weight-related peer teasing and self-esteem was stronger for gay males than for heterosexual males. Implications and directions for future research are explored.
How Do Officially Organized Services Meet the Needs of Elderly Caregivers and Their Spouses With Alzheimer's Disease?
Authors: Raivio Minna , Eloniemi-Sulkava Ulla , Laakkonen Marja-Liisa , Saarenheimo Marja , Pietilä Minna , Tilvis Reijo , Pitkälä Kaisu
Published: October 2007

The caregiving situation among caregivers and their spouses with Alzheimer's disease, the support and services received, the unmet needs, and the caregivers' satisfaction with the services are examined. The study included a survey of a random sample of 1943 caregivers of persons with Alzheimer's disease in Finland. Mean age of the caregivers was 78.2 years, and 35% had poor subjective health. Disabilities and behavioral symptoms were common among the spouses with Alzheimer's disease. The services most often offered were financial support (36%), technical devices (33%), physiotherapy (32%), and respite care in nursing homes (31%). Most often needed services were physiotherapy for the spouse with dementia (56%), financial support (50%), house-cleaning (41%), and home respite (40%). Only 39% of the caregivers were satisfied with the services, and 69% felt they did not have any influence on what services were offered. It was concluded that official services poorly meet the needs of these caregivers.
Provision of Morning Care to Nursing Home Residents With Dementia: Opportunity for Improvement?
Authors: Sloane Philip D. , Miller Lois L. , Mitchell C. Madeline , Rader Joanne , Swafford Kristen , Hiatt Shirin O.
Published: October 2007

Significant contact between nursing staff and nursing home residents with dementia occurs during assistance with activities of daily living during morning care; however, the content and process of morning care have received little attention in the scientific literature. To better understand the morning care process and its role in generation of pain symptoms, 51 videotaped episodes of morning care involving 17 nursing home residents from 3 long-term care facilities were coded and analyzed; each resident had a diagnosis of dementia and concern about possible pain during assistance with activities of daily living. The typical morning care episode involved performance of multiple activities of daily living during a short period of time, during which pain stimulation and expression occurred frequently. Much could be done to make morning care more an activity to be enjoyed rather than a task to be completed.
Phantoms of Home Care: Regulatory Constraints on Home Care Nurse Care Management of Persons With Alzheimer's Disease
Authors: Cabin William D.
Published: October 2007

Early indications are that the Medicare home health prospective payment system has controlled Medicare home health expenditures. However, studies indicate many unresolved questions about whether the prospective payment system improves patient quality of care and is cost-effective. The question persists as to whether the prospective payment system has intensified the Medicare home health benefit's historic focus on acute medical care, ignoring the needs of persons with chronic diseases. The article reviews effective home-based palliative care interventions and presents the views of 7 home health care nurses regarding the impact of Medicare requirements on their care decisions for one chronic disease population, patients with Alzheimer's disease. The nurses identify Alzheimer's disease symptom management and psychosocial needs as phantoms, omnipresent below the surface but not attended to by home care clinicians. Nurse coping strategies are discussed. The article asserts that the current failure to simultaneously address the cost and quality-of-life issues of persons with Alzheimer's disease who are cared for at home is analogous to the end-of-life care situation Medicare confronted in the 1970s prior to the Medicare hospice demonstration program, which preceded the Hospice Medicare Benefit. The article asserts that a similar demonstration is appropriate to determine how the prospective payment system might better address quality of life and costs of persons with Alzheimer's disease who are cared for at home.
ACE mediates ventilator-induced lung injury in ratsviaangiotensin II but not bradykinin
Authors: Wösten-van Asperen R. M. , Lutter R. , Haitsma J. J. , Merkus M. P. , van Woensel J. B. , van der Loos C. M. , Florquin S. , Lachmann B. , Bos A. P.
Published: October 2007

Ventilator-induced lung injury is characterised by inflammation and apoptosis, but the underlying mechanisms are poorly understood. The present study proposed a role for angiotensin-converting enzyme (ACE)viaangiotensin II (Ang II) and/or bradykinin in acute lung injury. The authors assessed whether ACE and, if so, Ang II and/or bradykinin are implicated in inflammation and apoptosis by mechanical ventilation.

Rats were ventilated for 4 h with low- or high-pressure amplitudes in the absence or presence of the ACE inhibitor captopril. Nonventilated animals served as controls. ACE activity, Ang II and bradykinin levels, as well as inflammatory parameters (total protein, macrophage inflammatory protein-2 and interleukin-6) were determined. Apoptosis was assessed by the number of activated caspase-3 and TUNEL (terminal deoxynucleotidyltransferase-mediated deoxyuridine triphosphate nick-end labelling)-positive cells.

Bronchoalveolar lavage fluid ACE activity, levels of total protein, inflammatory parameters and the number of apoptotic cells were increased in the high-pressure amplitude group as compared with the control group. Blocking ACE activity by captopril attenuated inflammation and apoptosis in the latter group. Similar results were obtained by blocking Ang II receptors, but blocking bradykinin receptors did not attenuate the anti-inflammatory and anti-apoptotic effects of captopril.

The current authors conclude that inflammation and apoptosis in ventilator-induced lung injury is, at least in part, due to angiotensin-converting enzyme-mediated angiotensin II production.