bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Manifestations of Severe Gastrointestinal Motility Disturbance
Authors: Anuras Sinn , Anuras Jitra
Published: June 2007

Severe gastrointestinal motility disturbance, or pseu doobstruction, can cause symptoms and signs that mimic mechanical bowel obstruction in patients. The symptoms depend on the parts of the gastrointestinal tract involved. Patients may have dysphagia with esoph ageal involvement, gastroparesis with stomach involve ment, intestinal pseudoobstruction with small bowel in volvement, or colonic pseudoobstruction with colonic involvement. Patients often have involvement of more than one part of the gastrointestinal tract. Gastrointesti nal motility abnormality can be the result of diseases that cause either smooth muscle or myenteric plexus abnormalities and dysfunction. It is important to locate the dysfunctional segment of the bowel so that proper treatment can be initiated. The incidence of severe gas trointestinal motility disturbance is not known, but it is probably more common than has been recognized. Me chanical obstruction of the bowel is much more com mon than pseudoobstruction; therefore, it must be ruled out before a diagnosis of pseudoobstruction is made. Gastrointestinal contents are moved along the di gestive tract as a result of normal coordinated pro pulsion of its wall. Abnormal gastrointestinal motil ity from either hypoactivity or uncoordinated hyperactivity causes ineffective propulsion and re tention of the contents in the defective organ. Ob structive symptoms of the defective organ will de velop in patients with severe gastrointestinal motility disturbance. Table 1 lists these manifesta tions. They may occur individually or in combi nation, depending on the diseases that cause the abnormal motility. In this review we discuss pathophysiology, causes, clinical manifestations, diagnosis, and treatment of these problems.
Unstable Angina Pectoris: An Interventional Approach to Management
Authors: Johnson Eric , Ports Thomas
Published: June 2007

The therapy of unstable angina has changed consider ably in the last 15 years. An improved understanding of the pathophysiology has led to many of the changes. Thrombus, platelet activation, progression of athero sclerosis, and coronary vasospasm all appear to have a role. Initial management in unstable angina should begin with aggressive medical therapy with nitrates, calcium antagonists, beta blockers, and aspirin. In patients who are refractory to aggressive medical management, early cardiac catheterization and coronary arteriography is in dicated. The literature appears to confirm that patients with unstable angina who are stabilized with aggressive medical therapy fare as well as those treated with emer gency bypass surgery. Percutaneous transluminal coro nary angioplasty (PTCA) is the treatment of choice in medically refractory unstable angina patients with single-vessel coronary disease.

New approaches include culprit lesion angioplasty, thrombolytic therapy, coronary sinus retroperfusion, and new catheter-based revascularization methods such as intracoronary stents, laser methods and atherectomy. Culprit lesion angioplasty involves angioplasty of only the angina-producing artery in patients with multivessel coronary disease. Early data suggest that this may be an effective short-term alternative to multivessel PTCA or bypass surgery. Recent data also suggest a beneficial role for thrombolytic therapy and synchronized coronary si nus retroperfusion with arterial blood in patients with unstable angina. New catheter-based approaches are in the early stages of development, and their eventual role in the treatment of coronary artery disease and unstable angina remains to be elucidated.
Pulmonary Barotrauma in the Intensive Care Unit
Authors: Powner David J.
Published: June 2007

Disruption of lung parenchyma by airway gas (baro trauma) frequently occurs in the intensive care unit. Gas may move from the airspace into several abnormal loca tions as a result of dissection along anatomical fascial planes to potentially produce interstitial emphysema, subpleural cysts, pneumomediastinum, subcutaneous emphysema, pneumopericardium, pneumothorax, pneu moperitoneum, pneumoretroperitoneum, bronchopleu ral fistulas, and air-entry into blood vessels. Although usually of limited clinical consequence, this extra-alve olar air may produce clinically significant morbidity and mortality. Recognition of these potential complications of pulmonary disease and its therapy may assist the clini cian in correctly diagnosing, avoiding, and treating the manifestations of pulmonary barotrauma.
Analytic Reviews : State-of-the-art Management of Severe Closed-head Injury
Authors: Duffy Kent R. , Becker Donald P.
Published: June 2007

Brain injury represents the most serious result of head trauma. In the last decade we have witnessed important advances in understanding the pathophysiological re sponses of the brain and body to severe head injury. A significant increase in good recoveries and reduction in mortality have been realized by using programs that provide rapid transport and patient triage, early diag nosis of intracranial masses and removal of large lesions, controlled positive-pressure ventilation, treatment of elevated intracranial pressure, prevention of secondary insults, and intensive management. This review empha sizes acute management of severe closed-head injury in an intensive care unit setting. Many of these same princi ples for trauma can be applied to the intensive manage ment of any brain injury, including stroke. Future ad vances are discussed.
Indications for and Complications of Rectal Tube Use in Critically Ill Patients
Authors: Channick Richard , Curley Frederick J. , Irwin Richard S.
Published: June 2007

To better define the indications for and complications of rectal tube use in critically ill patients we prospectively studied every patient admitted to an intensive care unit over a 20-month period who required a rectal tube. Of these patients, 2.8% had rectal tubes inserted. Ninety- two percent were inserted to help decrease soiling from diarrhea and 6% were inserted to deliver medica tions. Tubes were in place an average of 3.3 days, and no complications were identified. Rectal tubes may be safely and effectively used to prevent soiling in critically ill patients with diarrhea. The use of rectal tubes as ad juncts to healing and preventing pressure sores in criti cally ill patients merits further study.
Acute Respiratory Failure in Pregnancy
Authors: Hollingsworth Helen M. , Pratter Melvin R. , Irwin Richard S.
Published: June 2007

Acute respiratory failure in pregnancy has multiple etiologies, including thromboembolism, amniotic fluid embolism, venous air embolism, aspiration of gastric contents, respiratory infections, asthma, beta-adrenergic tocolytic therapy, and pneumomediastinum and pneu mothorax. Proper management of acute respiratory fail ure in pregnancy requires an understanding of the specific diseases and the normal gestational changes that occur in maternal respiration (decreased functional re sidual capacity, increased minute ventilation, mild respi ratory alkalosis) and hemodynamics (increased cardiac output, increased blood and plasma volume, unchanged central pressures). Knowledge of the determinants of oxygen delivery to fetal tissue (uterine blood flow, pla cental transfer, fetal circulation) and how they are af fected by changes in maternal hemodynamics, position, acid-base status, and medications can help sustain nor mal fetal development, whenever possible, without compromising maternal care. Diagnostic testing such as radiography, hemodynamic monitoring, and fetal moni toring are considered in terms of attendant risk to the mother or the fetus, alterations in normal values related to gestation, and indications for usage. Similarly, the risks and benefits of supportive and specific therapies for the various etiologies of acute respiratory therapy are reviewed.
Analytic Reviews : Hemolytic Transfusion Reactions: A Review of Mechanisms, Sequelae, and Management
Authors: Capon Stephen M. , Sacher Ronald A.
Published: June 2007

The transfusion of blood and blood products is an im portant therapeutic procedure, but it is associated with several potentially serious adverse effects. Among these complications are hemalytic reactions, which in most cases result from the interaction between donor red cell antigens and recipient plasma antibodies. Clinical mani festations and sequelae are largely determined by the physical and immunological characteristics of the anti gens and antibodies. Early recognition may be difficult in the anesthetized or intensively monitored patient. Acute hemolytic reactions are responsible for significant morbidity and mortality and may lead to life-threatening shock, disseminated intravascular coagulation, and renal failure. Fortunately, fatal hemolytic transfusion reactions are rare; they usually result from clerical errors. Proper diagnosis and management requires sound clinical judg ment, thorough laboratory investigation, and timely therapeutic intervention.
Analytic Reviews : Organ Procurement and Brain Death in Trauma Patients
Authors: Mackersie Robert C.
Published: June 2007

The success rates and effectiveness of transplantation programs continue to increase, as does the need for cadaveric organs. Increasing organ procurement is a worthwhile goal that can be fully justified on economic, humanistic, and ethical bases. Although a great deal of progress has been made in terms of public and political awareness of organ procurement problems, additional changes and further education will be necessary before the number of cadaveric organs that are needlessly wasted can be reduced.

Management of patients with unsurvivable head in juries or patients who are candidates for organ donation is a complex task involving critical care management, the declaration of brain death, and the identification of, and request for, organ donation from next of kin. This process involves the coordinated efforts of neurosur geons, critical care specialists, social workers, and the transplant team coordinators in organ procurement pro grams. Patients are best managed in tertiary centers that have staffs with the expertise and interest in performing these tasks. The time to cardiac death in brain-dead pa tients is frequently short and is hastened by the develop ment of rapidly progressive derangements in gas ex change, fluid and electrolyte homeostasis, temperature regulation, coagulation, and cardiovascular function. Premature death under these circumstances continues to be a major reason for organ-procurement failure. Ag gressive monitoring and treatment of the multiple med ical problems encountered, however, may reduce the number of patients who die prematurely and thus in crease organ procurement rates.
Upper Respiratory Tract Infections in the Critically I11
Authors: Jacobs Teresa E. , Irwin Richard S. , Raptopoulos Vassilios
Published: June 2007

A review of severe upper respiratory tract infections that present in the critically ill (supraglottitis [epi glottitis], deep neck infections, and sinusitis) is pre sented with attention to pathogenesis, pathophysiology, diagnosis, differential diagnosis, and treatment. Supra glottitis is increasingly diagnosed in adults and, as with children, early recognition is crucial to limit mortality. To aid in diagnosis and treatment, a management al gorithm is used. Deep cervical infections, usually exten sions of upper airway infections, can spread along fascial planes with fatal results. Knowledge of the interconnec tions between anatomical spaces is a prerequisite to diagnosis and treatment. Sinusitis will present in the critically ill as orbital or intracranial complications or as a nosocomial infection. Discussions of acute and chronic community-acquired sinusitis in general, noso comial sinusitis, and sphenoid sinusitis as a separate en tity highlight differences in clinical presentation and bacteriology that are important to diagnosis and treat ment.
You Don't Need a Judge to Terminate Treatment
Authors: Mishkin Douglas B.
Published: June 2007

Professional autonomy implies professional responsibil ity. Health care professionals who harbor unfounded fears of liability for complying with patient decisions to terminate treatment create unwarranted obstacles to fulfilling their responsibility to know and respect their patients' rights. Keeping patient requests to terminate treatment inside the hospital and out of the courts pro motes informed and shared decision-making by patient and physician, and reduces the genuine risk of legal liability.
Capnography in the Intensive Care Unit
Authors: Morley Thomas F.
Published: June 2007

Recent technical innovations have made portable cap nographic monitoring systems available for intensive care unit use. Some of these systems require little tech nical expertise to operate. Capnography has several clin ically relevant applications. It may be used as a monitor of respiration (apnea monitor), of wasted ventilation, or as a reflection of arterial carbon dioxide tension. In some clinical settings, it may provide information about changes in lung perfusion or carbon dioxide produc tion. Because this technique is noninvasive and con tinuous, it offers certain advantages over intermittent arterial blood gas monitoring. The advantages and limi tations of this technique are discussed.
People and Technology Management in Flexible Manufacturing: An Apparel Industry Case Study
Authors: Loker Suzanne
Published: June 2007

Interviews were conducted with senior and middle managers, sales and marketing staff, and production employees who worked in teams at a small apparel manufacturing plant in the northeastern United States. The input of technology management was incorporated into Bailey’s model of high-performance work systems (i.e., flexible manufacturing) and used as a conceptual framework to organize and analyze the case study. Interviews focused on technology management, employee involvement, technical and people skills, and employee discretionary effort. Interrelationships among people and technology created greater organizational capacity. Employees at all levels in the firm described their opportunities for involvement, technical and soft skill development, and the discretionary efforts by employees that these opportunities promoted. The results support implementation of flexible or high-performance work systems that focus on technology management, skill development, and employee involvement through team organization. Additional quantitative and qualitative research is recommended to evaluate the performance effects of these work systems and clarify the relationships among these variables.
Appearance and Dress as a Source of Information: A Qualitative Approach to Data Collection
Authors: Johnson Kim K. P. , Schofield Nancy A. , Yurchisin Jennifer
Published: June 2007

A content analysis of 39 women’s responses to open-ended interview questions revealed a) what impressions they formed of others based on appearance and dress, as well as what cues they chose, and b) that they believed that others also used appearance and dress cues when forming impressions of them. Neither participants’ impressions of others nor participants’ beliefs regarding others’ impressions of them contained information that extended beyond the perceived person to include other people or things associated with the perceived person. Instead, the content of the information inferred included personality characteristics, information about behaviors, biological traits, health and hygiene, and social roles. Most participants believed that both they and others were accurate at decoding information from general appearance and dress cues, although some participants believed that accuracy was dependent upon the situation or related to specific appearance or dress cues.
Acceptance of Mass Customization of Apparel: Merchandising Issues Associated With Preference for Product, Process, and Place
Authors: Lee Seung-Eun , Kunz Grace I. , Fiore Ann Marie , Campbell J. R.
Published: June 2007

The purpose of our research was to examine apparel merchandising issues associated with mass customization. A questionnaire was developed to explore preferences for mass customization product, process, and place that have the potential of affecting success of a mass customization program. The questionnaire was administered to a convenience sample of 131 college students. Data were analyzed using descriptive statistics, t-tests, McNemar tests, within-subject ANOVA, and Bonferroni multiple comparisons. Successful mass customization of apparel at retail is dependent on identification of appropriate dimensions of product, process, and place. Our implications address merchandising issues associated with customer involvement in customizing design and fit of apparel products in retail store settings.
Teaching, Consulting, and Conducting Research Across Cultures: An International Opportunity in Tajikistan
Authors: Daly M. Catherine
Published: June 2007

Sponsored by the Winrock International Program1 in May 1996, I had an opportunity to teach, consult, and conduct preliminary research in Tajikistan, one of the Newly Independent States of the former Soviet Union in Central Asia.2 Using a reflexive perspective3 this paper details the logistics, negotiations and collaborations with emphasis on my teaching and consulting work plan prior to my assignment in the Textile Industry Program4 at the Technological University of Tajikistan in Dushanbe. These arrangements subsequently affected my teaching and consulting opportunities in other regions of Tajikistan and the preliminary research I conducted. This international opportunity reflects not only what is required of those who conduct international projects but as well suggests implications for textile and apparel scholars interested in designing similar development work related to their professional area of interests.
Testing the Behavioral Intentions Model of Online Shopping for Clothing
Authors: Kim Youn-Kyung , Kim Eun Young , Kumar Shefali
Published: June 2007

This study tested the predictability of modified Fishbein’s behavioral intentions model in the context of online shopping for clothing. Specifically, the study examined the relative importance of attitude and subjective norm in influencing consumer intention to shop for clothing online. A mailing survey was conducted with 303 adults who had a computer at home and had access to the Internet in the United States. Data were analyzed to estimate the behavioral intention model of online shopping (i.e., measurement model and structural model). Attitude toward online shopping was composed of two factors: product and convenience and service. The results supported the modified behavioral intentions model; both attitude and subjective norm influenced behavioral intention. Implications are drawn for online retailers of clothing.
Lyocell Solutions from Alternative Cellulose Sources
Authors: Dever Maureen , Collier Billie J. , Petrovan Simioan , Collier John R.
Published: June 2007

Lyocell fibers, a generic subclass of rayon fibers, are produced from cellulose dissolved in N-methylmorpholine oxide (NMMO). The lyocell solutions typically consist of blends of cellulose from similar low and high degree of polymerization (DP) dissolving pulps to achieve desired spinnability and fiber properties. The objective of this research was to determine if alternative lower value cellulose sources could be used as raw materials for lyocell by characterizing solutions made from these sources. Shear viscosity, which strongly affects spinning of fibers, of ten cellulose sources at four concentrations was compared to that of five industrial dissolving pulp standards with DPs from 670 to 1720. Bleaching, concentration, cellulose source, and their interactions had significant effects on shear viscosity. Kudzu, sugarcane bagasse, recycled, and thermomechanical cellulose pulps had higher viscosities than did the more highly processed hardwood and softwood. Bagasse was similar to the lowest DP dissolving pulp standard. Recycled and thermomechanical pulps were similar to the higher DP standard and bleaching affected the shearing behavior of these less pure pulps. Shear viscosity measurements were effective in determining differences among the pulps.
In the Bag: Contact Natural Dyes
Authors: Kadolph Sara J. , Casselman Karen Diadick
Published: June 2007

Contact dyeing is a practical alternative to the more common immersion method of natural dyeing. Contact dyeing is a very low liquor ratio method where the actual natural dyestuff is placed around and between the goods to be dyed. The dyestuff and goods are compressed into a bundle that is placed in a plastic bag and heated by using steam, a microwave oven, or solar energy. The focus in most dyeing is on duplication and replication of color and motif. In contact dyeing, the focus is shifted to use of innovative materials such as organic waste, found objects, and pantry or kitchen items. Appropriate dyestuffs, materials, and equipment are described, but specific results are unpredictable. This chance factor is the primary goal in contact natural dyeing: to create complex, random patterns and colors easily and inexpensively, without the use of chemical mordants that are used with immersion natural dye methods.
Knitwear Product Development Process: A Case Study
Authors: Pitimaneeyakul Uraiwan , LaBat Karen L. , DeLong Marilyn R.
Published: June 2007

A well-defined product development process assists the organization to determine its future direction, plan for rapid changes, create new product line profits, and plan for technology adoption and implementation (Thomas, 1993). The goal of this research was to propose an optimal product development process for knitwear companies by examining the process used by a major U.S. sweater company and comparing its process to established processes. Yin’s (1984) single case study and Patton’s (1990) qualitative research approaches were adapted for data collection. Various methods of collecting data were employed, including interviewing key personnel, making direct observations, and examining written documents. Preliminary suggestions for improving the product development process included extending market research to include end users, using pre-costing early in the process, integrating quality assurance, and using computer-aided-design and product development management software.
Television Apparel Shopping: Impulse Buying and Parasocial Interaction
Authors: Park Ji Hye , Lennon Sharron J.
Published: June 2007

The purpose of this study was to explore impulsivity as a motivation for television apparel shopping and to investigate impulse buying, parasocial interaction, television exposure, and television shopping program exposure among television apparel shoppers. One hundred fifty-four questionnaires were returned from television apparel shoppers. A content analysis revealed four broad categories of motivations for television shopping for apparel. Using simple regression analyses, the present research found (a) a positive relationship between impulse buying and television shopping exposure, (b) a positive relationship between impulse buying and parasocial interaction, and (c) positive relationships between parasocial interaction and both television shopping exposure and television exposure.
Casual Versus Formal Uniforms: Flight Attendants' Self-perceptions and Perceived Appraisals by Others
Authors: Adomaitis Alyssa Dana , Johnson Kim K. P.
Published: June 2007

Flight attendants were required to wear a casual uniform consisting of khakis and t-shirts in place of a formal one consisting of a suit. Within a year, management eliminated the casual uniform and returned to the formal uniform. The purpose of our research was to investigate whether type of uniform (formal versus casual) worn influenced flight attendants' role enactment and self-perceptions at work and in what ways, if any, the change to a casual uniform affected employee relationships with peers and passengers. Interview data were gathered from 37 flight attendants who experienced the switch from a formal to a casual uniform and then back again. Participants were asked to reflect on their experiences with co-workers and customers, as well as to reflect on their own perceptions and behaviors while wearing the formal and casual uniforms. Data were analyzed using the line-by-line approach (Van Manen, 1990). Flight attendants' behavior, self-perceptions, and feelings about their ability to carry out their role as flight attendants, as well as their perceived treatment by others were altered when wearing a casual uniform as compared to wearing a formal uniform.
Using the WebCT NAFTA Program to Promote Analytical Thinking and Global Awareness Competencies Through a Team Approach
Authors: Eckman Molly , Frey Diane K.
Published: June 2007

Recent focus on educational accountability has led to emphasis on innovative and effective pedagogy to achieve competencies. Effective pedagogy supports various learning styles and higher order thinking. The WebCT-based lesson implemented in this study served to: 1) assess achievement of two competencies (analytical thinking, global awareness) essential for the global industry, 2) support field independent/dependent learning styles, and 3) promote development of higher order cognitive skills. Students responded to WebCT case questions addressing outsourcing decisions. The lesson supported achievement of the two competencies as indicated by self-assessment and instructor-scored essays. The Group Embedded Figures Test categorized students' learning styles as field independent/dependent. There was instructional support for students regardless of different learning styles. Essays provided evidence that students engaged in higher order thinking. WebCT-based instruction can be effective for achieving analytical and global competencies, accommodating different learning styles, and promoting higher order thinking when solving complex global apparel economic topics.
Studying Drugs in Human Milk: Time to Unify the Approach
Authors: Begg Evan J. , Duffull Stephen B. , Hackett L. Peter , Ilett Kenneth F.
Published: June 2007

The trend globally for mothers to breastfeed has highlighted the need for information on drug transfer into breast milk and the extent to which the suckling neonate may be exposed and affected. This reviewdiscusses robust study methodologies that will yield high-quality information on all aspects of this process. Methods for assessing drug transfer into breast milk are examined. The place of the milk/plasma ratio, the amount of drug in breast milk, and the volume of milk produced are discussed in the context of their utility in estimating both absolute and relative infant dose. The measurement of plasma drug concentrations and pharmacodynamic effects in the breastfed infant exposed to drugs are identified as important factors that can assist in deciding whether drug present in breast milk is a significant risk for the nursing infant.
The Fatty Acid Composition of Human Milk in Northern Nigeria
Authors: Okolo Seline N. , VanderJagt Timothy J. , Vu Trang , VanderJagt Thomas A. , VanderJagt Dorothy J. , Okonji Maria , Huang Y-S , Chuang Lu-Te , Onwuanaku Carol , Glew Robert H.
Published: June 2007

The authors previously reported that the milk of Yoruba women in southwestern Nigeria was deficient in •-linolenic acid and contained a high percentage (42%) of medium chain–length fatty acids (MCFA, C10-C14). In the present study, the authors used capillary gas-liquid chromatography to analyze the milk of Hausawomen in the northern region of Nigeria. The milk of the Hausa women contained 27% MCFA, 10.6% linoleic acid, 0.41% •-linolenic acid, 0.52% arachidonic acid, and 0.32% docosahexaenoic acid. The proportion of •-linolenic acid in the serum phospholipids of a subset of exclusively breastfed infants ( n=15; mean age, 6.2 ± 0.3 months) was below the limit of detection (<0.03%). While the milk of women in northern Nigeria is adequate with regard to n-3 and n-6 fatty acids, to satisfy the requirements for •-linolenic acid, it may be necessary to supplement the infants of these women after the first 6 months of life.
Nipple Shields for Preterm Infants: Effect on Milk Transfer and Duration of Breastfeeding
Authors: Meier Paula P. , Brown Linda P. , Hurst Nancy M. , Spatz Diane L. , Engstrom Janet L. , Borucki Lynn C. , Krouse Ann M.
Published: June 2007

This study reports breastfeeding outcomes for 34 preterm infants whose mothers used ultra-thin silicone nipple shields to increase milk transfer. Mean milk transfer was compared for 2 consecutive breastfeedings without and with the nipple shield. Total duration of breastfeeding was calculated for a maximum of 365 days. Mean milk transfer was significantly greater for feedings with the nipple shield (18.4 ml vs. 3.9 ml), with all 34 infants consuming more milk with the nipple shield in place. Mean duration of nipple shield use was 32.5 days, and mean duration of breastfeeding was 169.4 days; no association between these variables was noted. The nipple shield was used for 24.3% of the total breastfeeding experience, with no significant association between the percentage of time the shield was used and total duration of breastfeeding. These findings are the first to indicate that nipple shield use increases milk intake without decreasing total duration of breastfeeding for preterm infants.
The Relationship Between the Timing of Maternal Postpartum Hospital Discharge and Breastfeeding
Authors: Margolis Lewis H. , Schwartz J. Brad
Published: June 2007

This study examines the association between discharge timing and breastfeeding, controlling for demographic, economic, and health factors that influence both. Using the 1988 National Maternal and Infant Health database, maximum-likelihood modeling was used to generate 2-equation models to estimate both outcomes simultaneously. The joint estimation of breast-feeding and discharge timing demonstrates that mothers who spent 1 night in the hospital were more likely to breastfeed than mothers who spent 2 or 3 nights in the hospital (OR=1.96, 95% C.I. 1.86-2.03). Furthermore, the model altered the association between breastfeeding and age, breastfeeding advice, and prenatal classes. In 1988, when decisions were a function of clinical judgments about readiness for discharge, early discharge was associated with an increased likelihood of breastfeeding. Instead of basing discharge solely on predetermined rules, derived largely from financial criteria, attention to the decision-making process should be an important part of newborn discharge policies.
Polycystic Ovary Syndrome: A Connection to Insufficient Milk Supply?
Authors: Marasco Lisa , Marmet Chele , Shell Ellen
Published: June 2007

Despite advances in lactation skills and knowledge, insufficient milk production still continues to mystify mothers and lactation consultants alike. Based on 3 cases with similar threads, a connection is proposed between polycystic ovary syndrome (PCOS) and insufficient milk supply. Described are the etiology and possible symptoms of PCOS such as amenorrhea/oligomenorrhea, hirsutism, obesity, infertility, persistent acne, ovarian cysts, elevated triglycerides, and adult-onset diabetes, along with possible pathological interference with mammogenesis, lactogenesis, and galactopoiesis. Clinical suggestions include guidelines for screening mothers and careful monitoring of babies at risk. Further research is necessary to confirm the proposed association and to develop therapies with the potential to improve lactation success.
Knowledge and Attitudes of Pediatric Office Nursing Staff About Breastfeeding
Authors: Register Nancy , Eren Margaret , Lowdermilk Dietra , Hammond Rosalie , Tully Mary Rose
Published: June 2007

This descriptive study documents nurses'breastfeeding knowledge and attitudes. The nursing staffs of 27 private pediatric practices in North Carolina were surveyed. The 42-item questionnaire included questions about who was responsible for breastfeeding support, what staff nurses knew and believed about breastfeeding, and where their breastfeeding education was obtained. The response rate was 59% (134 out of 227). Only 5% responded that a breastfeeding patient experiencing problems would be referred to a physician, whereas 81% selected a lactation consultant, and 38% selected a member of the nursing staff. Knowledge scores ranged from 19 to 33 (out of 33). Attitude scores ranged from 10 to 30 (out of 30). Only 46% of respondents reported having received breastfeeding education in their training programs; 85% had received on-the-job training. The nurses surveyed were involved in breastfeeding support, yet many had incorrect information and negative attitudes toward breastfeeding.
Use of Anti-Infective Agents During Lactation: Part 1—Beta-Lactam Antibiotics, Vancomycin, Quinupristin-Dalfopristin, and Linezolid
Authors: Chin Karen G. , Mactal-Haaf Christina , McPherson Charles E.
Published: June 2007

Because many antibiotics are excreted into the breast milk, it can be difficult for a practitioner to choose an antibiotic for a lactating patient that will have minimal risks to her nursing infant. This article is the first of a three-part series discussing the use of anti-infective agents during lactation. The authors review general information regarding use and common side effects of several classes of antibiotics. They also summarize information, including documented milk concentrations, milk-to-plasma ratios, and other pharmacokinetic properties, in a table that can help practitioners choose antibiotics that may be considered safe for the lactating mother.
Predicting Breastfeeding Duration Using the LATCH Breastfeeding Assessment Tool
Authors: Riordan Jan , Bibb Diane , Miller Marsha , Rawlins Tim
Published: June 2007

The authors tested the validity of the LATCH breastfeeding assessment tool, controlling for intervening variables in 133 dyads. LATCH scores, mother's evaluation of an index feed, and intended duration of breastfeeding were assessed postpartum and followed 6 weeks. Women breastfeeding at 6 weeks postpartum had higher LATCH scores ( x± SD= 9.3 ± 0.9) than those who weaned ( x± SD = 8.7 ± 1.0), due to only one measure, breast/nipple comfort. Women who weaned before 6 weeks reported lower breast/nipple comfort (1.5 ± 0.5) than those who were still breastfeeding at 6 weeks (1.7 ± 0.5, P< .05). Total LATCH scores accounted for 7.3% of variance in breastfeeding duration. Total LATCH scores positively correlated with duration of breastfeeding (n = 128; r= .26, P= .003) and to mothers' scores (n = 132; r= .58, P= .001). Correlations among LATCH measures ranged from .02 to .51. The LATCH tool is a useful identifies the need for follow-up with breastfeeding mothers at risk for early weaning because of sore nipples.
Disruption of Lactogenesis by Retained Placental Fragments
Authors: Anderson Ann M.
Published: June 2007

This case report describes a situation in which lack of milk production led the mother to seek help from a lactation consultant in private practice. Despite extensive breast stimulation with the baby at breast and mechanical breast expression, no milkwas produced. Retained placenta was suspected by the lactation consultant. The mother was later diagnosed with placenta increta. Only when this condition was diagnosed and resolved did milk onset occur. It is important to evaluate for retained placental fragments when lactation appears to be delayed.
Sensory Defensiveness: A Theory of Its Effect on Breastfeeding
Authors: Weiss-Salinas Denise , Williams Nancy
Published: June 2007

This article describes one type of sensory integrative disorder: sensory defensiveness. An examination of the possible relationship of this disorder to an infant's difficulties with breastfeeding is conducted. A family case study is detailed, followed by treatments implemented by the authors. Possible long-term sequelae, as well as the need for more interdisciplinary research, are discussed.
Weaning, Complementary Feeding, and Maternal Decision Making in a Rural East African Pastoral Population
Authors: Sellen Daniel W.
Published: June 2007

A small-scale, prospective study of breastfeeding and weaning practices was conducted in a seminomadic pastoral population in northern Tanzania (Datoga of Mbulu District, Arusha Region). Focus group participants suggested that weaning patterns are strongly influenced by seasonal factors, and individual mothers often stated an intention to introduce adult staple foods and terminate breastfeeding at the end of the long rains. However, a combination of maternal self-perception, assessment of infant well-being, and indicators of household food supply influenced the actual progression of weaning for individual children. The results suggest that interventions to promote exclusive breastfeeding and improve complementary feeding practices in rural East African pastoral populations could build on maternal attention to infantcentered cues and address household-level constraints on caregivers making decisions about young child feeding.
Breastfeeding Knowledge and Beliefs Among Adults in Eastern Tobago
Authors: Bovell-Benjamin Adelia C. , Benjamin William , Ivey Marsha , Simeon Donald T.
Published: June 2007

Using a cross-sectional survey, the knowledge and beliefs about breastfeeding were evaluated among adults in Eastern Tobago (N = 509). Of the respondents, 95%, 69%, and 48% indicated that a baby should be exclusively breastfed at birth, 3 months, and 6 months, respectively. The baby's mother was thought to have the greatest influence on breastfeeding decisions. Of the respondents, 63% and 80% were unaware of expressed breast milk and cup-feeding a neonate, whereas 82% believed that a solely breastfed baby should receive water. Additionally, 23% and 44% felt that breastfeeding should be terminated before 6 months and between 6 and 12 months, respectively. Inadequate maternal nutrition and employment were reported as the principal factors affecting breastfeeding. There is a lack of knowledge about the anatomy and physiology of lactation and about the benefits of exclusive breastfeeding. These findings are useful for guiding the development and implementation of interventions to promote breastfeeding in Tobago.
Bottle-Feeding as a Tool to Reinforce Breastfeeding
Authors: Kassing Dee
Published: June 2007

Babies may need supplementation due to difficulty breastfeeding. Others must be fed by alternative feedingmethods because they are separated from mothers who have returned to employment or school. Recognizing that mothers and caregivers are often not comfortable using other alternative feedingde vices, the author endeavored to develop a method of bottle-feeding that would meet the needs of these mothers and their babies without causingsuck confusion. The resultingbottle-feedingmethod requires babies to expend effort and use their oral anatomy in ways very similar to breastfeeding.
Cup or Bottle for Preterm Infants: Effects on Oxygen Saturation, Weight Gain, and Breastfeeding
Authors: Rocha Neide M. N. , Martinez Francisco E. , Jorge Salim M.
Published: June 2007

The impact of cup-feeding or bottle-feeding on weight gain, oxygen saturation, and breastfeeding rates of preterm infantswas studied in 34 bottle-fed and 44 cup-fed preterm infants. At initiation of oral feeding, postconceptional age and weight were 37.2 ± 2.2 weeks and 1676 ± 83 g for the bottle-fed group (BF) and 37.0 ± 1.6 weeks and 1637 ± 40 g for the cup-fed (CF) group, respectively. No significant differences between groups were found with regard to time spent feeding, feeding problems, weight gain, or breastfeeding prevalence at discharge or at 3-month follow-up. Possible beneficial effects of cup-feeding were lower incidence of desaturation episodes (13.6% vs 35.3%, CF vs BF, P= .024) and a higher prevalence of breastfeeding at 3 months among those still breastfeeding at the first follow-up visit (68.4% vs 33.3%, CF vs BF, P= .04).
A 5-Year Follow-up Study of Hospital Breastfeeding Policies in the Philadelphia Area: A Comparison With the Ten Steps
Authors: Kovach Andrea Crivelli
Published: June 2007

The purpose of this study was to describe the current status of hospital breastfeeding policies and practices in the Philadelphia area, to assess hospitals’current implementation levels of the Ten Steps to Successful Breastfeeding, and to compare current implementation levels with 1994 baseline data. Most surveyed hospitals were fully implementing 5 of the Ten Steps. Thirty-seven percent of the hospitals were classified as high implementers and 63% as partial implementers of the Ten Steps overall. Key factors that affect implementation of each step were identified through in-depth discussions. Areas identified as needing the greatest attention were breastfeeding education of health care professionals and mothers, prenatal and postdischarge outreach to mothers, and the restriction of infant supplementation. Additionally, ethnic diversity and cultural beliefs of the mother-infant couple that influence breastfeeding choices need to be considered.
The Family Management of Breastfeeding Low Birth Weight Infants
Authors: Krouse Anne M.
Published: June 2007

Human milk plays a vital role in the health and development of low birth weight (LBW) infants, yet the initiation and duration rates of breastfeeding in this population are far below those of term infants. Families play an important role in the breastfeeding experience and therefore may contribute to the overall success or lack thereof of the experience. This qualitative study used naturalistic inquiry to describe the family management styles of 13 breastfeeding families of LBW infants. The family management style conceptual framework guided this inquiry, with management styles emerging from the families’ definition of the experience and their management behaviors within their unique sociocultural context. These families described facilitating, maintaining, and obstructing family management styles. Through the identification of distinct management styles, interventions may be developed that will assist these families to achieve their breastfeeding goals.
Breastfeeding and Employment: An Assessment of Employer Attitudes
Authors: Libbus M. Kay , Bullock Linda F. C.
Published: June 2007

Both research and anecdotal reports suggest that maternal employment is associated with failure to initiate breastfeeding and early breastfeeding attrition. The objective of this studywas to describe the experience with and attitudes toward breastfeeding of a sample of employers in a small Midwestern city in the United States. Based on an analysis of 85 mail-out questionnaires, we found that less than half of the employers had personal experience with breastfeeding. A large percentage of the sample, however, indicated that they would be willing to facilitate women who wished to breastfeed or express milk in the workplace. However, these employers also stated that they saw little value to their business of supporting breastfeeding in the work environment. Thus, enhancement of breastfeeding opportunity in the work environment may come as a result of public and employer education but, more likely, will require some type of directive from official sources.
The Effect of State Tax Incentives on Economic Growth and Firm Location Decisions: An Overview of the Literature
Authors: Buss Terry F.
Published: June 2007

This article reviews the tax study literature to assess the state of knowledge about the relationship among taxes, related factors, and economic growth as well as the use of tax incentives to influence business locations. Although tax studies have become increasingly sophisticated, especially during the past decade, they have tended to yield conflicting results regarding whether taxes matter. Some studies focus on costs and benefits of tax incentives, but few look to see whether public monies could have been better spent or whether tax incentives were economically justified. Tax studies offer little guidance to policy makers concerned about fine-tuning tax rates or tax offerings and effectively employing tax incentives as economic development tools.
Mothering for the State
Authors: Swartz Teresa Toguchi
Published: June 2007

This article draws on ethnographic research with a nonprofit foster family agency to examine how payment affects caregivers’motivations and performance, as well as how state bureaucratic organization and professional supervision affect their carework. Findings suggest that contrary to conventional thought, economic interests and altruistic motives coexist for foster mothers. Although monetary compensation is a concern for these mostly working-class women, impetus for caring also stems from traditional gendered ideals of mothering, nurturing, and staying at home with their biological children. However, state regulations and rules (designed to protect children) intervene in foster mothers’parenting and private lives and undermine their intrinsic motivations and rewards. The conclusion reflects on what this case reveals about the challenges of paid carework, especially under conditions of government supervision and regulation.
Radical Caring in an Ethnic Shelter
Authors: Rudrappa Sharmila
Published: June 2007

The author examines South Asian American women caregivers in two domestic violence organizations, namely Apna Ghar, the Chicago shelter for battered immigrant women, and Saheli, a support group for abuse survivors in Austin, Texas. Through informal interviews with Apna Ghar workers and Saheli volunteers and participant observation at Apna Ghar, she outlines the concept of “radical caring.” Radical caring emerges at the conjunction of individual and organizational motivations. However, radical caring is inherently contradictory; first, the caregivers’ traditional gender identities are used to alter the very same gender ideologies in their racialized communities. Second, workers attempt to preserve the dignity of care receivers even as they engage in tasks that undermine their self-respect. Third, caseworkers exercise authority so that residents’ autonomy may be enhanced. The author argues that although organizations such as Apna Ghar hold the potential for social change, professionalization of shelter work along with the contradictions inherent in caregiving compromise radical caring.
Vocational Interests and Career Efficacy Expectations in Relation to Occupational Sex-Typing Beliefs for Eighth Grade Students
Authors: Ji Peter Y. , Lapan Richard T. , Tate Kevin
Published: June 2007

Following the recommendations of Lent, Brown and Hackett's Social Cognitive Career Theory (2000), we measured eighth grade boys' and girls' perception of the proportion of men and women employed in occupations and their level of interest and self-efficacy for those occupations. Results indicated that eighth grade boys and girls expressed stronger career interest in and higher self-efficacy for those occupations that they rated as employing more of their own gender. The study highlights how career practitioners can work with adolescents to widen their perceived range of occupational choices.
Nurse Ministry the Nurse as Modern Day Shaman
Authors: Stohl Christina
Published: June 2007

Nurses in frequent contact with persons experiencing severe stress in the form of hospitalization, disability or life threatening illness are likely to be faced with questions about the meaning of life and the nature of spirituality. Nurses who have not sought their own answers to such questions may be stimulated to do so as they are called upon to relate on a deeper level with patients. Holistic nurses are increasingly exploring and writing about spirituality as a significant factor in patient care.

In so doing, nurses have the opportunity to broaden and deepen their own perspectives and experiences of spirituality which, in turn, may lead them to delve into a variety of spiritual or religious philosophies. This article proposes a concept of holistic nursing encompassing the spirituality of the nurse. Nurse ministry is the name given this model of practice. The activities of nurse ministers are discussed and ways of developing such a practice suggested.