bluuebunny/crossref_metadata_2025 huggingface dataset:
Case series of a single centre's treatment of ovulatory infertility with clomiphene citrate and intrauterine insemination in 2002
Authors: Costello Michael F. , Emerson Sandra , Miranda Therese , Bakhtyari Mo Bashir , Clements Sarah , Hughes Graeme , Steigrad Stephen
Published: March 2004

The present paper reports a single department's retrospective case series of all clomiphene citrate (CC) combined with intrauterine insemination (IUI) treatment cycles for ovulatory infertility performed during 2002. Thirty‐eight couples with unexplained, endometriosis, male or unilateral tubal factor infertility had undergone 71 cycles of CC and IUI. The clinical and ongoing cycle pregnancy rates were 20 and 17%, respectively. Seven percent of the clinical pregnancies were multiple pregnancies, with all multiple pregnancies being twin gestations. The current use of CC and IUI is an effective early treatment option in couples with ovulatory infertility presenting to our department.
Will there ever be an end to the Caesarean section rate debate?
Authors: Dietz Hans Peter , Peek Michael J.
Published: March 2004

Caesarean section rates continue to rise. To date, no serious attempt has been made to address this issue. There are no scientific grounds for identifying an ‘appropriate’ level for Caesarean section rates. A ‘Term Cephalic Trial’ may provide such information, but poses major logistic and ethical challenges. The authors propose that a combination of known and newly developed predictors of emergency operative delivery may allow an antenatal risk assessment that could make intervention trials both ethically sound and logistically feasible.
Hysterectomy and endometrial ablation in New South Wales, 1981 to 1999–2000
Authors: Yusuf Farhat , Siedlecky Stefania
Published: March 2004

Objective:  To examine the trends in hysterectomy in New South Wales (NSW) from 1981 to 1999–2000 and the impact of endometrial ablation.

Data:  Computerised discharge summaries from private and public hospitals for the years 1981, 1991, 1994–1995 and 1999–2000 obtained from the NSW Health Department. All records listing hysterectomy in women over the age of 20 in each period were selected and those listing endometrial ablation since 1991 were also selected. Operative procedure, diagnosis, hospital type, length of stay and demographic data were recorded. Annual figures since 1988–1989 for hysterectomy and ablation were also obtained.

Findings:  Initially it appeared that the introduction of endometrial ablation might reduce hysterectomy rates, but the combined rate of hysterectomy and endometrial ablation continued to rise to a peak in 1992–1993 and has declined since. The hysterectomy rate in 1999–2000 was lower than in 1981. There has been a marked shift from abdominal to vaginal hysterectomy, with an increase in laparoscopically assisted operations. Overall, the mean age at operation has been rising, although the mean age for vaginal hysterectomy has fallen. The shift to private hospitals and reduction in hospital stay have continued.

Conclusion:  The trends are consistent with the increased use of laparoscopic and ablation techniques, improvements in hormonal contraceptive use, and better access to abortion, which have facilitated women's decisions to postpone their births and to conserve their childbearing to older ages. Further development of these techniques will have an impact on gynaecological training and practice in the next decade.
In vivo PLT increments after transfusions of WBC‐reduced PLT concentrates stored for up to 7 days
Authors: Dijkstra‐Tiekstra M.J. , Pietersz R.N.I. , Hendriks E.C.M. , Reesink H.W. , Huijgens P.C.
Published: March 2004

BACKGROUND: Bacterial screening and improvement of storage conditions of leukoreduced PLT concentrates (LR‐PCs) allows extension of their storage period from 5 to 7 days.

STUDY DESIGN AND METHODS: For in vitro studies, 40 LR‐PCs made from five buffy coats and plasma were studied for 8 days. For in vivo studies, routinely produced LR‐PCs stored for 2 to 7 days after blood collection were administered to clinically stable thrombocytopenic patients. CI1 h was calculated after 353 transfusions (67 patients), and CCI1 h, after 195 transfu‐sions (55 patients), with pretransfusion PLT counts of not greater than 20 × 109 per mL.

RESULTS: Storage experiments showed that the pH of LR‐PCs remained greater than 6.8 for 8 days, provided that the PLT concentration was less than 1.3 × 109 per mL. Routinely produced LR‐PCs had a volume of 282 ± 15 mL (n = 10,193) and contained 329 × 109± 40 × 109 PLTs (n = 3467). For 7‐day‐old LR‐PCs, 76 of 78 (97%) of the transfusions resulted in a CI1 h of at least 10 and 37 of 39 (95%) in a CCI1 h of at least 7.5, which indicated levels for successfulness. Mean ± SE values of CI1 h and CCI1 h of 7‐day‐old LR‐PCs were 28.7 ± 2.3 (n = 78) and 19.0 ± 2.0 (n = 39), respectively. No significant differences were observed between 5‐ and 7‐day‐old LR‐PCs transfused with respect to CI1 h and CCI1 h values.

CONCLUSION: In vitro and in vivo studies showed that LR‐PCs can be stored for up to 7 days with excellent clinical results, provided that they are routinely screened for bacterial contamination.
Enhanced effect of vascular endothelial growth factor, thrombopoietin peptide agonist, SCF, and Flt3‐L on LTC‐IC and reporter gene transduction from umbilical cord blood CD34+ cells
Authors: Smith Stephen L. , Kiss Joseph , Siatskas Christopher , Medin Jeffrey A. , Moldwin Richard L.
Published: March 2004

BACKGROUND: Hemangioblastic precursors have been identified that give rise to both endothelial cells and HPCs, suggesting that common growth factor requirements may exist.

STUDY DESIGN AND METHODS: The effect of vascular endothelial growth factor (VEGF) in combination with thrombopoietin peptide agonist (TPOA), Flt‐3 L (F), and SCF (S) on long‐term culture‐initiating cell (LTC‐IC), CFU, differentiation, and transduction of cord blood (CB) CD34+ were evaluated up to 4 weeks in culture.

RESULTS: At Week 4, in cultures containing T/F/S and VEGF, the LTC‐IC increased 1000‐fold (from 37 ± 8 to 37,012 ± 14,329) with a frequency of 3.4 in 10,000 cells. In the T/F/S cultures without VEGF, the LTC‐IC increased 675‐fold (to 25,086 ± 12,102) with a frequency of one LTC‐IC in 10,000 cells. The addition of VEGF significantly increased (p < 0.05) the LTC‐IC per 10,000 CB CD34+ cells. Transduction with reporter gene enhanced green fluorescent protein (EGFP), resulted in an increase in EGFP+ CFU at Week 1 and EGFP + LTC‐IC at Weeks 1 and 4. The cells maintained their multilineage expression when cultured in conditions for erythroid, myeloid, or megakaryocytic differentiation. Peak percentage EGFP coexpression of GlyA and CD11b was 51 ± 6 percent and 63 ± 15 percent, respectively, at Week 2, while CD41a was 34 ± 17 percent at Week 4.

CONCLUSION: T/F/S and VEGF have an enhanced effect on total LTC‐IC output and frequency but do not appear to significantly alter the differentiation or transducibility characteristics of CB HPCs in vitro.
Variables determining blockage of WBC‐depleting filters by Hb sickle cell trait donations
Authors: Beard Martin J. , Cardigan Rebecca , Seghatchian Jerard , Krailadsiri Pranee , Williamson Lorna M.
Published: March 2004

BACKGROUND: Sickle cell trait donations can block leukodepletion (LD) filters or fail to LD, but the variables affecting blockage are unclear.

STUDY DESIGN and METHODS: To identify critical variables for further study, the relationship was investigated between filter blockage and donor characteristics, processing conditions, PLT and coagulation system activation, and microvesicle formation in donations with (n = 63) and without (n = 40) sickle trait. With eight filter types whole blood was LD either at ambient temperature on Day 0 or after overnight 4°C hold. Markers of PLT activation (CD62P and CD63 expression and soluble CD62P) and coagulation activation (activated FXII and prothrombin fragment 1 + 2 [F1 + 2]), RBC microvesicles, blood gases, and residual WBCs were measured.

RESULTS: All Day 0 filtrations blocked (n = 7). On Day 1, no filter tested was 100 percent successful, with most achieving an approximate 50 percent success rate. Two filters blocked consistently and an additional filter did not block, but resulted in 50 percent of units with high residual WBC counts (30 × 106‐394 × 106/unit). Day 1 filtration was not improved if performed at 4°C. Donor RBC variables and prefiltration measures varied little between blocked and successful filtrations except pO2, where 9 of 17 blockages had a pO2 of less than 5.0 kPa, compared with 0 of 13 completed filtrations. F1 + 2 levels increased after filtration in sickle trait units, a consequence of slow flow rate.

CONCLUSION: Filter blockage in sickle trait donors cannot be predicted by donor characteristics or filter type and is not related to PLT or coagulation activation, but can be reduced by storing units at 4°C before filtration.
The use of a bacteria detection system to evaluate bacterial contamination in PLT concentrates
Authors: Rock G. , Neurath D. , Toye B. , Sutton D. , Giulivi A. , Bormanis J. , Olberg B. , Holme S. , Wenz B. , Ortolano G. , Nelson E.
Published: March 2004

BACKGROUND: Random‐donor PLTs (RDPs) are functional at 7 days. Nevertheless, since the mid‐1980s, concern for bacterial contamination has caused the storage period to be reduced to 5 days. The ability of a bacteria detection system (BDS, Pall) to determine bacterial contamination and permit extension of the PLT shelf life to 7 days was assessed.

STUDY DESIGN AND METHODS: Blood was collected into CP2D and leukoreduced RDPs were prepared. Upon arrival at the hospital, a 2‐ to 3‐mL aliquot was removed from each RDP and introduced into the Pall BDS pouch with a sterile docking device. The pouch was incubated at 37°C for 24 hours and then the oxygen content was measured to determine bacterial contamination. Additionally, the RDPs were pooled and an aliquot was removed for culture with standard manual techniques. CCIs were calculated 1 hour after infusion.

RESULTS: A total of 12,062 individual RDPs were tested. The Pall BDS detected bacteria in 5 units. All of these were positive on repeat sampling. Propionibacterium acnes, coagulase‐negative Staphylococcus, and Bacillus species were confirmed by manual technique in 3 units, one could not be identified, and one was negative. Aliquots from PLT pools were positive in 80 of 2201 pools when tested by manual methods. Of these, 79 were false‐positives and 1 unit contained coagulase‐negative Staphylococcus. The Pall BDS was easy to use and required less than 5 minutes for all manipulations. After 7 days of storage, the PLTs gave an average CCI of 16 × 1011± 3.39 × 1011 1 hour after transfusion (n = 9).

CONCLUSIONS: The Pall BDS permits evaluation of RDPs for bacterial contamination. Culture‐negative PLTs were successfully transfused in our institution up to and including 7 days after storage with good CCIs.
The significance of third‐generation HCV RIBA‐indeterminate, RNA‐negative results in voluntary blood donors screened with sequential third‐generation immunoassays
Authors: Kiely Philip , Kay Deborah , Parker Susan , Piscitelli Lisa
Published: March 2004

BACKGROUND:One of the problems associated with the use of anti‐HCV immunoblot assays is the inter‐pretation of indeterminate results without detectable HCV RNA. The purpose of this study was to examine the significance of third‐generation RIBA (RIBA‐3)‐indeterminate, RNA‐negative results in voluntary blood donors.

STUDY DESIGN AND METHODS:Since June 2000 all Australian Red Cross Blood Service testing sites have used an anti‐HCV sequential immunoassay testing strategy whereby donors who are reactive on the primary screening immunoassay are tested on a secondary immunoassay and if reactive on both assays, further tested by immunoblot. From the four testing sites that use RIBA‐3, the result profiles of donors who were RIBA‐3‐indeterminate, HCV RNA‐negative were analyzed.

RESULTS:From 2,661,786 donations screened for anti‐HCV during the study period, 102 RIBA‐3‐indeterminate, RNA‐negative donors were identified, most of whom were reactive to either c33p (69.6%) or c22p (27.5%). The RIBA‐3‐indeterminate, RNA‐negative donors showed a significantly higher screening immunoassay signal strength to assay cutoff (S/CO) distribution than those with biologic false‐reactive (BFR) results (1.853 vs. 1.524, p < 0.05) but a significantly lower distribution than RIBA‐3‐positive, RNA‐negative (1.853 vs. 4.546, p < 0.05) or RNA‐positive (1.853 vs. 6.467, p < 0.05) donors. The RIBA‐3‐indeterminate, RNA‐negative donors showed a similar distribution of c33c and c22p band intensities compared with RIBA‐3‐positive, RNA‐negative donors but significantly lower distribution of band strengths compared to the RIBA‐3‐positive, RNA‐positive group. Compared to the indeterminate donors with previous anti‐HCV‐negative or BFR results, the indeterminate donors not previously screened for anti‐HCV showed higher immunoassay S/CO ratio distributions, a higher proportion with c22p reactivity (16.2% vs. 36.7%), and higher frequency of risk factors (46.4% vs. 75.0%).

CONCLUSIONS:Our analysis suggests that a combination of indicators can be used to help clarify RIBA‐3‐indeterminate, RNA‐negative results. Specifically, donors with high S/CO ratios on a screening immunoassay, RIBA‐3 reactivity to c22p or c33c with band intensity of 2+ or greater, without a previous history of negative or BFR donations and with an identifiable risk factor, have a high probability of representing true anti‐HCV rather than nonspecific reactivity.
Measurement of anti‐D intrinsic affinity with unlabeled antibodies
Authors: Debbia Martine , Lambin Patrick
Published: March 2004

BACKGROUND: The method most commonly used for measuring the affinity of MoAbs specific for the D antigen is a binding assay using 125I‐labeled MoAb. Although the method is relatively simple, there are several drawbacks that can lead to inaccurate results. The objective of the present work was to develop a method for the deter‐mination of the affinity of anti‐D MoAb using unlabelled antibodies.

STUDY DESIGN AND METHODS: Rh‐positive RBCs were sensitized with varying amounts of unlabeled anti‐D MoAb, and, at equilibrium, the amount of anti‐D bound to the RBCs was measured by ELISA. The affinity and the number of antigenic sites were determined with the Scatchard and Langmuir equations.

RESULTS: The method was applied to determine the affinity of several MoAbs specific for the D antigen on RBCs of different Rh‐positive phenotypes. Similar results were observed with both equations. The affinity constant (Ka) for 3 MoAbs specific for the D antigen on group O R1r RBCs ranged from 1.3 to 7.4 108 M–1, depending on the antibody. When measured by a binding assay with 125I‐labeled anti‐D MoAbs, the Ka were significantly lower, indicating that 125I‐labeling diminishes anti‐D affinity, even when the labeling is at a low level.

CONCLUSION: A simple ELISA method was developed for the measurement of the affinity of anti‐D MoAbs for the D antigen and for the number of antigenic sites per RBC. As a result, the affinity of anti‐D can be estimated accurately, thus avoiding the drawbacks inherent in modification of the antibody by 125I‐labeling.
Network computer‐assisted transfusion‐management system for accurate blood component–recipient identification at the bedside
Authors: Miyata Shigeki , Kawai Takeshi , Yamamoto Suguru , Takada Masahiro , Iwatani Yasuyuki , Uchida Osamu , Imanaka Hideaki , Sase Kazuhiro , Yagihara Toshikatsu , Kuro Masakazu
Published: March 2004

BACKGROUND: ABO‐mismatched transfusions caused by human error are among the most serious problems in transfusion therapy. The major cause is misidentification of a recipient or a blood component at the bedside.

STUDY DESIGN AND METHODS: A network computer‐assisted transfusion‐management system has been developed with bar coding as a fail‐safe/fool‐proof system for accurate component–recipient identification at the bedside, which allows us to monitor the usage of blood components in real time. The efficacy of this system was evaluated to prevent human errors by monitoring the transfusion process via the network and analyzing voluntary and mandatory reports with regard to transfusion errors over a 3‐year period. The crossmatch‐to‐transfusion ratio for operations and outdate rate of RBCs were calculated to assess economic benefit.

RESULTS: More than 60,000 blood components have been transfused perfectly to the intended recipients via the network, and one human error was prevented by the system. After establishment of the network system, the crossmatch‐to‐transfusion ratio for operations and outdate rate of RBCs have been gradually reduced from around 2.5 to 1.8 and from 3.9 to 0.32 percent, respectively.

CONCLUSION: The network computer‐assisted management system greatly contributes to safe and efficient transfusion therapy.
Transfusions via hand‐held syringes and small‐gauge needles as risk factors for hyperkalemia
Authors: Miller Michal A. , Schlueter Annette J.
Published: March 2004

BACKGROUND: Pediatric emergency RBC transfusions are often infused rapidly through 22‐gauge (ga) or smaller needles or catheters using hand‐held syringes. Data relating needle size, unit age, and infusion rate are needed to assess the risk of hemolysis and hyperkalemia in this setting.

STUDY DESIGN AND METHODS: Multiple simulated transfusions were performed during storage of RBC units. Aliquots from five units were rapidly passed through needles (18, 20, 22‐25 ga) using a hand‐held syringe. Resulting plasma Hb and K+ concentrations were measured. Free Hb levels were used as a measure of needle‐associated hemolysis (NAH).

RESULTS: Passage through 18‐ga and 20‐ga needles caused no hemolysis, but rapid passage through 23‐ga, 24‐ga, and 25‐ga did. RBCs stored less than 7 days showed significant K+ release with 23‐ to 25‐ga needles. The greatest needle‐associated K+ release was 10 mEq per L, on Day 5. Due to high K+ concentrations resulting from spontaneous efflux, K+ release from NAH was not detectable after 2 or more weeks of storage.

CONCLUSIONS: Rapidly transfusing RBCs using hand‐held syringes through 23‐ga or smaller needles can cause hemolysis. In RBCs stored 2 weeks or more, NAH does not measurably increase K+ concentrations above that present from storage‐related efflux. During rapid transfusions, RBC storage time is the primary risk factor for transfusion‐associated hyperkalemia.
RBCs labeled at two biotin densities permit simultaneous and repeated measurements of circulating RBC volume
Authors: Mock Donald M. , Lankford Gary L. , Widness John A. , Burmeister Leon. F. , Kahn Daniel , Strauss Ronald G.
Published: March 2004

BACKGROUND: The extend potential applications of a nonradioactive method for measuring circulating RBC volume, we tested the hypothesis that RBC volume could be determined independently using two populations of RBCs labeled with low‐density biotin (LDB1) and high‐density biotin (HDB).

STUDY DESIGN AND METHODS: In 10 healthy adults, autologous RBCs were labeled with HDB, LDB, or 51Cr. The labeled RBCs were mixed and transfused. RBC volume was measured in postinfusion peripheral venous blood by quantitating dilution of each population of labeled RBCs.

RESULTS: RBC volume measured using either LDB or HDB cells agreed well with RBC volume measured using 51Cr. For the regression of RBC volume by LDB versus RBC volume by 51Cr, correlation = 0.994 and slope = 0.933. For HDB versus 51Cr, correlation = 0.982 and slope = 0.953. RBC volume measured a second time in four subjects with HDB agreed well; mean CV for the differences between HDB and 51Cr were less than 5 percent.

CONCLUSIONS: Using RBCs labeled with two different densities of biotin, RBC volume can be accurately measured simultaneously and repeatedly in the same subject without radiation exposure.
Complete or partial seroreversion in immunocompetent individuals after self‐limited HCV infection: consequences for transfusion
Authors: Lefrère Jean‐Jacques , Girot Robert , Lefrère François , Guillaume Nicolas , Lerable Joelle , Marrec Nadine Le , Bouchardeau Françoise , Laperche Syria
Published: March 2004

BACKGROUND: The disappearance of anti‐HCV antibodies over time, after a self‐limited infection, also referenced seroreversion, has been observed. The frequency of this phenomenon remains controversial, especially in immunocompetent subjects. However, it has important implications in the context of transfusion inquiries, in particular in case of a blood donor suspected to have transmitted HCV through a past blood donation.

STUDY DESIGN AND METHODS: Our findings are presented of a longitudinal study, including 16 patients from a cohort of 78 immunocompetent, multitransfused individuals who were positive for anti‐HCV (EIA and confirmatory assay [RIBA]) and followed over a long period of time without having received any antiviral therapy. The aim was to establish whether a past and self‐resolved HCV infection could evolve toward a negative serology.

RESULTS: The 16 patients were classified in three groups: 1) 12 patients who remained anti‐HCV positive with no evolution in their RIBA pattern after a mean follow‐up of 7.6 years; 2) one patient who presented a complete seroreversion 6 years after enrollment; and 3) three patients with a partial seroreversion over a mean follow‐up of 16 years.

CONCLUSION: HCV infection is not always characterized by a persistent antibody response, even in immunocompetent individuals. This should be taken into consideration when transfusion inquiries are conducted.
Compatibility testing without a centrifuge: the slide Polybrene method
Authors: Lin Marie
Published: March 2004

BACKGROUND: A simple and rapid slide Polybrene method (SP) for pretransfusion compatibility testing is described. SP is particularly suitable for use in developing countries where, due to limited resources, centrifuges and biologic reagents may not be readily available.

STUDY DESIGN AND METHODS: The original manual Polybrene method (MP) was modified for use on glass microscope slides, eliminating the need for test tubes and centrifugation. The sensitivity of SP for detecting alloantibodies to RBC antigens was compared with that of MP and the IAT.

RESULTS: Both SP and MP were more sensitive than the IAT for detecting anti‐E. SP detected 21 of 23 examples of anti′‐Mia′ and 7 of 8 examples of anti‐E. Kidd and Diego system antibodies were also readily detectable by SP, although the reactions were weaker than those observed with both MP and IAT. However, both SP and MP failed to detect some examples of antibodies to Kell system antigens.

CONCLUSIONS: SP is an acceptable method for compatibility testing in developing countries, particularly in populations where the frequency of K is low (e.g., southeast Asia). The reagents are inexpensive and can be prepared in‐house. SP is simple to use, does not require a centrifuge, and can be performed by personnel with minimal training.
Global Health Issues and Challenges
Authors: Dickenson‐Hazard Nancy
Published: March 2004

Purpose:

To describe issues, challenges and potential strategies in achieving nursing's global preferred future, focused on promoting healthy communities worldwide.

Methods:

Three sets of Arista conferences, a total of 7 conferences, were sponsored by Sigma Theta Tau International Honor Society of Nursing. Arista2 and Arista3—the focus of this report—were held in different world regions. A total of 109 invited multidisiclinary participants identified conditions that affect nursing and health care, strategic actions to address those conditions, and recommendations for the nursing profession. Reports from each conference are synthesized in this executive summary.

Findings and Conclusions:

Both common and unique themes were identified in various world regions. Key components of the preferred future were professional restructuring and the delivery of holistic, human, and culturally appropriate care. Participants in all regional conferences recommended strategic actions regarding: student‐centered educational systems, environments in which nurses practice, the way nurses lead, the knowledge nurses need, the settings in which nurses work, the conditions under which the profession operates, the influence of nurses, and the ways nurses learn.
Managing Children's Cancer Pain in Morocco
Authors: McCarthy Patricia , Chammas Georgette , Wilimas Judith , Alaoui Fouzia Msefer , Harif Mohamed
Published: March 2004

Purpose:

To identify issues in managing pain of children with cancer in the two pediatric oncology centers in Morocco.

Methods:

Focus groups were conducted with pediatric oncology nurses and physicians.

Findings:

Four themes were identified: (a) children's cancer pain is an overwhelming concern to the Moroccan nurses and physicians who participated in this study; (b) training and resources for children's cancer pain management are lacking in Morocco; (c) some impediments to pain relief were verbalized, such as a stoic approach to suffering and limited use of some drugs; and (d) a critical need exists for a comprehensive pain management approach for children with cancer in Morocco.

Conclusions:

This study elucidated issues in managing children's cancer pain in Morocco and increased knowledge of current practice issues. A program of policy research has been initiated with the aim of establishing guidelines for practice policies for managing children's cancer pain in Morocco.
External Validity, Generalizability, and Knowledge Utilization
Authors: Ferguson Linda
Published: March 2004

Purpose:

To examine the concepts of external validity and generalizability, and explore strategies to strengthen generalizability of research findings, because of increasing demands for knowledge utilization in an evidence‐based practice environment.

Framework:

The concepts of external validity and generalizability are examined, considering theoretical aspects of external validity and conflicting demands for internal validity in research designs. Methodological approaches for controlling threats to external validity and strategies to enhance external validity and generalizability of findings are discussed.

Conclusions:

Generalizability of findings is not assured even if internal validity of a research study is addressed effectively through design. Strict controls to ensure internal validity can compromise generalizability. Researchers can and should use a variety of strategies to address issues of external validity and enhance generalizability of findings. Enhanced external validity and assessment of generalizability of findings can facilitate more appropriate use of research findings.
The Experience of Becoming a Mother for Single, Unpartnered, Medicaid‐Eligible, First‐Time Mothers
Authors: Keating‐Lefler Rebecca , Wilson Margaret E.
Published: March 2004

Purpose:

To understand the experience of becoming a mother for single, unpartnered, Medicaid‐eligible, first‐time mothers in the United States and to discover the basic social psychological problem and process experienced by the mothers during the first 3 months postpartum.

Design:

Grounded theory.

Methods:

Semi‐structured interviews were conducted and audiotaped with 20 single, unpartnered, Medicaid‐eligible, first‐time mothers at 1, 2, and 3 months postpartum. Data analysis was completed using the constant comparative method of data analysis.

Findings:

The women used the basic social psychological process of “reformulating life” to manage their “grieving of multiple losses.”“Reformulating life” included “believing in future possibilities,”“submerging self in the mother role,”“daring to dream life's options,”“development of a new self‐definition, identity, and future,” and “risking a new life course: attempting new roles.” Social support and personal resilience facilitated the basic social psychological process of “reformulating life.”

Conclusions:

Single, unpartnered, Medicaid‐eligible, first‐time mothers in this study managed their “grieving multiple losses” by “reformulating life.” The uniqueness of this substantive theory is the relationship between pregnancy, loss, and grief.
Cultural Incommensurability in Psychodynamic Psychotherapy in Western and Japanese Traditions
Authors: Kozuki Yoriko , Kennedy Michael G.
Published: March 2004

Purpose:

To examine cultural incommensurability between clients of Japanese ancestry and Western therapists.

Design:

Aggregated case‐study method was used to analyze psychotherapy cases of Japanese individuals seen by Western therapists. Eight cases were selected for this study from a private practice client pool.

Findings:

Themes were: (a) only observable data were valued for diagnosis and treatment; (b) cultural stereotypes hampered treatment; (c) individuation and separation occurred within a social web of norms in Japanese culture; (d) key concepts in mental health such as “death and dying” and “rape” were interpreted by clients within a Japanese cultural framework, resulting in unique psychological reactions and behaviors, which had not been recognized by Western therapists; (e) psychological effects of immigration were minimized or ignored by Western therapists; (f) culturally unfamiliar behaviors were “pathologized” by Western therapists; and (g) Western therapists showed ethnocentric biases regarding the effects of immigration.

Conclusions:

Various forms of misunderstanding and culturally ignorant practices were found in the treatment of eight Japanese clients by these Western therapists. These ineffective and often harmful practices were unrecognized by the Western therapists.
Barriers to Family Care in Psychiatric Settings
Authors: Rose Linda E. , Mallinson R. Kevin , Walton‐Moss Benita
Published: March 2004

Purpose:

To identify barriers to family care in psychiatric settings and to describe family and provider perspectives about what constitutes effective family care.

Design and Methods:

A qualitative exploratory approach with focus groups. Seventy‐eight people participated in 11 focus groups conducted with families, patients, and health professionals.

Findings:

Families identified poor quality care, conflict with health professionals about treatment, and lack of a role for families in the treatment. African American families also identified isolation of their communities from the mental health care system. Adolescents emphasized their role as caregivers and their needs for support. Health professionals conveyed concerns about system‐based barriers, professional practice‐based barriers, and family‐based barriers to care. Patients stated the need for their families to be better educated about mental illness.

Conclusions:

The lack of family care in psychiatric settings is a multifaceted problem. Current health policies do not show endorsement of a family care approach. Responses from families and health professionals indicated conflicting opinions about content of family care. Health professionals reported they often lacked training and resources to deal with complex family issues. Families believed that lengthy and intensive interventions were neither necessary nor desired to address their concerns. Family care can be improved by focusing on building rapport and communicating problems and concerns between families and health professionals.
Health Disparities and Mental Retardation
Authors: Fisher Kathleen
Published: March 2004

Purpose:

To identify health care needs and the availability and accessibility of health care services for people with mental retardation (MR).

Methods:

Review of the literature on health disparities and mental retardation was performed using MEDLINE, PubMed, the Cumulative Index to Nursing & Allied Health Literature (CINAHL), and PsycInfo from 1992 to 2002.

Findings:

Deficiencies in care identified in the literature included general health screening and care for physical symptoms, mental health, women's care, dental services, health maintenance, and prevention.

Conclusions:

Disparities in health care place people with MR at high risk for morbidity and premature mortality.
Review of Intervention Studies of Families with Hospitalized Elderly Relatives
Authors: Li Hong , Melnyk Bernadette Mazurek , McCann Robert
Published: March 2004

Purpose:

To critique intervention studies of family caregivers in the hospital care for elderly relatives for (a) synthesizing the characteristics of interventions and outcomes, (b) evaluating the effectiveness of the intervention studies, and (c) identifying the strengths and limitations of the intervention studies as a basis for future research.

Methods:

An integrated literature review was used to examine nine intervention studies (1983–2003) of adult family caregivers of older family members in the hospital setting.

Findings:

Although the existing intervention studies have provided a solid base for further study of family care for hospitalized elders, the analysis indicated the following limitations of the existing literature: (a) lack of a clearly defined theoretical framework to guide the interventions and selection of study variables, (b) lack of comparison groups and observation of interventions, and (c) limitations with generalizability of findings.

Conclusions:

Nine intervention studies of family caregivers in the hospital care of elderly patients age 60 years or above were found that were conducted in the past 10 years. Although progress has been made in family caregiving of hospitalized elders, future research should include outcomes based on well‐defined theoretical frameworks, control of confounding variables, and samples from diverse populations.
A Theory‐Driven Approach to Evaluating Quality of Nursing Care
Authors: Sidani Souraya , Doran Diane M. , Mitchell Pamela H.
Published: March 2004

Purpose:

To review the propositions of a theory‐driven approach and to discuss its application to evaluating the quality of nursing care.

Organizing Framework:

The focus in the theory‐driven approach to evaluation is on identifying patient, professional, and setting characteristics that affect the processes of care at micro and meso levels, which in turn contribute to outcome achievement. Implications for examining the interrelationships among characteristics, processes, and outcomes are discussed and illustrated with examples from published research.

Conclusions:

Determining how these variables influence each other provides a valid and comprehensive understanding of the contribution of nursing within the health care system.
Economic and Clinical Disparities in Hospitalized Patients with Type 2 Diabetes
Authors: Dowell Marsha A. , Rozell Billie , Roth David , Delugach Harry , Chaloux Patricia , Dowell Jennifer
Published: March 2004

Purpose:

To identify and describe economic and clinical relationships and trends associated with selected access, equity, and outcome characteristics of a large inpatient population with Type 2 diabetes.

Design:

Longitudinal, descriptive cross‐sectional study with secondary analyses of data about 101,944 patients in hospitals in the United States (US), 40 years of age and older with a primary diagnosis of Type 2 diabetes from the Health Care Cost and Utilization Project (HCUP‐3) database for 1994–1997.

Methods:

Descriptive analysis, hierarchical, random‐effects regression modeling, and contrasts between covariate‐adjusted means. Hospital charge data were highly skewed in a positive direction requiring a logarithmic transformation. Variables for the study included both hospital and patient characteristics.

Findings:

Significant racial and sex disparities were found in health care access, equity, and outcomes, with equity characteristics showing alarming disparities in types of procedures (amputations and peripheral vascular bypass grafts) performed, lengths of stay, and dispositions.

Conclusions:

Disparities in health care access, equity, and outcomes continue to exist on the basis of sex, ethnicity, and age as well as the type and location of the hospital. Access and equity are values that, despite rhetoric in relation to health care utilization, have not been systematically attained.
Job Stress, Job Performance, and Social Support Among Hospital Nurses
Authors: AbuAlRub Raeda Fawzi
Published: March 2004

Purpose:

To investigate (a) the effect of job‐related stress on job performance among hospital nurses, and (b) the effect of social support from coworkers on the stress‐performance relationship.

Design:

A correlational descriptive survey was used to investigate these relationships among a convenience sample of 263 American hospital nurses and 40 non‐American nurses who were accessible via the Internet.

Methods:

Data were collected using a Web‐based structured questionnaire, which included the Nursing Stress Scale, the Schwirian Six Dimension Scale of Nursing Performance, the McCain and Marklin Social Integration Scale, and the demographic form. Descriptive statistics, Pearson product‐moment correlations, and hierarchical regression techniques were used to analyze the data.

Findings:

Perceived social support from coworkers enhanced the level of reported job performance and decreased the level of reported job stress. The analysis also indicated a curvilinear (U‐shaped) relationship between job stress and job performance; nurses who reported moderate levels of job stress believed that they performed their jobs less well than did those who reported low or high levels of job stress.

Conclusions:

Results indicted the importance of social support from coworkers, as well as the need for further research to test the U‐shaped relationship between job stress and job performance.
Measuring Patient‐Level Clinical Outcomes of Home Health Care
Authors: Keepnews David , Capitman John A. , Rosati Robert J.
Published: March 2004

Purpose:

To examine the use of the Outcomes Assessment and Information Set (OASIS) data to analyze patient‐level outcomes of home health care.

Design:

OASIS data were obtained on 1,015 patients who received home health care services for 60 days or fewer from a large, independent home health agency between August 1998 and December 1999.

Methods:

An index was constructed consisting of 16 OASIS measures, primarily activities of daily living (ADL) and instrumental activities of daily living (IADL). Scores were computed for functional status on admission and at discharge. Predictors of functional status at discharge were identified by regression analysis.

Findings:

78.1% of patients improved, 18.5% declined, and 2.8% showed no change. The model explained 57.2% of variance in functional status at discharge. Age, visual impairment, having Medicaid as a payer, urinary incontinence, cognitive impairment, and use of unplanned or emergency care were negatively associated with functional outcomes of care. Being treated for open wounds or lesions, cardiovascular and orthopedic conditions were positively associated with functional outcomes.

Conclusions:

OASIS data can be used to analyze patient‐level functional outcomes of short‐term home health services. Further research is needed to continue refining methods of analyzing patient outcomes and their predictors.
Cholecystokinin and panic disorder
Authors: Bourin Michel , Dailly Eric
Published: March 2004

Evidence for implication of cholecystokinin (CCK) in the neurobiology of panic disorder is reviewed through animal and human pharmacological studies. The results of these investigations raise two issues: (i) selectivity of action of CCK-2 agonists in anxiety disorders; and (ii) aberrations of the CCK system in anxiety disorders, both of which are discussed.
On The Optimization of Circular Radiating Fins With Fin to Fin and Fin to Base Radiant Interaction
Authors: Krikkis Rizos N. , Razelos Panagiotis
Published: March 2004

In the present study the optimum dimensions of circular rectangular and triangular profile fins with fin-to-fin and fin-to-base radiant interaction are determined. The basic assumptions are one-dimensional heat conduction and black surface radiation. The governing equations are formulated by means of dimensionless variables and solved numerically. The optimum fin dimensions, bore thickness and height, are presented in generalized dimensionless form and explicit correlations are provided for the dimensionless optimum parameters. The results are analyzed and reported in diagrams that give insight to the operational characteristics of the heat rejection mechanism.
Solution of the Radiative Integral Transfer Equations in Rectangular Absorbing, Emitting, and Anisotropically Scattering Homogeneous Medium
Authors: Altac¸ Zekeriya , Tekkalmaz Mesut
Published: March 2004

Radiative integral transfer equations for a rectangular absorbing, non-emitting, and linearly anisotropically scattering homogeneous medium are solved numerically for the incident energy and the net heat flux components using the method of “singularity subtraction.” A benchmark problem is chosen as a rectangular homogeneous cold participating medium which is subject to externally uniform diffuse radiation on the bottom wall. The solutions for the incident energy and net heat flux components for selected points for a square domain are provided in tabular form for benchmarking purposes.
Kinematics Synthesis of Linkage Mechanisms With Cam Integrated Joints for Controlled Harmonic Content of the Output Motion
Authors: Yuan Lifang , Rastegar Jahangir S.
Published: March 2004

A new method is presented for the modification of the output motion of linkage mechanisms with closed-loop chains using cams positioned at one or more of its joints. As an example and to present the basic concept, the method is applied to a four-bar linkage mechanism that is synthesized for function generation for the purpose of eliminating the high harmonic component of the output link motion. By eliminating the high harmonic component of the output motion of a mechanism, the potential vibrational excitation that the mechanism can impart on the overall system, including its own structure, is greatly reduced. The resulting system should therefore be capable of operating at higher speeds and with increased precision. For mechanisms with rigid links, the primary source of high harmonics in the output motion is the nonlinearity of the kinematics of their closed-loop chains. With the present method, a selected range or ranges of high harmonic motions generated due to such nonlinearities may be eliminated by integrating appropriately designed cams that are used to vary the effective length of one or more of the links during the motion. A numerical example is provided together with a discussion of the related topics of interest.
On the Basis Screws and Screw Systems of Point-Line and Line Displacements
Authors: Zhang Yi , Ting Kwun-Lon
Published: March 2004

This paper presents a method to derive and characterize the basis screws and the screw systems associated with a general point-line displacement. The transformation of a point-line between positions is depicted as a screw displacement about their common normal accompanied by a pure translation along the point-line. Such an interpretation of point-line displacement leads to a simple screw triangle used in deriving the basis screws and the screw system. The expressions of the basis screws and screw systems are simple and concise while the geometric meaning explicit. The result from basis screws of point-line displacement is also extended to line displacement and an example is given to demonstrate the simplicity of the method.
A Computational Approach to Profile Generation of Planar Cam Mechanisms
Authors: Zhang Yuhua , Shin Joong-Ho
Published: March 2004

A new approach, called a Relative Motion Method (RMM), is proposed for designing the shape of the disk cam, which uses the relative velocity and the relative acceleration of a follower respect to a cam to discover the profile coordinate, the pressure angle and the radius of curvature on the cam. It is characterized by the procedures of automatic derivation and solution with computers and the suitability not only for general disk cams with different kinds of follower, such as sharp edge follower, roller follower, flat-faced follower, and so on, but also for the double-disk conjugate cams, single-disk conjugate cams and roller gear conjugate cams. A program for design automation of shape of the disk cam and the kinematics simulation of this kind of mechanism has been developed using the proposed approach with C++ language. Finally, an example is given.
Displacement Analysis of Spherical Mechanisms Having Three or Fewer Loops
Authors: Wampler Charles W.
Published: March 2004

Spherical linkages, having rotational joints whose axes coincide in a common center point, are sometimes used in multi-degree-of-freedom robot manipulators and in one-degree-of-freedom mechanisms. The forward kinematics of parallel-link robots, the inverse kinematics of serial-link robots and the input/output motion of single-degree-of-freedom mechanisms are all problems in displacement analysis. In this article, loop equations are formulated and solved for the displacement analysis of all spherical mechanisms up to three loops. We show how to solve each mechanism type using either a formulation in terms of rotation matrices or quaternions. In either formulation, the solution method is a modification of Sylvester’s elimination method, leading directly to numerical calculation via standard eigenvalue routines.
Type Synthesis of 3-DOF Spherical Parallel Manipulators Based on Screw Theory1
Authors: Kong Xianwen , Gosselin Cle´ment M.
Published: March 2004

A spherical parallel manipulator (SPM) refers to a 3-DOF (degree-of-freedom) parallel manipulator generating 3-DOF spherical motion. A method is proposed for the type synthesis of SPMs based on screw theory. The wrench systems of a spherical parallel kinematic chain (SPKC) and its legs are first analyzed. A general procedure is then proposed for the type synthesis of SPMs. The type synthesis of legs for SPKCs, the type synthesis of SPKCs, as well as the selection of inputs of SPMs are dealt with in sequence. An input validity condition of SPMs is proposed. SPKCs with and without inactive joints are synthesized. The number of overconstraints of each SPKC is also given. The phenomenon of dependent joint groups in an SPKC is revealed for the first time.
Design of Steerable Endoscopes to Improve the Visual Perception of Depth During Laparoscopic Surgery
Authors: Breedveld Paul , Hirose Shigeo
Published: March 2004

Visual feedback during laparoscopic surgery is provided by an endoscope with a camera that is inserted through a small incision in the abdominal wall. The incision restricts the endoscope movements to 4 degrees of freedom (DOF), making it impossible to observe organs from different sides. This paper describes two 6 DOF steerable endoscopes that contain a new spatial parallelogram-mechanism to transform the handgrip movements into movements of the steerable tip. Part of the mechanism is a new kind of spring that combines high torsion stiffness with a low bending stiffness. The endoscopes and the spring have been applied for two international patents.
A Novel Harmonic Drive With Pure Involute Tooth Gear Pair
Authors: Maiti Rathindranath
Published: March 2004

Consider commercially available “harmonic drives” or “strain wave gearings” (all patented designs). The tooth profiles of the mating pairs of teeth of the noncircular (pitch curve) flex gear and circular (pitch circle) ring gears are nearly conjugate and noninvolute. Evidently none of them offers ideal gear kinematics. In this paper, we propose a new wave generator (or cam) to drive flex gears of harmonic drives with fully conjugate gear pairs of purely involute profiles. The cam profile is made of circular arcs at the two diametrically opposite contact zones and shifted elliptical curves for the other two zones. The geometric construction is done in such a way that tip interference is properly avoided for both engagement and disengagement with nominally stubbed or full depth tooth involute gears. We develop the theory of geometric and gearing conditions. We have also built a physical model in order to verify the geometry of tooth interference and other relevant gearing kinematics.