bluuebunny/crossref_metadata_2025 huggingface dataset:
Differences in service attitudes and experiences among families using three types of support services
Authors: Bass David M. , Mccarthy Catherine , Eckert Sharen , Bichler Joyce
Published: June 2007

One goal of support services for family members of Alzheimer's patients is to facilitate the use of other formal services. Few existing studies empirically test the relationship between support service use and the use of other community or residential services. This research describes the relationship between support and other service use by comparing families who used three types of support services:

• Information and referral • Educational programs; and • Support groups.

Data from in-person interviews with 127 family caregivers showed that families who used one of the three support services differed in the use of other services, service attitudes, past service experiences, and reasons for support service use. Results profile the characteristics of families who turn to different types of support services and illustrate the importance of past service characteristics for explaining current and future utilization.

Information and referral (I & R), educational programs, and support groups are commonly provided support services for family members of Alzheimer's disease victims. These three support services share the common goal of facilitating and encouraging the use of other formal services for Alzheimer patients and their family members. Despite this goal, research on support services has seldom considered whether their use is related to the use of other services.
Decisions about guardianship for older persons: Incompetency criteria
Authors: Kjervik Diane K. , Miller Ida , Jezek Kenda , Weisensee Mary G.
Published: June 2007

The purpose of this study was to explore the beliefs of key decision makers about deficits in older persons who are declared legally incompetent and placed under guardianship. Grounded theory was used for qualitative data generation and analysis. Three focus group discussions were held with a total of twenty participants (seven legal professionals; seven health and social services professionals; and six family caregivers) who had been involved in guardianship proceedings for persons 65 years old and older Deficits identified were in self-care, safety, cognition, changes in self, emotion, physical status, interpersonal relationships, trust, social isolation, social nuisance, and context.
An Alzheimer's Disease Bill of Rights
Authors: Bell Virginia Marsh , Troxel David
Published: June 2007

New trends in Alzheimers disease research, treatment, and care suggest that the 1980's emphasis on caregivers will shift to a greater focus in the 1990's on the individual with dementia. A 12-point Alzheimer's disease Bill of Rights is proposed to serve as a touchstone for families, professionals, and in some cases those with the disease to evaluate quality of care. The authors note that the rights are not absolute and must be applied in the context of each individual's cognitive abilities and medical situation.
The changing face of sexual intimacy in Alzheimer's disease
Authors: Kuhn Daniel R.
Published: June 2007

Sexual problems encountered by married couples coping with Alzheimer's disease appear to be a fairly common, yet seldom addressed consequence of the disease. This article reviews current knowledge about the impact of Alzheimer's disease on sexuality. The major effects of the disease on the sexual responses of affected individuals and their spouses are discussed and highlighted through examples. Guidelines for interventions by social workers and other professionals who work with these couples are recommended.
The caring partnership: Staff and families of persons institutionalized with Alzheimer's disease
Authors: Maas Meridean , Buckwalter Kathleen C. , Swanson Elizabeth , Specht Janet , Tripp-Reimer Toni , Hardy Mary A.
Published: June 2007

This article has set forth a strategy to increase family/staff cooperation in the care of persons institutionalized with AD. The FIC program was developed as an outgrowth of research that demonstrated family member dissatisfaction with their roles. It is specifically designed to provide a partnership role with staff for families whose relatives with AD are institutionalized. Hypothesized outcomes include the reduction of stress in caregiving, increased satisfaction in role and improved patient cognitive and functional outcomes. Testing of the FIC is currently underway.
Factors contributing to minimizing weight loss in patients with dementia
Authors: Griffin Randy L.
Published: June 2007

The literature has suggested that residents with dementia are more apt to sufferfrom nutritional difficulties and weight loss as compared to other residents in long term care facilities. This article will discuss the negative impact dementia symptoms have on normal eating patterns and nutritional intake. Interventions to minimize weight loss will be introduced and described as a part of a unique assisted dining program called “Caring Hands.”
Hip fracture in patients with Alzheimer's disease
Authors: Shua-Haim J. R. , Parikh A. , Gross J. S.
Published: June 2007

The purpose of this study was to evaluate the outcome of hip fracture repair and rehabilitation in patients with Alzheimer's disease.

A retrospective study of patients with Alzheimer's disease, who sustained hip fracture repair during the years 1992 and 1993 was done. All patients were living in the community and were followed in the Memory Disorder Institute (MDI) in a large community hospital. A total of nineteen patients with dementia had sustained a hipfracture and 14 patients met the criteria of probable Alzheimer's disease. Five patients were excluded due to non Alzheimer's type of dementia. Surgical hip repair was performed in 13 patients. One patient refused surgery. All patients had 10 days of rehabilitation for ambulation. Patients who needed longer rehabilitation were transferred to a rehabilitation center.

Post operative findings include the fact that all 14 patients were able to ambulate 25 feet with assistance in the rehabilitation department (including a patient who refused surgical repair). One month follow-up after hospital discharge reveals that patients with pre-hip fracture Mini-Mental Status (MMSE) equal or below 15 (total of 9 patients), were unable to ambulate with any assistance. There were four patients with MMSE > 15. Three were able to ambulate after hip surgical repair (with or without assistance), although one patient was non ambulatory. Interestingly, even the patient who refused surgical repair (MMSE = 10), was able to ambulate 50 feet with a walker while in the hospital After discharge to her home, she was unable to ambulate.

Our findings suggest that none of the patients with Alzheimer's disease and MMSE ≤ 15, who sustained hip fracture repair were able to ambulate one month after hospital discharge.
Review of state policies regarding Special Care Units: Implications for family consumers and health care professionals
Authors: Gerdner Linda A. , Buckwalter Kathleen C.
Published: June 2007

This article compares and contrasts state regulations regarding minimum standards for the establishment of Special Care Units (SCUs). A case study approach is then used to assess the criteria for two special care units in Iowa (which requires licensure) and two special care units in Illinois (which does not require licensure). The article concludes with implications for family consumers and health care professionals related to placement decisions, research, policy development and consumer education.
A simulated driving evaluation for patients with Alzheimer's disease
Authors: Shua-Haim Joshua R. , Gross Joel S.
Published: June 2007

A prospective study concerning the driving ability of 41 patients with the diagnosis of Alzheimer's disease (AD) was performed. Using a simulated driving test we evaluated the predictive value of the MMSE,'4 ADL,5-7 and IADL&9 to determine the ability of a person with Alzheimer's disease to drive. All patients were driving at the time of the evaluation.

There was no correlation between driving performance and functional status evaluated by ADL and IADL. When comparing driving performance with cognitive evaluation by MMSE, a significant number of patients with MMSE c 22failed the test, compared to patients with MMSE > 22 (P = 0.01, Fisher's exact test).

No patient with a MMSE < 20 passed the driving test. The authors recommend that health care professionals who are caring for people with Alzheimer's disease with a MMSE of22 or less should request a driving evaluation.
Differences in caregivers of demented and lucid chronically ill family members
Authors: Karlin Nancy J. , Bromley Susan P.
Published: June 2007

The relationship between social support, mood states, and burden was studied in 63 caregivers of chronically ill family members. These caregivers were categorized as providing care for either chronically ill demented or lucid family members. Contact was made with participating caregivers and their medical personnel so as to verify that reported illness did not overlap in both categories (e.g., AIDS with dementia). No differences were evident between caregivers of demented and lucid family members on age, gender, familial relationship, use of formal support, number of health problems or hours spent with the family member Caregivers of demented family members differ from caregivers of lucid chronically ill family members in the level of expressed emotional burden, and amount of revealed fatigue/inertia. However, differences between these caregivers were not evident on levels for time, social, developmental, or physical burden as measured by the Caregiver Burden Inventory (CRI); nor were differences evident on dimensions of tension-anxiety, depression-dejection, anger-hostility vigor activity, or confusion-bewilderment as measured by the Profile of Mood States (POMS).
Comparisons of agitation associated with Alzheimer's disease and acquired brain in jury
Authors: Corrigan John D. , Bogner Jennifer A. , Tabloski Patricia A.
Published: June 2007

Agitation is manifested in many clinical populations. However research andpractice has been pursued solely within these distinct populations. This study examined whether behavioral components ofagitation (i.e., aggressiveness, disinhibition and lability) are differentially expressed in persons with post-traumatic agitation versus those with dementia and agitation due to Alzheimer's disease. Subjects were 19 agitated older adults with dementia due to Alzheimer's disease, 19 agitated older adults with recently acquired brain injury, and 19 agitated younger adults with recent acquired brain injury Agitation was measured using the Agitated Behavior Scale (ABS), with observations selected to assure that the overall level of agitation in each group was comparable. Analysis of variance indicated that the Total ABS score did not differ among the three groups, confirming that overall agitation was comparable. Differences between groups were not signifcantfor either Disinhibition or Lability subscale scores. However, a significant difference was evident for aggression. Planned comparisons indicated that the Alzheimer's and younger brain injury groups differed in this behavior but neither differed fom the older brain injury group. The findings provide initial support for the hypothesis that the manifestation of agitation is similar across affected populations
Ensuring the adequacy of long term care of AD patients: Special challenges and advocacy mechanisms
Authors: Kosberg Jordan I. , Garcia Juanita L. , Dulka Iryna M.
Published: June 2007

The world is aging. The United Nations' has estimated an increase in those 65 years of age and older in the world from 6 percent of the total population in 1985 to 9.7 percent of the population by the year 2025. The growth in the elderly population is most significant among the oldest of the old.

While the incidence of Alzheimer's disease (AD) is related to advanced age (as are other forms of dementia), it can be concluded that the aging of the world will result in an increase in the worldwide number of AD patients. For example, in the United States presently there are in excess of 2.5 million persons with AD and 100,000 AD patients are dying on a yearly basis-it is the fourth leading cause of death in the United States for the elderly, following heart disease, cancer, and stroke.2 Holmes et al project that the number of AD victims in the United States will increase to over 14 million persons by the year 2050.3 It has been estimated that one-third of all American families have at least one parent who has AD.4
General and specific events and depressive symptoms in Alzheimer's disease caregivers
Authors: Cook Joan M. , Pearson Jane L. , Ahrens Anthony H.
Published: June 2007

Daily unpleasant and pleasant events and specific unpleasant caregiving events were examined in relation to depression in 93 caregivers of demented patients. This study differs from previous research on caregivers in that it focuses on general events (hassles) in addition to specific caregiving events (hassles). Even after controlling for specific unpleasant caregiving events, general unpleasant and pleasant events accounted for additional variance in depressive symptomatology. The results are discussed in terms of their importance for treatment of caregiver depression.
Use of Goal Attainment Scaling in a Dementia Special Care Unit
Authors: Hartman Deborah , Borrie Michael J. , Davison Elizabeth , Stolee Paul
Published: June 2007

Evaluation of Dementia Special Care Units presents particular challenges, including measuring the attainment ofgoals for residents with limited potential for treatment and rehabilitation. Goal Attainment Scaling (GAS) has been found to be a sensitive measure of individualized tangible outcomes in geriatric rehabilitation and mental health settings. In this study, GAS was used to set individualized functional and recreation goals for 10 residents of a Dementia Special Care Unit in a chronic care and rehabilitation hospital. Goal attainment was measured over a two month follow-up period GAS was found to be a feasible and responsive method of measuring individualized client goals. GAS is a promising clinical and research tool for measurement of client-centered outcomes in individuals with dementia
l-FAAD (Instrument for Affirming Alzheimer's Disease): Understanding & affirming stage specific cognitive decline as it correlates to early childhood development
Authors: Holthaus Jean
Published: June 2007

To assist in understanding the changing needs of persons with Alzheimer's disease (AD), the I-FAAD (Instrument for Affirming Alzheimer's Disease) was produced It is a table that includes stage specific concepts regarding degenerative dementia, early childhood development, helpful caregiver behaviors, caregivers' emotional recycling, and helpful affirmations. Hopefully, it can help caregivers understand and incorporate behaviors and messages that correlate to early childhood development needs.
A behavior mapping method for assessing efficacy of change on special care units
Authors: Bell Paul A. , Smith Jeffrey M.
Published: June 2007

It is often difficult to quantify outcomes when special care units implement changes such as new activity programs, increased staff time, or modified floor plans. We present a behavior mapping strategy that can be used to quantify the impact of such changes. As an example, we show how the method was used to compare a newly opened Alzheimer unit with an established Alzheimer unit across a three-month period The incidence of clean face and clean clothes at the new unit started out below the frequencies at the established unit, but matched the performance at the established unit by the end of the study. Walking, the most common behavior, was twice as likely to occur as sleeping during the day. Shouting, swearing, and hitting were extremely rare events. The behavior mapping method could be adapted as one index of quality of care.
A comparison of assessments made by nurses, informal caregivers, and legal professionals of incapacity criteria for guardianship of older persons
Authors: Kjervik Diane K. , Weisensee Mary G. , Anderson Joanne , Carlson John R.
Published: June 2007

In order to determine the criteria by which health care, legal professionals, and informal caregivers who care for older persons make decisions to seek guardianships, a 22-item scale developed by the investigators was distributed to decision-makers. Responses from 206 caregivers were evaluated using descriptive statistics and robust ANO VA. Of most importance to determining incapacity were criteria related to endangerment of self or others, and of least importance were criteria involving activity levels and social participation. Decision-makers were in agreement about nine of the 22-items, and disagreed about the remaining thirteen. Informal caregivers were generally less willing than professionals to indicate that criteria were highly important to incompetence. The close and intimate relationships informal caregivers have with older relatives or friends as opposed to the more formal relationships that health care and legal professionals have with them might affect judgments about when proxy decision-making is needed.
Validation Therapy: Restoring communication between persons with Alzheimer's disease and their families
Authors: Touzinsky Lisa
Published: June 2007

There are millions of families who are faced with the pains of Alzheimer's disease (AD) every day. One of the most salient and pervasive issues they encounter is related to their loved ones' decline in communication. As a person progresses through AD, their ability to communicate deteriorates. This paper offers the use of Validation Therapy (VT) as a tool for meaningful communication for families and persons with AD. The principles and techniques of VT are presented. A case study employing the use of VT between a man with AD and his daughter demonstrates the process of VT between family members. The benefits that VT holds for families specifically is explored. This paper emphasizes the need for families to be informed of options and of alternatives to standard communication and supports VT as a viable tool.
Building adult day center census by preventing premature terminations
Authors: Cox Nancy J. , Reifler Burton V. , Yates Kim
Published: June 2007

The purpose of this article is to report on participant discharges from adult day centers, and to determine if some terminations might be preventable, or at least delayed. Thirteen reasons for participant termination, reported over a 39-month period by 49 adult day programs operating 53 adult day centers, were reviewed. Participants (i.e., client population served) at these day centers included: Adults with Alzheimer's disease or related disorders (on average 70.5 percent of the total client base); persons with mental retardation/developmental disabilities; individuals with chronic mental illness; and/or adults with physical problems. Each reason for participant termination was examined based on the potential to reduce the number of terminations. Three basic categories were used as a point of reference: 1) good potential for improvement; 2) moderate potential for improvement; and 3) little or no potentialfor improvement. The discussion offers a variety of considerations from which adult day centers can monitor and evaluate discharges, implement strategies to reduce the number of unnecessary terminations, and maintain center census.
Dementia with parkinsonism: Alzheimer's disease is more common than dementia with Lewy bodies
Authors: Lippa Carol F. , Smith Thomas W. , Swearer Joan
Published: June 2007

The spectrum ofpathologic diagnoses in patients presenting with dementia who subsequently develop parkinsonism is incompletely defined. To address this issue, we examined the brains from 19 patients with symptomatic parkinsonism within a year of their initial evaluation for dementia. Eighteen patients met CERAD pathologic criteria for Alzheimer k disease (AD), 14 of these hadpure AD and four had AD with concurrent cortical Lewy bodies (CLB). Only one case had dementia with Lewy bodies (DLB) without AD changes. Wefound no clinicalfeatures that could distinguish pure AD patientsfrom patients with CLB with certainty however the presence of disordered ideation increased the likelihood of DLB. We conclude that patients who present with dementia and subsequently develop parkinsonism frequently have AD if other signs of DLB are absent.
Attribution of emotion in advanced Alzheimer's disease: Family and caregiver perspectives
Authors: Tappen Ruth M. , Williams Christine
Published: June 2007

This qualitative study explored family and caregiver perspectives on the expression of emotion by individuals in the middle and late stages of Alzheimer's disease (AD). Indepth interviews were conducted with family members and facility staff Respondents readily ascribed expression of a wide range of emotions to individuals in the advanced stages of AD. More negative than positive emotions were identified. Caregivers attributed much of the negative emotion to individual response to the difficulties imposed by the disease. Differences by stage of the disease and sudden shifts in mood were also described, including a difficult period coinciding with recognition of increasing deficits and their consequences in the middle stages.
Mental health issues and Alzheimer's disease
Authors: Kane Michael N.
Published: June 2007

As the prevalence of Alzheimer's disease (AD) increases, concerns have been voiced regarding how to best maintain and treat those affected. Psychiatric symptoms may be a prominent and influencing factor in decisions regarding the most appropriate level of care. The behavioral manifestations of AD, particularly agitation, may present dilemmas for formal and informal caregivers. The most significant dilemmas surrounding appropriate care for individuals manifesting psychiatric symptoms and negative behaviors may include the safety of caregivers as well as the safety of the diagnosed individual. These dilemmas may be compounded when there is not adequate psychiatric/psychotherapeutic intervention. This paper will seek to examine the psychopathology associated with AD as well as some intensive and restrictive interventions available to formal and informal caregivers when less intensive and less restrictive interventions fail. The intensive and restrictive interventions discussed include institutionalization, physical and chemical restraints, and psychiatric hospitalization.
Dementia in the severely aphasic: Global aphasia without hemiparesis—A stroke subtype simulating dementia
Authors: Nagaratnam Nages , Mcneil Catriona
Published: June 2007

Patients with severe aphasia and possible dementia cannot be adequately assessed for want of normative data. We describe four patients with global aphasia without hemiparesis who were referred for evaluation of dementia without the knowledge that they had previously suffered a stroke. All four had no neurological deficits except for language dysfunction. The study looked at the utility of the commonly-used dementia scales in patients with severe aphasia and possible dementia. The findings indicated the limitations of verbal, non-verbal cognitive tests and the reliance on informant reports. Appropriate weighting of these may help in arriving at a more accurate diagnosis. Until guidelines for a reliable criteria are established, the clinician should assess the patient in a global way and not just in one aspect of the patient's symptomatology. Dementia in the severely aphasic remains a diagnostic challenge and merits further study.
Stages of caregiving
Authors: Pfeiffer Eric
Published: June 2007

Scales delineating the stages of Alzheimer's disease (AD) have been published by a number of authors. These scales have been found to be extremely useful in clinical practice as well as in research on Alzheimer patients. But the care of an Alzheimer patient generally involves not only the identified patient but also a primary caregiver. Based on my work with Alzheimer patients and their families, I have recognized and described the stages of caregiving as experienced by caregivers. They are as follows:

Stage 1: Coping with the initial impact of being told the diagnosis.

Stage 2: To be or not to be...a caregiver?

Stage 3: At-home caregiving—the long journey.

Stage 4: Considering institutional placement.

Stage 5: Caregiving during residential or institutional placement.

Stage 6: Death of the patient—grief and relief. Stage 7: Resuming life—healing and renewal.
Cognitive attributions, depressive symptoms and hopelessness as predictors of perceived desirability of physician-assisted suicide in Alzheimer's caregivers
Authors: Roscoe Lori A. , Cohen Donna
Published: June 2007

This study compared attitudes towards physicianassisted suicide in two groups of older persons, 57-caregivers of relatives with Alzheimer's disease (AD) and 46-non-caregivers. A series of two-way ANOVAs by caregiver status and level of depressive symptoms compared hopelessness scores, attribution styles, and beliefs about physician-assisted suicide. Two attributional style scales were significantly associated with depressive symptoms. Subjects who felt less in control of the stresses in their lives reported more depressive symptoms (F = 10.16, p = .002). Subjects who felt that the factors causing stress were unchangeable also reported significantly more depressive symptoms (F = 5.41, p = .022). Over twothirds of both groups believed assisted suicide was a rational decision in some circumstances, but 40 percent of caregivers and only 24 percent of non-caregivers believed physicians should assist patients in committing suicide.
Caregiver satisfation with Adult Day Service Programs
Authors: Jarrott Shannon E. , Zarit Steven H. , Parris-Stephens Mary Ann , Townsend Aloen , Greene Rick
Published: June 2007

Caregivers typically report high levels of satisfaction with adult day service (ADS) programs. However, studies of satisfaction are often limited by methodological problems. For example, items may only assess global satisfaction rather than caregivers’ feelings about specific aspects of ADS use. Additionally, caregivers’ responses may reflect their expectations or attitudes about ADS rather than satisfaction with the program. This study uses multiple indicators of a program's success to evaluate caregiver satisfaction with ADS after three and 12 months of program attendance. Reported are rates of satisfaction with various features of ADS services, perceived benefits and drawbacks associated with ADS use, and how those evaluations change over time. We also examine factors associated with caregivers’ evaluation of ADS.
Effectiveness of Special Care Unit (SCU) placements in reducing physically aggressive behaviors in recently admitted dementia nursing home residents
Authors: Leon Joel , Ory Marcia G.
Published: June 2007

Using a sample of new dementia admissions who entered selected nursing facilities December 1992 through June 1994, this paper compares special care dementia units (SCUs) to non-specialized (traditional) nursing home care in their effectiveness in reducing physically aggressive behaviors within six-months of placement. Findings indicate that SCUs admit younger and more highly aggressive residents. Our results indicate that when differences in age and baseline levels of disruptive behaviors are controlled, SCU placement showed no positive or negative effect on the frequency of aggressive behaviors. Rather than SCU placement, it was the increased use of psychotropic medications and the reduction in the use of physical restraints that showed a relationship with lower levels of physically aggressive behaviors. While SCUs do not appear to be the hoped for panacea with regard to reducing physically aggressive behaviors, they still appear to serve a useful function within the broader context of the provision of services for residents with dementia within the nursing home.
How to cope: Documenting the changing information needs of Alzheimer's caregivers
Authors: Steffen Ann M. , Tebb Susan , McGillick Janis
Published: June 2007

Educational programs for family caregivers of persons with dementia are quite popular, but vary in content and evaluation strategies. This article describes the development and content of the award winning How To Cope classes offered by the St. Louis Chapter of the Alzheimer's Association. Two methods were used to obtain feedback and revise the program. Results from a telephone survey of past participants (n=35) and two focus groups (n=16) were combined to validate the continued usefulness of the program and develop curriculum recommendations.
Predictors of driving cessation, independent living, and power of attorney decisions by dementia patients and caregivers
Authors: Wackerbarth Sarah , Johnson Mitzi M. S.
Published: June 2007

This study examines factors associated with decisions made by dementia patients and their caregivers regarding whether the patient should cease driving, live alone or with their spouse, and assign a Durable Power of Attorney. Using data collected by the Alzheimer's Disease Research Center (ADRC) in the Memory Disorders Clinic at the University of Kentucky Medical Center, we analyzed 827 first visits to predict patients’ and caregivers’ decisions. Caregiver relationship and patient gender and perceptions of patient abilities, as measured by Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) were more important than cognitive functioning, as measured by the MMSE, in predicting decisions made. These findings have theoretical implications for modeling the impact of the course of the disease and practical implications for interventions aimed at supporting the decision-making processes of patients and caregivers.
A social cognitive examination of responses to family conflicts by Arfican-American and Chinese-American carrgivers
Authors: Weitzman Patricia Flynn , Chee Yeon Kyung , Levkoff Sue E.
Published: June 2007

Conflict between caregivers and their family members has been examined in relation to caregiver burden. However, specific theoretical models have not been applied to analyses of caregiver family conflicts. Nor has there been much research on the family conflicts of ethnic minority caregivers. Using Selman's1 interpersonal conflict strategies and their related levels of social perspective coordination as our framework, we content analyzed conflict reports of African-American and Chinese-American caregivers. Overall, there were more similarities in the strategies and social perspective coordination levels of the two groups than differences. In narratives where conflict was present (78 percent), about half of caregivers in both groups reported higherlevel conflict strategies, and half reported lower-level strategies. More advanced social perspective coordination seemed associated with greater satisfaction with family sharing of responsibilities in both groups. If these data patterns bear up under further testing, training in conflict resolution and social perspective coordination skills may prove an effective means of fostering better social relationships and sharing arrangements between caregivers and family members, and be a worthwhile complement to existing stress reduction interventions for caregivers.
Richard Rodriguez's Writings: An Account of Cultural Complexity and Search for Identity
Authors: Soldan Angelika , Zavaletta Elizabeth
Published: June 2007

This article discusses how Richard Rodriguez, in his two autobiographical novels Hunger of Memory and Dialogues With My Father, queers his own life experiences and arrives at a “bricol(l)age” identity. This is neither an essentialist nor a freely floating identity. His cosmopolitan Americanness is anchored in a manifold of communities and(re)balances a broad variety of dichotomies (Catholic-Protestant, México-America, English-Spanish, feminine-masculine, public-private, rational-emotional, urban-rural, close-alienated) that shape his life.
The Stacking of Latinos in Major League Baseball: Does it Matter if a Player is Drafted?
Authors: González G. Leticia
Published: June 2007

According to the stacking theories first developed by Loy and McElvogue, minority individuals are assigned to noncentral playing positions based on ascribed characteristics such as race or ethnicity. This study investigates whether the draft has an impact on stacking patterns. The period from 1995 to 1999 was analyzed. Results indicate that two out of three Latino players are not drafted, that nondrafted players tend to be over represented at second base and short stop, and that drafted players are not stacked in any position.
The Recruitment of Work-Bound, At-Risk Hispanic High School Students by Texas Community Colleges
Authors: Montiel Arturo
Published: June 2007

The growth of the Hispanic population, and current Texas legislation highlight the need for an effective recruitment strategy by community colleges. Many work-bound, at-risk Hispanic high school students are not targeted in recruitment practices. This study aimed to describe the frequency and perceived effectiveness of recruitment tools used to recruit this population. The findings suggested that the participants did not implement what they perceived to be the most effective ways to recruit the population.
Experiential Analysis of a Multicultural Learning Adventure in a Hispanic-Serving Institution
Authors: Craven Annette E. , Kimmel Jessica C.
Published: June 2007

Two faculty members of a liberal arts, Catholic university use constructivist learning theory and Reuven Feuerstein's concept of the mediated learning experience to create an environment of enculturation in an interdisciplinary philosophy course for doctoral students from multiple cultures. This article demonstrates how two female faculty members of Anglo descent translated the experience into the definition and development of thinking skills and meaning making for students in a Hispanic-serving institution from multiple cultures with diverse areas of professional expertise and very different personal philosophies.
Access to Doctoral Study for Hispanic Students: The Pragmatics of “Race” in (Recent) Texas History and Policy
Authors: Oliva Maricela
Published: June 2007

This article discusses the historical developments and major policy shifts that contextualize higher education access for Hispanic and other underrepresented students in Texas. How state educators and policy makers provide access notwithstanding a changing context is described. Reference is made to a specific institution and doctoral program in South Texas as an example of the effort to address the state's moral and economic imperatives of ensuring access to higher education for Hispanic students.
Improving the Faculty's Effectiveness in Increasing the Success of Hispanic Students in Higher Education—Pronto!
Authors: De Los Santos Gilberto , Hume Evelyn C. , Cortes Angelica
Published: June 2007

This article examines the role of the faculty in increasing the success of Hispanic students in higher education and offers suggestions for improving teaching effectiveness. As educators, some professors operate from a teaching- oriented paradigm, whereas others are more learner oriented. Learner-oriented techniques such as client-sponsored projects, classical music, and brain exercises are methods to accelerate Hispanic students' learning, therefore increasing the success of Hispanic students in higher education.
Predicting Persistence of Hispanic Students in Their 1st Year of College
Authors: Otero Rafael , Rivas Olivia , Rivera Roberto
Published: June 2007

The authors used a logit model with partial derivatives to identify which demographic and academic variables are associated with 1st-year attrition and persistence of Hispanic students and to determine the extent to which these factors affect the students' decision to remain or leave the university. The model was able to correctly predict the students' decision to continue or leave the university for 4 of every 5 students participating in a program developed for at-risk students.
Building Sustainable Power
Authors: González Cristina
Published: June 2007

This article offers recommendations for Latino faculty members who wish to become academic administrators, for institutions of higher learning that want to recruit Latino administrators, and for the Hispanic community, which needs to move past its current seesaw regime of endurance and impatience and start applying gentle, but constant, pressure on universities to foster the development of Latino academic leaders.
Long-Term Results of Local Thrombolysis Followed by First Rib Resection: An Encouraging Clinical Experience in Treatment of Subclavian Vein Thrombosis
Authors: Yilmaz E. N. , Vahl A. C. , van Heek N. T. , Vermeulen E. G. J. , Rauwerda J. A.
Published: June 2007

The purpose of this study was to present the long-term results of our experience, which includes thrombolysis, surgical decompression, and long-term anticoagulation. The medical records of 24 patients who were admitted to Academic Hospital Vrije Universiteit, Amsterdam, the Netherlands, between January 1983 and October 1997, with effort thrombosis of the subclavian vein were reviewed. There were 21 men and 3 women, with a mean age of 30.5 years and an average duration of the symptoms of 2.9 days. Clinical diagnosis was confirmed by phlebography and duplex in all patients. A loading dose of 10,000 units streptokinase was given followed by an infusion at a rate of 10,000 units per hour. Phlebography was repeated daily in order to evaluate the effect of the treatment. Thrombolysis was achieved in 2 to 8 days (mean 5 days). After achievement of complete thrombolysis, anticoagulation with heparin and coumarin derivatives was started; the latter were continued for 3 months.

Six to 12 weeks after the thrombolysis, patients with costoclavicular compression syndrome underwent surgery. A transaxillary first rib resection, partial scalenotomy, and transection of the tendon of subclavian muscle were performed. Thrombolysis was achieved in all patients but one, with a successful lysis percentage of 95.8%. In one patient, the local streptokinase therapy had to be discontinued because of pulmonary embolism. Resection of the first rib was performed on 19 patients. Two patients refused to be operated on. The other three were lost to follow-up, right after the thrombolytic therapy. In long-term evaluation, all the patients who underwent first rib resection were symptom free, whereas the two patients who refused to be operated on had pain and discoloration of the affected arm, although venous patency was achieved.

The subclavian vein thrombosis occurs as a result of repetitive trauma due to anatomic constriction of the vein by the clavicle and the first rib complex. Therefore, we advise addressing the therapy not only to the superimposed thrombus but also to the correction of the underlying anatomic abnormality.
Radial Shunting for Renal Ischemia During Reconstruction of the Renal Artery
Authors: Igari Tsuguo , Hoshino Shunichi , Iwaya Fumio
Published: June 2007

A new method of preserving the kidney during reconstruction of renal arteries is presented. This method of continuously perfusing the kidney with normothermic, autologous blood flow from a radial artery is very simple and provides enough time to reconstruct renal arteries even for inexperienced surgeons.
Dorsal Pedal Venous Oximetry for Assessing Treatment of Chronic Venous Insufficiency: Effects of Daflon 500 mg
Authors: Ener Behçet K.
Published: June 2007

Daflon 500 mg has been shown to have beneficial effects on microcirculatory disturbances causing tissue hypoxia in chronic venous insufficiency (CVI). To assess the effects of Daflon 500 mg on venous disorder in the lower extremity by means of dorsal pedal venous oximetry measurements, a 4-week prospective study was carried out in 33 patients having a mild or moderate stage of CVI in one leg. In treatment with Daflon 500 mg at a daily dose of two tablets, there were significant (p>0.05) increases in partial pressure of oxygen (Po2), oxygen saturation (So2) and pH, and a decrease in partial carbon dioxide pressure (Pco2). Clinical findings attributable to CVI were markedly improved. Comparison of dorsal pedal venous, oximetry parameters in the symptomatic leg and the clinically unaffected other leg was made before and after 4 weeks of oral therapy. Significant (p>0.05) differences were observed between involved and healthy lower limbs.
Vascular Ring Type IIIB1 Causing Tracheoesophageal Compression in an Adult
Authors: Samuels Louis E. , Michaelik Jarik , Ravishankar Raman , Thomas Matthew P. , Kaufman Marla S. , Wechsler Andrew S.
Published: June 2007

Vascular rings are congenital lesions that cause tracheobronchial and esophageal symptoms as a result of compression of these structures. The majority of cases are recognized in infancy, childhood, and occasionally adolescence. Rarely, vascular rings first present in adulthood. The authors present the case of a vascular ring in an elderly woman who complained of dysphagia.
Ureteral Obstruction Following Aortic Surgery: Guidelines for Successful Management
Authors: Seelig Matthias H. , Oldenburg W. Andrew
Published: June 2007

Ureteral obstructions following aortoiliac or aortofemoral bypass grafting for aortoiliac occlusive and aneurysmal disease are infrequently reported. Ureteral obstructions can be self-limiting and resolve without further treatment or can signify a more serious underlying complication such as graft infection or a pseudoaneurysm formation. The authors present a series of five patients with ureteral obstruction secondary to aortobifemoral bypass grafting. Different treatment options are described and an algorithm for the management of these complications is presented.
Cystic Adventitial Disease of the Popliteal Artery: An Illustrative Case and Literature Review
Authors: Patel Gavish N. , Braastad Fred E. , DeBord James R.
Published: June 2007

Lower extremity claudication most commonly results from atherosclerotic disease. Cystic adventitial disease of the popliteal artery is a rare entity that also manifests with symptoms of claudication. The disease usually occurs in otherwise healthy men without cardiovascular risk factors for atherosclerosis. Extrinsic compression of the arterial lumen leads to arterial insufficiency in these patients. A fairly typical case of cystic adventitial disease of the popliteal artery is reported and a review of the literature is presented.
Femorofemoral Arterial Bypass: Subcutaneous or Preperitoneal
Authors: Read Raymond C. , Barnes Robert W. , Eidt John F. , Hauer-Jensen Martin , Moursi Mohammed M.
Published: June 2007

A salutary, long-term result, using preperitoneal placement in a patient transferred after repeated failure of subcutaneous prosthetic femorofemoral bypass, prompted a review of this procedure by the authors.

From 1972 to 1996, 61 men and 1 woman, aged 28 to 80 years, received 67 initial or “redo” interpositions for unilateral, predominately-sinistral ischemia, 45% being operated on as emergencies. They were considered unfit for the preferred direct transabdominal reconstruction under general anesthesia because of cardiopulmonary comorbidity. Follow up, extending to 20 years, was complete in 93.5%. Operative mortality was 6.6%, all from cardiogenic shock after atherothromboembolism secondary to transfemoral intraaortic balloon pulsation after myocardial infarction (MI) or coronary artery bypass graft (CABG). Most bypasses were subcutaneous; however, 17% were preperitoneal. The author's cumulative initial patency was similar for those operated on with primary (23) and postaortofemoral bypass graft (post-AFBG) (29) ischemia. Preperitoneal placement (10) was associated with better primary prosthetic patency and less infection than subcutaneous (42) insertion.
Can the Cost of Distal Vascular Reconstruction be Reduced Without Sacrificing Quality? Analysis of 500 Cases
Authors: Choi Daniel S. , Darling R. Clement , Roddy Sean P. , Kreienberg Paul B. , Chang Benjamin B. , Paty Philip S. K. , Lloyd William E. , Shah Dhiraj M.
Published: June 2007

The goal of clinical pathways is to reduce the cost of the hospitalization while maintaining acceptable results (patency, morbidity, and mortality). Patients who present with lower extremity revascularization pose a difficult problem, for they have significant comorbid medical disease. In this study the authors analyze their results and the treatment cost for patients undergoing lower extremity revascularization before and after the institution of clinical pathways.

Data were collected independently by the hospital financial office, and surgical outcomes were derived from the prospectively collected computerized vascular registry. Data were analyzed for 12 months before and after institution of pathways. Cost, length of stay (LOS), and use of ancillary service as well as mortality, morbidity, and patency rates were evaluated. During each period, patients were selectively admitted to the intensive care unit based on perioperative risk factors independent of the pathway.

Three hundred ninety-nine patients with distal reconstructions were placed on the path during this time period. These were compared to a group of 286 patients who were not on the path in the year prior. The LOS decreased from 14.3 days to 9.2 days. Electrolyte laboratory panels decreased from 12 draws per patient per admission to two draws per patient per admission. This trend was also seen in complete blood count (11.8 to 6.8), glucose (12.6 to 2.1), and electrolytes (12.2 to 1.8). Perioperative mortality rates were similar (2.5% vs 1.9%) with no change in morbidity rates. Total cost for hospitalization decreased by 27% after institution of the clinical pathway.

From these data, the authors can demonstrate that the institution of clinical pathways not only decreased total cost, use of ancillary laboratory tests, and LOS but also did not negatively impact on outcome.
Transaortic Septectomy as Treatment for Chronic Mesenteric Ischemia After Aortic Dissection
Authors: Desai Tina R. , Davidovitch Roy I. , Schwartz Lewis B. , McKinsey James F.
Published: June 2007

Visceral ischemia can present as an acute or chronic complication of aortic dissection, which is associated with high morbidity and mortality rates, up to 50-87%. Furthermore, the optimal management strategy for this problem is unclear. The authors present a case of chronic mesenteric ischemia complicating a Stanford type A aortic dissection which was treated with transaortic septectomy.

A 56-year-old man presented with chronic abdominal pain and a 30-pound weight loss after operative repair of an ascending aortic dissection with replacement of his aortic valve and ascending aorta. Two prior attempts at balloon fenestration of his aortic dissection in the area of his mesenteric vessels had failed to improve his symptoms. Angiography, computed tomography scan, and duplex evaluation of the aorta revealed a 5 cm suprarenal aorta with the false lumen occupying the majority of the diameter. The origins of the mesenteric vessels from the true lumen were compressed by the septum. The patient underwent a septectomy and aortoplasty of his suprarenal aorta via a retroperitoneal approach. A postoperative duplex scan showed widely patent origins of the celiac, superior mesenteric, and renal arteries. The patient's postprandial pain completely resolved before hospital discharge.

Aortoplasty and septectomy presents a newly described treatment of complications of aortic dissection and has been utilized in the acute and chronic settings. It allows successful treatment of aneurysmal and occlusive complications in the dissected aorta. The evaluation and operative treatment of a patient with both these complications is discussed.