bluuebunny/crossref_metadata_2025 huggingface dataset:
One‐dimensional thermal modelling of Acadian metamorphism in southern Vermont, USA
Authors: Armstrong T. R. , Tracy R. J.
Published: March 2003

One‐dimensional thermal (1DT) modelling of an Acadian (Devonian) tectonothermal regime in southern Vermont, USA, used measured metamorphic pressures and temperatures and estimated metamorphic cooling ages based on published thermobarometric and geochronological studies to constrain thermal and tectonic input parameters. The area modelled lies within the Vermont Sequence of the Acadian orogen and includes: (i) a western domain containing garnet‐grade pre‐Silurian metasedimentary and metavolcanic rocks from the eastern flank of an Acadian composite dome structure (Rayponda–Sadawga Dome); and (ii) an eastern domain containing similar, but staurolite‐ or kyanite‐grade, rocks from the western flank of a second dome structure (Athens Dome), approximately 10 km farther east. Using reasonable input parameters based on regional geological, petrological and geochronological constraints, the thermal modelling produced plausible P–T  paths, and temperature–time (T –t) and pressure–time (P–t) curves. Information extracted from P–T –t modelling includes values of maximum temperature and pressure on the P–T  paths, pressure at maximum temperature, predicted Ar closure ages for hornblende, muscovite and K‐feldspar, and integrated exhumation and cooling rates for segments of the cooling history. The results from thermal modelling are consistent with independently obtained pressure, temperature and Ar cooling age data on regional metamorphism in southern Vermont. Modelling results provide some important bounding limits on the physical conditions during regional metamorphism, and indicate that the pressure contemporaneous with the attainment of peak temperature was probably as much as 2.5 kbar lower than the actual maximum pressure experienced by rocks along various particle paths. In addition, differences in peak metamorphic grade (garnet‐grade versus staurolite‐grade or kyanite‐grade) and peak temperature for rocks initially loaded to similar crustal depths, differences in calculated exhumation rates, and differences in 40Ar/39Ar closure ages are likely to have been consequences of variations in the duration of isobaric heating (or ‘crustal residence periods’) and tectonic unroofing rates. Modelling results are consistent with a regional structural model that suggests west to east younging of specific Acadian deformational events, and therefore diachroneity of attainment of peak metamorphic conditions and subsequent 40Ar/39Ar closure during cooling. Modelling is consistent with the proposition that regional variations in timing and peak conditions of metamorphism are the result of the variable depths to which rocks were loaded by an eastward‐thickening thrust‐nappe pile rooted to the east (New Hampshire Sequence), as well as by diachronous structural processes within the lower plate rocks of the Vermont Sequence.
Constraints on the application of carbon isotope thermometry in high‐ to ultrahigh‐temperature metamorphic terranes
Authors: Satish‐Kumar M. , Wada H. , Santosh M.
Published: March 2003

Nine marble horizons from the granulite facies terrane of southern India were examined in detail for stable carbon and oxygen isotopes in calcite and carbon isotopes in graphite. The marbles in Trivandrum Block show coupled lowering of δ13C and δ18O values in calcite and heterogeneous single crystal δ13C values (− 1 to − 10‰) for graphite indicating varying carbon isotope fractionation between calcite and graphite, despite the granulite facies regional metamorphic conditions. The stable isotope patterns suggest alteration of δ13C and δ18O values in marbles by infiltration of low δ13C–δ18O‐bearing fluids, the extent of alteration being a direct function of the fluid‐rock ratio. The carbon isotope zonation preserved in graphite suggests that the graphite crystals precipitated/recrystallized in the presence of an externally derived CO2‐rich fluid, and that the infiltration had occurred under high temperature and lowfO2conditions during metamorphism. The onset of graphite precipitation resulted in a depletion of the carbon isotope values of the remaining fluid+calcite carbon reservoir, following a Rayleigh‐type distillation process within fluid‐rich pockets/pathways in marbles resulting in the observed zonation. The results suggest that calcite–graphite thermometry cannot be applied in marbles that are affected by external carbonic fluid infiltration. However, marble horizons in the Madurai Block, where the effect of fluid infiltration is not detected, record clear imprints of ultrahigh temperature metamorphism (800–1000 °C), with fractionations reaching <2‰. Zonation studies on graphite show a nominal rimward lowering δ13C on the order of 1 to 2‰. The zonation carries the imprint of fluid deficient/absent UHT metamorphism. Commonly, calculated core temperatures are  > 1000 °C and would be consistent with UHT metamorphism.
Grain‐scale melt distribution in two contact aureole rocks: implications for controls on melt localization and deformation
Authors: Marchildon N. , Brown M.
Published: March 2003

The grain‐scale spatial arrangement of melt in layer‐parallel leucosomes in two anatectic rocks from two different contact aureoles located in central Maine, USA, is documented and used to constrain the controls on grain‐scale melt localization. The spatial distribution of grain‐scale melt is inferred from microstructural criteria for recognition of mineral pseudomorphs after melt and mineral grains of the solid matrix that hosted the melt. In both rocks, feldspar mimics the grain‐scale distribution of melt, and quartz is the major constituent of the solid matrix. The feldspar pockets consist of individual feldspar grains or aggregates of feldspar grains that show cuspate outlines. They have low average width/length ratios (0.54 and 0.55, respectively), and are interstitial between more rounded and equant (width/length ratios 0.65 for both samples) quartz grains. In two dimensions, the feldspar pockets extend over distances equivalent to multiple quartz grain diameters, possibly forming a connected three‐dimensional intergranular network. Both samples show similar mesoscopic structural elements and in both samples the feldspar pockets have a shape‐preferred orientation. In one sample, feldspar inferred to replace melt is aligned subparallel to the shape‐preferred orientation of quartz, indicating that pre‐ or syn‐anatectic strain controlled the grain‐scale distribution of melt. In the other sample, the preferred orientation of feldspar inferred to replace melt is different from the orientations of all other mesoscopic or microscopic structures in the rock, indicating that differential stress controlled grain‐scale melt localization. This is probably facilitated by conditions of higher differential stress, which may have promoted microfracturing. Grain‐scale melt distribution and inferred melt localization controls give insight into possible grain‐scale deformation mechanisms in melt‐bearing rocks. Application of these results to the interpretation of deep crustal anatectic rocks suggests that grain‐scale melt distribution should be controlled primarily by pre‐ or syn‐anatectic deformation. Feedback relations between melt localization and deformation are to be expected, with important implications for deformation and tectonic evolution of melt‐bearing rocks.
Calc‐silicate reactions and bedding‐controlled isotopic exchange in the Notch Peak aureole, Utah: implications for differential fluid fluxes with metamorphic grade
Authors: Nabelek P. I.
Published: March 2003

Fluid compositions and bedding‐scale patterns of fluid flow during contact metamorphism of the Weeks Formation in the Notch Peak aureole, Utah, were determined from mineralogy and stable isotope compositions. The Weeks Formation contains calc‐silicate and nearly pure carbonate layers that are interbedded on centimetre to decimetre scales. The prograde metamorphic sequence is characterized by the appearance of phlogopite, diopside, and wollastonite. By accounting for the solution properties of Fe, it is shown that the tremolite stability field was very narrow and perhaps absent in the prograde sequence. Unshifted oxygen and carbon isotopic ratios in calcite and silicate minerals at all grades, except above the wollastonite isograd, show that there was little to no infiltration of disequilibrium fluids. The fluid composition is poorly constrained, but X(CO2)fluid must have been >0.1, as indicated by the absence of talc, and has probably increased with progress of decarbonation reactions.

The occurrence of scapolite and oxidation of graphite in calc‐silicate beds of the upper diopside zone provide the first evidence for limited infiltration of external aqueous fluids. Significantly larger amounts of aqueous fluid infiltrated the wollastonite zone. The aqueous fluids are recorded by the presence of vesuvianite, large decreases in δ18O values of silicate minerals from c. 16‰ in the diopside zone to c. 10‰ in the wollastonite zone, and extensive oxidation of graphite. The carbonate beds interacted with the fluids only along margins where graphite was destroyed, calcite coarsened, and isotopic ratios shifted.

The wollastonite isograd represents a boundary between a high aqueous fluid‐flux region on its higher‐grade side and a low fluid‐flux region on its lower‐grade side. Preferential flow of aqueous fluids within the wollastonite zone was promoted by permeability created by the wollastonite‐forming reaction and the natural tendency of fluids to flow upward and down‐temperature near the intrusion‐wall rock contact.
Regional‐scale Grenvillian‐age UHT metamorphism in the Mollendo–Camana block (basement of the Peruvian Andes)
Authors: Martignole J , Martelat J.‐E
Published: March 2003

The Mollendo–Camana Block (MCB) is a 50 × 150 km Precambrian inlier of the Andean belt that outcrops along the Pacific coast of southern Peru. It consists of stromatic migmatites of Paleoproterozoic heritage intensely metamorphosed during the Grenville event (c. 1 Ga; U‐Pb and U‐Th‐Pb ages on zircon and monazite). In the migmatites, aluminous mesosomes (FMAS) and quartzofeldspathic leucosomes (KFMASH), contain various amounts of K‐feldspar (Kfs), orthopyroxene (XMg Opx = 0.86), plagioclase (Pl), sillimanite (Sil; exceptionally kyanite, Ky) ilmenite (Ilm), magnetite (Mag), quartz (Qtz), and minor amounts of garnet (XMg Grt = 0.60), sapphirine (XMg Spr = 0.87), cordierite (XMg Crd = 0.92) and biotite (XMg Bt = 0.83). The ubiquitous peak mineral assemblage is Opx‐Sil‐Kfs‐Qtz‐(± Grt) in most of the MCB, which, together with the high Al content of orthopyroxene (10% Al2O3) and the local coexistence of sapphirine‐quartz, attest to regional UHT metamorphism (> 900 °C) at pressures in excess of 1.0 GPa. Fluid‐absent melting of biotite is responsible for the massive production of orthopyroxene that proceeded until exhaustion of biotite (and most of the garnet) in the southern part of the MCB (Mollendo‐Cocachacra areas). In this area, a first stage of decompression from 1.1–1.2 to 0.8–0.9 GPa at temperatures in excess of 950 °C, is marked by the breakdown of Sil‐Opx to Spr‐Opx‐Crd assemblages according to several bivariant FMAS reactions. High‐T decompression is also shown by Mg‐rich garnet being replaced by Crd‐Spr‐ and Crd‐Opx‐bearing symplectites, and reacting with quartz to produce low‐Al‐Opx‐Sil symplectites in quartz‐rich migmatites. Neither osumilite nor spinel‐quartz assemblages being formed, isobaric cooling at about 0.9 GPa probably followed the initial decompression and proceeded with massive precipitation of melts towards the (Os) invariant point, as demonstrated by Bt‐Qtz‐(± pl) symplectites in quartz‐rich migmatites (melt + Opx + Sil = Bt + Grt + Kfs + Qtz). Finally, Opx rims around secondary biotite attest to late fluid‐absent melting, compatible with a second stage of decompression below 900 °C. The two stages of decompression are interpreted as due to rapid tectonic denudation whereas the regional extent of UHT metamorphism in the area, probably results from large‐scale penetration of hot asthenospheric mantle at the base of an over‐thickened crust.
Effect of the chemical composition of the crust on the metamorphic evolution of orogenic wedges
Authors: Goffé B. , Bousquet R. , Henry P. , Le Pichon X.
Published: March 2003

Petrological data provide a good record of the thermal structure of deeply eroded orogens, and, in principle, might be used to relate the metamorphic structure of an orogen to its deformational history. In this paper, we present two‐dimensional thermal modelling of various subduction models taking into account varying wedge geometry as well as variation of density and topography with metamorphic reactions.

The models clearly show that rock type accreted in the wedge has important effects on the thermal regime of orogenic wedges. The thermal regime is dominated by radiogenic heat production. Material having high radioactive heat production, like the granodioritic upper crust, produces high temperature metamorphism (amphibolitic conditions). Material with low radioactive heat production results in low temperature metamorphism of greenschist or blueschist types depending on the thickness of the wedge.

Application of this model to seemingly unrelated areas of the Central Alps (Lepontine Dome, Grisons) and Eastern Alps (Tauern Window) explains the coexistence and succession of distinct Barrovian and blueschist facies metamorphic conditions as the result of a single, continuous tectonic process in which the main difference is the composition of the incoming material in the orogenic wedge. Accretion of the European upper continental crust in the Lepontine and Tauern Domes produces Barrovian type metamorphism while accretion of oceanic sediments results in blueschist facies metamorphism in the Valaisan domain.
Peritoneal Sclerosis: One or Two Nosological Entities?
Authors: Garosi Guido , Di Paolo Nicola
Published: March 2003

The frequency, pathology, animal models, pathogenesis, clinical manifestations, diagnostic criteria, therapy and prevention of peritoneal sclerosis are reviewed. Many of these aspects have a bimodal configuration which suggests that peritoneal sclerosis, usually considered a single pathology in peritoneal dialysis, is actually two distinct nosological entities: simple sclerosis and sclerosing peritonitis. The former is very frequent, with minor anatomical alterations and low clinical impact; it is reproducible in animals by means of peritoneal dialysis, and is clearly due to the poor biocompatibility of peritoneal dialysis solutions. The latter is rare, with radical anatomical alterations and high mortality requiring valid methods of diagnosis, therapy and prevention; it can only be reproduced in animal models by means other than peritoneal dialysis and seems to be due to factors both related and unrelated to peritoneal dialysis.
Improving Compliance in Dialysis Patients: Does Anything Work?
Authors: Kutner Nancy G.
Published: March 2003

Noncompliance with prescribed therapy significantly impacts dialysis patient care and outcome. At least one‐half of hemodialysis (HD) patients are likely to be noncompliant with some part of their treatment regimen, and one‐third of peritoneal dialysis (PD) patients are believed to miss prescribed exchanges. Psychosocial issues, younger age, and smoking behavior have been linked with compliance problems in multiple studies. Few interventions have been rigorously tested, but patient education and/or individualized attention, supervision, encouragement, and support are widely advocated strategies to improve patient compliance. Areas in need of continued study include psychosocial determinants of compliance in PD as well as HD patients, compliance behavior patterns over time, and the parameters within which dialysis compliance can vary and still achieve specified treatment goals.
The Other Side of the Coin: Impact of Toxin Generation and Nutrition on the Uremic Syndrome
Authors: Vanholder Raymond , Glorieux Griet , Lameire Norbert
Published: March 2003

Both the morbidity of the uremic syndrome and the generation of uremic toxins are attributed to malnutrition. If protein intake and catabolism result in the generation of solutes, then nutritional intake should be related directly to toxicity. On the other hand, inadequate nutrition has been linked to inflammation and mortality. It remains difficult to reconcile these two lines of thought. Several possibilities exist that might account for this apparent paradox: 1) not all nutritional and protein degradation products are toxic; 2) toxins generated from increased protein intake are removed if protein intake is linked to dialysis dose; 3) albumin acts as a buffer for toxicity—hypoalbuminemia favors liberation of protein‐bound toxins from their binding sites, enhancing their toxicity; 4) solutes generated from tissue breakdown are more toxic than those generated by nutritional protein; 5) both high and low concentrations of solutes have a negative impact; 6) toxic compounds unrelated to protein breakdown are specific causes of malnutrition and inflammation; 7) and/or residual renal function plays a key role in the elimination of compounds discussed under possibility 6. Thus the uremic syndrome should be considered as a potentially fatal interaction among inflammation, malnutrition, low levels of albumin in the plasma, accumulated protein‐bound solutes and generation of nonnutritionally related toxins. Not only optimal dialysis, but also optimal nutritional intake and optimal utilization of these nutrients should help neutralize this chain of events.
Renal Transplantation Update Series Editors: V. Ram Peddi and M. Roy First: Hepatobiliary Diseases After Kidney Transplantation Unrelated to Classic Hepatitis Virus
Authors: Ahsan Nasimul , Rao K. Venkateswara
Published: March 2003

Multiple studies during the past decades have identified chronic liver disease as an important cause of morbidity and mortality in kidney transplant recipients. It has been reported that up to 25% of patients will have some degree of abnormal liver functions during the immediate posttransplant period. In these patients, liver failure has been implicated as the cause of death in approximately 30% of the long‐term survivors. While infections from hepatitis virus remain the main cause of ongoing liver damage, many other opportunistic infections with various potential to alter liver function have also been identified. In addition, posttransplant patients are also exposed to hepatotoxic adverse effects of many pharmacotherapeutics including immunosuppressive and nonimmunosuppressive agents. Since there are numerous reports dealing with classic viral hepatitis after kidney transplantation, this review primarily focuses on post‐kidney transplant liver diseases which are not due to classic hepatitis viruses.
Automated Peritoneal Dialysis Symposium: Utilization of PD Modalities: Evolution
Authors: Venkataraman Vijaya , Nolph Karl D.
Published: March 2003

In the early 1960s, peritoneal dialysis (PD) was introduced as a form of long‐term maintenance therapy in patients with end‐stage renal disease (ESRD). We have come a long way since. Increasing understanding of peritoneal kinetic behavior, its innovative manipulation to meet patient needs, critical monitoring of clinical outcomes, and parallel development in technology have all contributed to the worldwide success of the therapy over the past four decades. In this article we review the evolution of the various PD modalities in the context of these factors.
Automated Peritoneal Dialysis Symposium: The Role of APD in the Management of Pediatric Patients: A Report of the North American Pediatric Renal Transplant Cooperative Study
Authors: Fine Richard N. , Ho Martin
Published: March 2003

In an attempt to delineate the role of automated peritoneal dialysis (APD) in the management of the pediatric patient with end‐stage renal disease (ESRD), the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS) dialysis registry database was queried concerning the incidence and outcome of APD compared to those enrolled who were undergoing continuous ambulatory peritoneal dialysis (CAPD). During the 10‐year period from January 1, 1992 to January 1, 2002, 65% of the 4150 index dialysis patients enrolled in NAPRTCS underwent peritoneal dialysis (PD). APD was the dialysis modality of 69% of those choosing PD, indicating that APD was the primary dialysis modality for children during this time interval. This initial comparison of APD and CAPD from the NAPRTCS dialysis registry database indicated that there was a higher percentage of younger patients choosing APD, the time to transplantation was shorter for the CAPD patient, and the incidence and time to first peritonitis episode was significantly (p = 0.006) better in the APD population. There was no difference in the other parameters evaluated between the APD and CAPD patients. These data indicate the significant role of APD in the management of pediatric patients with ESRD, especially in infants, who frequently require an extended period of dialysis prior to reaching the eligibility criteria for transplantation.
Trends in Prostate and Breast Cancer Clinical Research as Reported in the American Society of Clinical Oncology Proceedings
Authors: Chlebowski Rowan T. , Curti Mario
Published: March 2003

Objectives: To identify recent clinical research trends, all abstracts relevant to prostate and breast cancer reported in the American Society of Clinical Oncology (ASCO) Proceedings from 1994 to 1999 and for 1 year in the American Urological Association Proceedings were reviewed.

Methods: Abstracts were identified and prospectively categorized in 31 areas including study design, sample size, and study outcome.

Results: In the ASCO Proceedings, abstracts on breast cancer (n = 1718) greatly exceeded those on prostate cancer (n = 340). Randomized clinical trials were also more frequently reported in breast cancer compared to prostate cancer (176 versus 30 reports, respectively [5.7 times greater]; p < 0.01) and entered >12 times as many patients (121,923 women versus 9,761 men, respectively; p < 0.01) in this period. For breast cancer, the number of reported randomized clinical trials increased and nearly doubled over the 6‐year period, whereas for prostate cancer no such trend was seen. For prostate cancer, the vast majority (82%) of the 130 clinical trial reports were nonrandomized studies, and most entered very few patients (median patient entry, 26.2). Although randomized clinical trial reports on breast cancer described significant survival benefits in 16 trials in both advanced disease (benefit seen in 7 of 109 studies [6%]) and especially in adjuvant therapy (benefit seen in 9 of 67 studies [12%]), in prostate cancer only a single randomized clinical trial reported a significant survival benefit in this period.

Conclusions: Despite comparable annual incidence and mortality, prostate cancer receives only a fraction of the clinical trial activity afforded breast cancer.
“God Brought All These Churches Together”: Issues in Developing Religion‐Health Partnerships in an Appalachian Community
Authors: Simpson Mary Rado , King Marilyn Givens ,   Mary Rado Simpson is a Doctoral Candidate at the College of Nursing and Marilyn Givens King is an Associate Professor at the College of Nursing and the Center for Rural Health at the University of Kentucky, Lexington, Kentucky.
Published: March 2003

This study explored health‐related and organizational religious activities in an Appalachian community and identified cultural issues in the development of religion‐health partnerships. Partnerships between religious groups and health providers are a channel for health promotion efforts to vulnerable populations and must be approached from the culture of the community. An ethnographic, exploratory study of health‐related and organizational activities in nonmainline religious groups yielded the use of prayer requests, anointing, testimonial, and denominational links as potential health resources. Organizational decisions were by congregational consensus and theological interpretation. The communal setting of worship as an informal resource to a community of believers, especially the vulnerable, was a viable model for religion‐health partnerships in central Appalachia. Implications for nursing practice, education, and research also are addressed.
The Client Encounter Form: Conceptual Development, Reliability Analysis, and Clinical Applications
Authors: Bear Mary , Holcomb Lygia
Published: March 2003

This descriptive correlational study investigated the reliability of a new measure of client‐nurse practitioner interaction, the Client Encounter Form (CEF), and used the CEF to describe the domains of client‐nurse practitioner interaction that occurred during problem and preventative visits at a primary care clinic. The CEF is based on Cox's Interactional Model of Client Health Behavior. Data were collected from a convenience sample of 41 primary care clinic visits. Descriptive data on all clients and the patterns of use characterized by the CEF were collected using retrospective chart review (n= 60). Reliability testing showed the CEF has high interrater reliability; Cohen's Kappas for its dimensions ranged from 0.78–1.0. The CEF was also shown to be useable in a primary care clinic. Health information, affective support, goal setting, and technical procedures were consistently part of the nurse‐client interactions in this sample, demonstrating they are part of the nurse practitioner model of care. Analysis revealed different patterns of interaction for preventative and problem‐oriented visits. Preventative visits had higher levels of health promotion information, psychological affective support, and health promotion goal‐setting behaviors. Problem visits included more information regarding the client's diagnosis, medications, and treatments, and more affective support related to the client's physical condition.
Predictors of Health Promotion Lifestyle Among Three Ethnic Groups of Elderly Rural Women in Taiwan
Authors: Wang Hsiu‐Hung
Published: March 2003

The purpose of this study was to examine the predictors of health promotion lifestyle (HPL) and examine the similarities and differences among three ethnic groups of elderly rural women in Taiwan. Pender's Health Promotion Model was used as the conceptual framework of this study. A convenience sample of 599 elderly rural women was recruited from three rural areas: Kao‐Shu, San‐Di‐Men, and Ma‐Chia. Ho‐Lo, Hakka, and aboriginal people are the three main ethnic groups in these areas. Of the 599 elderly women, 391 completed all of the interview questions. Subjects ranged from 65 to 91 years old. All instruments used in this study have been evaluated for their content validity. The interrater reliability and alpha coefficient reliability of all instruments were greater than 0.70. A survey‐interview method was used to collect data. Findings showed that the predictors of HPL have differences and similarities among elderly rural women from different ethnicities. In the group of elderly Ho‐Lo women, age, education, living arrangements, and perceived barriers to health promotion lifestyle (PBaHPL) were significant predictors and they explained 41.9% of total variance in HPL. In the group of elderly Hakka women, education, number of chronic health problems, PBaHPL, and perceived benefits of health promotion lifestyle (PBeHPL) were significant predictors in explaining 53.9% of total variance in HPL. Finally, in the group of elderly aboriginal women, living arrangements, PBaHPL, and PBeHPL were significant predictors in explaining 70.0% of total variance in HPL. Community nurses can use their understanding of different ethnic groups to assess, identify, and use effective health promotion interventions for elderly rural women.
Wellness Profile of Midlife Women with a Chronic Illness
Authors: Paul Lynn , Weinert Clarann
Published: March 2003

Among issues important to women's health are their wellness profiles including indicators such as activity level, weight status, breakfast and snacking patterns, health status perceptions, and alcohol and tobacco use. This is particularly true for midlife women with a long‐term illness. The purpose of this study is to identify the wellness profile of a group of midlife women with multiple sclerosis (MS), and to compare their lifestyle indicators with national health statistics. Overall, the women in the study group indicated a lower perception of their health status and were less active. However, the women in this study group demonstrated healthier body weights, used less tobacco and alcohol, had better breakfast patterns, and comparable snacking patterns, indicating that they may be more attuned to their bodies than women without chronic illnesses. Identifying women's wellness profiles can assist practitioners in addressing the issues of health for women managing a long‐term illness.
Community Resiliency: The Potential for Community Health Nursing Theory Development
Authors: Kulig Judith C
Published: March 2003

There is insufficient theory development within community health nursing that addresses the community as a collective and not simply as groupings of aggregates. Conceptual clarification of nursing's domains is needed, however, before theory development can take place. In an attempt to rectify this situation, this article discusses the environment domain. Community resiliency, or the ability of a community to deal with adversity and in so doing reach a higher level of functioning, is presented as a useful framework to gain greater understanding of this particular domain. Findings from research that have resulted in a community resiliency model for describing the environment domain, within which rural‐based community health nurses (CHNs) work, are presented. The relevance for community health nursing theory is included with recommendations for future research and subsequent theory development.
A Synthesis of Qualitative Home Visiting Research
Authors: McNaughton Diane B
Published: March 2003

Over the past decade, a body of qualitative research has been developed which describes the home visiting practice of public health nurses (PHNs) to maternal‐child clients. This article reports a synthesis of these studies. The purpose of the synthesis was to identify common elements and differences between the research reports that would lead to theory development or support of existing theories. Methods were based onMiles and Huberman's (1994)text on qualitative data analysis. Results of the synthesis indicated that building and preserving relationships with the client is the central focus of home visiting and provides a foundation for problem identification and problem solving. Clients control access to their homes as well as the information they are willing to share with the nurse. The goals of home visiting relate to empowering mothers, supporting their independence and decision making. Similarities to Peplau's theory of Interpersonal Relations and Cox's Interaction Model of Client Health Behavior (IMCHB) are noted.
Mothers' Explanatory Models of Lack of Child Growth
Authors: Reifsnider Elizabeth , Allan Janet , Percy Melanie
Published: March 2003

This qualitative study elicited the explanatory models (EMs) of child growth held by mothers of growth‐deficient children. EMs are culturally constructed explanations for a specific illness and its treatment (Kleinman, 1980). The EM concept was adapted for this study to focus on a child health condition instead of an illness. The sample comprised 22 mothers of growth deficient children who were interviewed 2 years after the conclusion of an intervention study to promote child growth. Growth deficiency was defined as below the 10th percentile for weight, height, or weight for height on the National Center for Health Statistics (NCHS) growth grids (Hamill, Drzid, Johnson, Reed, & Roche, 1976). Three major domains were identified in the EMs of growth held by mothers: (1) illness or heredity (etiology); (2) keeping track of growth (course); and (3) helping my child grow (treatment). The mothers in this study were concerned about their children's size and growth patterns and they monitored their children's growth with the methods available to them. They identified illnesses and allergies as environmental factors that negatively impact their children's growth. All mothers viewed size as a function of heredity. The findings from this study suggest that an emphasis on size will not encourage mothers to focus on their children's growth. The EMs for growth and size were different. Health care providers may be more effective in enhancing children's growth by teaching parents how to deal with the day‐to‐day problems of children who are picky eaters, stretching limited food money, creating mealtime schedules, and dealing with illnesses before they become severe.
The Psychosocial Impact of Interactive Computer Use Within a Vulnerable Elderly Population: A Report on a Randomized Prospective Trial in a Home Health Care Setting
Authors: Billipp Susan Heyn
Published: March 2003

Quality of care for vulnerable elderly clients makes it important to consider the psychosocial effects of interactive computer use as a means to communicate for social, functional, and/or health care purposes in a home health care setting. In a 3‐month randomized prospective trial, telecommunications terminals were installed in the private residences of computer‐illiterate persons, 65‐years‐of‐age and older, providing visiting nurses the opportunity to teach computer use with three different training methods. The control group had similar weekly nurse visits, but no computer terminal use. Pre‐posttests using the Rosenberg Self‐Esteem Scale and the Geriatric Depression Scale compared change in self‐esteem and depression scores of computer‐use clients with the scores of the control group clients.

Interactive computer use, alone, did not significantly change scores. Compared to the control group, however, there was a significant change toward improved self‐esteem and depression when interactive computer use was accompanied with weekly nurse computer training. Weekly training with a significant other, as a substitute for the nurse trainer, significantly improved self‐esteem scores but not depression scores. Interactive computer use was not associated with decreased self‐esteem or increased depression. Attitude changes and responses to the particular telecommunication service used in this study were mixed, suggesting future research should be based on improved telecommunication systems with access to programs that have greater practical application to the needs of elderly clients.
Managing Asthma Within the Context of the Rural Family
Authors: Barrett Jena Clayton , Gallien Elaine , Dunkin Jeri , Ryan Lisa
Published: March 2003

The purpose of this qualitative study was to describe the experiences of rural families caring for children with asthma. The chief caregivers from six rural families were interviewed about the family's daily experiences in living with asthma, their knowledge of asthma triggers, and strategies for managing asthma. Parental knowledge about asthma and asthma management strategies was quite good. The cost of asthma regimens and school policies about medications were major barriers to better control. Other management strategies were directed at maintaining normality of family life.
Development and Evaluation of an Instrument to Measure Seniors' Attitudes Toward the Use of Bathroom Grab Bars
Authors: Lockett Donna , Aminzadeh Faranak , Edwards Nancy
Published: March 2003

Bath grab bars can minimize the effects of many age‐related deficits that may contribute to bath‐related falls. Despite their potential value, bathroom safety devices remain largely underutilized by many community‐living older adults and knowledge concerning attitudinal factors that influence the use of grab bars is sparse. This void of knowledge is due, at least in part, to the lack of instruments to measure the psychosocial constructs influencing bathroom safety device use.  This study examined the psychometric properties of a newly developed Grab Bar Use Attitude scale (GUAS). Instrument formation, including item generation, evaluation by a panel of experts, and pilot testing of the draft instrument to establish its face and content validity, was followed by instrument validation using 546 community‐living seniors.  Results of principal components analysis of the GUAS revealed a two‐factor solution, explaining 56% of the variance. The two constructs may best be described as functional/safety and psychosocial consequences of using grab bars. Psychometric analyses of the 9‐item scale provided empirical evidence of the internal consistency of the total scale and each subscale. Finally, the GUAS distinguished between regular grab bar users and nonregular users. Implications for use are discussed.
The Effectiveness of the Around‐ the‐Clock In‐Home Care System: Did It Prevent the Institutionalization of Frail Elderly?
Authors: Murashima Sachiyo , Asahara Kiyomi
Published: March 2003

Abstract This study compares two communities in Japan from the perspective of community health care resources and their use by the elderly during 1992–98. In one community, programs of home care services for the elderly were reorganized to provide around‐the‐clock in‐home nursing and home help services seven days a week (ACC). Official records were the major sources of data. Evidence from the analysis indicated that ACC might contribute to less use of institutionalization as an alternative to home care, even though, in some instances, institutionalization is the only appropriate alternative.
Human Papillomavirus Is Present in Some Cases of Childhood Penile Lichen Sclerosus: An In Situ Hybridization and SP‐PCR Study
Authors: Drut Rosa Mónica , Gómez María Atilia , Drut Ricardo , Lojo María Mercedes
Published: March 2003

Abstract: Lichen sclerosus (LS) is a skin disease that may affect both sexes at all ages and at any site. Its etiology remains unknown. The observation of focal koilocytotic‐like changes in the stratum malpighii in prepuce samples of LS in children prompted us to investigate the presence of HPV‐DNA. Twenty‐three paraffin‐embedded samples of LS lesions from children aged 4 to 14 years were studied using nested‐PCR and in situ hybridization (ISH). Twelve out of 23 cases amplified HPV‐DNA (8 cases corresponded to HPV‐DNA type 6; 2 cases each to HPV‐DNA types 16 and 18). ISH detected HPV sequences in the nuclei of koilocytotic and some parakeratotic cells in 13 cases (9/13 also HPV‐DNA positive by PCR). Our results demonstrated the presence of HPV‐DNA in roughly 70% of cases of LS of the prepuce in children. We highlight the observation of koilocytotic‐like changes in the prepuce and its association with HPV. The possible pathogenetic significance between the virus and the lesion is not settled.
Localized Microcystic Lymphatic Malformations—Ultrasound Diagnosis
Authors: Davies Derek , Rogers Maureen , Lam Albert , Cooke‐Yarborough Claire
Published: March 2003

Abstract: Microcystic lymphatic malformations present with a wide variety of clinical manifestations that may make diagnosis difficult. We present four patients with microcystic lymphatic malformations that have been confirmed by both histology and ultrasound appearance. Five further cases of microcystic lymphatic malformations with unusual presentations, in which ultrasound was used to support the diagnoses, are then presented. The use of ultrasound as a tool to aid in the diagnosis of microcystic lymphatic malformations is then discussed and compared with other investigative techniques.
Immediate and Delayed Hypersensitivity to Mite Antigens in Atopic Dermatitis
Authors: Varela Paulo , Selores Manuela , Gomes Eva , Silva Elvira , Matos Eduarda , Dos Santos Lopes , Amado João , Massa António
Published: March 2003

Atopic dermatitis (AD) is a common disorder and appears to be on the increase, especially among children. It was thought at first to be a manifestation of immediate hypersensitivity, but it is now known that delayed hypersensitivity also plays an important role. Sensitivity to mite antigens is found in 20% to 60% of patients when immediate hypersensitivity is evaluated by the detection of specific IgE antibodies and prick tests, and in 30% to 50% of patients when delayed hypersensitivity is studied by patch testing. A prospective randomized study was carried out in the pediatric dermatology clinic on a sample of 51 children under 15 years of age. A prevalence of immediate and delayed hypersensitivity to mites, like that described for other populations, was found. It was further found that there was a positive association, not described in the literature, between the younger age groups and delayed hypersensitivity to mite antigens, while the opposite was true for immediate hypersensitivity. We believe that patch tests with airborne allergens, specifically mites, should be part of the protocol for assessing children with AD, particularly in the younger age groups.
A Prospective Survey of Pediatric Dermatology Clinic Patients in Kuwait: An Analysis of 10,000 Cases
Authors: Nanda Arti , Al‐Hasawi Fowzia , Alsaleh Qasem A.
Published: March 2003

Skin diseases are common in children. However, only a very few prospective epidemiologic surveys are available in the literature. The present survey was directed at determining the spectrum and pattern of skin diseases of children in Kuwait. A total of 10,000 consecutive new patients were studied; 96% were children of Arab descent. A female preponderance (52%) was observed, and infants constituted the largest group within the patient population (28.7%). A total of 162 dermatoses were recorded. Atopic dermatitis was the most prevalent dermatosis (31.3%), followed by viral warts (13.1%), alopecia areata (6.7%), pityriasis alba (5.25%), psoriasis (4%), and diaper dermatitis (4%). Atopic dermatitis was the most frequently seen dermatosis in children of all age groups, whereas, viral warts were more prevalent in school‐age children. The prevalence of alopecia areata and psoriasis was higher than reported earlier in other ethnic groups. A female preponderance was seen in children with alopecia areata, psoriasis, vitiligo, acne vulgaris, contact dermatitis, and pityriasis rosea. Dermatitis, superficial cutaneous infections, and nevi/nevoid disorders were the important groups studied.
Granulomatous Cheilitis and Crohn's Disease in a 3‐Year‐Old Boy
Authors: Dummer Wolfgang , Lurz Christa , Jeschke Reinhard , Meissner Nicole , Rose Christian , Bröcker Eva‐Bettina
Published: March 2003

Granulomatous cheilitis and Crohn's disease are disorders of unknown etiology. There are case reports describing their coincidence and pointing out the necessity of ruling out systemic disorders once the diagnosis of granulomatous cheilitis is made. However, such reports are few and the causal association of both diseases is controversial in the literature. We report the youngest patient so far, a 3‐year‐old boy, who had granulomatous cheilitis and Crohn's disease simultaneously. This coincidence so early in life strongly suggests that both represent manifestations of the same disease.
Treatment of Linear Scleroderma with Oral 1,25‐Dihydroxyvitamin D3 (Calcitriol) in Seven Children
Authors: Elst  , Van Suijlekom‐Smit  , Oranje
Published: March 2003

Linear scleroderma is a connective tissue disorder that characteristically involves the skin. Skin induration and pigmentary changes present in a linear distribution. Severe functional and cosmetic disability may occur, especially in growing children. No effective therapy for the fibrotic stage of scleroderma is available at present. Recently a beneficial effect of oral 1,25‐dihydroxyvitamin D3 (calcitriol) treatment was reported in adults. Calcitriol has a dose‐dependent inhibition on fibroblast proliferation and collagen synthesis and has immunoregulatory activities. We assessed the efficacy of oral calcitriol treatment in seven pediatric patients with linear scleroderma. During the treatment dietary calcium intake was restricted. Calcium, inorganic phosphate, creatinine, and urea in the serum and urine was monitored. The urinary calcium:creatinine ratio was measured. The effects of the treatment were evaluated using a clinical scoring system. No side effects were observed. Five of the seven patients showed a good to excellent improvement of their lesions. One of them partly relapsed after 19 months, but showed an excellent response to a second therapy session with calcitriol. One patient with rapidly progressive disease failed to respond to therapy. Our results indicate that calcitriol can be an effective agent for treating localized scleroderma in children.
A Juvenile Case of Overlap Syndrome of Systemic Lupus Erythematosus and Polymyositis, Later Accompanied by Systemic Sclerosis with the Development of Anti‐Scl 70 and Anti‐Ku Antibodies
Authors: Nitta Yukiko , Muramatsu Masahito
Published: March 2003

Abstract: We describe a 16‐year‐old girl with an overlap syndrome consisting of systemic lupus erythematosus (SLE) from the age of 7 and polymyositis (PM) from the age of 10, later accompanied by systemic sclerosis (SSc) from the age of 15. She was diagnosed as having SLE with exudative malar erythema, photosensitivity, and discoid rashes with positive antinuclear antibody (ANA) and anti‐DNA antibody titers. The diagnosis of PM was also made in accordance with findings of a high titer of muscle enzymes and a muscle biopsy specimen demonstrating marked degeneration of the muscle fibers and perivascular infiltration of mononuclear cells. She developed Raynaud's phenomenon and pitting ulcers on her fingers with positive anti‐Scl 70 and anti‐Ku antibodies, leading to a diagnosis of SSc. The patient was treated with prednisolone. To our knowledge this is the youngest case of SLE‐PM overlap syndrome later accompanied by SSc.
Nail Matrix Arrest Following Hand‐Foot‐Mouth Disease: A Report of Five Children
Authors: Clementz Gina C. , Mancini Anthony J.
Published: March 2003

Abstract: Hand‐foot‐mouth disease (HFMD) is a contagious enteroviral infection occurring primarily in children and characterized by a vesicular palmoplantar eruption and erosive stomatitis. Nail matrix arrest has been associated with a variety of drug exposures and systemic illnesses, including infections, and may result in a variety of changes, including transverse ridging (Beau's lines) and nail shedding (onychomadesis). The association of HFMD with Beau's lines and onychomadesis has not been reported previously. Five children, ages 22 months–4 years, presented with Beau's lines and/or onychomadesis following physician‐diagnosed HFMD by 3–8 weeks. Three of the five patients experienced fever with HFMD, and none had a history of nail trauma, periungual dermatitis, periungual vesicular lesions, or a significant medication intake history. All patients experienced HFMD within 4 weeks of one another, and all resided in the suburbs of the Chicago metropolitan area. In all patients the nail changes were temporary with spontaneous normal regrowth. The mechanism of the nail matrix arrest is unclear, but the timing and geographic clustering of the patients suggests an epidemic caused by the same viral strain.
A Pediatric Case of Dermatofibrosarcoma Protuberans: An Immunohistochemical Study
Authors: Patrizi Annalisa , Vespignani Federica , Fraternali Giulio Orcioni , Neri Iria
Published: March 2003

Abstract: Dermatofibrosarcoma protuberans (DFSP) is a fibrohistiocytic tumor of intermediate malignancy that usually occurs in early or mid‐adult life as a nodular cutaneous mass. DFSP has rarely been reported during childhood or at birth. We report a case of childhood DFSP that illustrates the usefulness of immunohistochemical analysis in the differential diagnosis between DFSP and other fibrohistiocytic proliferations occurring in the skin. A prompt and correct diagnosis is very important in order to ensure appropriate treatment and to prevent local recurrences.