bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hurricane Katrina and Perinatal Health
Authors: Harville Emily W. , Xiong Xu , Buekens Pierre 
Published: November 2009

ABSTRACT: We review the literature on the effects of Hurricane Katrina on perinatal health, and providing data from our own research on pregnant and postpartum women. After Katrina, obstetric, prenatal, and neonatal care was compromised in the short term, but increases in adverse birth outcomes such as preterm birth, low birthweight, and maternal complications were mostly limited to highly exposed women. Both pregnant and postpartum women had rates of post‐traumatic stress disorder similar to, or lower than, others exposed to Katrina, and rates of depression similar to other pregnant and postpartum populations. Health behaviors, such as smoking and breastfeeding, may have been somewhat negatively affected by the disaster, whereas effects on nutrition were likely associated with limited time, money, and food choices, and indicated by both weight gain and loss. We conclude that, with a few specific exceptions, postdisaster concerns and health outcomes for pregnant and postpartum women were similar to those of other people exposed to Hurricane Katrina. In such situations, disaster planners and researchers should focus on providing care and support for the normal concerns of the peripartum period, such as breastfeeding, depression, and smoking cessation. Contraception needs to be available for those who do not want to become pregnant. Although additional physical and mental health care needs to be provided for the most severely exposed women and their babies, many women are capable of surviving and thriving in postdisaster environments.
Clinical Real‐Time Monitoring of Gaseous Microemboli in Pediatric Cardiopulmonary Bypass
Authors: Wang Shigang , Woitas Karl , Clark J. Brian , Myers John L. , Ündar Akif 
Published: November 2009

AbstractWe describe the occurrence and distribution of gaseous microemboli with real‐time monitoring in a pediatric cardiopulmonary bypass (CPB) circuit and in the cerebral circulation of patients using the Emboli Detection and Classification (EDAC) system and transcranial Doppler (TCD). Four patients (weights 3.2–13.8 kg) were studied. EDAC monitors were located on the venous line and on the postfilter arterial line to measure gaseous microemboli in the CPB circuit. TCD was used to measure high‐intensity transient signals (HITS) in the middle cerebral artery. Before the initiation of CPB, EDAC detected gaseous microemboli in two cases when giving volume through the arterial line. At the initiation of CPB, gross air appeared in the venous line and gaseous microemboli were detected in the arterial line in all patients. EDAC detected a total of 3192–14 699 gaseous microemboli in the arterial line during the whole CPB period, more than 99% of which were smaller than 40 microns. After cessation of CPB, EDAC detected gaseous microemboli in the arterial line in all cases. The TCD detected HITS in two cases (25 and 315), and detected no HITS in two cases. We observed that the venous line acted as a principal source of gaseous microemboli, particularly when using vacuum‐assisted venous drainage, and that a significant number of these gaseous microemboli smaller than 40 microns were subsequently transferred to the patient. Using EDAC and TCD together could strengthen the monitoring of gaseous microemboli in the extracorporeal circuit and cerebral circulation.
Chronic Naltrexone Treatment and Ethanol Responsivity in Outbred Rats
Authors: Hill Katherine G. , Sable Helen J. K. , Ferraro III Frank M. , Kiefer Stephen W. 
Published: November 2009

Background:  Acute naltrexone treatment in rats produces significant alterations in ethanol palatability (increase in the aversiveness of the solution) and ethanol consumption during tests of restricted access (decrease in consumption). The effects of chronic naltrexone exposure, accomplished by implantation of osmotic mini‐pumps, were examined in the present study.Methods:  Rats were surgically implanted with intraoral fistulae for taste reactivity testing. The animals were given 2 bottles (distilled water and 10% ethanol, v/v) for 3, 2‐week phases: Pre‐Drug, Drug, and Post‐Drug. After the Pre‐Drug phase, rats were assigned to groups (counterbalanced based on ethanol intake) and implanted with a mini‐pump containing saline, 7.5 mg/kg/d naltrexone, or 15 mg/kg/d naltrexone. The pumps were removed 2 weeks later. During each 2‐week phase, taste reactivity tests with 10% ethanol were conducted at 1, 7, and 14 days (a total of 9 reactivity tests).Results:  The 7.5 mg/kg/d dose produced only minor effects on 10% ethanol reactivity and consumption during the Drug phase. The 15 mg/kg/d naltrexone dose generally shifted taste reactivity responding to 10% ethanol in a negative direction and produced a transient decrease in ethanol consumption. The 15 mg/kg/d group significantly increased ethanol consumption beyond the level of consumption by the Saline group when the pumps were removed, although the increase was delayed 48 hours. By the end of the Post‐Drug period, this naltrexone group returned to control levels of ethanol consumption.Conclusions:  Chronic naltrexone treatment at 15 mg/kg/d significantly decreased the palatability of a 10% ethanol solution, an effect seen even after drug withdrawal. Naltrexone had a minor effect on ethanol consumption during treatment but did decrease overall levels of fluid consumption. The significant increase in ethanol consumption postdrug by the high‐dose naltrexone group, presumably due to receptor up‐regulation during treatment, is important and understanding this effect and developing means of overcoming it within a clinical practice would be useful goals.
A Comparison of Two Single‐Item Screeners for Hazardous Drinking and Alcohol Use Disorder
Authors: Dawson Deborah A. , Pulay Attila J. , Grant Bridget F. 
Published: November 2009

Background:  There is increasing interest in and physician support for the use of single‐item screeners for problem drinking.Methods:  In a representative sample of U.S. adults (n = 43,093) and within selected subgroups, past‐year frequency of drinking 5+/4+ drinks and maximum drinks consumed on any day were evaluated as screeners for past‐year alcohol dependence, any alcohol use disorder (AUD), and any AUD or hazardous drinking, using standard measures of screening performance. AUDs were defined according to DSM‐IV criteria. Hazardous drinking was defined as consuming >14 drinks/wk or 5+ drinks on any day for men and >7 drinks/wk or 4+ drinks on any day for women.Results:  Optimal cutpoints for both screeners varied across population subgroups, and these variations should be taken into account in order to maximize screening performance. At the optimal cutpoints for the total population, the sensitivity and specificity of maximum drinks were 89% and 82% for dependence at ≥5 drinks, 90% and 79% for any AUD at ≥4 drinks, and 90% and 96% for any AUD or hazardous drinking at ≥4 drinks. Comparable values of sensitivity and specificity for 5+/4+ frequency were 90% and 83% at ≥3 times a year, 87% and 82% at ≥once a year, and 88% and 100% at ≥once a year, respectively. Specificity was lower when only past‐year drinkers were considered. The 5+/4+ frequency screener yielded fairly low sensitivity in predicting alcohol problems among the elderly and among Blacks. Results supported a past‐year reference period for frequency of 5+/4+ drinks and substantiated gender‐ and age‐specific thresholds for defining risk drinking.Conclusions:  Both of the single‐item screeners performed nearly on a par with the AUDIT‐C and have potential for use in primary and emergency care settings.
Alterations in Brain Glucose Utilization Accompanying Elevations in Blood Ethanol and Acetate Concentrations in the Rat
Authors: Pawlosky Robert J. , Kashiwaya Yoshihiro , Srivastava Shireesh , King Michael T. , Crutchfield Calvin , Volkow Nora , Kunos George , Li Ting‐Kai , Veech Richard L. 
Published: November 2009

Background:  Previous studies in humans have shown that alcohol consumption decreased the rate of brain glucose utilization. We investigated whether the major metabolite of ethanol, acetate, could account for this observation by providing an alternate to glucose as an energy substrate for brain and the metabolic consequences of that shift.Methods:  Rats were infused with solutions of sodium acetate, ethanol, or saline containing 13C‐2‐glucose as a tracer elevating the blood ethanol (BEC) and blood acetate (BAcC) concentrations. After an hour, blood was sampled and the brains of animals were removed by freeze blowing. Tissue samples were analyzed for the intermediates of glucose metabolism, Krebs’ cycle, acyl‐coenzyme A (CoA) compounds, and amino acids.Results:  Mean peak BEC and BAcC were approximately 25 and 0.8 mM, respectively, in ethanol‐infused animals. Peak blood BAcC increased to 12 mM in acetate‐infused animals. Both ethanol and acetate infused animals had a lower uptake of 13C‐glucose into the brain compared to controls and the concentration of brain 13C‐glucose‐6‐phosphate varied inversely with the BAcC. There were higher concentrations of brain malonyl‐CoA and somewhat lower levels of free Mg2+ in ethanol‐treated animals compared to saline controls. In acetate‐infused animals the concentrations of brain lactate, α‐ketoglutarate, and fumarate were higher. Moreover, the free cytosolic [NAD+]/[NADH] was lower, the free mitochondrial [NAD+]/[NADH] and [CoQ]/[CoQH2] were oxidized and the ΔG′ of ATP lowered by acetate infusion from −61.4 kJ to −59.9 kJ/mol.Conclusions:  Animals with elevated levels of blood ethanol or acetate had decreased 13C‐glucose uptake into the brain. In acetate‐infused animals elevated BAcC were associated with a decrease in 13C‐glucose phosphorylation. The co‐ordinate decrease in free cytosolic NAD, oxidation of mitochondrial NAD and Q couples and the decrease in ΔG′ of ATP was similar to administration of uncoupling agents indicating that the metabolism of acetate in brain caused the mitochondrial voltage dependent pore to form.
Evaluación de Calidad en Ensayos Clínicos: Consideraciones para la Investigación de Resultados en la Medicina Intervencional contra el Dolor*
Authors: Hartrick Craig T. 
Published: November 2009

ResumenLa evaluación de calidad en ensayos clínicos involucra múltiples consideraciones. Mientras que es obligatorio cumplir con las pautas de la Buena Práctica Clínica y asimismo con las normas de la Conferencia Internacional sobre Armonización, una serie de factores adicionales contribuyen a la calidad total de un informe de prueba. Principal entre dichos factores es la selección de una hipótesis comprobable de prueba. Se necesita una hipótesis que sea novedosa, interesante, factible, ética y relevante. La metodología utilizada para evaluar la hipótesis se debe delinear con suficiente detalle y documentación para asegurar su reproducibilidad y transparencia. Esto es esencial para interpretar los resultados y para evaluar su aplicabilidad en la práctica clínica. Aunque los ensayos controlados aleatorizados (ECA) actualmente representan el estándar metodológico para asegurar la calidad de diseño de las pruebas de investigación, su valor se limita por no poder simular adecuadamente la práctica clínica. En particular con respecto a las terapias intervencionales, los diseños ECA sufren de problemas científicos y éticos. Pruebas observacionales bien diseñadas pueden superar algunos de estos incovenientes, pero generalmente requieren poblaciones de prueba muy numerosas. Modernos avances tecnológicos en comunicación hacen posible el mejor agrupamiento de datos y la institución de nuevas normas para la investigación intervencional del dolor.
Investigación Clínica de Técnicas Intervencionales de Manejo del Dolor: Perspectiva de un Epidemiólogo/Ensayista
Authors: Taylor Rod 
Published: November 2009

ResumenA diferencia de las terapias farmacológicas, las terapias intervencionales contra el dolor comprenden la compleja interacción entre el técnico clínico (“el operador”), el procedimiento clínico, y el equipo/aparato médico. Es fundamental entender dicha interacción para apreciar los desafíos que presenta el diseño de ensayos clínicos para procedimientos Intervencionales contra el dolor crónico. El presente artículo resume la evolución de la evidencia que requieren quines toman las decisiones y quienes pagan los servicios de salud para definir sus políticas, examina los retos específicos que se presentan en el diseño de ensayos clínicos de procedimientos intervencionales, y perfila posibles soluciones de diseño que respondan a estos retos.
Percutaneous and Mucocutaneous Exposures in Nursing Students: An Italian Observational Study
Authors: Petrucci Cristina , Alvaro Rosaria , Cicolini Giancarlo , Cerone Marina Pisegna , Lancia Loreto 
Published: November 2009

Abstract Purpose: To investigate occupational exposures to biological material potentially infected by blood‐borne viruses in nursing student population during the course years. Design and Methods: An observational retrospective study was designed. Data were collected in May 2007. Two‐thousand‐two‐hundred‐fifteen nursing students from the 3 years of degree course were enrolled in the four Italian universities. A structured questionnaire was constructed and was given out unannounced to nursing students in four universities on a randomly chosen day. The likelihood of association between nursing student exposure and certain assumed risk factors was measured. Findings: The exposure risk is associated with each study year of nursing students. Specifically, the probability of accidental exposure is reduced significantly with the increase of clinical skills during the training period. The risk for exposure in the 1st year students appears significantly higher than in those of the next years (odds ratio [OR] 1.465; 95% confidence interval [CI] 1.105–1.943). Data highlighted a gradual increase of bio‐safety knowledge in nursing students from the 1st to the 3rd years of study. However, a statistically significant association exists only between awareness of a correct use of gloves and exposure risk (OR 0.435; 95%CI 0.227–0.834). Mucocutaneous exposures are more frequent than percutaneous exposures (62.2%), and the hollow‐bore needle is the device most often involved. In 42.5% of cases, accidental exposures occurred when nursing students are working alone in a medical ward or surgery area. Conclusions: During their clinical training, nursing students can encounter a real risk for percutaneous and mucocutaneous exposures to blood potentially infected with blood‐borne viruses. However, this risk is reduced with an increase in clinical skills. Clinical Relevance: Results show that some new strategies are necessary for exposure risk reduction such as development of simulation laboratories for nursing practice and the adequate presence of tutors in clinical training education.
Strategies and Criteria for Clinical Decision Making in Critical Care Nurses: A Qualitative Study
Authors: Ramezani‐Badr Farhad , Nasrabadi Alireza Nikbakht , Yekta Zohre Parsa , Taleghani Fariba 
Published: November 2009

Abstract Purpose: To explore the reasoning strategies and criteria for clinical decision making used by Iranian critical care nurses. Design and Methods: In this qualitative descriptive study, 14 critical care nurses from four educational hospitals affiliated with Tehran University of Medical Sciences (TUMS) participated. Data were collected through semistructured in‐depth interviews. Content analysis was used to analyze the data. The interviews were transcribed verbatim and analyzed concurrently with the data collection. Findings: Three main themes emerged concerning the reasoning strategies: intuition, recognizing similar situations, and hypothesis testing. Three other main themes emerged regarding the participants' criteria for clinical decision making: the patients' risk‐benefits, organizational necessities, and complementary sources of information. Conclusions: The findings of this study provided a deep understanding of the reasoning strategies and criteria used by Iranian critical care nurses regarding their clinical decision making. Participants demonstrated use of a range of reasoning strategies and criteria. The cause for using different decision‐making strategies and criteria was not entirely clear and may have been related to different patients’ situations, nurses’ knowledge and their previous experiences, interdisciplinary professional relationships, and kinds of decisions included determining the patient's problems, selecting appropriate care, and deciding whether or not to perform decisions of care. Clinical Relevance: Deeper understanding of how nurses make decisions in the stressful environment of the critical care units provide useful information to facilitate making more efficient decisions as well as promoting the outcomes of independent and collaborative nursing care interventions.
Psychometric Evaluation of the Chinese Version of the Diabetes Coping Measure Scale
Authors: Huang Min‐Feng , Courtney Mary , Edwards Helen , McDowell Jan 
Published: November 2009

Abstract Purpose: To evaluate the psychometric properties of a Chinese version of the Diabetes Coping Measure scale (DCM‐C). Methods: A self‐administered questionnaire was completed by 205 people with type 2 diabetes from the endocrine outpatient departments of three hospitals in Taiwan. Confirmatory factor analysis, criterion validity, and internal consistency reliability were conducted to evaluate the psychometric properties of the DCM‐C. Findings: Confirmatory factor analysis confirmed a four‐factor structure (χ2/df ratio = 1.351, good of fit index (GFI) = .904, comparitive fit index (CFI) = .902, root mean square error of approximation (RMSEA) = .041). The DCM‐C was significantly associated with hemoglobin A1c and diabetes self‐care behaviors. Internal consistency reliability of the total DCM‐C scale was .74. Cronbach's alpha coefficients for each subscale of the DCM‐C ranged from .37 (tackling spirit) to .66 (diabetes integration). Conclusions: The DCM‐C demonstrated satisfactory reliability and validity to determine the use of diabetes coping strategies. The tackling spirit dimension needs further refinement when applying this scale to Chinese populations with diabetes. Clinical Relevance: Healthcare providers who treat Chinese people with diabetes can use the DCM‐C to implement an early determination of diabetes coping strategies.
A New Information Exchange System for Nursing Professionals to Enhance Patient Safety Across Europe
Authors: Stievano Dr. Alessandro , Jurado Máximo González , Rocco Gennaro , Sasso Loredana 
Published: November 2009

Abstract Purpose: Ensuring safe healthcare services is one of today's most challenging issues, especially in light of the increasing mobility of health professionals and patients. In the last few years, nursing research has contributed to the creation of a culture of safety that is an integral part of clinical care and a cornerstone of healthcare systems. Organizing Constructs: European institutions continue to discuss methods and tools that would best contribute to ensuring safe and high‐quality care, as well as ensuring access to healthcare services. According to the European Commission between 8% and 12% of patients admitted to hospitals in the European Union member states suffer from adverse events while receiving care, although some of these events are part of the intrinsic risk linked to receiving care. However, most of these adverse events are caused by such avoidable healthcare errors as, for instance, diagnosis mistakes, inability to act on the results of tests, medication errors, failures of healthcare equipment and hospital infections. Nosocomial infections alone are estimated to affect 4.1 million inpatients, that is, about 1 of every 20 inpatients, causing avoidable suffering and mortality, as well as an enormous loss of financial resources (at least €5.48 billion a year). Conclusions: The Internal Market Information (IMI) System, developed by the European Commission, aims at contributing to patient safety by means of a timely and updated exchange of information among nursing regulatory bodies on the good standing and scope of practice of their registrants. Through the IMI System, the European Federation of Nursing Regulators will improve its electronic database on nurses to allow national nursing regulatory bodies to exchange the information needed to recognize the nurses' educational and professional qualifications and competencies. This process both facilitates the mobility of professionals and ensures high‐quality nursing practice in an even and consistent way across the European Union. Clinical Relevance: On a national basis, nursing regulatory bodies play an important role in ensuring patient safety through high standards of nursing education and competence, whereas on an international basis, patient safety can assured by a better exchange of information between national regulatory bodies on the good professional standing of nurses.
Reforms, globalization, and endogenous agricultural structures
Authors: Swinnen Johan F.M. 
Published: November 2009

AbstractIn this article, I draw lessons from two quasi‐natural experiments (the transition process in former Communist countries and the rapid globalization of food chains) on the optimality of farms and agricultural structures more generally. I argue that (a) the farm structures that have emerged from the transition process are much more diverse than expected ex ante; (b) this diversity is to an important extent determined by economic mechanisms which are influenced by initial conditions and reform policies; (c) non‐traditional farm structures have played an important role during transition because they were optimal to address the specific institutional and structural constraints imposed by the transition process; (d) there is more diversity than often argued in the farms that are integrated in global food chains; (e) endogenous institutional (contracting) innovations in food chains may lock existing farm structures in a long‐run institutional framework; and (f) indicators based on farm structures are not a good measure of welfare effects of the globalization of food chains.
Optimal farm size in an uncertain land market: the case of Kyrgyz Republic
Authors: Savastano Sara , Scandizzo Pasquale Lucio 
Published: November 2009

AbstractThis article applies a real options model to the problem of land development. Making use of the 1998–2001 Kyrgyz Household Budget Survey, we show that when the hypothesis of decreasing return to scale holds, the relation between the threshold value of revenue per hectare and the amount of land cultivated is positive. In addition, the relation between the threshold and the amount of land owned is positive in the case of continuous supply of land and negative when there is discontinuous supply of land. The direct consequence is that, in the first case, smaller farms will be more willing to rent land and exercise the option where, in the second case, larger farms will exercise first. The results suggest three main conclusions: (i) the combination of uncertainty and irreversibility is an important factor in land development decisions, (ii) farmer behavior is consistent with the continuous profit maximization model, and (iii) farming unit revenue tends to be positively related to farm size, once uncertainty is properly accounted for.