Development and validation of a scale for the end of life caregiving appraisal.
End-of-life caregiving experiences can be complex. Family members experience physical and mental suffering as they anticipate their impending loss. Healthcare providers should be able to provide good quality of end-of-life (EOL) care and support for primary EOL caregivers. Studies have highlighted the role of healthcare providers providing information in the EOL situation to caregivers of chronic disease patients. This has resulted in the development of the End-of-life Caregiving Experience Appraisal Scale (EOLCAS) presented in this paper. The purposes of this study were to develop a scale that can evaluate the experiences of EOL caregivers, and to test the reliability and validity of this scale.



The scale domains were derived from systematic review of 35 relevant studies. We then examined its content validity with nurse scholars and clinicians using content validity index. To examine construct validity, a total of 175 caregivers from tertiary hospital setting in Korea participated in this study from December 2007 to May 2008. For the construct validity, factor analysis was utilized.



The scale was composed of 32 items with four subscales: two negative appraisals (physical suffering and burden), one positive appraisal (maturation), and one neutral appraisal (social support pursuit). In this sample, the Cronbach's alpha for the entire scale was .84 indicating adequate reliability. However, Cronbach's alpha of subscales was varied.



Nurses and other healthcare professionals could use the EOLCAS to assess the experiences of EOL caregivers to understand their experience in the EOL and enhance their quality of life although psychometrics of EOLCAS shows limited findings.

title: Factor structure investigation of perceived facilitators and barriers in end-of-life care among Korean nurses.
abstract: The aim of this study was to assess the validity and reliability of the Korean version of a questionnaire assessing facilitators/barriers in end-of-life care that was originally developed for nurses in the USA.



Back-translation was undertaken to produce the Korean version. A principal component analysis with varimax rotation and Cronbach's alpha was used to test factorial validity and reliability, respectively.



The analysis examined data from 383 nurses in a tertiary hospital in Korea. For end-of-life care facilitators, five factors accounted for 59% of the total variance. The factors were labeled "family preparedness", "support for nurses", "nurse-patient relationship", "transition after death", and "decision-making". Six factors, explaining 59% of the variance, were extracted for end-of-life care barriers. These factors were "misunderstanding patient's will", "preoccupied nursing workload", "lack of institutional support", "dealing with family's maladaptive coping", "visiting hours", and "communication about patient's status with family members". Cronbach's alpha was 0.89 for the 23 facilitator items and 0.90 for the 24 barrier items.



Overall, the findings demonstrate that the questionnaire has measurement properties in a sample of Korean nurses. Further studies are needed with different populations to reflect end-of-life care in various clinical settings.

title: Korean nurses' perceived facilitators and barriers in provision of end-of-life care.
abstract: This study examined nurses' perceived facilitators and barriers to end-of-life (EOL) care in clinical settings. The study participants were 383 Korean nurses working at tertiary hospitals. The nurses had an average of 7.6 years of clinical experience. The three highest-scoring facilitating items were 'family member acceptance of patient death', 'having time to prepare the family for the patient's expected death' and 'having the physician meet with the family after the patient's death to offer support and validate the given care'. The top two perceived barriers were 'families not accepting what the physician is telling them about the patient's prognosis' and 'dealing with angry family members'. Nurses who had received EOL care education showed a higher score in perception of facilitators than nurses who did not receive that education. EOL care for patients and their families is a challenge; thus, continuing education should be provided to improve nursing practice.

title: Measurement issues across different cultures.
abstract: The purposes of this methodologic paper are to (1) describe theoretical background in conducting research across different cultures; (2) address measurement issues related to instrument administration; and (3) provide strategies to deal with measurement issues.



A thorough review of the literature was conducted. A theoretical background is provided, and examples of administering instrument in studies are described.



When applying an instrument to different cultures, both equivalence and bias need to be established. Three levels of equivalence, i.e., construct equivalence, measurement unit equivalence, and full score comparability, need to be explained to maintain the same concept being measured. In this paper, sources of bias in construct, method, and item are discussed. Issues related to instrument administration in a cross-cultural study are described.



Researchers need to acknowledge various group differences in concept and/or language that include a specific set of symbols and norms. There is a need to question the philosophical and conceptual appropriateness of an assessment measure that has been conceptualized and operationalized in a different culture. Additionally, testing different response formats such as narrowing response range can be considered to reduce bias.

title: Korean version of the Revised Caregiving Appraisal Scale: a translation and validation study.
abstract: This paper is a report of a study to examine the reliability and validity of a Korean version of the Revised Caregiving Appraisal Scale with Korean caregivers of older stroke survivors.



The Revised Caregiving Appraisal Scale was developed in the United States of America for an American English-speaking population to measure primary caregivers' appraisals of potential stressors and the efficacy of their coping efforts related to caregiving experiences.



Using the back-translation method, the instrument was translated into Korean. The Korean version of the Revised Caregiving Appraisal Scale was self-administered by 147 primary family caregivers recruited from three outpatient clinics and two home health agencies in Korea. The study was conducted in 2005.



In this sample, Cronbach's alpha for the total scale was 0.86. Reliability coefficients for each of the five subscales ranged from 0.40 to 0.85. Two subscales, burden and satisfaction, showed good reliability; one subscale, impact, showed marginally acceptable reliability; two subscales, mastery and demand, had low reliability. Principal components factor analysis of the Korean version of the Revised Caregiving Appraisal Scale yielded six factors. Except for the mastery domain, which was divided into two factors, the other factors were similar to those in the original scale.



The Korean version of the Revised Caregiving Appraisal Scale had adequate reliability and validity in a sample of Korean caregivers of stroke survivors. It can be used to assess the impact of caregiving and interventions on Korean caregiver attitudes. Further studies are needed with different categories of caregiver.

title: Development of a conditional gene expression system using a zearalenone-inducible promoter for the ascomycete fungus Gibberella zeae.
abstract: The ascomycete fungus Gibberella zeae is an important plant pathogen that causes fusarium head blight on small grains. Molecular studies of this fungus have been performed extensively to uncover the biological mechanisms related to pathogenicity, toxin production, and sexual reproduction. Molecular methods, such as targeted gene deletion, gene overexpression, and gene fusion to green fluorescent protein (GFP), are relatively easy to perform with this fungus; however, conditional expression systems have not been developed. The purpose of this study was to identify a promoter that could be induced by zearalenone (ZEA) for the development of a conditional expression system in G. zeae. Through microarray analysis, we isolated one zearalenone response gene (ZEAR) whose expression was increased more than 50 times after ZEA treatment. Northern blot analysis showed that the ZEAR transcript dramatically increased after 1 h of ZEA treatment. To determine the utility of the ZEAR promoter, called Pzear, in a conditional expression system, we transformed a Pzear::GFP fusion construct into G. zeae. Our data showed a ZEA concentration-dependent increase in GFP expression. We also replaced the promoter of G. zeae metE (GzmetE), an essential gene for methionine biosynthesis, with the Pzear promoter. The growth of the Pzear-GzmetE mutant on minimal medium was dependent on the ZEA concentration supplemented in the medium and showed that GzMetE expression was induced by ZEA. This study is the first report of an inducible promoter in G. zeae. Our system will be useful for the characterization of essential gene functions in this fungus through differential and ZEA-dependent gene expression. In addition, the Pzear promoter may be applicable as a biosensor for the detection of ZEA contamination in agricultural products.

title: Respiration-induced B0 field fluctuation compensation in balanced SSFP: real-time approach for transition-band SSFP fMRI.
abstract: In functional MRI (fMRI) the resonance frequency shift induced from respiration is a major source of physiological noise. In transition-band SSFP fMRI the respiration-induced resonance offset not only increases noise interference, it also shifts the activation band. This leads to a reduction in the contrast-to-noise ratio (CNR) and the potential for varying contrast levels during the experiment. A novel real-time method that compensates for the respiration-induced resonance offset frequency is presented. This method utilizes free induction decay (FID) phase information to measure the resonance offset. For compensation, one can update the resonant frequency in real time by changing the transmit RF pulse and receiver phases to track the measured offset. The results show decreased signal power in the respiration frequency band and increased numbers of activated voxels with higher Z-scores compared to uncompensated experiments.

title: Less is more: management of pediatric splenic injury.
abstract: To analyze national trends in the nonoperative management of pediatric splenic injury.



Retrospective cohort analysis.



All children and adolescents 18 years or younger from 2 national databases who were hospitalized with pediatric splenic injury.



Data from 9 years of the National Inpatient Sample database (2000-2008) and 3 years of Kids' Inpatient Database (2000, 2003, and 2006).



We calculated and chronicled rates of splenectomy, angiography, and transfusion from 2000 to 2008.



During the study period, the rate of splenectomy decreased from 18.25% to 10.86%. Changes in nonoperative management included more than a 2-fold increase in angiography, from 2.43% to 6.94%, and a significant increase in transfusion, from 7.71% to 11.49%. Operative management was associated with increased length of stay (9.15 vs 6.52 days) and higher mean total hospital charges ($74 981.26 vs $36 156.30). Cases occurring in rural locations were more likely to undergo operative management (odds ratio, 1.24 [95% CI, 1.18-1.31]; P < .001), but less likely to undergo angiography (0.82 [0.76-0.89]; P < .001).



Children with pediatric splenic injury are undergoing fewer splenectomies but more angiography. Rural location may be an independent risk factor for operative management. Further studies are needed to assess for disparity in access to and availability of aggressive nonoperative management.

title: Oregon 'Pinot noir' grape anthocyanin enhancement by early leaf removal.
abstract: Complete cluster zone leaf removal of 'Pinot noir' was initiated at three separate pre-véraison growth stages (bloom, grain-pea size, and bunch closure) and maintained leaf free until harvest, for four growing seasons (2008-2011). Fruit anthocyanin composition was examined at harvest for the last two vintages (2010 and 2011) and compared to a control-no cluster zone leaf removal. Experiments were conducted at two commercially operating Oregon vineyards (site A=420 rootstock/'Pinot noir' 115 scion and site B=3309C rootstock/'Pinot noir' 777 scion). All clusters contained the five anthocyanins typically found in 'Pinot noir'. Leaf removal at bloom and maintained until harvest produced maximum anthocyanin accumulation in 'Pinot noir' grapes (site A=85.24 mg/100 g and site B=125.06 mg/100 g), compared to no leaf removal (control; site A=57.91 mg/100 g and site B=97.56 mg/100 g). Even leaf removal at bunch closure (last leaf removal initiation period) increased grape anthocyanin (site A=73.22 mg/100 g and site B=118.93 mg/100 g) compared to control, but total anthocyanins were lower than grapes from bloom leaf removal (first time period). Results differed slightly by vineyard site and rootstock/scion combination.

title: Protein loop modeling by using fragment assembly and analytical loop closure.
abstract: Protein loops are often involved in important biological functions such as molecular recognition, signal transduction, or enzymatic action. The three dimensional structures of loops can provide essential information for understanding molecular mechanisms behind protein functions. In this article, we develop a novel method for protein loop modeling, where the loop conformations are generated by fragment assembly and analytical loop closure. The fragment assembly method reduces the conformational space drastically, and the analytical loop closure method finds the geometrically consistent loop conformations efficiently. We also derive an analytic formula for the gradient of any analytical function of dihedral angles in the space of closed loops. The gradient can be used to optimize various restraints derived from experiments or databases, for example restraints for preferential interactions between specific residues or for preferred backbone angles. We demonstrate that the current loop modeling method outperforms previous methods that employ residue-based torsion angle maps or different loop closure strategies when tested on two sets of loop targets of lengths ranging from 4 to 12.