Advances in the respiratory system treatment of cystic fibrosis.
Explore the source record for details and available documents.
Cystic Fibrosis↗
Biomedical subjects
K R White
Publications and source records attributed to K R White.
Universal screening for infant hearing impairment: simple, beneficial, and presently justified.
In a recent article, Bess and Paradise (Pediatrics 93 (1994) 330-334) rejected the recommendation of the National Institutes of Health that all infants be screened for hearing loss on being released from their birthing hospital. This article responds to their objections with data from the literature and operational newborn hearing screening programs. These data show that universal newborn hearing screening is practicable, effective, cost-efficient, and safe, and concludes that such programs should be implemented without further delay.
Audiometry, Evoked Response↗
Transient evoked otoacoustic emission-based screening in typical nurseries: a response to Jacobson and Jacobson.
Jacobson and Jacobson (Int. J. Pediatr. Otorhinolaryngol. 29 (1994) 235-248) recently questioned whether TEOAE-based newborn hearing screening similar to what was recommended by the National Institutes of Health could be implemented in a typical nursery setting. They concluded that, 'the theoretical advantage of TEOAEs as a method for screening newborn babies at risk for hearing loss may not be realized in acute practice.' This article presents data based on dozens of currently operational TEOAE-based newborn hearing screening programs which demonstrate that the concerns raised by Jacobson and Jacobson are not representative of what is being experienced by operational newborn hearing screening programs.
Hearing Disorders↗
The transition from victim to victor: application of the theory of mastery.
1. Serious, chronic disease, such as sarcoidosis, evokes life-changes that may require mastering stress, recovering self-esteem and finding alternative sources of satisfaction for what is lost. 2. The theory of mastery offers patients and nurses an explanation of how to emerge ever stronger and more resilient in dealing with the self and the environment. 3. Over time, four stages of the theory of mastery may be encountered: certainty, change, acceptance, and growth. Nurses may assist patients to see how they may "master" each stage to achieve personal growth, hence a greater quality of life.
Adaptation, Psychological↗
Culturally diverse management teams. Mercy International sponsors project on Guam.
In 1989 Mercy International Health Services (MIHS) sent a team of advisers to help upgrade the skills of the managers of Guam Memorial Hospital. Their experience offers lessons for U.S. healthcare organizations as they become culturally diverse. The hospital had a number of problems, including high management turnover, troubles with financial resources, political interference, and a building that did not meet codes. The advisers also planned to prepare the hospital for an accreditation survey by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). MIHS, which has a growing presence in the Pacific, does not take charge of healthcare organizations. Instead, it trains local persons to assume leadership roles. At Guam Memorial Hospital, the MIHS advisers spent their first year assessing the organization and the various cultures represented on its staff. Then the advisers devoted three years to coaching and mentoring their Guamanian counterparts. The advisers learned that the hospital had basically been run by one person. It had no management team, either formal or informal. The advisers began their coaching by forming a management team in the dietary department. When the rest of the hospital staff saw that team perform successfully, they became willing to join similar teams themselves. Guam Memorial Hospital had changed by the time the MIHS advisers left the island in 1993. It has not yet been accredited, but it does have management teams working to meet JCAHO standards. The hospital also has in place a continuous quality improvement system, with more than three years of documentation. And the hospital building now conforms to codes.
Accreditation↗
Referral rates and cost efficiency in a universal newborn hearing screening program using transient evoked otoacoustic emissions.
Recently, a National Institutes of Health Consensus Statement recommended that all infants be screened for hearing prior leaving the birthing hospital using a two-stage screening process based on transient evoked otoacoustic emissions (TEOAEs). Although the value of identifying hearing loss before 1 year of age is widely recognized, the feasibility of universal newborn hearing screening using TEOAE is sometimes questioned because it is presumed that the technique has a high false positive rate and is not cost efficient. This paper presents new data for 4253 infants from an operational universal newborn hearing screening program using a TEOAE procedure that answers those arguments.
Acoustic Stimulation↗
Screening all newborns for hearing loss using transient evoked otoacoustic emissions.
The importance of identifying hearing loss before 12 months of age is well established. Although recent research provides some evidence for the value of transient evoked otoacoustic emissions (TEOAEs) in newborn hearing screening, data are needed from large-scale clinical evaluations about the value of using TEOAE for screening high-risk and healthy babies. A cohort of 1850 infants from the well-baby nursery (WBN) and neonatal intensive care unit (NICU) were screened with TEOAE using a 2-stage process. Infants referred from the first stage prior to being discharged from the hospital were rescreened 4 to 6 weeks later. Those who did not pass the second-stage TEOAE screening were referred for diagnostic auditory brainstem response (ABR) and/or behavioral audiological evaluation for confirmation of hearing loss, fitting with amplification, and enrollment in early intervention programs. Eleven infants with unilateral or bilateral sensorineural hearing loss > 25 dB (a prevalence of 5.95 per 1000) and 37 with unilateral or bilateral recurrent conductive hearing loss > 25 dB (a prevalence of 20.0 per 1000) were identified from this cohort. These results suggest that TEOAE is a promising technique for screening newborns for hearing loss and should be evaluated further as a tool for universal newborn hearing screening.
Acoustic Stimulation↗
Stroboscopic hearing as a mechanism for prey discrimination in frequency-modulated bats?
A hypothesis was proposed that bats employing frequency-modulated (FM) echolocation pulses could utilize dynamic information of a flying insect to discriminate prey on the basis of "stroboscopic hearing." To test this hypothesis, single unit recordings were made from the inferior colliculus (IC) of the little brown bat, Myotis lucifugus. Response characteristics of IC units to trains of modulated and unmodulated sound pulses were analyzed at various pulse repetition rates that corresponded to a bat's pulse emission rates during the different stages of its target directed flight. The results show that amplitude modulation (AM) across a train of sound pulses was faithfully encoded in the units' discharge pattern when the pulse repetition rate was different from the AM frequency. When the AM frequency was integer multiples of the pulse repetition rate, the stimulus amplitude was reduced drastically under these conditions. Consequently, the discharge of an IC unit diminished precipitously, or if there was a phase delay between the pulse onset and the modulating sinusoidal waveform the unit fired to each modulation cycle with more or less the same vigor as if the modulation was absent. These data indicate that the across-pulse amplitude modulation becomes undetectable when the AM frequency is integer multiples of the pulse repetition rate. It is interpreted that FM bats can potentially employ a "stroboscopic hearing" strategy for discriminating insects on the basis of the wing-beat frequency of the prey.
Acoustic Stimulation↗
Processing of amplitude-modulated signals that mimic echoes from fluttering targets in the inferior colliculus of the little brown bat, Myotis lucifugus.
1. Neurophysiological recordings were undertaken to determine how neurons in the central nucleus of the inferior colliculus (ICc) of the little brown bat, Myotis lucifugus, extract amplitude modulations that span across a series of tone pulses (i.e., signals that simulate echoes from fluttering targets). Two types of stimuli were presented to the bats. The first served as a control and consisted of an unmodulated train of tone pulses having different repetition rates (TPu, 5-400 pulses per second). The second was a train of tone pulses that were sinusoidally amplitude modulated (TPm, 5-110 Hz) across sequential pulses. The modulated trains of pulses were presented at five different repetition rates (25, 50, 100, 200, and 400 pulses per second) encompassing the range of biosonar emission rates in these bats at different stages of target-directed flight. 2. One hundred fifty-two single neurons were isolated in the ICc of M. lucifugus; their basic response properties and temporal firing patterns were characterized. The best frequencies (BFs) ranged from 10 to 80 kHz and the minimum thresholds at BF were distributed widely (10-95 dB SPL). The frequency tuning selectivity ranged widely, from very broadly tuned (Q10dB = 1.3) to narrowly tuned (Q10dB = 89). Units with very narrow frequency tuning (Q values > 20) were restricted to BFs of 30-50 kHz. The temporal firing pattern of ICc units could be categorized into primary-like (PL), chopper (C), onset-immediate (OI), and onset-late (OL). 3. In response to TPu ICc units exhibited varying degrees of response selectivities as evidenced by their count-based response functions (using the spike count as a measure) versus repetition rate. The count-based response functions of ICc units exhibited five filtering characteristics including band-pass, low-pass, high-pass, band-suppression, and all-pass characteristics. The temporal firing pattern of a unit showed certain correlations with its count-based response function. For example, the majority of OI and OL units, and about half of the C units, showed tuned band-pass response functions. The remaining C and onset types showed mostly low-pass response functions. In contrast, PL neurons showed mostly high-pass response functions, but one third displayed band-pass response functions. 4. The ability of ICc neurons to time-lock their discharges to the individual pulses in a train was characterized by using the synchronization coefficient (SC) as a measure. The SC was plotted against the repetition rate to construct units' synchronization-based response function.(ABSTRACT TRUNCATED AT 400 WORDS)
Acoustic Stimulation↗
Using transient evoked otoacoustic emissions for neonatal hearing screening.
The Rhode Island Hearing Assessment Project was developed to determine the feasibility of establishing a valid cost-effective method of screening newborn hearing through a universal early identification programme. In a sample of 1850 infants, sensorineural hearing loss was identified in 11 infants using transient evoked otoacoustic emissions (TEOAEs). A second sample of 1451 infants showed similar trends in hearing loss identification. TEOAE was shown to have significant potential as a newborn screening tool when used in a carefully designed hospital-based early identification programme.
Acoustic Stimulation↗
Characterization and differential expression of protein kinase C isoforms in PC12 cells. Differentiation parallels an increase in PKC beta II.
Nerve growth factor (NGF) treatment of PC12 cells induced a 2.8-fold increase in protein kinase C activity concomitant with differentiation and acquisition of neuritis. PKC protein isoforms were separated by sequential chromatography on DEAE-Sephacel/hydroxylapatite. A broad peak of PKC activity eluted which corresponded to the alpha PKC isoform. In control cells, message for all six PKC isoforms was detected and expressed as epsilon greater than zeta = gamma greater than delta greater than beta greater than alpha. Western blot of whole cell lysates revealed a large increase in the beta II, while slight changes were observed for the other five PKC isoforms during treatment (1-14 days) with NGF (50 ng/ml). In parallel, coordinate changes in the expression of the individual transcripts for the six isoforms occurred during NGF treatment. Induction and accumulation of PKC beta II may play a role in maintenance of neuronal morphology.
Animals↗
The effectiveness of screening programs based on high-risk characteristics in early identification of hearing impairment.
Prompt identification of educationally significant hearing loss is yet an unattained goal. However, there is some evidence that the ability to identify and diagnose hearing loss at an early age has been significantly improved through the use of carefully designed screening protocols such as birth certificate-based high-risk registries. To evaluate the efficiency of birth certificate-based screening programs, 70 parents and guardians of 6- to 9-yr-old children with significant sensorineural losses were surveyed regarding their child's identification history. Each of these children was born in the state during the time a birth certificate-based screening program was in full operation. Results indicate that children with at least one risk factor for hearing impairment were identified an average of 7.7 mo earlier than children with no risk history. However, only 50% of the children with sensorineural hearing losses exhibited any of the risk factors and a significant number of children with risk factors were missed by the system. Had admission to a neonatal intensive care unit been considered a risk factor, 63% of the children would have exhibited at least one risk factor. More extensive implementation of high-risk registries in conjunction with more widespread education of parents and primary care providers regarding early behavioral indicators of hearing loss, procedures for referral, and appropriate intervention and management services needs to be considered.
Age Factors↗
Maintaining acceptably low referral rates in TEOAE-based newborn hearing screening programs.
This article describes factors that can affect the refer rate for otoacoustic emission (OAE) based newborn hearing screening, including the population of infants being screened, the adequacy of probe fit, software options used, external ear conditions, screener training, and baby handling. The effect of the infant's age on screening outcomes is also discussed using results of screening for 1328 regular nursery newborns, ranging in age from 6 to 60 hours, who were screened with transient evoked otoaoustic emissions (TEOAE) prior to hospital discharge. The youngest infants (6-9 hours old) were as likely to pass (90% pass rate) as the infants who were 24-27 hours old (94% pass rate). The results of this study are consistent with reports from many TEOAE-based screening programs that have demonstrated that acceptably low refer rates (mean = 6.9%) can be obtained when appropriate screening procedures are followed.
Acoustic Stimulation↗
Cost analysis of TEOAE-based universal newborn hearing screening.
Although more and more hospitals are implementing universal newborn hearing screening programs, there is still very little information available about the costs of newborn hearing screening programs. The few articles which have been published evaluate technologies or protocols which are no longer used, are incomplete, or are based on hypothetical estimates of the costs and time necessary to do screening. After briefly reviewing the extant literature, this article describes a cost analysis of a TEOAE-based universal newborn hearing screening program. Reasons why the cost per baby ($7.42) is lower than in previous reports are explained, and the benefits of having accurate cost analysis data are summarized.
Acoustic Stimulation↗
Challenging the dominant logic of Emergency Departments: guidelines from chaos theory.
Chaos is order without predictability (1 ). Any unfortunate patient who has recently made a trek to an Emergency Department (ED) or even better, has watched the immensely popular TV show, ER, knows that the visit can be a frustrating and a time consuming experience. The waits are so protracted that one can observe all cycles of birth, death, love, and romance in the waiting room. The process is tedious for the patient who must tell one's tale to a triage nurse, a registration clerk, the primary nurse, the nursing care partner, and finally the emergency physician. Then, the patient must face more delays while being pushed, ineffectively, in a horizontal fashion, through vertical functional silos of care, such as laboratory and radiology. The mind-set or dominant logic of this system of ED patient flow assumes that waits are acceptable and unavoidable, and that the function of the ED is to care for only the truly emergent patient. This dominant logic, coupled with the market constraints of population-based versus case-based payment mechanisms, has led to a declining trend in ED visits for the first time in 20 years (2). In order to improve the quality of ED care as well as to increase acceptability for patient and payer, the dominant logic must be challenged. An understanding of chaos theory and perception of the Emergency Department as a complex adaptive system foster methods for challenging the dominant logic.
Emergency Service, Hospital↗
Accelerated second degree advanced practice nurses: how do they fare in the job market?
Accelerated, nontraditional, advanced practice nursing programs are an alternative way to increase the supply of nurse practitioners. This study profiles demographic and job characteristics of second degree, non-nurse college graduates who pursued graduate degrees in nursing. Graduates' sex, age, income, previous education, nursing experience, factors describing the scope of the advanced practice role, and quality of the educational experience were studied. Data were collected from 29 graduates (57%) from Virginia Commonwealth University's accelerated second-degree nursing program from 1995 through 1999. The findings have implications for nursing educators, health care administrators, employers, and other persons who plan and recruit for this type of nursing education program.
Adult↗
How does Catholic hospital sponsorship affect services provided?
Catholic hospitals maintain a significant presence in delivering hospital services in the United States, but little is known about the ways they differ from other ownership forms in similar market environments. This paper analyzes characteristics of Catholic, other private nonprofit, and investor-owned hospitals in metropolitan areas of the United States to identify the extent to which Catholic hospitals differ from other ownership types on three dimensions of mission-driven identity--access, stigmatized, and compassionate care services. Based on 1993 data, Catholic hospitals offered more compassionate care services than other private nonprofit hospitals, and more compassionate care and stigmatized services than investor-owned hospitals, controlling for four market and six organizational characteristics. The results may help Catholic hospitals differentiate their services and help justify their tax-exempt status.
Catholicism↗
Hospital marketing orientation and managed care processes: are they coordinated?
The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p < .05) decrease in managed care processes coordinated with the formal marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers.
Contract Services↗