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Biomedical subjects

R Shell

Publications and source records attributed to R Shell.

13 recordsLinked to original sources
PubMed2001

Compression of the trachea by the innominate artery in a 2-month-old child.

SUMMARY. We utilized improved methods for assessing airway structure and function to define the clinical significance of the innominate artery syndrome. Both infant pulmonary function tests (IPFT) and noninvasive controlled ventilation computed tomography (CVCT) were used, along with traditional diagnostic techniques in a 2-month-old child with compression of the trachea by the innominate artery. These tests provided objective documentation of functional impairment before surgery and improvement postoperatively. These tests should aid in the understanding of this controversial syndrome and help to further define treatment options.

Airway Obstruction↗
PubMed2001

Serum and lower respiratory tract drug concentrations after tobramycin inhalation in young children with cystic fibrosis.

OBJECTIVES: To assess the serum and lower respiratory tract tobramycin concentrations (C(T)) produced by a single dose of tobramycin for inhalation delivered by a nebulizer and a compressor in patients with cystic fibrosis (CF) 6 months to 6 years of age. STUDY DESIGN: We performed a dose escalation study of serum C(T) measured before and 0.5, 1, 2, and 4 hours after a single dose of inhaled tobramycin, either 180 mg (10 patients) or 300 mg (19 patients). In a separate group of 12 patients, epithelial lining fluid (ELF) C(T) was measured by bronchoalveolar lavage 30 to 45 minutes after a 300-mg dose. RESULTS: A 180-mg dose of inhaled tobramycin produced a mean peak serum C(T) of 0.5 microg/mL (SD 0.4; range, <0.2 to 1.4 microg/mL). A 300-mg dose produced a mean peak serum C(T) of 0.6 microg/mL (SD 0.5; range, <0.2 to 1.2 microg/mL). These peak values are well below the accepted maximum trough concentration with parenteral dosing (2 microg/mL). The target ELF C(T) was 20 microg/mL, 10-fold greater than the minimal inhibitory concentration for most Pseudomonas aeruginosa isolates from very young patients with CF (2 microg/mL). Mean ELF C(T) was 90 microg/mL (SD 54; range, 16 to 204 microg/mL) and exceeded the target concentration in 11 patients. CONCLUSION: In patients with CF ages 6 months to 6 years, a single 300-mg dose of inhaled tobramycin appears to produce safe peak serum concentrations and drug concentrations in the bactericidal range in the lower respiratory tract.

Administration, Inhalation↗
PubMed2001

Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants.

OBJECTIVE: To describe 13 neurologically normal infants with chronic respiratory symptoms who had swallowing dysfunction with silent chronic aspiration without gastroesophageal reflux (GER) as the cause of their respiratory symptoms. BACKGROUND: Infants with neurologic disorders and infants with GER are known to have chronic respiratory symptoms. Isolated swallowing dysfunction and aspiration without GER in neurologically normal infants have not been widely reported. DESIGN: Retrospective chart review. SETTING: A tertiary pulmonary-care center at a children's hospital. PATIENTS: One hundred twelve otherwise healthy infants referred for respiratory symptoms who underwent esophageal pH studies and videofluoroscopic swallow studies (VSSs). METHODS: The records of infants referred between January 1997 and December 1999 to the Department of Pediatric Pulmonology who underwent 24-h esophageal pH monitoring and VSS as part of an evaluation for recurrent stridor and/or wheezing were reviewed. Significant GER was diagnosed if the percentage of time with esophageal pH < 4 was > 6%. Infants included in the study presented with recurrent respiratory symptoms, were born at term, were neurologically normal, had normal results of esophageal pH studies, but had abnormal results of VSSs (n = 13). RESULTS: All 13 infants presented with a variety of recurrent respiratory symptoms including wheezing and intermittent stridor. Ten of 13 infants had spitting and/or choking episodes with feeding. The mean (+/- SD) age at the onset of symptoms was 2.0 +/- 1.6 months, and the mean age at VSS was 5.9 +/- 3.4 months. All 13 infants had normal results of 24-h esophageal pH studies but had abnormal results for VSSs. All infants had evidence of swallowing dysfunction and direct silent aspiration of liquids with thin consistency. Six infants also were aspirating liquids with thick and/or semi-thick consistencies. None of the infants had evidence of structural anomalies on esophagograms. Nine infants were treated with thickened food, and in four infants oral feedings were stopped. Three of these infants required nasojejunal feeding, and one infant required gastrostomy tube feeding. VSSs were repeated every 3 months. In all infants, swallowing dysfunction resolved within 3 to 9 months. All infants tolerated the resumption of oral feeding. Videofluoroscopic documentation of the resolution of aspiration was followed by the resolution of respiratory symptoms in all infants. CONCLUSION: There is a subgroup of otherwise healthy infants, presenting with wheeze and/or stridor, who have isolated swallowing dysfunction and silent aspiration as the cause of their respiratory symptoms.

Chronic Disease↗
PubMed1999

A phase I study of adenovirus-mediated transfer of the human cystic fibrosis transmembrane conductance regulator gene to a lung segment of individuals with cystic fibrosis.

A third-generation adenoviral vector containing recombinant human cystic fibrosis transmembrane conductance regulator (CFTR) gene was delivered by bronchoscope in escalating doses to the conducting airway of 11 volunteers with cystic fibrosis. Assessments of dose-limiting toxicity (DLT), efficiency of gene transfer, and cell-mediated and humoral immune responses to vector administration were performed. DLT, manifest by flulike symptoms and transient radiographic infiltrates, was seen at 2.1 x 10(11) total viral particles. A highly specific assay for gene transfer was developed using in situ hybridization with an oligoprobe against unique vector sequence. Detectable gene transfer was observed in harvested bronchial epithelial cells (<1%) 4 days after vector instillation, which diminished to undetectable levels by day 43. Adenovirus-specific cell-mediated T cells were induced in most subjects, although only mild increases in systemic humoral immune response were observed. These results demonstrate that gene transfer to epithelium of the lower respiratory tract can be achieved in humans with adenoviral vectors but that efficiency is low and of short duration in the native CF airway.

Adenoviridae↗
PubMed1992

The cross-ethnic equivalence of parenting and family interaction measures among Hispanic and Anglo-American families.

Recently there has been concern over the need for developmental research within ethnic minority populations and interest in family processes within, and variability across, ethnic groups. Unfortunately, most of the research using standard scales of family processes has sampled middle-class Anglo-Americans, and the potential absence of cross-ethnic measurement equivalence threatens the validity of the research using these scales with ethnic minority populations. This study reports confirmatory factor analyses and construct validity coefficients for several parenting and family interaction scales among Anglo-American and Hispanic 8-14-year-old children and mothers. The findings indicate that the Children's Report of Parental Behavior Inventory (except the hostile control subscale), the Parent-Adolescent Communication Scale (open communication subscale only), and the Family Adaptability and Cohesion Evaluation Scales II appear to have sufficient cross-ethnic equivalence for English-speaking Hispanic samples. Further, the Family Routines Inventory and the problem communication subscale could benefit from additional scale development.

Adolescent↗
PubMed1991

Personality and socialization correlates of vicarious emotional responding.

The relations of personality and family characteristics to adults' negative vicarious emotional responses to sympathy and distress films were examined. Ss reported more sympathy and less personal distress and exhibited less skin conductance as well as heart rate deceleration when viewing a sympathy-evoking film. Dispositional emotional intensity and fantasy empathy were associated with greater self-reported emotional responding and higher skin conductance. Dispositional perspective taking and personal distress were positively and negatively correlated, respectively, with reported vicarious responding to the sympathy film when Ss were administered instructions to imagine the emotions of those in the films. Family cohesiveness was associated with reported sympathy and sadness in reaction to the sympathy film, whereas the expression of negative subordinate and positive emotional states in the home of origin was associated with women's reported responsivity.

Adult↗
PubMed1989

Mothers' emotional arousal as a moderator in the socialization of children's empathy.

Overall, our findings suggest that the moderating effects of maternal affective arousal in the socialization of children's empathic responding are complex. On the one hand, at low levels of mothers' affective intensity, positive relations were found between children's sad facial reactions and mothers' prosocial suggestions. At the highest levels of affective responding, however, mothers' altruistic responding was significantly and positively related to children's sad facial responses, and mothers' altruism and inductive reasoning was negatively related to children's distressed facial reactions (Table 2). The negative relation of mothers' inductions and altruistic responding to children's facial distress reactions at high levels of mothers' affective responding could be interpreted to mean that these practices are associated with decreases in children's personal distress reactions to distressed peers (that is, with decreases in one's focus on one's own negative feelings). However, the positive relations between mothers' inductions and altruistic responding and children's facial distress reactions at low levels of mothers' emotional responding could support the interpretation of facial distress reactions as vicarious emotional responses. The affective response depicted by the children in the empathy films involved physical distress, so a purely vicarious affective (that is, empathic) response might be expected to be expressed facially as a distressed reaction. Thus, the variability in the results regarding children's facial distress reactions suggests that to interpret them as an index of either empathy or personal distress requires considering the nature of the empathy stimulus and may ultimately require assessing additional criterion variables (for example, examining the relation of facial distress reactions to actual prosocial behavior). Results not found in previous research were that high-intensity parental affect combined with negative control practices was associated with a lessening of children's sympathetic orientations, whereas situational definitions were positively associated with children's facial distress reactions to peer distress. The variability in these findings may be explained, in part, by the interpretation that parental affect may potentiate the impact of the semantic content of parental messages to the child. That is, if the content of the message is inductive, the mother's intense affect may heighten the meaningfulness of the relation between the child's behavior and its consequences for the peer's situation or feelings (unless, of course, the parent overwhelms the child with information).

Altruism↗
PubMed1989

Relation of sympathy and personal distress to prosocial behavior: a multimethod study.

Assessed sympathy and personal distress with facial and physiological indexes (heart rate) as well as self-report indexes and examined the relations of these various indexes to prosocial behavior for children and adults in an easy escape condition. Heart rate deceleration during exposure to the needy others was associated with increased willingness to help. In addition, adults' reports of sympathy, as well as facial sadness and concerned attention, were positively related to their intention to assist. For children, there was some indication that report of positive affect and facial distress were negatively related to prosocial intentions and behavior, whereas facial concern was positively related to the indexes of prosocial behavior. These findings are interpreted as providing additional, convergent support for the notion that sympathy and personal distress are differentially related to prosocial behavior.

Adult↗
PubMed1989

The role of sympathy and altruistic personality traits in helping: a reexamination.

The purposes of this study were (a) to examine the role of social evaluative concerns in the self-report of sympathy and in the relation of sympathy to helping; and (b) to determine the role of "altruistic personality" traits and situationally induced vicarious emotional responses in the intention to help. Dispositional and situational self-reports of sympathy and other vicarious emotional reactions were obtained for persons who also were given the opportunity to assist a needy other. Moreover, dispositional measures of concern with social evaluation and an altruistic orientation were obtained, and a bogus pipeline manipulation was instituted for half the study participants. Both dispositional and situational self-reported sympathy were positively related to helping, as were other personality indices viewed as reflecting altruistic characteristics. The relations for the dispositional indices of sympathy were not due solely to social evaluative concerns or to other egoistic concerns. The effects on intended helping of dispositional sympathy, perspective taking, and the tendency to ascribe responsibility for others to the self appeared to be both direct and mediated by situational sympathetic responding. Finally, situational sadness did not mediate the effects of sympathetic responsiveness.

Adult↗
PubMed1987

Consistency-based compliance: when and why do children become vulnerable?

This study examines the nature and development of behavioral consistency pressures in children. Specifically, we examined the effectiveness of the foot-in-the-door procedure in producing consistent prosocial behavior and self-attributions in kindergartners and second and fifth graders. Children were either induced to comply with a request to share prize coupons or were not given this initial prosocial experience. Those who complied either were labeled as helpful by an adult or were not. Later, children were given the opportunity to help under public or private circumstances. Moreover. children's understanding of trait stability, their internal preference for consistent behavior, and their belief that adults prefer behavioral consistency were assessed. Consistent responding began to occur within the foot-in-the-door procedure in the second grade, and this developmental shift was paralleled by a shift in children's understanding of trait stability. Furthermore, once the foot-in-the-door effect appeared among the second and fifth graders, its strength was significantly affected by the children's internal preference for consistency.

Child↗
PubMed1987

Commitments to help by children: effects on subsequent prosocial self-attributions.

Children of both sexes and at several ages were or were not induced to make a commitment to help hospitalized children by sorting papers. The commitments occurred under either public or private circumstances. Later, the children discovered that the commitment to help would require that they give up their recess times (i.e. breaks). The willingness of subjects to live up to their commitments and the altruistic self-attributions resulting from those commitments were measured. It was found that, regardless of conditions, virtually all subjects were willing to give up recess time to help. However, their self-attributions differed systemically with condition: only after making a private commitment to help did subjects come to see themselves as more altruistically oriented. Further, this effect appeared earlier for girls than for boys and persisted at least one month after the initial commitment. No such effects occurred for public commitments, suggesting that children as young as eight years were able to discount the self-relevant implications of prosocial commitments made under public scrutiny.

Adolescent↗
PubMedDate not supplied

Perceived barriers to teaching for critical thinking by BSN nursing faculty.

The ability to think critically is considered an essential skill of nursing graduates and competent nursing practice. Yet, the literature reports that teachers are having difficulty teaching for critical thinking and that critical thinking is lacking in new nursing graduates. This research study sought to identify barriers to the implementation of critical thinking teaching strategies by nursing faculty currently teaching in generic baccalaureate programs in Tennessee. Surveys were mailed to 262 nursing faculty; 194 were returned, and 175 were usable. Students' attitudes and expectations represented the single greatest barrier to the implementation of critical thinking teaching strategies, followed by time constraints and the perceived need to teach for content coverage. Recommendations to support and encourage faculty to teach for critical thinking are outlined.

Adult↗