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PubMed1990

Reach for Excellence--a clinical ladder promotion system.

The clinical ladder at Lutheran Hospital-La Crosse, La Crosse, Wisconsin, exemplifies the decentralized management of the department. The four-tiered promotion system rewards the nurse who uses clinical expertise to promote high quality nursing practice by functioning as role model, resource, teacher for colleagues, and change agent. Specific criteria comprise the Performance Description/Appraisal and build through each level of the ladder. Applicants submit a portfolio to peer review committees. Salary increases accompany promotion.

Career Mobility↗

PubMed1994

Better jobs, better care: building the home care work force.

This paper focuses on providing quality care in the paraprofessional home care industry. Despite government policies that have encouraged home-based care for 20 years, home health care still remains relegated to second-class status by the rest of the health care industry. Home care is unique because it relies primarily on paraprofessional care delivered by a home care aide working alone, essentially as a guest in the client's home. The resulting interpersonal dynamic between patient and caregiver--which develops far from the eyes of the primary physician, regulators, and third-party payers--is one unlike any other patient-caregiver relationship in the health care system. The quality of care received by the client is linked directly to the quality of the paraprofessional's job: "good jobs" are prerequisite for "good service." Good jobs, however, are not enough. They must be supported by paraprofessional agencies that add real value to the home care service. Part I We define quality home care as meeting the client's needs. Unfortunately, since home care is provided in dispersed, minimally supervised settings, measuring quality of service is very difficult. For this reason, we suggest that it is the front-line employee--the home care aide who is present for hours every visit--who can best determine if the client's needs are being met, and who is best positioned to respond accordingly. Part II To best meet client needs, paraprofessional home care must be built around the home care aide. This requires that home care aides (1) be carefully selected during the hiring process, (2) be well trained, and (3) be empowered with considerable responsibility and capacity to respond to the daily needs of the clients. This Model, one that emphasizes the front-line employee, is in full keeping with the "total quality management" innovations that are currently reorganizing America's service industries. Unfortunately this model is not typically reflected in current paraprofessional home health care practice. Part III Building the home care service around home care aide requires redesigning the paraprofessinal's job in 5 ways: 1. Make work pay, by providing a minimum of $7.50 per hour and a decent benefits package.(ABSTRACT TRUNCATED AT 400 WORDS)

Health Services Needs and Demand↗

PubMed1997

[Age-related decline in forced expiratory volume in one second and forced vital capacity based on a longitudinal observation of Japanese males].

Forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) of 243 healthy male Japanese workers were measured on as annual basis over seven years, and their longitudinal decline was compared with the age coefficient of cross-sectional prediction equations reported previously for Japanese adults. In this study, a man, assumed to be 1.65 meter tall, was expected to have a respective 22 ml and 11 ml decline annually in FEV1 and FVC. Age-related differences of those indices obtained from cross-sectional prediction equations, however, ranged from 22 ml to 31 ml a year in FEV1 and from 16 ml to 25 ml in FVC for men of the same height. Furthermore, in those equations, age was simply employed as a first-order explanatory variable for ages ranging from the later teens to over sixties, although age-related acceleration of FVC decline is suggested in this study. These results indicate that evaluations of measurements relating to time-series pulmonary functions on cross-sectional prediction equations might be biased. This is probably due to the influence of age-cohort. It seems necessary to build up the reference standards for longitudinal pulmonary function change for an appropriate evaluation of time-series data of FVC and EFV1.

Adult↗

PubMed1994

Building community for health: lessons from a seven-year-old neighborhood/university partnership.

This article presents two case studies highlighting the role of community conflict in the process of community empowerment. A graduate program for community health nurses (CHNs) in a large Midwestern city formed a partnership with a diverse, integrated neighborhood for the dual purposes of enhancing the community's capacity to improve its own health and teaching CHNs community organizing as a means to improve health. Central to the partnership are a broad definition of health, trust developed through long-term involvement, a commitment to reciprocity, social justice, and Freire's model of adult learning. Two initiatives that gave rise to major conflicts between community groups are analyzed. Conflicts, external and internal to the community, proved to be both powerful catalysts and potential barriers to the use of Freirian themes in community organization. Both university and community participants report needing better skills in the early recognition and management of conflict. We conclude that conflict management theory must be integrated with empowerment education theory, particularly when empowerment education is applied in a diverse community.

Adolescent↗

PubMed1998

Effects of lung volume and involuntary breathing movements on the human diving response.

The effects of lung volume and involuntary breathing movements on the human diving response were studied in 17 breath-hold divers. Each subject performed maximal effort apnoeas and simulated dives by apnoea and cold water face immersion, at lung volumes of 60%, 85%, and 100% of prone vital capacity (VC). Time of apnoea, blood pressure, heart rate, skin capillary blood flow, and fractions of end-expiratory CO2 and O2 were measured. The length of the simulated dives was the shortest at 60% of VC, probably because at this level the build up of alveolar CO2 was fastest. Apnoeas with face immersion at 100% of VC gave a marked drop in arterial pressure during the initial 20 s, probably due to high intrathoracic pressure mechanically reducing venous return. The diving response was most pronounced at 60% of VC. We concluded that at the two larger lung volumes both mechanical factors and input from pulmonary stretch receptors influenced the bradycardia and vasoconstriction, resulting in a nonlinear relationship between the breath-hold lung volume and magnitude of the diving response in the near-VC range. Furthermore, the involuntary breathing movements that appeared during the struggle phase of the apnoeas were too small to affect the diving response.

Adult↗

PubMed1996

Temporal coding of low-frequency amplitude modulation in the torus semicircularis of the grass frog.

Single neuron responses to sinusoidal 20 Hz amplitude modulated tone bursts (612.5 ms stimulus-on time at the rate of once per 2.2 s) were studied in the auditory midbrain (torus semicircularis) of the immobilized grass frog (Rana temporaria temporaria). The characteristic frequency stimuli at 30 dB above the minimum threshold included 12 full modulation periods with fixed initial phase. Neurons generally showed good phase-locking to the envelope waveform. 160 of the 186 investigated neurons responded to 80% amplitude modulated stimuli with discharges synchronized to the modulation cycle. For this modulation depth the best phase-locking capability was observed for certain phasic and build-up units. The synchronous response to 10% modulated stimuli was observed in 104 units. Though a few (2 of 29) phasic units were capable of reproducing this modulation with very high fidelity, the general tendency was the increasing of phase-locking capacity for units with a substantial sustained activity. In this condition for 66 units (63% of the units displaying the synchronous response) we observed a significant improvement of phase-locking from the initial to the terminal periods of modulation. This effect could be interpreted as an initial stage of the enhancement of small amplitude changes in the course of the long-term adaptation.

Acoustic Stimulation↗

PubMedDate not supplied

National strategy for mass casualty situations and its effects on the hospital.

A mass-casualty situation (MCS) usually is short in duration and resolves itself. To minimize the risks to patients during MCS, planning is essential. This article summarizes the preparations needed at the hospital level, for a local MCS involving numerous trauma victims arriving to the Emergency Department at a short notice. Experiences and conclusions related to the implementation of the Israeli strategy in one hospital that combines the responsibilities of both the military and civilians are summarized. The Ministry of Health distributes the master MCS plan to each hospital where a local committee adapts it to the specific situation in a format of standing orders. After its approval by the Ministry of Health, an annual inspection is conducted to check the ability of the staff to manage a MCS. A full-scale drill is conducted every second year during which each site's readiness level and the continuity of the flow of care are tested. In building the strategy for treating trauma victims during a MCS, a few assumptions were taken into account. The goal of treatment in a MCS is to deliver an acceptable quality of care while preserving as many lives as is possible. In theory, the capacity of the hospital is its ability to manage a load of patients in the range of 20% of the hospital bed capacity. Planning and drilling are the ways to minimize deviations from the guidelines and to avoid management mistakes. Special attention should be paid to problems related to the initial phase of receiving the first message, outside communication, inside hospital communication, and staff recruitment. Other issues include: free access to the hospital; opening a public information center; and dealing with the media and very important persons (VIPs). A new method for creating the needed MCS plan in the hospital is suggested. It is based upon knowledge of management techniques that used multi-level documents, which are spread via Intranet between the different key figures. Using this method, it is possible to keep the strategy, the source documentation, and reasons for choosing it, as well as immediate release of checklists for each functions. This detailed, time consuming work is worthwhile in the long run, when the benefits of easy updating and better preparedness are apparent.

Disaster Planning↗

PubMed2004

Therapeutic alliance, negative mood regulation, and treatment outcome in child abuse-related posttraumatic stress disorder.

This study examined the related contributions of the therapeutic alliance and negative mood regulation to the outcome of a 2-phase treatment for childhood abuse-related posttraumatic stress disorder (PTSD). Phase 1 focused on stabilization and preparatory skills building, whereas Phase 2 was comprised primarily of imaginal exposure to traumatic memories. Hierarchical regression analyses indicated the strength of the therapeutic alliance established early in treatment reliably predicted improvement in PTSD symptoms at posttreatment. Furthermore, this relationship was mediated by participants' improved capacity to regulate negative mood states in the context of Phase 2 exposure therapy. In the treatment of childhood abuse-related PTSD, the therapeutic alliance and the mediating influence of emotion regulation capacity appear to have significant roles in successful outcome.

Adult↗

PubMed1982

Density dependence of maximal expiratory flows in normal subjects: influence of sex, age, body build and spirographic variables.

We studied the correlation between density-dependence parameters (delta He, volume of isoflow) and age, body build, spirography and forced expiratory fows in 69 healthy non-smokers (16 females) aged 18 to 51 years. Density dependence variables showed no significant differences between young (less than 35 years) males and females. Volume of isoflow per cent of forced vital capacity (Viso V % FVC) was poorly significantly related to age (r = +0.25 P less than 0.05) and weight (r = +0.27 P less than 0.05). Significant correlations were found between density dependence at low lung volume and the FEV1/VC ratio (r = 0.31, P = 0.01 for delta He 25%; r = -0.40, P less than 0.001 for Viso V% FVC) or the forced expiratory flows with air (Viso V% FVC vs. FEF 25% r = -0.42, P less than 0.001). These correlations were closer in females as compared to males. Volume of isoflow was well related to delta He 25% (r = -0.64, P less than 0.001), but the relationship with delta He 50% was weaker (r = -0.38; P less than 0.01).

Adolescent↗

PubMed1986

Gastrointestinal microflora in mammalian nutrition.

A mammal is a complex organism consisting of eukaryotic animal cells and eukaryotic and prokaryotic microbial cells. Most of the microorganisms reside in communities in the gastrointestinal tract. These gastrointestinal microfloras are known to serve nutritional functions in ruminants, pseudoruminants, and monogastric mammals with only modest or no foregut fermentations but with extensive hindgut fermentations in blind cecal pouches. In adult animals, the microflora hydrolyzes exogenous (dietary) and endogenous polymers, and provides the adult with all or at least a significant proportion of its carbon, energy, vitamins, and macromolecular building blocks. The flora also functions as a conservator of nitrogen that would otherwise be excreted as urea. In exchange, the flora competes directly with the host tissues for nutrients ingested in the diet, and also competes indirectly by somewhat repressing the absorptive capacities of the animal tissues. When the synergism is in balance, the animal tissues and the microflora operate in harmony for the health and nutritional welfare of the host as a whole. The system may be unbalanced by antibacterial drugs that destroy the microflora and by diseases of the animal tissues that destroy the controls regulating where indigenous communities localize in the tract, their microbial composition, and their biochemical activities. At such times, the nutrition of the animal tissues can be adversely affected to the extreme. Humans living in developed and developing countries have extensive microfloras in their hindguts. Humans living in developing countries may also have extensive microfloras in their small bowels. Those floras may function in nutrition of the animal tissues of man much the same as do floras in similar locations in the gastrointestinal tracts of mammals other than man. However, animals of some species other than human gain much of the nutritional benefit from their microflora through the practice of coprophagy. Since adult humans do not normally practice coprophagy, any nutritional benefit from the microflora depends upon the capacity of the bowel mucosa, principally that of the large bowel, to absorb bacterial products, e.g. short-chain volatile fatty acids. Such absorption undoubtedly occurs, but is surely not a major source of carbon and energy for the animal tissues of man.

Anaerobiosis↗

PubMed2002

Bronchial responsiveness to eucapnic hyperventilation and methacholine following exposure to organic dust.

STUDY OBJECTIVE: Inhalation of dust in a swine confinement building causes an intense airway inflammatory reaction in the airways and increased bronchial responsiveness to methacholine. The aims of the present study were to investigate whether exposure to organic dust also influences bronchial responsiveness to an indirect stimulus, and to assess the duration of increased postexposure bronchial responsiveness. DESIGN: Twenty-two healthy nonatopic, nonsmoking subjects were exposed to dust for 3 h in a swine confinement building. Lung function was assessed, and either a methacholine bronchial provocation (n = 11) or a challenge with eucapnic hyperventilation of dry air (n = 11) was performed before exposure and at 7 h, 1 week, 2 weeks, and 4 weeks after exposure. RESULTS: Vital capacity and FEV(1) decreased 3% and 6%, respectively (p < 0.001), and airway resistance increased 15% (p < 0.05) after exposure. The median provocative dose of methacholine causing a 20% decline in FEV(1) fell from 1.38 mg (25th to 75th percentiles, 0.75 to 7.20 mg) before exposure to 0.18 mg (0.11 to 0.30 mg) after exposure (p = 0.004). Corresponding values for the dose-response slope were 15.3%/mg (2.88 to 25.3%/mg) and 100.2%/mg (2.1 to 27.3%/mg), respectively (p = 0.01). Bronchial responsiveness to eucapnic hyperventilation was not affected by the exposure: FEV(1) fell 4.3% (- 7.2 to - 1.8%) before and 4.8% (- 6.7 to - 1.6%) after exposure (p = 0.72). One week after exposure, the bronchial responsiveness to methacholine was normalized. CONCLUSIONS: The bronchial responsiveness to methacholine but not to dry air increases after exposure to swine house dust. Thus, exposure to organic dust induces increased bronchial responsiveness with different characteristics from that frequently found in asthma.

Adult↗

PubMed2006

Physical and performance differences among forwards, defensemen, and goalies in elite women's ice hockey.

Positional differences have been examined in women's basketball, field hockey, netball, and volleyball, but not in elite women's ice hockey. Our purpose was to describe and compare physical, fitness, and skating performance characteristics of forwards (F), defensemen (D), and goalies (G). Subjects were 112 University of Alberta women players (21.4 +/- 2.9 years of age). A full anthropometric battery was conducted on each player. Heath-Carter anthropometric somatotypes were calculated. Percent body fat (%fat) was estimated from both general and population-specific equations. Subjects performed off-ice fitness tests (vertical jump, 40-yd dash, Leger test for predicting .V(O2)max) and on-ice fitness (Modified 3-Repeat Sprint Skate Test-MRSS, blood lactate after sprint test) and skating performance tests (6.10-m acceleration test, Cornering S-Turn Agility Test). Descriptive statistics and multivariate analyses of variance were run using SPSS (Version 10.0) for the MacIntosh, with a significance level set a priori at p < 0.05. Significant positional differences were found for bicristal breadths (D > G, F > G); relaxed arm circumference (D > F, G > F); supraspinale and biceps skinfolds (G > D, G > F); and endomorphy (G > F). Significant differences among positions were also found for the MRSS (G > D > F) and agility tests (G > D, G > F). D tended to have the most robust build overall. F were leaner than D and G, and their smaller relaxed arm circumference measurements most likely reflect less subcutaneous fat on the upper arm. F had greater anaerobic power than D, followed by G, and they tended to have greater aerobic capacity. F and D were more agile than G. Performance demands appear to be position specific. F need to be the most versatile and fit because of a greater amount and variety of work performed both during practices and games; their required degrees of versatility and fitness are followed by those required of D and G.

Adult↗

PubMed2004

[Cardiac toxicity of cancer treatment regimes in children and adolescents: physiopathology, clinical data and the paediatric oncologist's point of view].

Over the last 20 years, the increase in the cure rate of childhood cancer and leukemia of almost 80% has facilitated the observation of middle and long-term sequelae, particularly of cardiovascular origin; such after-effects are the consequence of cytotoxic damage to the cells of the cardiovascular system, in particular by anthracyclines and radiotherapy, and all the more so by their combined use. Such destructive lesions to myocytes greatly hinder the capacity of the cardiac muscle to hypertrophy to meet the needs of bodily growth, pregnancy and certain intense sports activities. Endothelial cells also accelerate an early arteriosclerotic process, a potential cause of sudden death in the case of ostial stenosis. All such phenomena build up over time, together with the usual adult cardio-vascular risk factors. Finally, no cardiac tissue, pericardial, valvular endocardium or autonomic nervous tissue escapes these cytotoxic effects, giving rise to pericarditis, calcification, valvular leaks and arrythmias and conduction abnormalities. The resulting excessive cardiac mortality is one of the major concerns of paediatric oncologists, along with secondary tumours and leukaemia. This article analyses physiopathological consequences that are often asymptomatic or clinical, together with diagnostic, screening and follow-up methods for these patients, encouraging lifestyle modifications where appropriate or, when possible, treatment before the appearance of cardiac failure, myocardial infarction or sudden death. Other cytotoxic drugs such as high-dose cyclophosphamide, amsacrin, 5-FU and tubulin acting agents are also mentioned as a result of their cardiac toxicity, but this is not usually dose-cumulative.

Adolescent↗

PubMedDate not supplied

[Ontogeny of the immune response in mice. II. Direct hemolytic plaque forming cells and indirect hemolytic plaque forming cells in the spleen of mice antigenically stimulated at various ages].

Investigations were carried out by the direct and indirect haemolytic plaque (DHP and IHP) forming technique in order to determine the capacity of the lymphoid cells of A2G mice fetuses grafted on irradited adults and of mice of different ages, to react after antigenic stimulation with sheep red blood cells, by the synthesis of antibody belonging to the IgM and IgG class. Fetal lymphocytes build up again the lymphoid system of the animals irradiated with lethal doses and develop humoral mediated immune reactions. The sucklings coming in contact with the antigen within the first 20 hours after birth do not synthetize antibodies, and the sucklings stimulated up to the age of 5 days only synthetize antibodies in low amounts. In the spleen of the sucklings stimulated antigenically on day 0 and again on day 10, IgM and not IgG antibody forming cells are predominant. The secondary immune response in the sucklings up to the age of 5 days develops later necessitating a longer period than in the adults or older sucklings. The significance of these results is discussed with reference to the possible biological implications of alpha-proteins.

Age Factors↗

PubMed2003

Wasteless combined aggregate-coal-fired steam-generator/melting-converter.

A method of reprocessing coal sludge and ash into granulate for the building industry in a combined wasteless aggregate-steam-generator/melting-converter was developed and tested. The method involves melting sludge and ash from coal-fired steam-generators of power plants in a melting-converter installed under the steam-generator, with direct sludge drain from the steam generator combustion chamber. The direct drain of sludge into converter allows burnup of coal with high ash levels in the steam-generator without an additional source of ignition (natural gas, heating oil, etc.). Specific to the melting process is the use of a gas-air mixture with direct combustion inside a melt. This feature provides melt bubbling and helps to achieve maximum heat transfer from combustion products to the melt, to improve mixing, to increase rate of chemical reactions and to improve the conditions for burning the carbon residue from the sludge and ash. The "gross" thermal efficiency of the combined aggregate is about 93% and the converter capacity is about 18 t of melt in 100 min. The experimental data for different aspects of the proposed method are presented. The effective ash/charging materials feeding system is also discussed. The reprocessed coal ash and sludge in the form of granules can be used as fillers for concrete and as additives in the production of cement, bricks and other building materials.

Coal↗

PubMed2004

An evaluation of portable high-efficiency particulate air filtration for expedient patient isolation in epidemic and emergency response.

Extraordinary incidents resulting in airborne infectious disease outbreaks could produce patient isolation requirements that exceed most hospitals' capacity. This article investigates expedient methods to establish airborne infection isolation areas using a commercially available portable filtration unit and common hardware supplies. The study was conducted within a conventional, nonisolation hospital room, and researchers evaluated several airborne isolation configurations that did not require building ventilation or structural modifications. A portable high-efficiency particulate air filtration unit and full-length plastic curtains established a "zone-within-zone" protective environment using local capture and directional airflows. The cost of constructing the expedient configurations was less than US2,300 dollars and required fewer than 3 person-hours to construct. A medical nebulizer aerosolized polystyrene latex microspheres to generate respirable condensation nuclei. Aerosol spectrometers sized and counted respirable particles at the source patient and health care worker positions and in areas outside the inner zone. The best-performing designs showed no measurable source migration out of the inner isolation zone and mean respirable particle counts up to 87% lower at the health care worker position(s) than those observed directly near the source patient location. Investigators conclude that with careful implementation under emergency circumstances in which engineered isolation rooms are unavailable, expedient methods can provide affordable and effective patient isolation while reducing exposure risks and potential disease transmission to health care workers, other patients, and visitors.

Bioterrorism↗

PubMed2003

Preferences for cocaine- or pup-associated chambers differentiates otherwise behaviorally identical postpartum maternal rats.

RATIONALE AND OBJECTIVES: Our previous work uncovered a differential preference of maternal female rats for cues associated with pups versus cues associated with cocaine at three different postpartum time points. Our current study examines the preference for these cues in conjunction with an assessment of the capacity to express the maternal behavior at one of these time points. We examined dams at day 10 postpartum using a procedure that included two additional controls, and a complete assessment of the expression of maternal behavior and locomotor activity. METHODS: A conditioned place-preference procedure was used to determine the preference for cocaine- or pup-associated cues. The two controls were (1) a preconditioning test to verify no initial chamber preference and (2) a separate control group of postpartum day-10 dams exposed to chambers and cues but not to unconditioned stimuli. The expression of maternal behavior was determined by measurement of maternal nest building, retrieval of pups to the nest, grooming, crouching over pups, nursing, and maternal aggression. Locomotor activity was measured with an automated apparatus. RESULTS: Dams conditioned with cocaine or pups showed a preference for either the cocaine-associated chamber or the pup-associated chamber, confirming the existence of two similar-sized preference groups at this time point. Regardless of preference, dams had equal and robust expression of maternal behavior and similar locomotor capacity. The pre-conditioning test showed no initial chamber preferences and did not alter the conditioned preference response. The use of unconditioned stimuli in the place-preference conditioning procedure was effective and necessary for the preference response. CONCLUSION: Our current study has revealed that differences in the motivational state of the maternal dam emerge even while the expression of maternal behavior is constant and substantial. The data suggest that the difference in preference is a very specific appetitive response that is not linked to expression of maternal behavior or locomotor capacity.

Animals↗

PubMed2002

Functional dissection of the eukaryotic-specific tRNA-interacting factor of lysyl-tRNA synthetase.

In the cytoplasm of higher eukaryotic cells, aminoacyl-tRNA synthetases (aaRSs) have polypeptide chain extensions appended to conventional prokaryotic-like synthetase domains. The supplementary domains, referred to as tRNA-interacting factors (tIFs), provide the core synthetases with potent tRNA-binding capacities, a functional requirement related to the low concentration of free tRNA prevailing in the cytoplasm of eukaryotic cells. Lysyl-tRNA synthetase is a component of the multi-tRNA synthetase complex. It exhibits a lysine-rich N-terminal polypeptide extension that increases its catalytic efficiency. The functional characterization of this new type of tRNA-interacting factor has been conducted. Here we describe the systematic substitution of the 13 lysine or arginine residues located within the general RNA-binding domain of hamster LysRS made of 70 residues. Our data show that three lysine and one arginine residues are major building blocks of the tRNA-binding site. Their mutation into alanine led to a reduced affinity for tRNA(3)(Lys) or minimalized tRNA mimicking the acceptor-TPsiC stem-loop of tRNA(3)(Lys) and a decrease in catalytic efficiency similar to that observed after a complete deletion of the N-terminal domain. Moreover, covalent continuity between the tRNA-binding and core domain is a prerequisite for providing LysRS with a tRNA binding capacity. Thus, our results suggest that the ability of LysRS to promote tRNA(Lys) networking during translation or to convey tRNA(3)(Lys) into the human immunodeficiency virus type 1 viral particles rests on the addition in evolution of this tRNA-interacting factor.

Amino Acid Sequence↗