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Pentosan polysulfate sodium (PPS), a semisynthetic sulfated polysaccharide, is the only FDA-approved oral therapy for interstitial cystitis. Recent studies have described a progressive, vision-threatening macular condition associated with long-term PPS use. We reviewed all publications concerning PPS maculopathy to consolidate known clinical features and to evaluate the strength of this association. Current literature supports a strong dose-dependent association between PPS exposure and a progressive maculopathy impacting the retinal pigment epithelium (RPE) and RPE-photoreceptor interface that may worsen even after drug cessation. Initial symptoms may include prolonged dark adaptation and difficulty reading with relative visual acuity preservation. Fundus examination often shows macular pigment clumps corresponding to lesions of focal RPE thickening. Fundus autofluorescence most clearly depicts the condition, with a distinctive pattern of hypo- and hyperautofluorescent spots in the posterior pole that sometimes extends to the retinal periphery. Many cases also show a characteristic peripapillary hypoautofluorescent halo. Near infrared reflectance may aid in early detection. RPE atrophy, cystoid macular edema, and macular neovascularization may also occur, potentially resulting in loss of central acuity. This newly described association implies significant public health risk. Ophthalmologists should screen PPS users with multimodal retinal imaging, and prescribers should minimize dose and duration of PPS use.

Purpose Determine the efficacy of combination intravitreal and systemic antiviral therapy for the treatment of acute retinal necrosis (ARN) and risk factors impacting visual acuity (VA) and retinal detachment (RD) outcomes. Design Single-center retrospective case series. Participants Patients with an ARN diagnosis based on clinical features and polymerase chain reaction confirmation who were treated at a tertiary referral, university-based academic practice. Methods Patient records were reviewed for demographic information including age and gender. Snellen VA, disease findings including RD outcomes, optic nerve involvement, and treatments were recorded. Incidence rates of major VA and RD outcomes were calculated based on the number of events and exposure times. Cox proportional hazards regression modeling and survival analyses were used to identify factors related to VA and RD outcomes over time. Main Outcome Measures Logarithm of the minimal angle of resolution VA, 2-line or more VA gain, severe vision loss (SVL) of 20/200 or worse, RD development, and fellow eye involvement. Results Twenty-three eyes of 21 patients (11 male, 10 female) were reviewed. Thirteen patients (62%) had herpes simplex virus and 8 patients (38%) had varicella zoster virus. The event rate for 2-line or more VA gain was 0.49 events/eye-year (95% confidence interval [CI], 0.26–0.86 events/eye-year), whereas the rate of SVL was 0.61 events/eye-year (95% CI, 0.34–1.02 events/eye-year). Retinal detachment development was observed at a rate of 0.59 events/eye-year (95% CI, 0.33–1.00 events/eye-year). Thirteen of 23 eyes (57%) demonstrated RD with a mean time of 120 days after ARN diagnosis. With each additional quadrant of retina involved, a greater risk of RD development over time was observed (hazard ratio, 2.21; 95% CI, 1.12–4.35). Nine percent of eyes progressed with additional quadrantic involvement, despite combination systemic and intravitreal antiviral therapy; however, none of the 19 patients demonstrating unilateral ARN showed fellow-eye involvement after initiation of therapy. Conclusions Combination intravitreal and systemic antiviral therapy for ARN can be effective in improving VA and limiting retinitis progression. Each additional quadrant of retina involved was associated with a 2.2-fold greater risk of RD, which may impact monitoring, timing of intervention, and patient counseling.

The electrolytic production of Mg from MgO was experimentally and theoretically investigated near 1550 K. The experimental work was carried out in a SiC electrolytic cell housed in a 10 kW solar receiver that was located at the focal point of a concentrating solar furnace. The oxide was dissolved in either CaF 2 or MgF 2 . The cathode was Mo and the anode was either Pt or C graphite . Mg evolved as a gas, was quenched on cooling coils at the exit of the reactor and was collected for analysis. A thermodynamic cycle study indicates that the ideal thermal efficiency for the solar process is 35 percent for an inert anode and 39 percent for a carbon anode. Experimental results from both current-cell potential traces and X-ray diffraction verify the successful electrolysis of MgO and the production of Mg. The experimental decomposition potential of the oxide was near the expected thermodynamic value. As expected, the experimental decomposition potential was reduced when carbon replaced the inert anode. In the experiment with Pt as the anode and MgF 2 as the solvent, a current efficiency of 14 percent was measured.

Introduction The past decade has been marked by a gradual expansion of the traditional primary care role of the pediatric nurse practitioner (PNP) into practice arenas that call for more acute and critical care of children. The purpose of the study was to explore the educational programming needs of dual (combined) track PNP programs that prepare graduates to provide care to children and adolescents across the continuum of health and illness. Method A two-phase, exploratory, mixed method design was utilized. An electronic survey was completed by 65% of PNP program directors in the country. Semi-structured telephone interviews were conducted with hospital-based PNPs who were practicing in roles that met a range of health care needs across the primary and acute care continuum. Results Primary care and acute care programs have more common than unique elements, and the vast majority of clinical competencies are common to both types of program. Only three competencies appear to be unique to acute care programs. Discussion The Association of Faculties of Pediatric Nurse Practitioner Programs should utilize existing evidence and develop guidelines for dual PNP programs that focus on the provision of care to children across a wide continuum of health and illness.

www.jpedhc.org The Patient Protection and Affordable Care Act (PPACA) of 2010 is the legislation that created the foundation for reformof theU.S. health care system.The legislation established and funds diverse policies and projects to realign the financial incentives in the current health care insurance market. It encourages efficiency and quality and directs funds toward prevention and population health. Many regulations and rules from the legislation are currently being formulated to translate the law’s provisions into actual changes in health care practices and processes (Table 1). The law includes much for advanced practice nurses (APNs) to celebrate, such as funding for nursemanaged centers and increased nurse education loans and grants. Care innovations, a provision in the health care reform legislation, have significant potential for enhancing APN practice even though physician-exclusive language in the legislation resulted in nurse practitioners (NPs) not being fully included in key provisions of the care innovations reforms. This article focuses on one of the care innovations strongly supported in the PPACA, the health care/medical home. It provides background on the health care/medical home model, the importance of family-focused caremodels, and suggestions for possible partnership for APNs to forge with family advocacy groups to improve access and quality and to strengthen the position of NPs in the newmodels of health care delivery.

This paper introduces the concept of the temporal think tank(TM) (T3(TM)), a temporary in-house research center, based on case studies with a highly automated global manufacturer and in various small-sized manufacture (SME's). The T3(TM) brings individuals from across the organization together in a team setting in which they are charged to look at the future, develop their decision-making skills, and use entrepreneurial thinking to incubate new processes and/or products. After an appropriate time in the temporal think tank(TM), the individuals are asked to return to their regular positions to implement the best practices and best ideas and doing so spur the organization forward. At intervals, the temporal think tanks(TM) can be reconvened, or reconstituted with new participants. This approach prepares technology champions for the SME, who can return to the organization with a fresh outlook and renewed energy to keep the enterprise at the peak of efficiency and effectiveness.

The microwave spectra of the three singly substituted 13 C isotopomers and 18 O isotopomer of equatorial- trans cyclobutanol, c-C 4 H 7 OH, have been observed in natural abundance by a pulsed-jet Fourier transform microwave spectrometer. The fit for the normal species was improved from the previous study. The rotational constants for the α- 13 C, β- 13 C, γ- 13 C and 18 O isotopic species were determined. The five quartic centrifugal distortion constants were determined for the first time. These experimental values are compared to those obtained from ab initio and density functional theory calculations. By utilizing the previously reported microwave rotational constants for the O–D species along with the 15 constants determined from this study combined with the structural parameters predicted from the MP2(full)/6-311+G(d,p) calculations, adjusted r 0 parameters have been obtained. The determined heavy atom distances in A are: r 0 (C 1 –C 4,5 ) = 1.547(3), r 0 (C 6 –C 4,5 ) = 1.556(3), r 0 (C–O) = 1.412(3) A and angles O 2 C 1 C 4 , 5 = 120.2 ( 5 ) , C 4 C 1 C 5 = 88.9 ( 5 ) and puckering angle τC 6 C 5 C 4 C 1 = 31.3(10)°. The parameters are compared to the similar ones for some other monosubstituted cyclobutanes as well as to those for cyclobutane.

According to a recent national survey, 1 in 5 American households with children has at least 1 child with a chronic or disabling health condition. Advanced practice nurses can facilitate effective, comprehensive, coordinated care for children with special health care needs by understanding the implications of chronic conditions on families, including psychosocial effects on children and family members, screening and transition issues, and the system of care for children with special health care needs. This article provides key recommendations for primary and specialty care providers based on the latest evidence from research.

Care coordination is a process that involves assessment, planning, implementation, evaluation, education, monitoring, support, and advocacy. Pediatric nurse practitioners (PNPs) are well positioned to coordinate care but may not be well educated about potential conflicts of interest in balancing cost-containment constraints with obtaining maximum quality and quantity of care for children and families with complex needs. The philosophy of family-centered care is embodied in some care coordination models and absent in others. PNPs who aim to support families of children with special health care needs need to understand the complexity of interacting with multiple care coordination models across health and educational settings. PNPs may act as change agents to infuse family-centered care principles into existing and future care coordination models.

Introduction: The purpose of this study was to describe the characteristics of employment, the characteristics of children served, and the role functions of recent graduates of pediatric nurse practitioner (PNP) programs and to compare these characteristics across programs. Method: A 60-item multiple-choice survey tool was sent to graduates from 1996-1998 of 6 universities across the United States. Results: A total of 137 surveys were received for a return rate of 52%. Less than half of the respondents (44%) indicated that they were employed in a primary care practice. Seventy percent indicated they “often” or “sometimes” provided care to children with acute/critical conditions, and 77% reported caring for children with chronic conditions. Role functions of case management, staff development, consultation, administration, and implementation of research were performed “often” or “sometimes” by more than 50% of respondents. Findings were fairly consistent in 5 out of 6 programs surveyed. Discussion: Graduates of PNP programs are increasingly called on to provide care to children with complex health care needs in non-primary care settings. Role functions beyond the traditional areas required for pediatric primary care are now common practice. Educational programs should address these dynamic changes by assessing the adequacy of their curricula and clinical residencies in preparing graduates. J Pediatr Health Care. (2001). 15, 291-298.

Pediatric nurse practitioners (PNPs) can create excellent professional roles caring for children with special health care needs (CSHCN) and their families. Children with chronic conditions represent an estimated 31% of the US population younger than 18 years (approximately 20 million children in 1988). Five percent of all children who have multiple special needs account for approximately 40% of all pediatric health care expenditures. Skill building is needed for PNPs who have traditionally focused on wellness and common acute illnesses in primary care settings. Role theory and research can guide PNPs in creating roles and interventions to improve the health, safety, and developmental outcomes for CSHCN and their families. Two roles are described, with examples of specific nursing interventions. Assisting child care centers to serve children and families with special needs is an ideal role for PNPs who have knowledge of health and regulatory issues. Another important PNP role is working with adolescents with special health care needs as they transition from pediatric to adult care. Many resources (such as those from the Maternal and Child Health Bureau) are available to assist PNPs to create new roles and interventions for CSHCN and their families.

To examine outcomes related to health, growth, and use of community health and education services in children ages 6 to 8 years who received newborn intensive care because of prematurity or perinatal complications.Parents of 81 children who had received neonatal intensive care at a Midwest US tertiary care center completed a mailed questionnaire. Three birth weight groups (very low birth weight [VLBW]1500 g, n = 35; low birth weight [LBW] 1501-2500 g, n = 24, and normal birth weight [NBW]2500 g, n = 22) were compared regarding growth, health, and use of community-based services using descriptive statistics and one-way analysis of variance.VLBW and NBW groups had more ongoing health concerns. Growth patterns were similar in all groups. VLBW and NBW groups demonstrated greater use of community-based services, and service use increased at school age.Comprehensive systems are needed for follow-up of high-risk infants to detect and refer problems early. Neonatal histories must be tracked throughout childhood. Seriously ill term NBW infants are at risk for later morbidity and require follow-up similar to that provided for VLBW children.

Nurses are encountering many opportunities and incentives to engage in interdisciplinary initiatives. The aim of these initiatives, which are sponsored by private foundations, academic institutions, and managed care entities, is to increase the quality and efficiency of health care. Maintaining professional integrity in the midst of interdisciplinary collaboration is complex and warrants close examination. Contextual issues, which include differing values, professionalism, boundary questions, communication, and power, affect the success of interdisciplinary activities.

This qualitative study was carried out to add empirical data to the discussion of the essentials of advanced practice graduate nursing education. Study participants were 15 nurse practitioners (NPs) whose original preparation was as clinical nurse specialists (CNSs). These nurses subsequently completed post-master's preparation as NPs at a midwest US school of nursing. The nurses were interviewed regarding similarities and differences between the NP and CNS roles based on their own experiences. They stated that their 1-year post-master's NP educational program broadened their knowledge base and increased their skills of direct data collection in history taking and physical examination. They described increased NP role autonomy and clinical decision making. Comparison of study results with the six practice domains of the National Association of Nurse Practitioner Faculties (NONPF) Curriculum Guidelines appeared to verify the NONPF domains as being operant in advanced nursing practice. Each role had distinct expression of the NONPF practice domains, particularly in two areas: management of client health-illness states and the professional role. Results suggest that advanced practice graduate nursing curricular content needs to be explicit regarding CNS and NP role domains to retain the respective strengths of each. A "hybrid" CNS/NP curriculum faces the danger of lacking both the depth and specificity of knowledge that has resulted in the roles' past successes.

This paper presents a method for finding a best fit centerline for cylindrical shafts with interrupts on a polar CMM. The method is more accurate than previously used methods on eccentric and tilted shafts with an interrupted or discontinuous circumference.

This paper describes the development of closed form solutions for the kinematic variables that control machine motions in a conical point twist drill grinding machine. The machine was developed using a kinematic closed loop link mechanism model based on the principles of the Denavit-Hartenburg 4 × 4 transformation techniques. Using the equations developed here reduces the computational time by a factor of 100 compared to a previously used iterative method and allows greater flexibility in the motion of the drill during grinding.

This paper presents the tolerance specification of robot kinematic parameters using the Taguchi method. The concept of employing inner and outer orthogonal arrays to identify the significant parameters and select the optimal tolerance range for each parameter is proposed. The performance measure based on signal-to-noise ratios (S/N) using the Taguchi method is validated by Monte Carlo simulations. Finally, a step-by-step tolerance specification methodology is developed and illustrated with a planar two-link manipulator and a five-degree-of-freedom Rhino robot.

Dr Buhl and colleagues (Dec 2, p 1294) report significant reductions in systemic glutathione concentrations in symptomless HIV seropositive individuals and suggest that this may be important in the immune dysfunction of HIV infection. They measured glutathione in venous plasma and in bronchial epithelial lining fluid and found reductions of 30% and 60%, respectively, in 14 HIV seropositive patients compared with 19 controls