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The purpose of this article is to explain the importance of evaluating and documenting the freeway space (interdental rest position), in initial examinations and at the completion of therapy in patients exhibiting an open mandibular resting position. The freeway space measurements obtained can be shared with parents, patients, and referral sources. To this end, the muscular, neural, and sensory components related to the freeway space are discussed, as well as airway, dental eruption patterns, tactile feedback, and orthodontic relapse considerations. An extraoral method for evaluating the dimensions of the anterior freeway space is proposed.

There is an immediate need for noninvasive therapies to improve the functional abilities of persons blinded by traumatic injury. The BrainPort Vision Pro, an updated hands-free oral electronic vision device, enables perception of visual information using the tongue as a substitute for the eye. Purpose The purpose of this study was to evaluate the impact of the BrainPort Vision Pro on real-world functional task performance in persons who are profoundly blind (light perception or worse) due to traumatic injury (ocular or cortical). Methods This was a prospective, within-subjects, repeated-measures study. Participants received ten hours of device training and were required to use the device independently for 1 year. Functional performance measures of object identification, orientation and mobility, word identification, and environmental awareness were assessed at baseline, post-device training, and quarterly throughout the year. Results Seventeen profoundly blind adults were enrolled in the study. No clinically significant device-related adverse events were reported, demonstrating minimal risks associated with the BrainPort Vision Pro. None of the participants could successfully perform any of the functional tasks at baseline, without the device. After 1 year of independent device use, all participants could identify objects, and 41% identified words beyond chance level while using the device. Forty-one percent of participants could locate a sign, 94% followed a line without veering off, 71% avoided obstacles, 71% walked through a doorway without collision, 100% of participants recognized a door, and 71% identified a window. Conclusions Results demonstrate significant improvements in real-world functional task performance in skill areas important to everyday life. The BrainPort Vision Pro offers a nonsurgical method for improving visual function in persons blinded by trauma. The device can enhance independence and support the successful integration of profoundly blind persons, including veterans and returning service members, into community life.

A recent special issue in the Journal of Business Ethics gathered together a variety of papers addressing the challenges of putting virtue ethics into practice (Fontrodona et al in J Bus Ethics 113(4):563–565, 2013). The editors prefaced their outline of the various papers with the assertion that exploring the practical dimension of virtue ethics can help business leaders discover their proper place in working for a better world, as individuals and within the family, the business community and society in general (Fontrodona et al in J Bus Ethics 113(4):563–565, 2013). Scholars are yet to explore the role of virtuous organisational leaders in the pursuit of Eudaimonia. This paper is a qualitative study which considered company directors’ self-understandings in light of a virtue ethics conceptual framework. The aim of the study is to explore whether virtue ethics rather than deontology and consequentialism is a better vehicle for expressing directors’ self-understandings about their ideals and role.

Introduction This study was conducted to evaluate the functional performance of the BrainPort V100 device, an FDA-cleared sensory-substitution system, in persons who are profoundly blind (that is, have some or no light perception). Methods This was a prospective, single-arm, multicenter clinical investigation. Participants received 10 hours of device training and were required to use the device in their everyday environments for 1 year. Functional performance measures of object identification, orientation and mobility (O&M), and word identification were assessed at baseline, in post-device training, and at the 3-, 6-, 9-, and 12-month time points. Results Fifty-seven participants completed the study and used the device for 1 year. No device-related serious adverse events were reported, demonstrating that the risks associated with the BrainPort are minimal. Participants performed object recognition (91.2% success rate) and O&M (57.9% success rate) tasks beyond chance level. Discussion This study demonstrates that the BrainPort can be used safely and independently by persons who are blind. Participants with profound blindness can accomplish a set of tasks more successfully by using the BrainPort than without the device. Following initial training, performance on these tasks was maintained or improved over the course of 1 year. Implications for practitioners The BrainPort is a noninvasive and nonsurgical device that heightens functional independence for persons who are blind. The device presents users with more information about their environment than conventional assistive devices, and can enhance independence in performing activities of daily living.

PURPOSE To determine the effects of diabetic retinopathy (DR), increased foveal thickness (FT), and adaptive optics (AO) on wavefront aberrations and Shack-Hartmann (SH) image quality. METHODS Shack-Hartmann aberrometry and wavefront error correction were performed with a bench-top AO retinal imaging system in 10 healthy control and 19 DR subjects. Spectral domain optical coherence tomography was performed and central FT was measured. Based on the FT data in the control group, subjects in the DR group were categorized into two subgroups: those with normal FT and those with increased FT. Shack-Hartmann image quality was assessed based on spot areas, and high-order (HO) root mean square (RMS) and total RMS were calculated. RESULTS There was a significant effect of DR on HO and total RMS (p = 0.01), and RMS decreased significantly after AO correction (p < 0.001). Shack-Hartmann spot area was significantly affected by DR (p < 0.001), but it did not change after AO correction (p = 0.6). High-order RMS, total RMS, and SH spot area were higher in DR subjects both before and after AO correction. In DR subgroups, HO and total RMS decreased significantly after AO correction (p < 0.001), whereas the effect of increased FT on HO and total RMS was not significant (p ≥ 0.7). There were no significant effects of increased FT and AO on SH spot area (p = 0.9). CONCLUSIONS Diabetic retinopathy subjects had higher wavefront aberrations and less compact SH spots, likely attributable to pathological changes in the ocular optics. Wavefront aberrations were significantly reduced by AO, although AO performance was suboptimal in DR subjects as compared with control subjects.

If you've been to a grocery or pharmacy, read any women's magazines, or even watched the briefest amount of television, chances are you've come face to face with messages advocating the use of herbs for everything from improving memory to restoring balance in your life. Now, more often now then ever, women are taking herbs without counsel and direction from practitioners (Eisenberg et al., 1993). Ever since the passage of the Dietary Supplement Health and Education Act in 1994, the U.S., herbal market has boomed-with estimated 1999 sales of $5 billion in products found in almost every conceivable retail venue: pharmacies, discount retailers, supermarkets, convenience stores, and the World Wide Web, to name a few. And growth within this dynamic market is at a projected annual 30 percent (Foster & Tyler, 1999). Estimates and survey data show that approximately one in three U.S. adults reaches for alternative therapies, from time to time, to manage health and well-being. Bottom line: nurses are going to see women who are taking herbs, and who may or may not tell their practitioners about their herbal practices. But practitioners must at least ask women and chart the information they receive in medical records. As the Baby Boomer generation enters midlife, the symptoms and treatments related to menopause are increasingly discussed and debated—including the use of herbs for relief from the many symptoms often associated with perimenopause.

Health care reform has moved postbirth care into the community without assessment of how this may change parents' needs. Mother–father pairs (n = 117) in six sites in four countries were interviewed at 5 to 10 days postbirth and again between 6 and 8 weeks postbirth to determine their needs. Content analysis revealed both parents in all sites had a strong focus on self-needs throughout the postbirth period. Postpartum programs oriented solely to family–centered care may not meet the specific needs of contemporary parents.

Changes in prenatal care practices resulted from a pilot study with 12 urban New Mexican women who received no prenatal care. The women were interviewed regarding their reasons for not receiving care during pregnancy, health behaviors, and perceived neonatal outcomes. Data on actual neonatal outcomes were taken from the medical record. Maternal reasons for no prenatal care were socio-demographic, system-related, attitudinal, and outside forces of job and childcare. To ensure a healthy baby, the women made changes in their nutrition, self-care activities, substance use, sleep, and exercise activities. All of the women perceived they had a healthy baby. Yet 61% of the neonates had complications and 45% were low birth weight. The research findings were used to develop a care management program that included case management and utilization management.

Shoulder dystocia-when the fetal head retracts or recoils against the maternal perineum ("turtle sign") and external rotation is not accomplished-occurs in approximately 1 of every 200 deliveries. It's often diagnosed after the emergence of the fetal head when delivery is prevented by impaction of the fetal shoulders within or above the maternal pelvis. When it occurs, shoulder dystocia is an obstetric emergency.

Maria is a 22‐year‐old single Hispanic woman with four children. She began smoking at 13 years of age and became sexually active at 14 years of age. Over the last eight years, she has had multiple sexual partners and a history of gonorrhea and chlamydia. When she came to the clinic for a routine Papanicolau (Pap) test, she had several clusters of cervical warts. These tested positive for human papilloma virus (HPV) type11. She was also at the clinic for her final application of Podophyllin but when questioned, Maria had never heard of HPV. Josephine is a 44‐year‐old married non‐Hispanic white woman with two children who always has yearly Pap tests. Seven years ago, she had "vaginal warts," and her primary care provider treated her with trichloroacetic acid. She wasn't aware which HPV type caused her warts, or of their exact location. Also, no information was provided to her about the increased risk for cervical cancer in women with certain types of cervical HPV. Charlotte is a 29‐year‐old single African American woman with one child. She became sexually active at 16 years of age and has since had two abortions. Her sexual history includes two previous partners; she came to the clinic to renew her oral contraceptive prescription. Upon pelvic examination, cervical dysplasia was suspected; colposcopic cytology results confirmed the diagnosis. Charlotte was unaware of any history of HPV but she did know that Pap tests could screen for cervical cancer. In addition, she thought the Pap test was done to diagnose sexually transmitted diseases such as syphilis and gonorrhea.

Opioids remain a common method of treating chronic pain conditions despite some controversy. In an effort to address some of the risks of opioid medications, opioid risk assessment has become a standard of care when opioids are used to treat a chronic pain condition. Research to date has found that clinical interviews may be superior to currently available patient-completed written questionnaires in identifying patients likely to engage in medication aberrant behavior. The Brief Risk Interview (BRI) has been developed as a risk assessment tool that has the sensitivity of a clinical interview while eliminating the need for the lengthy process of an interview. The current study compared the predictive ability of the BRI with two commonly used patient-completed risk assessment tools: the Opioid Risk Tool (ORT) and the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R). After clinical staff at a pain practice underwent a 1-hour training program, 124 consecutive new patients were evaluated using the BRI, ORT, and SOAPP-R. Follow-up data found that the BRI was a good predictor of medication aberrant behavior and offered better sensitivity and better overall predictive accuracy than the ORT or the SOAPP-R. Overall, it appears that the BRI is a valid risk assessment tool that, after a brief training session, can be used effectively by pain clinicians. Further study is needed in other practice settings and with larger sample sizes.

A retrospective chart review was conducted to determine why women received no prenatal care during pregnancy and their subsequent maternal and neonatal outcomes. Five hundred and eighty medical records from 1990 through 1993 that were labeled as no care were reviewed. Actually, only 270 records had no care and of these, 92 had 156 recorded reasons as to why women did not receive prenatal care. These reasons were categorized into three types of barriers: attitudinal, sociodemographic, and system-related. The majority of the women were young, Hispanic, unmarried, between 20 and 29 years of age, and uninsured, and had one to three children. Overall, the women did not smoke cigarettes, drink alcohol, or use drugs during pregnancy. Overall, the women had good maternal and newborn outcomes. Results suggest a need to reevaluate the effect of prenatal care use on young Hispanic women.

The purpose of this research was twofold: to describe the types of drugs and alcohol abused by pregnant multisubstance abusers enrolled in a substance abuse and treatment programme, and to describe the types of changes in drug-taking behaviours during pregnancy. An exploratory study, including interviews and chart reviews, was conducted with 31 pregnant multisubstance abusers. Drug-taking behaviours, demographic factors of age, ethnicity, martial status, education, and pregnancy characteristics of gravida, living children, level of prenatal care and trimester of pregnancy were measured. Most of the women were in their Twenties, Hispanic, single and had some high school education. Most of the women were multiparas to grand multiparas, yet they had only one or two living children, and all were receiving prenatal care. Their self-reports were validated by urine screening. Generally, the women reported that they did change their drug-taking behaviours, and many women decreased their substance abuse.

Recent corporate scandals in New Zealand, evidenced by the collapse of a large number of unlisted finance companies involved potentially narcissistic leadership, which in turn had created narcissistic organisational identities where unethical behaviour was the norm. This paper uses a virtue ethics approach to argue that the narcissistic tendencies found in these organisational cultures are largely determined at the corporate governance level of the organisation. The board of directors is ultimately responsible for the moral or immoral identity of the organisation. However, instead of advocating for rule-based reform, we contend that the problem lies with the character of the directors and the manner in which they exercise their judgement. An emphasis on virtuous character and practical wisdom will encourage the development of a moral organisational identity and consequently improve individual ethical behaviour in organisations.

To investigate the relationship between depression and quantitative measures of visual function, we recruited 18 subjects with central scotomas from macular degeneration who were enrolled in a reading rehabilitation program. Psychological batteries and reading assessments were administered prior to rehabilitation; reading assessments and a measure of adaptation to vision loss were administered following rehabilitation. We investigated relationships between reported levels of depressive symptoms and reading and adaptation outcome measures by using Pearson product moment correlation analysis. Results revealed a significant relationship between depression levels and reading acuity difference scores (r(16) = 0.54, p = 0.02) and changes in adaptation to vision loss levels (r(16) = 0.62, p = 0.01), suggesting that those who reported greater depressive symptoms did not respond as well functionally to reading rehabilitation but reported greater improvement in levels of adaptation to vision loss following rehabilitation. Future research should focus on defining standard methods to assess and remediate depression as part of the rehabilitation process.

One hundred fifteen women were interviewed during their pregnancy. They were asked “What health behavior changes have you made since you became pregnant?”; This is the first study reported in the United States to allow women to identify their own health behaviors. In previous studies, women responded to the behaviors that the researchers listed on questionnaires. The women in our study named 18 changes in health behaviors they had made during pregnancy. More than 49% of the women made changes in their diet, exercise pattern, smoking habits, vitamin intake, and alcohol use. Further research is needed to identify what motivates changes in health behavior in pregnancy.

Purpose To quantify the effects of three vision rehabilitation training approaches on improvements in reading performance. Methods Thirty subjects with AMD participated in the training portion of the study. The median age of the subjects was 79 years (range, 54-89 years). The three training modules were: Visual Awareness and Eccentric Viewing (module 1), Control of Reading Eye Movements (module 2), and Reading Practice with Sequential Presentation of Lexical Information (module 3). Subjects were trained for 6 weekly sessions on each module, and the order of training was counterbalanced. All subjects underwent four assessments: at baseline and at three 6-week intervals. Reading performance was measured before and after each training module. A separate group of 6 subjects was randomly assigned to a control condition in which there was no training. These subjects underwent repeated assessments separated by 6 weeks. Results Reading speeds decreased by an average of 8.4 words per minute (wpm) after training on module 1, increased by 27.3 wpm after module 2, and decreased by 9.8 wpm after module 3. Only the increase in reading speed after module 2 was significantly different from zero. Sentence reading speeds for the control group, who had no reading rehabilitation intervention, was essentially unchanged over the 18 weeks (0.96 ± 1.3 wpm). Conclusions A training curriculum that concentrates on eye movement control increased reading speed in subjects with AMD. This finding does not suggest that the other rehabilitation modules have no value; it suggests that they are simply not the most effective for reading rehabilitation.

The purpose of this study was to describe and analyze the relationship between health and health behaviors among elderly Hispanic women who were lifetime U.S. residents. The number of elderly Hispanics is expected to grow faster than any other segment of the population within the United States. A random sample of 132 elderly Hispanic women enrolled in a health maintenance organization participated in this cross-sectional survey of health prevention, promotion, and protection behaviors and dimensions of health as measured by the Medical Outcomes Study Short Form—36. Results indicated that more than half of this group did not exercise regularly, one fourth did not eat regularly scheduled meals, and many had not participated in health screening. Among the women in this study, those whose lifestyles incorporated the more frequent practice of positive health behaviors also had better scores on 6 of the 8 specific health dimensions measured.

A descriptive survey was conducted with 31 pregnant women who were substance users enrolled in a perinatal treatment program. The purpose of the study was to determine the women's health behaviors by using open-ended questions. Most of the women were between 20 and 29 years of age, Hispanic, not married, unemployed, and had partial or completed high-school education. The women had multiple pregnancies with few living children. The majority of the women were 4 to 6 months pregnant and all had received prenatal care. The women made health behavior changes during pregnancy related to nutrition, substance use, self-care, exercise, lifestyle, and seeking counseling. Over 52% of the women reported they made these behavioral changes because they wanted a healthy baby.

Amnioinfusion is one of the most innovative techniques of the decade. The authors reviewed current literature, research indications, and nursing implications for amnioinfusion. Current technology has simplified the amnioinfusion procedure. This technique provides both therapeutic and prophylactic regimens for the intrapartum mother and her fetus, and it has many clinical implications for nursing.

Solution‐focused therapy is a fairly new idea in nursing. It began in the mid‐70s with a group of family therapists working in Milwaukee, S WI. The therapists adapted this brief therapy model, which originated at the Mental Research Institute in Palto Alto, CA. The solution‐focused therapy centers more on solutions rather than on problems and on the "then and there." It is goal‐driven, individual based, and focuses on strengths (what is good that is happening) rather than on weaknesses, such as problems. This premise and philosophy are now being applied in employee assistance programs, parenting techniques, pediatric applications, and schools.

Regional CBF was measured by 133Xe inhalation in unilateral cerebral infarction, carotid TIAs, and normal volunteers. Regional CBF values were bilaterally and symmetrically reduced in patients measured within 3 weeks after stroke. Later, rCBF values returned toward normal in the contralateral hemisphere of patients with infarction and in both hemispheres with carotid TIAs. In cases with carotid occlusive disease, flow reduction was seen in the contralateral posterior cerebral artery distribution, with hyperemia in ipsilateral occipital lobe caused by interhemispheric steal. Brainstem-cerebellar flow values were increased following acute cerebral infarction if patients were alert but reduced if consciousness was impaired.

Estimation is the most commonly used method to determine blood loss. According to the literature, estimating blood loss is not exact; there are wide margins of error and blood loss tends to be underestimated. Forty-two registered nurses were asked to estimate varied amounts of blood on 20 peripads. Both over- and underestimation occurred; 71% overestimated and 25% underestimated blood loss. There was also disagreement as to what constituted heavy, moderate or slight blood loss. There was no difference in accuracy among variables of education, years of experience, specialty area, or when and how nurses learned to estimate. Contrary to current literature, these nurses: 1 overestimated blood loss; 2 had significant difficulty in estimating very small and very large amounts of blood; 3 although in error, were consistent in estimating repeated samples with the same amounts of blood; 4 were not consistent in estimating heavy, moderate, and slight blood loss.

blood is on a given item, they usually respond by saying "heavy," "moderate," or "slight." But how much blood is a "moderate" amount? To be more precise, some nurses estimate blood loss in cc.'s, but how accurate are these estimates? The amount of blood loss is often underestimated in the clinical situation, and the validity of reports based on observation may be disputed(1). For example, blood loss tends to be underestimated during obstetrical emergencies, as well as during routine procedures(2-6). The nursing literature states only that the amount of saturation is to be noted and recorded. While the term "heavy" is defined as excessive and accompanied by clots, the term "excessive" is not defined(7-9). To determine how accurate estimation of blood loss is, we conducted a study with 25 nurses who were responsible for estimating blood loss from 10 A.M. to 3 P.M. The subjects who participated came from the following departments: nursing service, emergency room, operating room, labor and delivery, and postpartum. Staff from each department came as a unit to answer the questions. This eliminated their sharing answers. Their experience in estimating blood loss ranged from 6 months to 10 years. Each participant was responsible for estimating blood loss on a daily basis. The hospital did not use the number of years' experience as a criterion to determine who was responsible for blood-loss estimation. Arrangements had been made with the hospital blood bank to save the outdated whole blood (by 2 to 3 DOROTHY HENDEL (CLOUG(H, R.N., M.N., is assistant professor, level I coordinator, University of New Mexico College of Nursing, Albuquerque. She teaches medical/surgical nursing, which includes direct clinical supervision in the intensive care unit.

A geriatric health promotion programme was conducted to determine biometric changes in cardiovascular, nutritional and musculoskeletal status. Sixty-seven older adults participated in the study. The experimental group of 34 elderly subjects showed statistically significant increases in flexibility and high density lipoprotein with significant decreases in resting pulse rate, blood pressure, total cholesterol, weight and skinfold measures. The overall results of the wellness programme showed significant improvements in the physical health status of older adults.

Coitus during pregnancy is a crucial factor in the health maintenance of pregnant women. Fifty‐two women were surveyed regarding the information they received concerning sexual intercourse during and following pregnancy. This study showed that, overall, health professionals were not providing information to pregnant women about sexual intercourse and pregnancy. The health professionals who provided sexual information to pregnant women were shown to be inadequate in their efforts. Nurses need to take a more active role in the education of women and their partners about coitus during pregnancy and postpartum.