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An addendum to the AAPM's TG-51 protocol for the determination of absorbed dose to water in megavoltage photon beams is presented. This addendum continues the procedure laid out in TG-51 but new kQ data for photon beams, based on Monte Carlo simulations, are presented and recommendations are given to improve the accuracy and consistency of the protocol's implementation. The components of the uncertainty budget in determining absorbed dose to water at the reference point are introduced and the magnitude of each component discussed. Finally, the consistency of experimental determination of ND,w coefficients is discussed. It is expected that the implementation of this addendum will be straightforward, assuming that the user is already familiar with TG-51. The changes introduced by this report are generally minor, although new recommendations could result in procedural changes for individual users. It is expected that the effort on the medical physicist's part to implement this addendum will not be significant and could be done as part of the annual linac calibration., (© 2014 American Association of Physicists in Medicine.)

More than 600 RN-to-BSN programs currently exist in the United States, and the numbers of programs and students are growing rapidly. This unprecedented growth is a result of several factors, including the Institute of Medicine's recommendation that 80% of RNs be BSN prepared by 2020. This survey was undertaken to explore key ideas and issues related to RN-to-BSN education to gather information on how RN-to-BSN programs are changing and to uncover concerns posited by program directors. The survey indicated that lack of standardization has resulted in significant variability in expectations and requirements among RN-to-BSN programs. Further, numerous questions need to be answered and concerns addressed to develop strategies to maintain growth, improve access, and remove barriers without sacrificing quality. Findings can be used to ensure that RN-to-BSN education prepares graduates for the future health care system and that the outcome is not just a piece of paper., (Copyright 2013, SLACK Incorporated.)

Uterine leiomyomas (fibroids) are seen in up to 4% of pregnancies, and most commonly present with pain in pregnancy, which can be due to red degeneration or torsion. Most cases previously have been managed with open resection. We report the case of a 35-y-old primagravida woman, presenting with acute lower abdominal pain at 11 wk gestation. Ultrasound demonstrated an 8-cm fibroid only. She demonstrated features of lower abdominal peritonitis and was scheduled for a diagnostic laparoscopy. At operation, a torsed subserosal fibroid was found. She successfully underwent laparoscopic myomectomy with the endoGIA vascular stapler and subsequent Pfannenstiel delivery. The patient was discharged 48 h postoperatively to continue her pregnancy. This case demonstrates the safe application of laparoscopic excisional myomectomy in the first trimester of pregnancy. Previously reported cases in the literature have focused on open resection or bipolar diathermy enucleation and morcellation. A high degree of suspicion should be maintained for the diagnosis in patients presenting to the surgical service with acute lower abdominal peritoneal signs during pregnancy.

More than 600 RN-to-BSN programs exist in the United States. Little information is available describing many aspects of these programs (e.g., curricula, program length, prerequisites). This study was undertaken to obtain a snapshot of RN-to-BSN education. This review is vital given the rapid growth of these programs and the anticipated increase in number of "completion" students necessary to meet the Institute of Medicine's goal that 80% of RNs be BSN-prepared by 2020. Data were collected and analyzed within general areas, including background information, curriculum, instructional formats, and evaluation. Findings from the survey can be used by educators to evaluate their RN-to-BSN programs and compare them with other programs. Further, evidence of potential weaknesses were identified, and educators are challenged to ensure that encouraging growth, focusing on flexibility, and making programs more user friendly does not result in inferior education. Rather, academic and programmatic rigor must be maintained., (Copyright 2012, SLACK Incorporated.)

The objective of this study was to examine the chronic effects on lower-body strength in resistance trained men of performing varying training volumes over 6 weeks. A pretest and posttest design was used to investigate the effects on 1-repetition maximum (1RM) squat strength. Also, 1RM testing was performed at 3 weeks. Participants were randomly assigned to an intensity-matched (80% of 1RM) low (1-SET), moderate (4-SET), or high (8-SET) volume condition. In addition to significant strength increases in all groups at the end of the 6-week period, increases were observed at 3 weeks under the 4- and 8-SET conditions, which were greater than the improvement under the 1-SET condition. At 6 weeks, the magnitude of improvement was significantly greater for the 8-SET, as compared with that of the 1-SET group. The magnitude of improvement elicited in the 4-SET group was not different from that of the 1-SET or 8-SET groups. The results suggest that "high" volumes (i.e., >4 sets) are associated with enhanced strength development but that "moderate" volumes offer no advantage. Practitioners should be aware that strength development may be dependent on appropriate volume doses and training duration.

The optimal volume of resistance exercise to prescribe for trained individuals is unclear. The purpose of this study was to randomly assign resistance trained individuals to 6-weeks of squat exercise, prescribed at 80% of a 1 repetition-maximum (1-RM), using either one, four, or eight sets of repetitions to failure performed twice per week. Participants then performed the same peaking program for 4-weeks. Squat 1-RM, quadriceps muscle activation, and contractile rate of force development (RFD) were measured before, during, and after the training program. 32 resistance-trained male participants completed the 10-week program. Squat 1-RM was significantly increased for all groups after 6 and 10-weeks of training (P < 0.05). The 8-set group was significantly stronger than the 1-set group after 3-weeks of training (7.9% difference, P < 0.05), and remained stronger after 6 and 10-weeks of training (P < 0.05). Peak muscle activation did not change during the study. Early (30, 50 ms) and peak RFD was significantly decreased for all groups after 6 and 10-weeks of training (P < 0.05). Peak isometric force output did not change for any group. The results of this study support resistance exercise prescription in excess of 4-sets (i.e. 8-sets) for faster and greater strength gains as compared to 1-set training. Common neuromuscular changes are attributed to high intensity squats (80% 1-RM) combined with a repetition to failure prescription. This prescription may not be useful for sports application owing to decreased early and peak RFD. Individual responsiveness to 1-set of training should be evaluated in the first 3-weeks of training.

Purpose: This work presents the experimental extraction of the perturbation factor in megavoltage electron beams for three models of silicon diodes (IBA Dosimetry, EFD and SFD, and the PTW 60012 unshielded) using a plastic scintillation detector (PSD)., Methods: The authors used a single scanning PSD mounted on a high-precision scanning tank to measure depth-dose curves in 6-, 12-, and 18-MeV clinical electron beams. They also measured depth-dose curves using the IBA Dosimetry, EFD and SFD, and the PTW 60012 unshielded diodes. The authors used the depth-dose curves measured with the PSD as a perturbation-free reference to extract the perturbation factors of the diodes., Results: The authors found that the perturbation factors for the diodes increased substantially with depth, especially for low-energy electron beams. The experimental results show the same trend as published Monte Carlo simulation results for the EFD diode; however, the perturbations measured experimentally were greater. They found that using an effective point of measurement (EPOM) placed slightly away from the source reduced the variation of perturbation factors with depth and that the optimal EPOM appears to be energy dependent., Conclusions: The manufacturer recommended EPOM appears to be incorrect at low electron energy (6 MeV). In addition, the perturbation factors for diodes may be greater than predicted by Monte Carlo simulations.

Purpose: This work presents the experimental extraction of the overall perturbation factor PQ in megavoltage electron beams for NACP-02 and Roos parallel-plate ionization chambers using a plastic scintillation detector (PSD)., Methods: The authors used a single scanning PSD mounted on a high-precision scanning tank to measure depth-dose curves in 6, 12, and 18 MeV clinical electron beams. The authors also measured depth-dose curves using the NACP-02 and PTW Roos chambers., Results: The authors found that the perturbation factors for the NACP-02 and Roos chambers increased substantially with depth, especially for low-energy electron beams. The experimental results were in good agreement with the results of Monte Carlo simulations reported by other investigators. The authors also found that using an effective point of measurement (EPOM) placed inside the air cavity reduced the variation of perturbation factors with depth and that the optimal EPOM appears to be energy dependent., Conclusions: A PSD can be used to experimentally extract perturbation factors for ionization chambers. The dosimetry protocol recommendations indicating that the point of measurement be placed on the inside face of the front window appear to be incorrect for parallel-plate chambers and result in errors in the R50 of approximately 0.4 mm at 6 MeV, 1.0 mm at 12 MeV, and 1.2 mm at 18 MeV.

Purpose: The purposes of this study are to improve the accuracy of source and geometry parameters used in the simulation of large electron fields from a clinical linear accelerator and to evaluate improvement in the accuracy of the calculated dose distributions., Methods: The monitor chamber and scattering foils of a clinical machine not in clinical service were removed for direct measurement of component geometry. Dose distributions were measured at various stages of reassembly, reducing the number of geometry variables in the simulation. The measured spot position and beam angle were found to vary with the beam energy. A magnetic field from the bending magnet was found between the exit window and the secondary collimators of sufficient strength to deflect electrons 1 cm off the beam axis at 100 cm from the exit window. The exit window was 0.05 cm thicker than manufacturer's specification, with over half of the increased thickness due to water pressure in the channel used to cool the window. Dose distributions were calculated with Monte Carlo simulation of the treatment head and water phantom using EGSnrc, a code benchmarked at radiotherapy energies for electron scatter and bremsstrahlung production, both critical to the simulation. The secondary scattering foil and monitor chamber offset from the collimator rotation axis were allowed to vary with the beam energy in the simulation to accommodate the deflection of the beam by the magnetic field, which was not simulated., Results: The energy varied linearly with bending magnet current to within 1.4% from 6.7 to 19.6 MeV, the bending magnet beginning to saturate at the highest beam energy. The range in secondary foil offset used to account for the magnetic field was 0.09 cm crossplane and 0.15 cm inplane, the range in monitor chamber offset was 0.14 cm crossplane and 0.07 cm inplane. A 1.5%/0.09 cm match or better was obtained to measured depth dose curves. Profiles measured at the depth of maximum dose matched the simulated profiles to 2.6% or better at doses of 80% or more of the dose on the central axis. The profiles along the direction of MLC motion agreed to within 0.16 cm at the edge of the field. There remained a mismatch for the lower beam energies at the edge of the profile that ran parallel to the direction of jaw motion of up to 1.4 cm for the 6 MeV beam, attributed to the MLC support block at the periphery of the field left out of the simulation and to beam deflection by the magnetic field. The possibility of using these results to perform accurate simulation without disassembly is discussed. Phase-space files were made available for benchmarking beam models and other purposes., Conclusions: The match to measured large field dose distributions from clinical electron beams with Monte Carlo simulation was improved with more accurate source details and geometry details closer to manufacturer's specification than previously achieved.

Purpose: The purpose of this article is to facilitate translation of the Consensus Statement to practice for diabetes educators and other professionals who contribute to the care of individuals with diabetes., Methods: The 2007 Consensus Statement from the American Diabetes Association (ADA), European Association for the Study of Diabetes (EASD), International Federation of Clinical Chemistry and Laboratory Medicine (IFCC), and International Diabetes Federation (IDF) called for the standardization of glycated hemoglobin measurement in reporting and use of average glucose values in clinical practice., Results: Conversion of glycated hemoglobin percentage to average blood glucose was anchored historically in early laboratory techniques linked to disease outcomes rather than to definitive laboratory standardization. Recently, the A1C-Derived Average Glucose (ADAG) study demonstrated that A1C values can be accurately expressed as estimated average glucose (eAG) and endorsed eAG as the best way to standardize the expression of laboratory values of glycated hemoglobin., Conclusions: Adoption of the 2007 Consensus Statement will influence clinical practice and decision making and subsequently influence self-management for individuals with diabetes.

To model the transport of electrons through material requires knowledge of how the electrons lose energy and scatter. Theoretical models are used to describe electron energy loss and scatter and these models are supported by a limited amount of measured data. The purpose of this work was to obtain additional data that can be used to test models of electron scattering. Measurements were carried out using 13 and 20 MeV pencil beams of electrons produced by the National Research Council of Canada research accelerator. The electron fluence was measured at several angular positions from 0 degree to 90 degrees for scattering foils of different thicknesses and with atomic numbers ranging from 4 to 79. The angle, theta 1/e at which the fluence has decreased to 1/e of its value on the central axis was used to characterize the distributions. Measured values of theta 1/e ranged from 1.5 degrees to 8 degrees with a typical uncertainty of about 1%. Distributions calculated using the EGSnrc Monte Carlo code were compared to the measured distributions. In general, the calculated distributions are narrower than the measured ones. Typically, the difference between the measured and calculated values of theta 1/e is about 1.5%, with the maximum difference being 4%. The measured and calculated distributions are related through a simple scaling of the angle, indicating that they have the same shape. No significant trends with atomic number were observed.

Monte Carlo (MC) studies of the output of medical linear accelerators have demonstrated that in-air profiles are useful in the beam commissioning process. A recent investigation of x-ray profiles (Tonkopi et al, Med. Phys 32 (9), 2005) showed very good agreement between measurement and EGSnrc calculations but to achieve this level of agreement the beam linac spot size, energy and angular divergence had to be treated as variables. In this project we carried out measurements and MC calculations for an electron accelerator for which the initial beam parameters are well known. Two sets of investigations were carried out. In the first we measured electron scatter distributions for a range of scattering foils and electron energies of 13 and 20 MeV. The profiles were parameterised and compared to EGSnrc Monte Carlo calculations. It was found that generally the EGSnrc calculations gave agreement with the measurements within 1.5 %. In the second investigation, which is on-going, in-air profiles were obtained for photon beams produced using different targets (from beryllium to lead). Measured angular distributions were obtained using ion chambers with different build-up caps (low and high-Z) and the sensitivity of the data to small changes in geometry (e.g., moving the x-ray target) was investigated. The photon energy fluence was calculated using EGSnrc and preliminary indications are that the measured and calculated distributions agree to better than 5 %. Work supported in part by NIH grant R01 CA104777-01A2., (© 2008 American Association of Physicists in Medicine.)

For ion chambers with cavities open to the surrounding atmosphere, the response measured at a given temperature and pressure must be corrected using the standard temperature-pressure correction factor (P(TP)). A previous paper based solely on Monte Carlo simulations [D. J. La Russa and D. W. O. Rogers, Med. Phys. 33, 4590-4599 (2006)] pointed out the shortcomings of the P(TP) correction factor when used to correct the response of non-air-equivalent chambers for low-energy x-ray beams. This work presents the results of several experiments that corroborate these calculations for a number of ion chambers. Monte Carlo simulations of the experimental setup revealed additional insight into the various factors affecting the extent of the breakdown of P(TP), including the effect of impurities and the sensitivity to chamber dimensions. For an unfiltered 60 kV beam, the P(TP)-corrected response of an NE 2571 ion chamber measured at 0.7 atm was 2.5% below the response measured at reference conditions. In general, Monte Carlo simulations of the experimental setup using EGSnrc were within 0.5% of measured values. EGSnrc-calculated values of air kerma calibration coefficients (N(K)) at low x-ray energies are also provided as a means of estimating the level of impurities in the chambers investigated. Calculated values of N(K) normalized to the value measured for a 250 kV beam were obtained for three chambers and were within 1% of experiment with one exception, the Exradin A12 in a 50 kV beam.

The calibration of ion chambers in high-energy electron beams in terms of absorbed dose to water at the National Physical Laboratory requires knowledge of the ratio of perturbation factors in graphite and water phantoms. During a review of data required for the NPL calibration procedure an empirical model was developed to calculate the perturbation due to the rear wall, pwall, of a well-guarded ion chamber in a high-energy electron beam. The overall uncertainty in this method is estimated to be 0.4%, which is the lowest value reported to date. The model reproduces measured data at the 0.1% level or better and indicates that the NACP ion chamber has a nonzero perturbation factor in electron beams due to backscatter from the rear wall. The effect is small (<0.5%) at high energies (R50>4 cm, E0>10 MeV) but becomes large at low energies-up to 1.4% at E0=4 MeV (R50=1.2 cm). The model indicates that there is a nonzero correction for the NACP chamber in both a graphite and water phantom and that material adjacent to the air cavity has a significant effect on the measured ionization. These values are consistent with previous measurements and recent Monte Carlo calculations. The model could be used in the design of ion chambers and in the estimation of corrections for non-homogeneous systems, especially in the absence of accurate Monte Carlo simulations.

Bilirubin, the yellow substance usually responsible for neonatal jaundice, is currently monitored invasively or by observing/measuring skin colour. This paper investigates the feasibility of monitoring serum bilirubin concentration using light absorbance in a similar fashion to pulse oximetry. The light absorbance of bilirubin is shown to be sufficiently different to haemoglobin to in theory allow direct noninvasive serum bilirubin monitoring using light absorbance around 480nm.

This article presents an investigation of the influence of the ion chamber response, including buildup caps, on the measurement of in-air off-axis ratio (OAR) profiles in megavoltage photon beams using Monte Carlo simulations with the EGSnrc system. Two new techniques for the calculation of OAR profiles are presented. Results of the Monte Carlo simulations are compared to measurements performed in 6, 10 and 25 MV photon beams produced by an Elekta Precise linac and shown to agree within the experimental and simulation uncertainties. Comparisons with calculated in-air kerma profiles demonstrate that using a plastic mini phantom gives more accurate air-kerma measurements than using high-Z material buildup caps and that the variation of chamber response with distance from the central axis must be taken into account.

Studies indicate that roughly half of health care workers are not immunized against hepatitis B and influenza. Findings from a survey of 1,000 registered nurses (RNs) conducted to analyze their beliefs and actions related to immunization recommendations are reported. Only 8% of the responding RNs chose not to receive vaccination against hepatitis B. The primary reasons that nurses declined hepatitis B vaccination were because they were not working in nursing or did not believe they were at risk of exposure. Similarly, 86% of the RNs reported they had ever received a flu shot, and 69% reported of being immunized during 2 of the previous 4 years. Rationale for receiving immunization included belief in its effectiveness, belief that they were at risk of exposure, and that it was provided free of charge. Reasons for declining included concerns about side effects, lack of concern about getting the illness, and doubts about effectiveness. The nurses who responded to the survey appear to value immunizations and generally adhere to immunization recommendations. Further study needs to be conducted on related issues, including follow-up for assessment of long-term protection of hepatitis B immunization and adherence to guidelines for postexposure prophylaxis. Ongoing monitoring and further study of serious complications of hepatitis B immunizations are also needed.

Although most nurses believe spiritual care is an integral component of quality, holistic nursing care, they rarely address spiritual issues and typically feel unprepared to do so. One reason for nurses' lack of preparedness to provide spiritual interventions is that their basic education only minimally discusses spirituality and related issues. This is compounded by the problem that only sporadic reference to spiritual care is found in most nursing textbooks. This study was conducted to analyze the content related to spirituality in nursing textbooks in order to determine where spiritual care is addressed and evaluate its adequacy. A total of 50 textbooks from a wide variety of nursing specialty areas were selected from the most recent Brandon Hill list. These books were examined to assess the percentage of pages discussing spiritual issues and analyze inclusion of core content essential for nursing practice. Although there was considerable variation among the books from all specialty areas, overall, hospice/terminal care, fundamentals of nursing, health assessment/health promotion, and transcultural nursing textbooks provided the most information about spirituality and spiritual care. Textbooks focusing on professional issues, medical-surgical nursing, maternal-child health nursing, critical care nursing, and community health nursing contained the least spiritual content. Suggestions are made regarding how to integrate spiritual issues and spiritual care in all nursing textbooks that pertain directly to patient care.

This report contains the recommendations of the Electron Dosimetry Working Party of the UK Institute of Physics and Engineering in Medicine (IPEM). The recommendations consist of a code of practice for electron dosimetry for radiotherapy beams of initial energy from 4 to 25 MeV. The code is based on the absorbed dose to water calibration service for electron beams provided by the UK standards laboratory, the National Physical Laboratory (NPL). This supplies direct N(D,w) calibration factors, traceable to a calorimetric primary standard, at specified reference depths over a range of electron energies up to approximately 20 MeV. Electron beam quality is specified in terms of R(50,D), the depth in water along the beam central axis at which the dose is 50% of the maximum. The reference depth for any given beam at the NPL for chamber calibration and also for measurements for calibration of clinical beams is 0.6R(50.D) - 0.1 cm in water. Designated chambers are graphite-walled Farmer-type cylindrical chambers and the NACP- and Roos-type parallel-plate chambers. The practical code provides methods to determine the absorbed dose to water under reference conditions and also guidance on methods to transfer this dose to non-reference points and to other irradiation conditions. It also gives procedures and data for extending up to higher energies above the range where direct calibration factors are currently available. The practical procedures are supplemented by comprehensive appendices giving discussion of the background to the formalism and the sources and values of any data required. The electron dosimetry code improves consistency with the similar UK approach to megavoltage photon dosimetry, in use since 1990. It provides reduced uncertainties, approaching 1% standard uncertainty in optimal conditions, and a simpler formalism than previous air kerma calibration based recommendations for electron dosimetry.

This study investigated the impact of providing low-dose inhaled corticosteroids (ICS) at school or at home to asthmatic inner city children over a 14-week period, compared with the existing community standard. Eight elementary schools in the Dallas Independent School District with a high incidence of asthma located in predominantly urban African-American communities were randomly assigned to one of four groups. The treatment arms were school-based delivery of inhaled steroids, home-based delivery of inhaled steroids, and home-based delivery of inhaled steroids with school-based asthma education, and the control group was no change in current therapy. Fifty students were objectively diagnosed with mild, persistent asthma and participated in the study. Students in the treatment arms received beclomethasone (42 mcg/puff) 4 puffs, twice a day, either at school or at home. Students in the control, "community standard of care" group received no additional medical intervention. Higher peak flows for the treatment groups were seen in the first week and maintained throughout the study (P = .047). By week 5 significant differences were found in frequency of bronchodilator use (P = .025), episodes of nocturnal awakening with asthma symptoms (P = .022), and visits to the primary health care provider (P = .022). Treatment groups rated their asthma as "better than the week before" more frequently than the control group (P = .001). Delivering ICS in school is associated with improved asthma control than when anti-inflammatory medication was delivered to children with asthma in a home-based setting, and both are superior when compared with a control, "community standard of care" group in which no additional medical intervention occurred.

Although human infants suffer traumatic spinal cord injury, appropriate animal models have not been developed. The consequences of neonatal injury are not necessarily the same as in adults, so treatments designed for adults may not generalize to infants. Therefore, understanding the effects of traumatic injury to the developing cord is important. In this experiment, mid-thoracic spinal cords of 4-day-old rats were compressed with forceps by 0% (sham), 90% or 95% of the uncompressed width. On postoperative day (POD) 1 or 11, rats were suspended in harnesses and administered L-DOPA to activate locomotor circuits. Slight modifications of interlimb coordination remained on POD 11 following the lesser compression, whereas the amount of hindlimb air-stepping, step rates, step lengths and coordination were reduced and declined post-operatively following the greater compression. Lesions were proportional to severity of compression. Progressive motor dysfunction during air-stepping revealed deficits in descending control of lumbar circuits, whereas previous reports of recovery of overground walking probably reflect activation of reflex mechanisms caudal to the transection.

Apoptotic cell death is a fundamental and highly regulated biological process in which a cell is instructed to participate actively in its own demise. This process of cellular suicide is activated by developmental and environmental cues and normally plays an essential role in eliminating superfluous, damaged, and senescent cells of many tissue types. In recent years, a number of experimental studies have provided evidence of widespread neuronal and glial apoptosis following injury to the central nervous system (CNS). These studies indicate that injury-induced apoptosis can be detected from hours to days following injury and may contribute to neurological dysfunction. Given these findings, understanding the biochemical signaling events controlling apoptosis is a first step towards developing therapeutic agents which would target this cell death process. This review will focus on the molecular cell death pathways responsible for generating the apoptotic phenotype, summarize what is currently known about apoptotic signals activated in the injured CNS, and what potential strategies might be pursued to reduce this cell death process as a means to promote functional recovery.

Objective: To determine hepatic effects of halothane and isoflurane anesthesia in young healthy goats., Design: Randomized prospective clinical trial., Animals: 24 healthy 9-month-old female goats., Procedure: Goats were sedated with xylazine hydrochloride and ketamine hydrochloride and anesthetized with halothane (n = 12) or isoflurane (12) while undergoing tendon surgery. End-tidal halothane and isoflurane concentrations were maintained at 0.9 and 1.2 times the minimal alveolar concentrations, respectively, and ventilation was controlled. Venous blood samples were collected approximately 15 minutes after xylazine was administered and 24 and 48 hours after anesthesia, and serum aspartate aminotransferase (AST), sorbitol dehydrogenase (SDH), alkaline phosphatase (ALP), and gamma-glutamyltransferase (GGT) activities and bilirubin concentration were measured. Goats were euthanatized 25 or 62 days after anesthesia, and postmortem liver specimens were submitted for histologic examination., Results: All goats recovered from anesthesia and survived until euthanasia. Serum SDH, GGT, and ALP activities and bilirubin concentration did not increase after anesthesia, but serum AST activity was significantly increased. However, serum hepatic enzyme activities were within reference limits at all times in all except 1 goat in which serum AST activity was high 24 and 48 hours after anesthesia. This goat had been anesthetized with halothane and had the longest duration of anesthesia. No clinically important abnormalities were seen on histologic examination of liver specimens., Conclusions and Clinical Relevance: Results suggest that use of halothane or isoflurane for anesthesia in young healthy goats is unlikely to cause hepatic injury.

A stratified, random sample of 100 nursing theory instructors from across the United States was surveyed to gather information on essential content and concepts, assignments, textbooks, and related information for the purpose of updating a nursing theory course. A total of 44 usable questionnaires were returned. Results showed that there is general consensus on content that is considered essential in theory courses. Additionally, theory instructors responded that grand nursing theories are overemphasized whereas more emphasis needs to be placed on middle-range and practice theories, as well as the research-practice-theory triad. It was concluded that it is time to revise nursing theory courses to make them more research and practice oriented, timely, and relevant.

The expansive growth of doctoral programs in the United States has necessitated a need to determine demographic attributes of the academic program, characteristics of the students, admission criteria, and curriculum patterns. Seventy-eight doctoral programs were sent a researcher-designed survey and 48 (62 per cent) responded. Results show an increasing shift away from clinical doctorates to the research doctorate, although few differences exist within the research focus of doctoral nursing programs. Consistent with previous reports in the literature, curricula are fairly standard and few differences were noted based on a number of criteria including geographic location, type of degree granted, Carnegie classification of the university, or by the length of time the program has been in existence. Discussion of these findings is included.

Use of ambulance rides has been a very valuable learning experience for baccalaureate nursing students. It has given them an unusual opportunity to incorporate much of the knowledge they have gained from their nursing courses to plan and assist in the delivery of care for a variety of individuals and families. Because a call could involve virtually anything, it offers a unique combination of all aspects of nursing care including medical-surgical, pediatrics, obstetrics, and psychiatric nursing, as well as community health nursing.

The increasing emphasis placed on transcultural care among clinicians and educators, coupled with the lack of original research in this field, has led to a number of articles in journals and books that are poorly researched and referenced. Authors have a responsibility to critically review primary sources rather than rely on secondary sources that can be erroneous. Having established a unique contribution to the transcultural literature, nurse authors and educators have a responsibility to maintain high professional and ethical standards when disseminating information to readers.

Administration of L-DOPA (sc) to neonatal rats suspended in harnesses induces coordinated stepping of all four limbs (diagonal progression; L-DOPA-induced air-stepping) by 5 days of age. Because NMDA also induces locomotion in several species, NMDA receptor activation may be required for L-DOPA to elicit coordinated air-stepping. The purpose of the present experiment was to determine if the NMDA receptor antagonist, MK-801, would block L-DOPA-induced air-stepping in developing rats. Neonatal rats administered MK-801 alone rarely air-stepped with the forelimbs or hindlimbs in a coordinated fashion, whereas those treated with L-DOPA alone primarily stepped with all four limbs using a diagonal progression pattern during the session. In contrast, the number of limbs that stepped during the session was gradually altered in 5- to 20-day-old rats treated with MK-801 + L-DOPA. Gaits of those rats progressed from diagonal progression to extension of the forelimbs beneath the chin with hindlimb alternation, to forelimb extension without hindlimb activity. Twenty-day-olds treated with MK-801 + L-DOPA subsequently became completely inactive when the forelimbs dropped from their elevated position beneath the chin. In addition to the sequence just described, 15-day-old rats treated with the lowest concentration of MK-801 + L-DOPA occasionally stepped with one pair of homolateral limbs or stepped with the hindlimbs in near synchrony while the forelimbs either stepped in alternation, were extended beneath the chin or groomed the face. Because limb participation during L-DOPA-induced air-stepping was altered in neonatal rats pretreated with MK-801, NMDA receptor activation may be important for locomotor coordination (gait)., (Copyright 1999 Published by Elsevier Science B. V.)

This study was performed to determine if intraoperative local anesthesia improved control of postoperative pain after inguinal herniorrhaphy and to compare the effects of two commonly used local anesthetics on pain management. The Gate Control Theory of Pain formed the theoretical basis for this study. A retrospective nonexperimental study in an ex post facto design was used. Data were collected from 1990 through 1997 on 120 patient charts. The use of local anesthetic intraoperatively significantly decreased patients' lengths of stay postoperatively (P = 0.00) and need for postoperative narcotics (P = 0.00). Bupivacaine was found to be superior to lidocaine in decreasing the need for postoperative narcotic analgesia. Researchers concluded that many patients would benefit from intraoperative injection of local anesthesia. This information can affect patient care outcomes through decreasing recovery time, reducing postoperative pain, and reducing health care costs.

Acute mid-thoracic spinal cord transection eliminates hindlimb air-stepping in neonatal rats suspended in harnesses and administered L-DOPA. Because spinal cord transection eliminates all descending inputs to the hindlimb locomotor circuits, this experiment determined if coadministration of L-DOPA and quipazine (serotonin receptor agonist) would induce hindlimb air-stepping in rat pups 24 hr after transection. Hindlimb steps of spinally transected pups that received L-DOPA or quipazine alone were infrequent and slow; hindlimb steps induced by L-DOPA + quipazine occurred more frequently and were faster than those elicited by either drug alone. These findings suggest that catecholaminergic and serotonergic systems both contribute to hindlimb stepping.

In Experiment 1, rats of 5, 10, 15, and 20 days of age were injected with L-DOPA to elicit stepping and videotaped while suspended in air and in warm water. Inter- and intralimb coordination were similar for L-DOPA-induced air-stepping and swimming at all ages. Other parameters of locomotion, such as step length and step rate, varied by substrate. In Experiment 2, pups of 5 to 20 days of age received an injection of L-DOPA or the vehicle and were videotaped while freely swimming. L-DOPA-induced free swimming was more stereotyped and "automatonlike" than that of vehicle-injected animals. Through 15 days of age, all pups swam using all four limbs, but L-DOPA induced stricter synchrony of movement in diagonal limbs than was used by pups injected with the vehicle. At postnatal Day 20, vehicle-injected pups adopted the adult swimming pattern in which only the hindlimbs were used, whereas L-DOPA-injected pups continued to use the immature pattern, diagonal progression with all four limbs. These results suggest that L-DOPA-induced air-stepping and swimming are manifestations of the same central mechanisms and that parameters of L-DOPA-induced stepping are modified by the sensory and/or biomechanical effects of the substrate. Although the free swimming of L-DOPA-injected pups was kinematically similar to vehicle-treated pups, L-DOPA retarded transition to the adult swimming pattern.

A single dose of the non-competitive NMDA receptor antagonist MK-801 (dizocilpine maleate) induces neuronal necrosis in the posterior cingulate/retrosplenial (PC/RS) cortex of adult rats. The present studies further characterized this effect and evaluated several variables that affect its expression. Male and female rats of two strains (Sprague-Dawley and Fischer 344) and two ages (70 and 127 days) were given a single subcutaneous injection of vehicle (water) or MK-801 (0.5, 1.0 or 5.0 mg/kg). A simple behavioral response (recumbency) and number of necrotic neurons in the PC/RS cortex were evaluated. MK-801 induced dose-dependent recumbency which was more severe and of longer duration in females of either strain or age. In addition, female rats (regardless of strain, dose, or age) consistently had significantly more necrotic PC/RS neurons than male rats. In a second study, a high dose of MK-801 was given intraperitoneally (10 mg/kg) to male and female Sprague-Dawley rats (90-120 days of age). Necrotic neuron counts were determined at 5 separate rostrocaudal levels of the PC/RS cortex. At levels where neuronal necrosis occurred, the magnitude of the effect was significantly greater in females than males and the number of necrotic neurons increased along a rostral to caudal gradient. Our findings indicate that (1) MK-801 dose dependently induces recumbency and necrosis of PC/RS cortical neurons in both Sprague-Dawley and Fischer 344 rats, (2) female rats of either strain are more sensitive than their male counterparts, and (3) the extent of necrosis of PC/RS cortical neurons increases along a rostral to caudal gradient.

Nursing's Agenda for Healthcare Reform presents a vision and specific suggestions for the future of nursing. Changes proposed by the agenda challenge nursing educators to prepare new practitioners to deliver healthcare in community settings. The authors offer specific means for nursing educators to provide students with clinical experiences that are consistent with the agenda. These experiences include practice in primary-care settings and case management, and more effective health promotion activities.

In 1991, the Immunization Practices Advisory Committee (ACIP) issued recommendations calling for universal immunization of all U.S. infants against hepatitis B. These recommendations have been widely accepted without addressing several considerations including epidemiology of hepatitis B, economic costs, and questions regarding long-term immunity. Both sides in this issue are discussed.

The purpose for conducting this study was to quantify the forces exerted by a chiropractor on a patient during spinal manipulative therapy. Six patients received three treatments each from two chiropractors for a sacroiliac joint fixation. The Thompson technique was used to treat the patients. The force characteristics of the spinal manipulation were analyzed with respect to the following five points: preloading force, peak force, duration of manipulation, impulse of manipulation and point of application of the peak force. The results obtained indicated that all treatments have certain common characteristics; for example, a preload force is always followed by a large thrusting force. The values for the preload force, peak force, duration and impulse were found to have large standard deviations for a given adjuster and between patients. The location of the point of application of the peak force relative to a low back reference system appeared to be very consistent. However, it was not on the posterior superior iliac spines (PSIS) as expected, but always slightly medial to this point. This is the first study to report force results which were measured directly during spinal manipulative therapy in a clinical situation. In further studies, the results of this investigation will be compared to results obtained from a large population of patients and chiropractic adjusters. Differences in the force characteristics between chiropractors will be compared to clinical and objective measures of the rehabilitation process of the patients in order to find an "optimal" way of performing spinal manipulative therapies.

This study evaluated the effects of a wellness program at the workplace in relation to its impact on exercise, weight, smoking, and stress of the employee participants. A quasi-experimental design was selected in which data were collected at three specific intervals: before and immediately after program completion, and three months after program completion. The sample consisted of experimental and control groups. Persons (n = 59) who did participate in the wellness program made up the experimental group, and those (n = 49) who did not participate in the wellness program served as controls. Descriptive statistics were used to summarize the data. No significant differences were noted between participants and nonparticipants in the areas of exercise, weight, smoking, and stress between the initial evaluation and after completing the wellness program. The areas of stress reduction and increased exercise were emphasized more in the participants than the nonparticipants, however.

The purpose of this study was to assess the inter- and intraexaminer reliability of the Gillet-motion palpation procedure using 10 qualified chiropractors and 11 patients with a sacroiliac joint problem. Intraexaminer reliability was found to be statistically significant for all agreement scores investigated. Interexaminer reliability was found to be statistically significant for some of the agreement scores investigated but not for others. Severity of the low back problems did not seem to influence intra- or interexaminer agreement scores; however, chiropractor expertise did. High expertise was associated with lower intraexaminer agreement scores than low expertise. This finding is in contradiction with traditional beliefs and reported findings. The gait of the patient group was found to be significantly different from that of normal subjects as noted in an earlier report.