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Nurses may not prompt or offer assistance with oral hygiene care activities to patients who do not ask for help because they appear independent in their ability to perform their oral hygiene care. That is, nurses may be inclined to preserve patient autonomy over ensuring adequate oral hygiene outcomes. The purpose of this qualitative Interpretive Description study was to explore, with older patients in post-acute settings, their perspectives and experiences with being autonomous or relying on nursing staff for oral hygiene care. Bedside interviews with 21 patients revealed that: (a) their oral hygiene had deteriorated since hospitalization; (b) nurses may not be aware of patients' oral health values or offer help unless asked; and (c) patients are generally open to being asked if they need help with oral care, being prompted to complete oral care, being asked if they have completed oral care, and having nurses ensure adequate oral care., Competing Interests: Declarations of Competing Interest None, (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Chemicals found in personal care products and plastics have been associated with asthma, allergies, and lung function, but methods to address real life exposure to mixtures of these chemicals have not been applied to these associations., Methods: We quantified urinary concentrations of eleven phthalate metabolites, four parabens, and five other phenols in mothers twice during pregnancy and assessed probable asthma, aeroallergies, and lung function in their age seven children. We implemented Bayesian Profile Regression (BPR) to cluster women by their exposures to these chemicals and tested the clusters for differences in outcome measurements. We used Bayesian Kernel Machine Regression (BKMR) to fit biomarkers into one model as joint independent variables., Results: BPR clustered women into seven groups characterized by patterns of personal care product and plastic use, though there were no significant differences in outcomes across clusters. BKMR showed that monocarboxyisooctyl phthalate and 2,4-dichlorophenol were associated with probable asthma (predicted probability of probable asthma per IQR of biomarker z-score (standard deviation) = 0.08 (0.09) and 0.11 (0.12), respectively) and poorer lung function (predicted probability per IQR = -0.07 (0.05) and -0.07 (0.06), respectively), and that mono(3-carboxypropyl) phthalate and bisphenol A were associated with aeroallergies (predicted probability per IQR = 0.13 (0.09) and 0.11 (0.08), respectively). Several biomarkers demonstrated positive additive effects on other associations., Conclusions: BPR and BKMR are useful tools to evaluate associations of biomarker concentrations within a mixture of exposure and should supplement single-chemical regression models when data allow., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

The purpose of this study was to investigate the effects of visual condition (low light, full light, and full light with mirror) on balance control and technical form during two technical dance movements in a group of elite collegiate dance students. Dancers demonstrated higher center of pressure velocity indicating lower control while performing a static dance task (parallel relevé retiré) and a dynamic dance task (fondu relevé en croix) under low light conditions than either lighted condition. Measures of Western ballet technique (pelvic obliquity, knee extension, and ankle plantar flexion) showed no decrement under low light conditions. No effect of concurrent mirror feedback was found on either center of pressure velocity or technical requirements of the dance tasks.

Background: Most household air pollution (HAP) interventions in developing countries of sub-Saharan Africa have focused on a single source, such as replacing polluting cooking sources with cleaner burning cooking stoves. Such interventions, however, have resulted in insufficient reductions in HAP levels and respiratory health risks in children. In this study we determined how multiple HAP combustion sources and exposure-mitigation factors in the home environment influence child respiratory health alone and in combination., Methods: We carried out a case-control study to determine associations between multiple indicators of HAP and persistent cough among children (<15 years of age) seeking care at three primary-care clinics in Kampala, Uganda. HAP indicators included self-report of combustion sources inside the home (e.g., stove type, fuel type, and smoking); housing characteristics and cooking practices that mitigate HAP exposure (e.g., use of windows, location of cooking, location of children during cooking) and perceptions of neighborhood air quality. To explore joint associations between indicators of HAP, we applied a Bayesian clustering technique (Bayesian profile regression) to identify HAP indicator profiles most strongly associated with persistent cough in children., Results: Most HAP indicators demonstrated significant positive bivariate associations with persistent cough among children, including fuel-type (kerosene), the number of hours burning solid fuels, use of polluting fuels (kerosene or candles) for lighting the home, tobacco smoking indoors, cooking indoors, cooking with children indoors, lack of windows in the cooking area, and not opening windows while cooking. Bayesian cluster analysis revealed 11 clusters of HAP indicator profiles. Compared to a reference cluster that was representative of the underlying study population cough prevalence, three clusters with profiles characterized by highly adverse HAP indicators resulted in ORs of 1.72 (95% credible interval: 1.15, 2.60), 4.74 (2.88, 8.0), and 8.6 (3.9, 23.9). Conversely, at least two clusters of HAP indicator-profiles were protective compared to the reference cluster, despite the fact that these protective HAP indicator profiles used solid fuels for cooking in combination with an unimproved stove (cooking was performed predominantly outdoors in these protective clusters)., Conclusions: In addition to cooking fuel and type of cook stove, multiple HAP indicators were strongly associated with persistent cough in children. Bayesian profile regression revealed that the combination of HAP sources and HAP exposure-mitigating factors was driving risk of adverse cough associations in children, rather than any single HAP source at the home., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Water is the universal solvent and plays a critical role in all known geological and biological processes. Confining water in nano-scale domains, as encountered in sedimentary rocks, in biological, and in engineered systems, leads to the deviations in water's physicochemical properties relative to those measured for the non-confined phase. In our comprehensive analysis, we demonstrate that nano-scale confinement leads to the decrease in the melting/freezing point temperature, density, and surface tension of confined water. With increasing degree of spatial confinement the population of networked water, as evidenced by alterations in the O-H stretching modes, increases. These analyses were performed on two groups of mesoporous silica materials, which allows to separate pore size effects from surface chemistry effects. The observed systematic effects of nano-scale confinement on the physical properties of water are driven by alterations to water's hydrogen-bonding network-influenced by water interactions with the silica surface - and has implications for how we understand the chemical and physical properties of liquids confined in porous materials.

The development of hybrid nanomaterials mimicking antifreeze proteins that can modulate/inhibit the growth of ice crystals for cell/tissue cryopreservation has attracted increasing interests. Herein, we describe the first utilization of zirconium (Zr)-based metal-organic framework (MOF) nanoparticles (NPs) with well-defined surface chemistries for the cryopreservation of red blood cells (RBCs) without the need of any (toxic) organic solvents. Distinguishing features of this cryoprotective approach include the exceptional water stability, low hemolytic activity, and the long periodic arrangement of organic linkers on the surface of MOF NPs, which provide a precise spacing of hydrogen donors to recognize and match the ice crystal planes. Five kinds of Zr-based MOF NPs, with different pore size, surface chemistry, and framework topologies, were used for the cryoprotection of RBCs. A "splat" assay confirmed that MOF NPs not only exhibited ice recrystallization inhibition activities but also acted as a "catalyst" to accelerate the melting of ice crystals. The human RBC cryopreservation tests displayed RBC recoveries of up to ∼40%, which is higher than that obtained via commonly used hydroxyethyl starch polymers. This cryopreservation approach will inspire the design and utilization of MOF-derived nanoarchitectures for the effective cryopreservation of various cell types as well as tissue samples.

Targeted drug delivery remains at the forefront of biomedical research but remains a challenge to date. Herein, the first superassembly of nanosized metal-organic polyhedra (MOP) and their biomimetic coatings of lipid bilayers are described to synergistically combine the advantages of micelles and supramolecular coordination cages for targeted drug delivery. The superassembly technique affords unique hydrophobic features that endow individual MOP to act as nanobuilding blocks and enable their superassembly into larger and well-defined nanocarriers with homogeneous sizes over a broad range of diameters. Various cargos are controllably loaded into the MOP with high payloads, and the nanocages are then superassembled to form multidrug delivery systems. Additionally, functional nanoparticles are introduced into the superassemblies via a one-pot process for versatile bioapplications. The MOP superassemblies are surface-engineered with epidermal growth factor receptors and can be targeted to cancer cells. In vivo studies indicated the assemblies to have a substantial circulation half-life of 5.6 h and to undergo renal clearance-characteristics needed for nanomedicines., (© 2019 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Exposure to pyrethroid insecticides has been linked to adverse health effects, and can originate from several sources, including indoor residual spraying (IRS) for malaria control, home pest control, food contamination, and occupational exposure. We aimed to explore the determinants of urinary pyrethroid metabolite concentrations in a rural population with high pesticide use. The Venda Health Examination of Mothers, Babies and their Environment (VHEMBE) is a birth cohort of 752 mother-child pairs in Limpopo, South Africa. We measured pyrethroid metabolites in maternal urine and collected information on several factors possibly related to pesticide exposure, including IRS, home pesticide use, and maternal factors (e.g., dietary habits and body composition). We performed statistical analysis using both conventional bivariate regressions and Bayesian variable selection methods. Urinary pyrethroid metabolites are consistently associated with pesticide factors around homes, including pesticide application in yards and food stocks, and IRS in the home during pregnancy, while more distant factors such as village spraying are not. High fat intake is associated with higher metabolite concentrations, and women from homes drawing water from wells or springs had marginally higher levels. Home pesticide use is the most consistent correlate of pyrethroid metabolite concentrations, but IRS, dietary habits, and household water source may also be important exposure determinants.

Contaminant mixtures are identified regularly in public and private drinking water supplies throughout the United States; however, the complex and often correlated nature of mixtures makes identification of relevant combinations challenging. This study employed a Bayesian clustering method to identify subgroups of water sources with similar metal and metalloid profiles. Additionally, a spatial scan statistic assessed spatial clustering of these subgroups and a human health metric was applied to investigate potential for human toxicity. These methods were applied to a dataset comprised of metal and metalloid measurements from unregulated water sources located on the Navajo Nation, in the southwest United States. Results indicated distinct subgroups of water sources with similar contaminant profiles and that some of these subgroups were spatially clustered. Several profiles had metal and metalloid concentrations that may have potential for human toxicity including arsenic, uranium, lead, manganese, and selenium. This approach may be useful for identifying mixtures in water sources, spatially evaluating the clusters, and help inform toxicological research investigating mixtures., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

The original version of this Article contained an error in the spelling of the author Stanley S. Chou, which was incorrectly given as Stan Chou. This has now been corrected in both the PDF and HTML versions of the Article.

Background: Pregnant women may be co-exposed to multiple insecticides in regions where both pyrethroids and dichlorodiphenyltrichloroethane (DDT) are used for indoor residual spraying (IRS) for malaria control. Despite the potential for adverse effects on offspring, there are few studies in areas where IRS is currently used and little is known about the effects of pyrethroids on children's health., Methods: We investigated the relationship between concentrations of four urinary pyrethroid metabolites in urine and organochlorine pesticide concentrations in maternal blood collected near delivery on body weight and body composition among children ≤2 years old participating in the prospective South Africa VHEMBE birth cohort (N = 708). We used measurements of length/height and weight collected at 1 and 2 years of age to calculate body mass index (BMI)-for-age, weight-for-age, and weight-for-height z-scores based on World Health Organization standards. We fit separate single-pollutant mixed effects models for each exposure of interest and also stratified by sex. We also fit all analyte concentrations jointly by using a Bayesian kernel machine regression (BKMR) statistical method to assess variable importance of each analyte and to explore the potential for joint effects of the multiple exposures., Results: Single-pollutant linear mixed effects models showed that, among girls only, p,p'-DDT was associated with higher BMI-for-age (adjusted [a]β = 0.22 [95% CI: 0.10, 0.35]; sex interaction p-value = 0.001), weight-for-height (aβ = 0.22 [95% CI: 0.09, 0.34]; sex interaction p-value = 0.002), and weight-for-age (aβ = 0.17 [95% CI: 0.05, 0.29], sex interaction p-value = 0.01). Although single-pollutant models suggested that p,p'-DDT and dichlorodiphenyldichloroethylene (p,p'-DDE) were also associated with these outcomes in girls, p,p'-DDE was no longer associated in multi-pollutant models with BKMR. The pyrethroid metabolites cis-(2,2-dibromovinyl)-2,2-dimethylcyclopropane-1-carboxylicacid (cis-DBCA) and trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (trans-DCCA) were inversely related to BMI-for-age and weight-for-height overall; however, results suggested that weight-for-age and weight-for-height associations for trans-DCCA (sex interaction p-value weight-for-age  = 0.02; p-value weight-for-height  = 0.13) and cis-DCCA (sex interaction p-value weight-for-age  = 0.02; p-value weight-for-height  = 0.08) were strongest and most consistent in boys relative to girls. BKMR also revealed joint effects from the chemical mixture. For instance, with increased concentrations of p,p'-DDE, the negative exposure-response relationship for cis-DBCA on BMI-for-age became steeper., Conclusions: Our single-pollutant and multi-pollutant model results show that maternal serum p,p'-DDT concentration was consistently and positively associated with body composition and body weight in young girls and that maternal urinary pyrethroid metabolite concentrations (particularly cis-DBCA and trans-DCCA) were negatively associated with body weight and body composition in young boys. Joint effects of the insecticide exposure mixture were also apparent, underscoring the importance of using advanced statistical methods to examine the health effects of chemical mixtures., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

The limited flux and selectivities of current carbon dioxide membranes and the high costs associated with conventional absorption-based CO 2 sequestration call for alternative CO 2 separation approaches. Here we describe an enzymatically active, ultra-thin, biomimetic membrane enabling CO 2 capture and separation under ambient pressure and temperature conditions. The membrane comprises a ~18-nm-thick close-packed array of 8 nm diameter hydrophilic pores that stabilize water by capillary condensation and precisely accommodate the metalloenzyme carbonic anhydrase (CA). CA catalyzes the rapid interconversion of CO 2 and water into carbonic acid. By minimizing diffusional constraints, stabilizing and concentrating CA within the nanopore array to a concentration 10× greater than achievable in solution, our enzymatic liquid membrane separates CO 2 at room temperature and atmospheric pressure at a rate of 2600 GPU with CO 2 /N 2 and CO 2 /H 2 selectivities as high as 788 and 1500, respectively, the highest combined flux and selectivity yet reported for ambient condition operation.

Purpose of Review: The inter-correlated nature of exposure-based risk factors in environmental health studies makes it a challenge to determine their combined effect on health outcomes. As such, there has been much research of late regarding the development and utilization of methods in the field of multi-pollutant modeling. However, much of this work has focused on issues related to variable selection in a regression context, with the goal of identifying which exposures are the "bad actors" most responsible for affecting the health outcome of interest. However, the question addressed by these approaches does not necessarily represent the only or most important questions of interest in a multi-pollutant modeling context, where researchers may be interested in health effects from co-exposure patterns and in identifying subpopulations associated with patterns defined by different levels of constituent exposures., Recent Findings: One approach to analyzing multi-pollutant data is to use a method known as Bayesian profile regression, which aids in identifying susceptible subpopulations associated with exposure mixtures defined by different levels of each exposure. Identification of exposure-level patterns that correspond to a location may provide a starting point for policy-based exposure reduction. Also, in a spatial context, identification of locations with the most health-relevant exposure-mixture profiles might provide further policy relevant information. In this brief report, we review and describe an approach that can be used to identify exposures in subpopulations or locations known as Bayesian profile regression. An example is provided in which we examine associations between air pollutants, an indicator of healthy food retailer availability, and indicators of poverty in Los Angeles County. A general tread suggesting that vulnerable individuals are more highly exposed and have limited access to healthy food retailers is observed, though the associations are complex and non-linear.

An important aspect of the new sustainable development goals (SDGs) is a greater emphasis on reducing the health impacts from ambient air pollution in developing countries. Meanwhile, the burden of human disease attributable to ambient air pollution in sub-Saharan Africa is growing, yet estimates of its impact on the region are possibly underestimated due to a lack of air quality monitoring, a paucity of air pollution epidemiological studies, and important population vulnerabilities in the region. The lack of ambient air pollution epidemiologic data in sub-Saharan Africa is also an important global health disparity. Thousands of air pollution health effects studies have been conducted in Europe and North America, rather than in urban areas that have some of the highest measured air pollution levels in world, including urban areas in sub-Saharan Africa. In this paper, we provide a systematic and narrative review of the literature on ambient air pollution epidemiological studies that have been conducted in the region to date. Our review of the literature focuses on epidemiologic studies that measure air pollutants and relate air pollution measurements with various health outcomes. We highlight the gaps in ambient air pollution epidemiological studies conducted in different sub-regions of sub-Saharan Africa and provide methodological recommendations for future environmental epidemiology studies addressing ambient air pollution in the region., Competing Interests: The authors declare no conflict of interest.

We previously showed that potential prenatal exposure to agricultural pesticides was associated with adverse neurodevelopmental outcomes in children, yet the effects of joint exposure to multiple pesticides is poorly understood. In this paper, we investigate associations between the joint distribution of agricultural use patterns of multiple pesticides (denoted as "pesticide profiles") applied near maternal residences during pregnancy and Full-Scale Intelligence Quotient (FSIQ) at 7 years of age. Among a cohort of children residing in California's Salinas Valley, we used Pesticide Use Report (PUR) data to characterize potential exposure from use within 1 km of maternal residences during pregnancy for 15 potentially neurotoxic pesticides from five different chemical classes. We used Bayesian profile regression (BPR) to examine associations between clustered pesticide profiles and deficits in childhood FSIQ. BPR identified eight distinct clusters of prenatal pesticide profiles. Two of the pesticide profile clusters exhibited some of the highest cumulative pesticide use levels and were associated with deficits in adjusted FSIQ of -6.9 (95% credible interval: -11.3, -2.2) and -6.4 (95% credible interval: -13.1, 0.49), respectively, when compared with the pesticide profile cluster that showed the lowest level of pesticides use. Although maternal residence during pregnancy near high agricultural use of multiple neurotoxic pesticides was associated with FSIQ deficit, the magnitude of the associations showed potential for sub-additive effects. Epidemiologic analysis of pesticides and their potential health effects can benefit from a multi-pollutant approach to analysis.

Aim and Objective: The purpose of this study was to explore how nurses provide bedtime oral hygiene care, how they decide on interventions provided, and what factors influence their ability to provide oral care., Background: Current evidence links poor oral hygiene to systemic and infectious diseases such as pneumonia. Hospitalised patients, who now retain their teeth into older adulthood, often rely on nurses to provide oral hygiene care. Nurses have the potential to impact oral health outcomes and quality of life by controlling plaque. However, oral hygiene care practices of nurses in postacute hospital settings are relatively unknown., Design: A qualitative, exploratory multiple-case study was conducted with 25 nurses working on five inpatient units at different hospitals., Methods: Nurses were accompanied on their evening rounds to observe oral care practices, the physical environment and workflow. Thematic analysis was used to analyse the case study data including transcripts of guided conversations, field notes and documents. Within-case analysis was followed by cross-case analysis., Results: Findings indicate that (i) nurses often convey oral hygiene care to their patients as being optional; (ii) nurses are inclined to preserve patient autonomy in oral hygiene care; (iii) oral hygiene care is often spontaneous and variable, and may not be informed by evidence; and (iv) oral hygiene care is not embedded into bedtime care routines., Conclusions: Oral hygiene care is discretionary and often missed care., Implications for Practice: Nurses need knowledge of the health benefits of oral care, and skills related to assessment and approaches to oral care. Availability of effective products and supplies facilitates provision of oral care. The evidence for oral hygiene care practices, outcomes of nurse-administered oral care and nursing's role in influencing the oral health literacy of patients require further study., (© 2016 John Wiley & Sons Ltd.)

Dependent older hospitalized patients rely on nurses to assist them with the removal of plaque from their teeth, dentures, and oral cavities. Oral care interventions by 25 nurses on post-acute units, where patients have longer hospital stays, were observed during evening care. In addition to efforts to engage patients in oral care, nurses provided the following interventions: (a) supporting the care of persons with dentures; (b) supporting the care of natural teeth; (c) cleansing the tongue and oral cavity; and (d) moisturizing lips and oral tissues. Patients' oral hygiene care was supported in just over one-third of encounters. Denture care was inconsistently performed, and was infrequently followed by care of the oral cavity. Nurses did not encourage adequate self-care of natural teeth by patients, and infrequently moisturized tissues. Evidence-based oral hygiene care standards are required to assist nurses to support patients in achieving optimal oral hygiene outcomes., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Education is needed for enhanced capacity of acute hospitals to provide dementia care. A nonrandomized controlled, repeated-measures design was used to evaluate a dementia education program delivered to an intervention group (IG, n = 468), compared to a wait-listed group (n = 277), representing separate sites of a multisite hospital. Participants completed self-efficacy for dementia and satisfaction measures and provided written descriptions of dementia care collected at baseline, postintervention (IG only), and at 8-week follow-up. Oral narratives were gathered from IG participants 8 weeks postintervention. The IG demonstrated significant improvement in self-efficacy scores from baseline to immediately postintervention (P < .001), sustained at 8 weeks. There were no changes from baseline to 8 weeks postintervention evident in the wait-listed group (P = .21). Intervention group participants described positive impacts including implementation of person-centered care approaches. Implementation of dementia care education programs throughout hospital settings is promising for the enhancement of dementia care., (© The Author(s) 2016.)

Research indicates that multiple outdoor air pollutants and adverse neighborhood conditions are spatially correlated. Yet health risks associated with concurrent exposure to air pollution mixtures and clustered neighborhood factors remain underexplored. Statistical models to assess the health effects from pollutant mixtures remain limited, due to problems of collinearity between pollutants and area-level covariates, and increases in covariate dimensionality. Here we identify pollutant exposure profiles and neighborhood contextual profiles within Los Angeles (LA) County. We then relate these profiles with term low birth weight (TLBW). We used land use regression to estimate NO2, NO, and PM2.5 concentrations averaged over census block groups to generate pollutant exposure profile clusters and census block group-level contextual profile clusters, using a Bayesian profile regression method. Pollutant profile cluster risk estimation was implemented using a multilevel hierarchical model, adjusting for individual-level covariates, contextual profile cluster random effects, and modeling of spatially structured and unstructured residual error. Our analysis found 13 clusters of pollutant exposure profiles. Correlations between study pollutants varied widely across the 13 pollutant clusters. Pollutant clusters with elevated NO2, NO, and PM2.5 concentrations exhibited increased log odds of TLBW, and those with low PM2.5, NO2, and NO concentrations showed lower log odds of TLBW. The spatial patterning of pollutant cluster effects on TLBW, combined with between-pollutant correlations within pollutant clusters, imply that traffic-related primary pollutants influence pollutant cluster TLBW risks. Furthermore, contextual clusters with the greatest log odds of TLBW had more adverse neighborhood socioeconomic, demographic, and housing conditions. Our data indicate that, while the spatial patterning of high-risk multiple pollutant clusters largely overlaps with adverse contextual neighborhood cluster, both contribute to TLBW while controlling for the other., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The highly intercorrelated nature of air pollutants makes it difficult to examine their combined effects on health. As such, epidemiological studies have traditionally focused on single-pollutant models that use regression-based techniques to examine the marginal association between a pollutant and a health outcome. These relatively simple, additive models are useful for discerning the effect of a single pollutant on a health outcome with all other pollutants held to fixed values. However, pollutants occur in complex mixtures consisting of highly correlated combinations of individual exposures. For example, evidence for synergy among pollutants in causing health effects has been recently reviewed by Mauderly and Samet (2009). Also, studies cited in the Ozone Criteria Document (U.S. Environmental Protection Agency [U.S. EPA*] 2006) confirmed that synergisms between ozone and other pollutants have been demonstrated in laboratory studies involving humans and animals. Thus, the highly correlated nature of air pollution exposures makes marginal, single-pollutant models inadequate. This issue was raised in a report by the National Research Council (NRC 2004), which called for a multipollutant approach to air quality management. Here we present and apply a series of statistical approaches that treat patterns of covariates as a whole unit, stochastically grouping pollutant patterns into clusters and then using these cluster assignments as random effects in a regression model. Using this approach, the effect of a multipollutant pattern, or profile, is determined in a manner that takes into account the uncertainty in the clustering process. The models are set in a Bayesian framework, and in general, Markov chain Monte Carlo (MCMC) techniques (Gilks et al. 1998). For interpretation purposes, a best clustering is derived, and the uncertainty related to this best clustering is determined by utilizing model averaging techniques, in a manner such that consistent clustering obtained by the estimation process generally yields smaller standard errors while inconsistent clustering is generally associated with larger errors. These multivariate methods are applied to a range of different problems related to air pollution exposures, namely an association of multipollutant profiles with indicators of poverty and to an assessment of the association between measures of various air pollutants, patterns of socioeconomic status (SES), and birth outcomes. All of these studies involve an examination of regional-level exposures, at the census tract (CT) and census block group (CBG) levels, and individual-level outcomes throughout Los Angeles (LA) County. Results indicate that effects of pollutants vary spatially and vary in a complex interconnected manner that cannot be discerned using standard additive line ar models. Results obtaine d from these studies can be used to efficiently use limited resources to inform policies in targeting are as where air pollution reductions result in maximum health benefits.

Air pollution epidemiological studies suggest that elevated exposure to fine particulate matter (PM2.5) is associated with higher prevalence of term low birth weight (TLBW). Previous studies have generally assumed the exposure-response of PM2.5 on TLBW to be the same throughout a large geographical area. Health effects related to PM2.5 exposures, however, may not be uniformly distributed spatially, creating a need for studies that explicitly investigate the spatial distribution of the exposure-response relationship between individual-level exposure to PM2.5 and TLBW. Here, we examine the overall and spatially varying exposure-response relationship between PM2.5 and TLBW throughout urban Los Angeles (LA) County, California. We estimated PM2.5 from a combination of land use regression (LUR), aerosol optical depth from remote sensing, and atmospheric modeling techniques. Exposures were assigned to LA County individual pregnancies identified from electronic birth certificates between the years 1995-2006 (N=1,359,284) provided by the California Department of Public Health. We used a single pollutant multivariate logistic regression model, with multilevel spatially structured and unstructured random effects set in a Bayesian framework to estimate global and spatially varying pollutant effects on TLBW at the census tract level. Overall, increased PM2.5 level was associated with higher prevalence of TLBW county-wide. The spatial random effects model, however, demonstrated that the exposure-response for PM2.5 and TLBW was not uniform across urban LA County. Rather, the magnitude and certainty of the exposure-response estimates for PM2.5 on log odds of TLBW were greatest in the urban core of Central and Southern LA County census tracts. These results suggest that the effects may be spatially patterned, and that simply estimating global pollutant effects obscures disparities suggested by spatial patterns of effects. Studies that incorporate spatial multilevel modeling with random coefficients allow us to identify areas where air pollutant effects on adverse birth outcomes may be most severe and policies to further reduce air pollution might be most effective., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

Elite dancers often engage in mental practice during training, but little is known about the effects of discrete, repetitive motor imagery on dance movement performance. This study compared the effects of two motor imagery modalities, third-person visual imagery and kinesthetic imagery, on hip and pelvis kinematics during two technical dance movements, plié and sauté. Twenty-four female dancers (mean age: 26.04; mean years of training: 19.63) were randomly assigned to a type of imagery practice: visual imagery (VI), kinesthetic imagery (KI), or a mental arithmetic task control condition (MAT). No statistically significant effects of imagery group or task type were found for external hip rotation, sagittal pelvic excursion, or a ratio relating hip to pelvic movement, suggesting that imagery practice did not affect either temporal or kinematic characteristics of the plié or sauté.

Pain management for older adults in long-term care (LTC) has been recognized as a problem internationally. The purpose of this study was to explore the role of a clinical nurse specialist (CNS) and nurse practitioner (NP) as change champions during the implementation of an evidence-based pain protocol in LTC. In this exploratory, multiple-case design study, we collected data from two LTC homes in Ontario, Canada. Three data sources were used: participant observation of an NP and a CNS for 18 hours each over a 3-week period; CNS and NP diaries recording strategies, barriers, and facilitators to the implementation process; and interviews with members of the interdisciplinary team to explore perceptions about the NP and CNS role in implementing the pain protocol. Data were analyzed using thematic content analysis. The NP and CNS used a variety of effective strategies to promote pain management changes in practice including educational outreach with team members, reminders to nursing staff to highlight the pain protocol and educate about practice changes, chart audits and feedback to the nursing staff, interdisciplinary working group meetings, ad hoc meetings with nursing staff, and resident assessment using advanced skills. The CNS and NP are ideal champions to implement pain management protocols and likely other quality improvement initiatives., (Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.)

Purpose: We examined prospectively changes in current BMI and body weight dissatisfaction in women with and without eating disorders (EDs) during and after pregnancy compared to prepregnancy., Methods: We assessed pregnant women with (ED group, N = 18) and without an ED (Control group, N = 129) using current BMI and the discrepancy between current and desired BMI (body weight dissatisfaction). This is a measure representative of overall body dissatisfaction. Women were assessed retrospectively for prepregnancy, and prospectively at weeks 12-14 (first trimester), weeks 24-26 (second trimester) and weeks 34-36 (third trimester) during pregnancy and 3, 6 and 12 months after., Results: Compared with prepregnancy, current BMI for the ED group increased at trimester two and three and returned to prepregnancy levels postpartum, while current BMI for the Control group increased at trimester one, two, three, and remained above their prepregnancy BMI at 3, 6 and 12 months postpartum. Compared with prepregnancy levels, body weight dissatisfaction for the ED group improved at 6 and 12 months postpartum, while body weight dissatisfaction for the Control group increased at trimester two and three, and remained greater at 3 and 6 months postpartum before returning to prepregnancy levels at 12 months postpartum. Maximum dissatisfaction occurs in trimester three for both the ED (mean 2.98, SD 2.74) and Control groups (mean 2.93, SD 3.22)., Conclusions: Body dissatisfaction does not improve during pregnancy in women with or without EDs. Body weight dissatisfaction remained unchanged for women with EDs during pregnancy, before a decrease at 6 and 12 months postpartum. Body weight dissatisfaction increased for women without EDs, and remained elevated until 6 months postpartum. Despite this, women with and without EDs gained significant weight during pregnancy This suggests all women require information and support regarding body image during the pregnancy and in the 12 months postpartum.

Gentle Persuasive Approaches in Dementia Care (GPA), a curriculum originally designed for long-term care, was introduced into an acute care setting. This person-centered approach to supporting and responding to persons with behaviors associated with dementia was shown to be applicable for staff on an orthopaedic surgery unit where they had reported significant challenges and care burdens when faced with behaviors such as shouting, explosiveness, and resistance to care. Staff confidence in their ability to care for persons with behaviors increased after attending the 1-day GPA workshop, and they reported being highly satisfied with the curriculum, found it to be applicable to their practice, indicated that it was also useful for patients with delirium, and would recommend it to others. Some of the staff on the orthopaedic unit became certified GPA coaches. The passion of those champions, along with demonstrated success of the program on their unit, contributed to its spread to other units, including rehabilitation and acute medicine.

Gentle Persuasive Approaches (GPA) in Dementia Care, a program designed for staff caring for patients in long-term care who exhibit challenging behaviors, was implemented and has been sustained in an acute care setting. Outcomes include fewer codes indicating violent situations, a reduction in physical restraint and sitter use, and fewer reports of safety incidents involving agitated patients. In this article, we describe the innovation (GPA) and the strategies used to sustain its successful implementation.

Objective: Body dissatisfaction is present in a majority of women without eating disorders (EDs), and almost all women with EDs. We compared body dissatisfaction in women with and without EDs to determine at which BMI women are content with their weight, and to determine if body dissatisfaction is affected by the presence of purging behaviours., Methods: We assessed women, age 18 to 55 with an ED (N=431) and without an ED (N=719) using the discrepancy between their current and desired BMI. This measure of body weight dissatisfaction (BWD) has been validated as being representative of overall body dissatisfaction. We also measured perceptions of (i) Body Appearance and (ii) Body Image to confirm our results., Results: Women with and without EDs wished to lose weight until very low weights were achieved (BMI 15-16 kg/m(2) and BMI 18-19 kg/m(2) respectively). BWD is higher in women with EDs (median 1.77, IQR 0-4.61) than women without EDs (median 0.85, IQR 0-1.80, p<0.001). Purging behaviours in women with EDs were associated with lower BMIs to achieve body satisfaction (BMI 15-16 kg/m(2)) than women who did not purge (16-17 kg/m(2))., Conclusions: Body weight dissatisfaction is highly prevalent amongst women with and without EDs. Understanding body weight dissatisfaction in women with EDs and its association with purging may assist in the prevention, detection and treatment of these disorders. Women with EDs should be informed that body weight dissatisfaction will not resolve with the cessation of their disorder, as it is prevalent within the general population., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Nurses have a critical role in promoting oral health in dependent older adults residing in long-term care or having extended hospital stays. Strategies aimed at improving the quality of oral hygiene care nurses provide may contribute to better oral hygiene outcomes. The purpose of this systematic review was to examine the effect of intervention programs designed to enhance the ability of nurses or those to whom they delegate care to improve oral hygiene outcomes in frail older adults. Studies reported an educational program, either alone or augmented in some way. The study interventions consisted of: (a) single in-service education sessions; (b) single in-service education sessions supplemented by a "train-the-trainer" approach; and (c) education sessions supplemented with ongoing active involvement of a dental hygienist. None of the approaches emerged as being desirable over the others, as methodologically strong studies with good intervention integrity were lacking, and a variety of oral health outcomes were used to measure effectiveness of the interventions, making comparisons across studies difficult., (Copyright 2014, SLACK Incorporated.)

Aim: To report a concept analysis of oral hygiene care., Background: Oral hygiene care, as it is provided to older patients in hospital and long-term care settings by nurses and their delegates, has the potential to contribute to the oral health of patients while preventing aspiration pneumonia as well as periodontitis, which itself has been associated with several systemic diseases. However, the state of oral cleanliness in such patients tends to be poor and despite the existence of guidelines, nursing care practices may be inadequate and not reflective of recent advances in knowledge., Design: Concept analysis., Data Sources: A search of electronic databases (2002-2012), use of internet search engines, and hand searching yielded an international data set of 66 research studies, reviews, and practice guidelines., Review Methods: The concept analysis method of Walker and Avant was used to explore the concept of oral hygiene care in the context of frail older patients., Results: Oral hygiene care involves approaches informed by knowing the patient, inspecting the oral cavity, removing plaque, cleansing the oral tissues, decontaminating the oral cavity, using fluoride products and maintaining oral tissue moisture. Those attributes, along with their antecedents and consequences, form a conceptual framework from which a middle-range theory of nurse-administered oral hygiene care is derived that could be tested, evaluated, modified, and translated into practice., Conclusions: Clarity around the concept of oral hygiene care as a nursing intervention could enable nurses to impact oral health outcomes and possibly prevent systemic diseases in older patients., (© 2013 Blackwell Publishing Ltd.)

Objective: To compare prevalence of problems with body weight, eating and exercise (past or present) of female psychiatric inpatients with routine care, gynaecological and obstetric female outpatients, and eating disorder inpatients., Method: One thousand and thirty-eight females aged 18-55 years from routine care (n=99), gynaecological (n=263) and obstetric (n=271) outpatient clinics, and eating disorder (n=223) and general psychiatric units (n=182) participated. Participants self-reported past or current problems with weight, eating and exercise using a short survey. A sub-sample of women completed the Eating and Exercise Examination (EEE) which includes the Quality of Life for Eating Disorders (QOL ED)., Results: The prevalence of self-reported problems controlling weight (52%), disordered eating and eating disorders (43%) for the psychiatric patients was significantly greater than for the routine care and gynaecological and obstetrics outpatients. The psychiatric group had a significantly higher mean body mass index (BMI) of 27.3 kg/m(2) (standard deviation (SD)=6.7) and prevalence of self-reported obesity (28%) than the other groups., Conclusion: Treatment of women with psychiatric problems should include assessment and concurrent attention to body weight, eating disorder and exercise problems in association with appropriate medical, psychiatric, psychological and medication treatment of their presenting disorder.

Objectives: To evaluate the effectiveness of (1) dissemination strategies to improve clinical practice behaviors (eg, frequency and documentation of pain assessments, use of pain medication) among health care team members, and (2) the implementation of the pain protocol in reducing pain in long term care (LTC) residents., Design: A controlled before-after design was used to evaluate the effectiveness of the pain protocol, whereas qualitative interviews and focus groups were used to obtain additional context-driven data., Setting: Four LTC facilities in southern Ontario, Canada; 2 for the intervention group and 2 for the control group., Participants: Data were collected from 200 LTC residents; 99 for the intervention and 101 for the control group., Intervention: Implementation of a pain protocol using a multifaceted approach, including a site working group or Pain Team, pain education and skills training, and other quality improvement activities., Measurements: Resident pain was measured using 3 assessment tools: the Pain Assessment Checklist for Seniors with Limited Ability to Communicate, the Pain Assessment in the Communicatively Impaired Elderly, and the Present Pain Intensity Scale. Clinical practice behaviors were measured using a number of process indicators; for example, use of pain assessment tools, documentation about pain management, and use of pain medications. A semistructured interview guide was used to collect qualitative data via focus groups and interviews., Results: Pain increased significantly more for the control group than the intervention group over the 1-year intervention period. There were significantly more positive changes over the intervention period in the intervention group compared with the control group for the following indicators: the use of a standardized pain assessment tool and completed admission/initial pain assessment. Qualitative findings highlight the importance of reminding staff to think about pain as a priority in caring for residents and to be mindful of it during daily activities. Using onsite champions, in this case advanced practice nurses and a Pain Team, were key to successfully implementing the pain protocol., Conclusions: These study findings indicate that the implementation of a pain protocol intervention improved the way pain was managed and provided pain relief for LTC residents., (Copyright © 2012 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.)

Background: Research indicates that 40% of hospital-acquired delirium cases may be preventable. However, despite its clinical significance, delirium often goes unrecognized or is misdiagnosed. The purpose of this study was to assess the need for delirium education in acute care hospitals in Hamilton, Ontario., Methods: Approximately 100 health professionals were trained as delirium screeners. On 'Delirium Day', all patients ≥ 65 years of age in non-critical care areas in all acute care sites in Hamilton were identified. Those willing to take part in the prevalence study were assessed for delirium using the Standardized Mini-Mental State Examination and the Confusion Assessment Method. The Research Ethics Boards at Hamilton Health Sciences and St. Joseph's Healthcare Hamilton approved this quality assurance project., Results: Of the 562 patients eligible for screening, eight were excluded and six did not have sufficient data collected to assess for delirium. Of the 548 individuals screened for delirium, 10.6% screened positive. Prevalence estimates ranged by site from 0% to 21% and type of unit from 3.8% to 16%. Recognition of delirium by nursing staff was fair; but, documentation was usually absent., Conclusion: While the prevalence rates were somewhat lower than in other studies, the results support the need for education among health-care providers in the prevention, identification, and management of delirium.

According to data from the 1997 NICHD Study of Child Care, center-based child care can have deleterious effects on children's social-emotional development. We hypothesized that training child care professionals to develop positive relationships with children in their care would improve the quality of center-based child care. Thirty-three professional caregiver-child pairs participated in the intervention group and 24 professional caregiver-child pairs were assigned to a care as usual comparison group. The intervention consisted of an informational and a practice component with an emotional availability (EA) coach. The infants and toddlers (ages 11 to 23 months) in the classrooms were enrolled in the project only if they spent at least 20 hr per week in center-based care. The measures included were (a) the EA Scales, (b) the Attachment Q-Sort, and (c) the Classroom Interaction Scale. The intervention group professional caregiver-child relationships showed improvements on the EA Scales, Attachment Q-Sort, and the Classroom Interaction Scale from pre- to posttest, compared to the comparison group, who showed some decrements over a comparable period of time.

Background: Adherence to treatment is a complex and poorly understood phenomenon. This study investigates the relationship between older depressed patients' adherence to antidepressants and their beliefs about and knowledge of the medication., Methods: Assessment was undertaken of 108 outpatients over the age of 55 years diagnosed with depressive disorder and treated for at least four weeks with antidepressants. Adherence was assessed using two self-report measures: the Medication Adherence Rating Scale (MARS) and a Global Adherence Measure (GAM). Potential predictors of adherence investigated included sociodemographic, medication and illness variables. In addition, 33 carers were interviewed regarding general medication beliefs., Results: 56% of patients reported 80% or higher adherence on the GAM. Sociodemographic variables were not associated with adherence on the MARS. Specific beliefs about medicines, such as "my health depends on antidepressants" (necessity) and being less worried about becoming dependant on antidepressants (concern) were highly correlated with adherence. General beliefs about medicines causing harm or being overprescribed, experiencing medication side-effects and severity of depression also correlated with poor adherence. Linear regression with the MARS as the dependent variable explained 44.3% of the variance and showed adherence to be higher in subjects with healthy specific beliefs who received more information about antidepressants and worse with depression severity and autonomic side-effects., Conclusions: Our findings strongly support a role for specific beliefs about medicines in adherence. Challenging patients' beliefs, providing information about treatment and discussing side-effects could improve adherence. Poor response to treatment and medication side-effects can indicate poor adherence and should be considered before switching medications.

Purpose: The study purposes were twofold: (1) to explore barriers to pain management and those associated with implementing a pain management program in long-term care (LTC); and (2) to develop an interprofessional approach to improve pain management in LTC., Methods: A case study approach included both qualitative and quantitative components. We collected data at two LTC sites using seven focus groups for the licensed nurses, unregulated care providers and physicians, and 10 interviews with other health care provider groups, administration, and residents. We reviewed documents and administered a short survey to study participants to assess perceptions of barriers to pain management., Results: The findings revealed barriers to effective LTC pain management at the resident/family, health care provider, and system levels. We then developed a six-tiered model with proposed interventions to address these barriers., Conclusions: This model can guide the development of innovative approaches to improving pain management in LTC settings.

Nurses' perceptions of barriers preventing optimal pain management in older adults on acute medical units and the extent to which they perceived they had adopted four evidence-based practices related to pain assessment and management were often incongruent with actual practice. Eliciting reports of pain, offering pro re nata pain relief regularly, utilizing pain assessment tools in patients with cognitive impairment, redesigning documentation tools and processes, making nonpharmacological alternatives accessible, and helping patients and families manage side effects would target the 12 barriers having the biggest impact., (2010 Elsevier Inc. All rights reserved.)

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in hospitalized patients. Recent guidelines from the Department of Health and the National Institute for Health and Clinical Excellence recommend mandatory, universal VTE risk assessment for hospitalized patients and the provision of appropriate prevention measures (thromboprophylaxis). Careful selection of a suitable VTE risk assessment approach is required to improve the chance of its successful implementation in hospital. At-risk patients need to be identified, counselled and the most appropriate thromboprophylaxis selected, prescribed and delivered. Nurses are ideally placed to play a central role in the implementation of this change in clinical practice through leadership and education. Extended pharmacological thromboprophylaxis has been recommended in certain high-risk groups. New oral anticoagulants are being evaluated, which could change the way thromboprophylaxis is administered in future, benefiting both patients and nurses.

Persistent pain is a significant problem for older hospitalized adults and their health care team. A better understanding of the approach to pain management in the clinical setting will provide guidance for the development of improvements in clinical management. The purpose of this study was to determine the prevalence of pain and to examine the current state of pain assessment and management in older adults on the six acute medical units of an academic health sciences centre. Findings revealed that 70% of older patients were in pain, nurses had limited awareness of their patients' pain, documentation of pain assessment and management was lacking, and pain was under-treated. Utilization of practice guidelines related to management of persistent pain in older adults in acute care settings is recommended, and an approach to their implementation, including identifying and overcoming the barriers to such best practices, is warranted.

The purpose of this study is to explore attitudes and beliefs that affect decisions about prescribing and administering pain medications in older adults who live in long-term care (LTC), with a particular emphasis on those with cognitive impairment. At each of the four participating LTC facilities, data were gathered from three separate groups of health care professionals: physicians, registered nurses, and registered practical nurses. Based on grounded theory, a model was developed that highlighted critical decision points for nurses and physicians regarding pain management. The major themes that emerged from the data concerned pain assessment (lack of recognition of pain, uncertainty about the accuracy of pain assessment and diagnosis) and treatment (reluctance to use opioids, working to individualize pain treatments, issues relating to physician trust of the nurse on prescribing patterns). These findings may facilitate the development of innovative approaches to pain management in LTC settings.

Background and Objectives: Sarcoidosis is a systemic granulomatous disease of unknown aetiology and pathogenesis. This study evaluated the seasonal variation in the onset of symptoms, Tuberculin anergy and Kveim positive reaction in a cohort of 492 patients with sarcoidosis and in a subgroup of 248 patients with known Kveim test responses., Methods: The medical records of 492 patients with sarcoidosis were retrospectively reviewed. Roger's test for cyclic variation was used to assess the statistical significance of the observed seasonal variation., Results: For all sarcoidosis patients (n = 492) the onset of symptoms was most frequent in spring (61.8%) and least frequent in summer (31.7%) (P < 0.001). For patients with Tuberculin anergy (n = 364) the onset of symptoms was most frequent in spring and least frequent in autumn (P < 0.001); there was no seasonal variation among Tuberculin positive patients (n = 128). Of those patients with a Kveim test result (n = 248), the onset of symptoms was most frequent in spring and least frequent in summer (P < 0.001); there was no seasonal variation for patients with a negative Kveim results (n = 50 patients)., Conclusions: The onset of the symptoms was most frequent in spring and least frequent in the second half of the year (summer or autumn) in patients with sarcoidosis, Tuberculin anergy and a positive Kveim reaction. The significance of this finding in relation to aetiology and clinical utility needs to be further assessed.

Organizational interventions are being suggested to increase the rate of quality research dissemination and uptake. This article describes how one tertiary institution is using an evidence-based nursing (EBN) committee as an organizational strategy to shift its nursing culture toward clinical scholarship. A number of approaches and activities that have stimulated the movement toward evidence-based practice (EBP) are examined: organizational commitment to EBP, strategic positioning of the EBN committee within nursing's administrative structure, articulation of a mission, conceptualization of a model for EBN practice, learning on the job, selection and adoption of an evidence-based model for implementing change, marketing for a change in culture toward clinical scholarship, and other selected examples of projects undertaken by the committee. Action-oriented principles associated with committee experiences are related to the approaches and activities.

Although oriented carbon nanotubes, oriented nanowires of metals, semiconductors and oxides have attracted wide attention, there have been few reports on oriented polymer nanostructures such as nanowires. In this paper we report the assembly of large arrays of oriented nanowires containing molecularly aligned conducting polymers (polyaniline) without using a porous membrane template to support the polymer. The uniform oriented nanowires were prepared through controlled nucleation and growth during a stepwise electrochemical deposition process in which a large number of nuclei were first deposited on the substrate using a large current density. After the initial nucleation, the current density was reduced stepwise in order to grow the oriented nanowires from the nucleation sites created in the first step. The usefulness of these new polymer structures is demonstrated with a chemical sensor device for H(2)O(2), the detection of which is widely investigated for biosensors. Finally, we demonstrated that controlled nucleation and growth is a general approach and has potential for growing oriented nanostructures of other materials.

Accurate prediction of fall-prone hospitalized older adults may be integral to reducing falls. The STRATIFY, a simple 5-point falls prediction tool, was prospectively validated on a Geriatric Assessment and Rehabilitation Unit as a one-time initial predictor of patients likely to fall. Sensitivity and specificity were lower than in the original British study. Introducing risk assessments validated elsewhere on a patient care unit or on a hospital-wide scale requires caution.

Background: The aim of the present study was to assess the changes in frequency and pattern of religious symptomatology in a sample of psychiatric inpatients in Egypt suffering from some form of psychotic illness over the time span from 1975 to 1996., Method: A sample of 5275 files of psychotic inpatients at Behman psychiatric hospital in Cairo, Egypt, admitted between 1975 and 1996, were scrutinized for the presence or absence of "religious" symptoms. All the files with religious symptoms from this sample (n=632) and an additional 281 comparison files were analyzed., Results: Significant fluctuations in the frequency of religious symptoms over the period of the study were noted. The frequency of religious symptoms peaked in the mid-1970s to early 1980s, and again in the early and mid-1990s, relative to other time periods. Further analyses of changes in the frequency of specific religious themes or symptoms revealed that religious behaviors (i. e., increased reading of religious texts, preaching, and other types of overt religious expression), in particular, showed significant and consistent patterns of change., Conclusions: These findings were interpreted in light of the fluctuating emphasis on religion and religious affiliation in everyday life in Egypt during the period of the study. While the overall frequency of religious delusional themes in Egypt is sensitive to societal changes across time, the specific content of these delusions remains stable. On the other hand, the relative salience of behavioral modes of pathological religious expression is highly influenced by changing patterns of religious emphasis in Egyptian society.

Learning about aspects of one's personhood allows the nurse to know the individual as a person and to individualize the care provided. A pilot project was conducted on a supportive residential care unit to explore why health records in long-term care rarely reveal who the person is. Five nurse participants generated a list of features of an individual's personhood that they felt should be known by members of the team. They subsequently gathered that information from a variety of sources, with documentation in a designated location provided on the plan of care. They were thus able to overcome some of the previously encountered barriers to collecting and documenting the personhood data reflecting their knowledge of the individual as a person. Although nurses were successful in learning who the persons were, changes in approach to care as a result of the new knowledge have not been measured.