Feasibility and acceptability of a web-based HIV/STD prevention program for adolescent girls targeting sexual communication skills

Adolescent girls are at substantial risk of sexually transmitted diseases including HIV. To reduce these risks, we developed Health Education And Relationship Training (HEART), a web-based intervention focused on developing sexual assertiveness skills and enhancing sexual decision-making. This study assessed the feasibility and acceptability of this new program and examined if perceived acceptability varied according to participant ethnicity, sexual orientation or sexual activity status. Participants were part of a randomized controlled trial of 222 10th-grade girls (Mage = 15.26). The current analyses included those in the intervention condition (n = 107; 36% white, 27% black and 29% Hispanic). HEART took approximately 45 min to complete and was feasible to administer in a school-based setting. Participants found the program highly acceptable: 95% liked the program and learned from the program, 88% would recommend the program to a friend and 94% plan to use what they learned in the future. The primary acceptability results did not vary by the ethnicity, sexual orientation or sexual activity status of participants, suggesting broad appeal. Results indicate that this new online program is a promising method to reach and engage adolescents in sexual health education.

Survey of nongovernmental organizations providing pediatric cardiovascular care in low- and middle-income countries

BACKGROUND

Nearly 90% of the children with heart disease in low- and middle-income countries (LMICs) cannot access cardiovascular (CV) services. Limitations include inadequate financial, human, and infrastructure resources. Nongovernmental organizations (NGOs) have played crucial roles in providing clinical services and infrastructure supports to LMICs CV programs; however, these outreach efforts are dispersed, inadequate, and lack coordination.

METHODS

A survey was sent to members of the World Society for Pediatric and Congenital Heart Society and PediHeart.

RESULTS

A clearinghouse was created to provide information on NGO structures, geographic reach, and scope of services. The survey identified 80 NGOs supporting CV programs in 92 LMICs. The largest outreach efforts were in South and Central America (42%), followed by Africa (18%), Europe (17%), Asia (17%), and Asia-Western Pacific (6%). Most NGOs (51%) supported two to five outreach missions per year. The majority (87%) of NGOs provided education, diagnostics, and surgical or catheter-based interventions. Working jointly with LMIC partners, 59% of the NGOs performed operations in children and infants; 41% performed nonbypass neonatal operations. Approximately a quarter (26%) reported that partner sites do not perform interventions in between missions.

CONCLUSIONS

Disparity and inadequacy in pediatric CV services remain an important problem for LMICs. A global consensus and coordinated efforts are needed to guide strategies on the development of regional centers of excellence, a global outcome database, and a CV program registry. Future efforts should be held accountable for impacts such as growth in the number of independent LMIC programs as well as reduction in mortality and patient waiting lists.

Audit of the job satisfaction levels of the UK radiography and physics workforce in UK radiotherapy centres 2012

OBJECTIVE

Workforce planning reports identify a staff shortfall that jeopardizes the ability of UK radiotherapy centres to meet future demands. Obtaining an understanding of the work experiences of radiotherapy professionals will support the development of strategies to increase job satisfaction, productivity and effectiveness.

METHODS

A quantitative survey assessed job satisfaction, attitudes to incident reporting, stress and burnout, opportunities for professional development, workload, retention and turnover. Clinical oncologists were not included, as the Royal College of Radiologists, London, UK, had recently assessed their members' satisfaction. All questions were taken from validated instruments or adapted from the "UK National Health Service Staff Survey".

RESULTS

The survey yielded 658 completed responses (approximately 16% response rate), from public and private sectors. Over a third (36%) of respondents were classified as satisfied for job satisfaction with 11% dissatisfied and the remaining 53% ambivalent. A significant proportion of clinical staff (37.5%) report high emotional exhaustion. Presenteeism was an issue with 42.4% attending work despite feeling unable to fulfil their role.

CONCLUSION

Radiotherapy professionals are prone to the effects of compassion fatigue and burnout. Attention must be paid to workload and its impact on practitioners' job satisfaction. Professional development that is supported and informed by a performance development review is a simple and effective means of enhancing satisfaction. Individuals have a responsibility to themselves and their colleagues as their behaviours and attitudes influence job satisfaction.

ADVANCES IN KNOWLEDGE

This work identifies areas for future research to enhance the professional resilience of practitioners, in order to provide high-quality treatments.

Effect of thymectomy on human peripheral blood T cell pools in myasthenia gravis

The human thymus is required for establishment of the T cell pool in fetal life, but postnatal thymectomy does not lead to immunodeficiency in humans. Because thymectomy in humans is performed for treatment of myasthenia gravis (MG), we have studied patients with MG for effects of thymectomy on peripheral blood (PB) naive (CD45RA(+), CD62L(+)) and memory (CD45RO(+)) T cells. We have also determined the effect of thymectomy on levels of PB cells containing signal joint TCR delta excision circles (TRECs), a molecular marker of thymus emigrants that have divided few times after leaving the thymus. In 17 nonthymectomized and 26 thymectomized MG patients studied at varying times after thymectomy (1 day to 41 years), we found no significant mean difference in PB T cell TREC levels between ages 40 and 80 years. However, both thymectomized and nonthymectomized MG patients had lower PB T cell TREC levels than did age-matched normal subjects (p < 0.0001 for both). These data demonstrated that MG itself or treatment for MG decreased thymopoiesis independent of thymectomy. Next, to control for disease activity and treatment, we prospectively studied 10 MG patients before and from 27 to 517 days after thymectomy. We found that thymectomy decreased CD4 or CD8 T cell TREC concentrations most when thymopoiesis was active before thymectomy (six of six patients), but had little effect in patients when thymopoiesis was minimal (four of four patients). In contrast, there was no significant effect of thymectomy on absolute numbers of naive PB T cells. Thus, in MG, removal of a thymus with active thymopoiesis resulted in a significant fall in PB TREC(+) T cells postthymectomy.

Adaptation to metastatic cancer pain, regional/local cancer pain and non-cancer pain: role of psychological and behavioral factors

The present study compared the adaptation of cancer pain patients and chronic non-cancer pain patients. Differences between samples of cancer pain patients with and without metastatic disease were also examined. Cancer pain patients reported comparable levels of pain severity to non-cancer chronic pain patients; however, pain due to cancer was associated with higher levels of perceived disability (t(250) = 2.97, P < 0.004) and lower degree of activity (t(286) = 2.45, P < 0.04). The patients with cancer pain, particularly those with metastatic disease, reported significantly higher levels of support and solicitous behaviors from significant others, compared to non-cancer chronic pain patients. The majority of the cancer patients, both with (81%) and without (84%) metastatic disease as well as non-cancer chronic pain patients (85%), could be classified into one of three psychosocial subgroups that had been previously identified with non-cancer chronic pain patients: 'dysfunctional' (high levels of pain, perceived interference, affective distress and low levels of perceived control and activity), 'interpersonally distressed' (high levels of affective distress, negative responses from significant others and low levels of perceived support) and 'adaptive copers' (low levels of interference and affective distress, high levels of perceived control and activity). The distribution of the profiles was significantly different across groups (chi2(4) = 12.79, P < 0.02). However, within each profile. the response patterns were highly comparable across groups. Thus, contrary to the suggestions of some authors, cancer pain and non-cancer chronic pain patients share many features in common. Furthermore, the heterogeneity of psychosocial adaptation to pain within each patient group suggests the importance of psychological assessment in determining the pain management plan.

A validation study using the case-control method of the nursing diagnosis high risk for aspiration

PURPOSE

To develop further the nursing diagnosis risk for aspiration by determining risk factors present in patients who aspirated.

METHODS

The case-control design was used to compare cases (n = 131) and controls (n = 206) on past and present exposures thought to be risk factors for aspiration. Data were analyzed using univariate and multiple logistic regression.

FINDINGS

The following risk factors were statistically significant and comprise the final model: altered level of consciousness, metoclopramide (known to accelerate gastric emptying), vomiting, seizures, and unable to change own position.

CONCLUSIONS

The risk factors of altered level of consciousness and delayed gastric emptying are currently included in the NANDA taxonomy for the nursing diagnosis risk for aspiration. These risk factors are not included in the taxonomy: vomiting, seizures, and unable to change own position. Results of the study have been submitted to the Diagnosis Review Committee for consideration to further develop this diagnosis.

Developmental changes in the dendritic architecture of salt-sensitive neurons in the nucleus of the solitary tract

Recent studies have provided evidence that brainstem gustatory neurons undergo substantial dendritic growth during a period of postnatal development that coincides with the maturation of their response to salts, suggesting a relationship (perhaps causal) between the physiology and morphology of developing salt-sensitive neurons. In an initial effort to explore this issue, we used extracellular and intracellular recording and intracellular labeling techniques to examine the structure and function of individual gustatory neurons in the rostral nucleus of the solitary tract (rNST) of young (postnatal day [P] 22-28) and adult rats. We found that P22-28 cells that responded to all three of the salts in our taste array had a greater dendritic length, a greater cell volume, and more dendritic branches than the cells that responded to one salt. As a group, taste-sensitive neurons in P22-28 animals had a higher maximum dendritic branch order and a trend toward more dendritic branch points than gustatory neurons in adult animals. The dendritic arbors of P22-28 taste neurons that responded to all three salts were larger (greater surface area and volume), more extensive in the rostrocaudal axis and exhibited a higher maximum branch order, more branch points and higher swelling density than adult cells that responded to all three salts. These results demonstrate that the morphology of salt-sensitive gustatory neurons in developing animals is closely related to the number of salts that evoke a response. The data also support the postulate that gustatory neurons in the rat brainstem undergo substantial dendritic remodeling between the fourth week of life and adulthood. Dendritic remodeling may play an important role in the maturation of the rNST response to NaCl.

Ultrasound Devulcanization of SBR: Molecular Mobility of Gel and Sol

In an effort to support the recycling of rubbery polymers and composites, 1H NMR relaxation and pulsedgradient spin echo diffusion measurements have been performed on virgin and unfilled vulcanized strene-butadiene rubber (SBR), and networks after various extents of devulcanization using an ultrasound technique. The NMR methods recognize unentangled light molecules (e.g. sol), but do not distinguish between unattached entangled large molecules and chemical network segments. Devulcanization generates additional sol with a wide mass distribution, thus increasing both sol and gel mobility, but decreasing sol mean diffusivity. The latter effect is accounted for by the increasing mean sol molecular mass but also by the increasing glass transition temperature, which is related to main-chain stiffening seen in our earlier 13C NMR experiments. In addition to improving the molecular-level understanding of devulcanization, this study provides guidance for the optimization of the devulcanization parameters.

Percutaneous endoscopic gastrostomy

Percutaneous endoscopic gastrostomy (PEG) is now the technique of choice for patients requiring long-term enteral feeding. It is a good method for feeding patients with neurological dysphagia and can safely be kept in situ for long periods. PEG feeding requires a multidisciplinary approach, involving doctors, nurses, pharmacists, speech therapists, dieticians and carers. The insertion of a PEG, which requires two operators and two endoscopy nurses, is described in full. Feeding can commence after a few hours. Various types of feed and feed-ing patterns are described and their relative merits discussed. Although psychological problems may occur following PEG insertion, the procedure is usually well accepted by patients.

Preliminary experience with human oocyte cryopreservation using 1,2-propanediol and sucrose

Feasibility of cryopreservation of mature human oocytes using 1, 2-propanediol and sucrose was studied initially utilizing 1 and 2 day old unfertilized oocytes. Of these 285 aged oocytes 55% survived thawing, and 41% of 128 oocytes inseminated by single sperm intracytoplasmic injection (ICSI) fertilized normally. Limited embryonic development occurred in 51% of these embryos (n = 27) observed for the next 4 days. Cryosurvival of fresh donated oocytes (n = 81) was poorer (n = 20; 24.7%), while fertilization (n = 13; 65%) and embryo development (100%) was good prior to uterine transfer on day 3. Eight oocyte recipient cycles were undertaken, in which cryopreserved donated oocytes were thawed and inseminated by ICSI. Five of these cycles reached embryo transfer, and three pregnancies were initiated though none went successfully to term. Oocyte cryopreservation will ultimately facilitate oocyte donation procedures; however, cryosurvival of fresh frozen oocytes must be improved to at least the degree observed with aged unfertilized oocytes.

Ultrasound Devulcanization of Sulfur Vulcanized SBR: Crosslink Density and Molecular Mobility

Sulfur-cured SBR vulcanizates are devulcanized by high power ultrasonic irradiation in a continuous process under various processing conditions. Crosslink density and gel fraction of devulcanized rubber are measured. The unique dependence of crosslink density on gel fraction of devulcanized samples obtained at various processing conditions is established. DSC studies indicate a significant increase in the glass transition temperature of the devulcanized rubber having crosslink density lower than that of the original vulcanizates. Solid state NMR studies confirm that these changes in Tg are due to a decrease of molecular mobility as measured by a decrease in spin-spin relaxation time. Ultrasonic devulcanization is accompanied by a significant increase in xcis-trans isomerization. Chemical changes explaining the observed phenomena are discussed.

The team approach to percutaneous endoscopic gastrostomy feeding

The importance of early recognition and treatment of patients who are at risk of developing malnutrition is becoming increasingly recognised. Percutaneous endoscopic gastrostomy has become increasingly popular as a method of feeding, since its description in 1980, because of its ease of insertion and low morbidity and mortality. Its success, however, depends upon the use of a multidisciplinary approach.

Postoperative epidural bupivacaine-morphine therapy. Experience with 4,227 surgical cancer patients

BACKGROUND

We prospectively studied surgical cancer patients who received epidural bupivacaine-morphine to determine perioperative morphine use, side effects, and complications.

METHODS

All study patients received general-epidural anesthesia followed by epidural analgesia with 0.05% or 0.1% bupivacaine and 0.01% morphine at a rate of 5-10 ml.h-1 to keep the dynamic pain score at less than 5 (of 10). Patients were evaluated daily for pain relief, side effects, catheter migration, accidental removal, hypotension, respiratory rate, mental status changes, nausea and vomiting, and pruritus.

RESULTS

Over 4 yr, 4,227 patients (61% women, aged 68 +/- 24 yr) were studied. Lumbar epidural catheters (n = 2,248 or 53.18%) were used more frequently than thoracic catheters (n = 1,979 or 46.82%) (P < 0.00001). Most of the patients were discharged to the surgical wards after the procedures (n = 3,001, 71%). Those patients (n = 1,226, 29%) admitted to the surgical intensive care unit, spent 1.2 +/- 0.8 days. Epidural catheter failure occurred in 283 (6.3%) patients. Length of epidural analgesia therapy was 6.3 +/- 2.6 days. There were three cases (0.07%) of respiratory depression which were treated with oxygen, intravenous naloxone, and by stopping the epidural infusion for 6 h. Hypotension occurred in 126 patients (3%). There were no apparent cases of catheter migration to either the subdural or subarachnoid space. Nausea or vomiting occurred in 929 patients (22%). Pruritus occurred in 930 patients (22%).

CONCLUSIONS

Continuous epidural analgesia with 0.05-0.1% bupivacaine and 0.01% morphine is an effective method of postoperative analgesia with a low incidence of side effects, that can be safely administered on the surgical wards with no special monitoring equipment.

Self-management of recovery: implications for nursing practice

This article describes and discusses differences in responses to a 60-item survey instrument, the Carolina Self-Regulation Inventory (CSRI) from a selected sample of university faculty and staff. The CSRI was designed to measure the types of self-regulation strategies (SRS) individuals use to facilitate their recovery from illness episodes. When the CSRI was developed, 1,306 university employees participated in the survey. Four hundred eighty (36%) employees classified themselves as faculty; 346 (26%), staff; 418 (32%), midlevel administrators; and 62 (6%), blue-collar workers. This report focuses on the differences between the faculty and staff groups in the survey. Analysis revealed that the staff used a variety of strategies and had higher statistically significant means on the following CSRI subscales: visualization (t = 2.53, P less than .01), self-talk (t = 6.801, P less than .001), and external attention deployment strategies (t = 4.08, P less than .001). No significant differences were found between faculty and staff in the use of exercise and physical activity or interactive self-regulation strategies. Higher-educated faculty women tended to use fewer SRS when compared with female staff (F = 4.70; df = 8.819; P = .0009). Faculty women were similar to faculty men in their use of SRS. Female staff used significantly more SRS when compared with faculty of both genders and male staff (t = 2.81, P = .05). Nursing implications of self-regulation nursing assessments are discussed in terms of nursing interventions and need for more research.

Poor implantation of cryopreserved reinsemination-fertilized human embryos

OBJECTIVE

To investigate whether a poor rate of implantation after in vitro fertilization (IVF) was due to poor embryonic/endometrial synchrony during the original IVF cycle, we have cryopreserved reinseminated-fertilized embryos for later more synchronous replacement after thawing. The chance of implantation of fresh reinseminated fertilized human oocytes is approximately one tenth that of timely fertilized embryos. STUDY DESIGN AND DATA: Retrospective study of 35 original oocyte collections in which initial normal fertilization was 47.3% (129/273 oocytes), with 49.6% fertilization (67/135) upon reinsemination. Of these, 70 initially fertilized and 67 reinsemination-fertilized embryos were cryopreserved, and 50 initially fertilized and all 67 reinsemination-fertilized embryos were subsequently thawed with 72% and 63% cryosurvival, respectively, (not significant).

SETTING

Private infertility clinic.

RESULTS

In 11 cycles, 23 thawed initially fertilized embryos (group A) were replaced with a 21.7% implantation rate per embryo; in 10 cycles, 13 initially fertilized and 12 reinsemination-fertilized embryos (group B) were replaced together with an 8% implantation rate; finally, in 16 cycles, 30 reinsemination-fertilized embryos (group C) were replaced with a 3.3% implantation rate (group A versus group C: P = 0.076). Comparison of clinical pregnancies between these groups was significantly different (6/11 versus 1/16; P = 0.0427).

CONCLUSION

Reinsemination-fertilized embryos survive freezing as well as initially fertilized embryos, but better embryonic/endometrial synchrony does not improve chances of their implantation.

Stimulation cycles suppressed with gonadotropin-releasing hormone analog yield accelerated embryos

A retrospective study was performed to assess embryonic development and morphology in 71 patients whose follicular stimulation was regulated after down regulation with a gonadotropin-releasing hormone analog, leuprolide acetate. The embryos were compared with those from 66 patients who did not receive agonists and who were treated during the same period. A separate group of thawed embryos cryopreserved after down regulation in 21 patients was compared with embryos frozen after conventional stimulation during the same period from 21 other patients. Eleven morphological criteria were assessed in the fresh embryos, and analyses did not reveal any differences between the groups studied. However, the rate of development of embryos obtained during down-regulated cycles was significantly higher than that of embryos developing in conventional stimulation cycles. Although no significant morphological differences could be shown between the groups of cryopreserved embryos, there was a decreased incidence of implantation of embryos from patients who were exposed to analogs. It is suggested that embryos from down-regulated cycles should be cryopreserved earlier to correct for their accelerated development.

Immunosuppression supports implantation of zona pellucida dissected human embryos

The effect of low dose immunosuppression with methylprednisolone during the first 4 days after oocyte retrieval on potential immune cell invasion of partially zona dissected embryos in utero was investigated in alternate in vitro fertilization patients (n = 32). The incidence of pregnancy was significantly higher in patients receiving methylprednisolone (7 of 18, 39%) than in control patients (1 of 14, 7%). Twenty-eight percent (11 of 39) of the embryos replaced in the corticosteroid treated patients implanted, whereas only 7% (2 of 31) of embryos in control patients had a fetal heart beat. There were no side effects reported in any of the patients receiving corticosteroids. It can be concluded that methylprednisolone supports implantation of embryos with small holes in their zonae. However, the actual mechanisms of corticosteroid support on the interaction between immune cells and micromanipulated embryos are not well understood.

Observations on the morphology of pronuclei and nucleoli in human zygotes and implications for cryopreservation

The effects of cryopreservation on human zygotes at various stages between the appearance of pronuclei and their close association were investigated. Pronuclear zygotes (n = 233) from 101 patients were frozen using propanediol 21-35 h following egg collection. The incidence of implantation of thawed pronuclear zygotes frozen 29-35 h following oocyte collection was significantly higher than that of younger pronuclear zygotes (28 versus 10%, respectively). Zygote age did not affect cell survival following cryostorage. The diameter and association of pronuclei and the number and distribution of nucleoli were determined from video tape recordings of 140 fresh zygotes. Pronuclear migration continued after pronuclear enlargement. The number of nucleoli remained constant during pronuclear migration, but their random distribution within the pronucleus diminished. Strongly adhered pronuclei had significantly more aligned nucleoli on adjacent sides than pronuclei which were still visually separated by ooplasm. This equatorial distribution of nucleoli was noted in the majority of zygotes older than 26 h. The findings suggest that zygote cryopreservation should be initiated when pronuclear migration is completed. This moment can be determined accurately by studying pronuclear association and nucleolar alignment.

Partial zona dissection of human oocytes when failure of zona pellucida penetration is anticipated

Partial zona dissection (PZD) of human oocytes facilitates sperm penetration through mechanically made holes in the zona pellucida. Only 1 of 69 eggs was damaged when sucrose was used to shrink the ooplasm during micromanipulation. The fertilization rate of micromanipulated oocytes in 18 couples with male factor infertility was 68% (34/50), which compared favourably with insemination of non-micromanipulated controls (21/45, 47%). PZD was advantageous in oligozoospermic patients, but not in cases of asthenozoospermia, combined semen problems or immunological infertility. Three twin and two singleton pregnancies resulted following replacement of 23 micromanipulated and eight control embryos in 14 patients. No differences in embryo morphology and development rates were found between the micromanipulated and control groups. The incidence of polyspermy in couples with abnormal semen analyses was relatively low (less than 20%) possibly due to partial activation of the oocytes following exposure to sucrose. Polyspermy was high (57%) in normozoospermic patients with either immunological infertility (n = 3) or failure of fertilization in previous cycles (n = 4). In the three immunological patients, nine of 11 hyaluronidase and sucrose-exposed control embryos fertilized and six implanted, possibly indicating that cumulus and corona cells are contributing factors inhibiting fertilization in such cases.