High resolution laser excitation spectroscopy of the B2E-X2A1 transitions of calcium and strontium monoborohydride.

High resolution spectra of the B2E-X2A1 transitions of CaBH4 and SrBH4 have been recorded using laser excitation spectroscopy in a laser ablation/molecular jet source. Because of rotational cooling in the molecular jet and nuclear spin statistics, transitions arising from only the K'=1<--K"=0, K'=2<--K"=1, and K'=0<--K"=1 subbands have been observed. For each molecule, an analysis of the data using 2E and 2A1 symmetric top Hamiltonians yielded rotational, spin-orbit, and spin-rotation parameters for the observed states. For both molecules the rotational constants compare well with those calculated for a tridentate borohydride structure. A large reduction in the spin-orbit splitting and in the metal-ligand separation for each molecule indicates an increase in the amount of d atomic orbital character in the first excited 2E states of the monoborohydrides as compared to the monomethyl derivatives. For each molecule no evidence of internal rotation of the BH4- ligand was found. A change in the magnitude and sign of the spin-rotation constant epsilon1 confirms an energy reordering of the first excited 2E and 2A1 states in both CaBH4 and SrBH4 as compared to CaCH3 and SrCH3. The data also suggest that the B2E1/2 rotational energy levels of CaBH4 may be perturbed by a vibronic component of the A2A1 state.

High-resolution laser excitation spectroscopy of the A2E-X2A1 transition of SrCH3.

High-resolution laser excitation spectroscopy has been used to record the A (2)E-X (2)A(1) electronic transition of SrCH(3) in a laser ablation/molecular jet source. Transitions arising from the K(')=1<--K(")=0, K(')=0<--K(")=1, and K(')=2<--K(")=1 subbands have been observed and assigned. The data were modeled with (2)E and (2)A(1) symmetric top Hamiltonian matrices in a Hund's case (a) basis, using a least squares fitting program. Rotational and fine structure parameters for the A (2)E state were determined. A comparison of the spin-orbit energy separation in the A (2)E state to other strontium containing free radicals showed that the Jahn-Teller effect is negligible. The spin-rotation constants for the A (2)E state were calculated using the pure precession model and were found to be in good agreement with the experimentally determined parameters. These calculations suggest that the A (2)E state of SrCH(3) is not entirely of p orbital character. The rotational constants were used to estimate the structural parameters of SrCH(3) in the A (2)E state. The strontium-carbon bond length was found to decrease by approximately 0.006 A, and the hydrogen-carbon-hydrogen bond angle opened by approximately 0.8 degrees compared to the X (2)A(1) state, similar to the geometry changes observed for CaCH(3).

High-resolution spectroscopic investigation of the ~B2A1-- ~X2A1 transitions of CaCH3 and SrCH3.

High-resolution spectra of the ~B(2)A(1)-- ~X(2)A(1) transitions of CaCH(3) and SrCH(3) have been recorded in a molecular jet/laser ablation source using laser excitation spectroscopy. Transitions arising from the K = 0 and 1 sub-bands have been observed for both molecules. An analysis of the data using a (2)A(1) symmetric top Hamiltonian has determined rotational and spin-rotation constants for the ~B(2)A(1) state of each molecule. From the rotational constants, structures have been estimated for both CaCH(3) and SrCH(3). The spin-rotation constant, epsilon(bc) = (epsilon(bb) + epsilon(cc))/2, in the ~B(2)A(1) state for both molecules is in reasonable agreement with the value calculated using the pure precession approximation. For CaCH(3), the K' = 1 levels of the ~B(2)A(1) state exhibit a perturbation that interchanges the energy ordering of the spin-rotation components.

Preventing secondary pregnancy in adolescents: a model program.

The Dollar-A-Day program in Greensboro, North Carolina, was established in 1990 to prevent subsequent pregnancies in girls under 16 years of age who had already given birth to one child. Conceptualized by nursing professors and using principles from theories of adolescent development and social exchange, the program was planned and implemented in collaboration with nurses from the local health department. Weekly meetings featured food, an informal program focused on needs identified by members, setting of short-term goals, and an award of a dollar for each day they remained nonpregnant. After five years of operation with a series of small grants, only 15% of the 65 girls who had been enrolled in the program experienced subsequent pregnancies. The success of the program convinced health department officials to incorporate Dollar-A-Day into their budget as a permanent service to the population of adolescents they serve. It remains as a model program for others to emulate.

Postpartum sleep in the hospital. Relationship to taking-in and taking-hold.

This descriptive, correlational study examined the relationship of sleep in the hospital to the new mother's progression through Rubin's phases of taking-in and taking-hold in 120 women who had delivered vaginally. The Martell and Mitchell Postpartum Questionnaire, which measured taking-in and taking-hold, was completed the evening of delivery and the following two mornings. The Verran and Snyder-Halpern Visual Analog Sleep Scale was completed each morning. Both taking-in and taking-hold were present on the evening of delivery. There were small decreases in taking-in and small increases in taking-hold between the evening of delivery and the first morning. Sleep disturbance was high, and sleep effectiveness was low, on the first evening. Neither sleep measure was a predictor of change in taking-in or taking-hold. Findings indicate that taking-in and taking-hold are both present on the day of delivery and that increases in taking-hold take place despite high levels of sleep disturbance.

Assessment and measurement of acute pain.

Pain is a personal and individual experience. Pain assessment is a multidimensional process. A process is outlined that begins at admission and is systematically performed throughout the period of care. This process involves the patient in goal setting and selection of the instruments that will be used to assess the level of pain. Objective and subjective indicators of pain are described, but emphasis is on the patient's self-report as the major indicator of pain. Several instruments are described that help the patient and nurse to communicate more effectively. Using a variety of instruments allows the patient to select one that is most meaningful. Visual analog and verbal descriptor scales are described, as are how to use them in assessment of pain and evaluation of interventions. The emphasis is on assessment of the adult patient.

Sleep during the week before labor: relationships to labor outcomes.

This correlational study was conducted to examine the relationship between maternal sleep during the nights prior to the onset of labor and labor outcomes of length, type of delivery, and maternal perceptions of labor. Subjects (N = 99) were drawn from childbirth education classes at a women's hospital in the southeastern United States. Subjects completed the Visual Analog Sleep Scale each morning, beginning two weeks prior to their due dates. Following delivery, subjects completed the Perception of Labor and Delivery Scale, and researchers gathered data about their labors. These women reported poor sleep effectiveness coupled with high sleep disturbance; however, there were no significant correlations between sleep quality and length of labor or maternal perceptions of labor for either the night, or the week, prior to the onset of labor. This finding leads us to question the view that disturbed prenatal sleep will interfere with the progress of labor and lead to more cesarean sections.

A randomized trial of management of pre-labor rupture of membranes at term in multiparous women using vaginal prostaglandin gel.

OBJECTIVE: To compare conservative management of pre-labor spontaneous rupture of membranes (SROM) with the use of prostaglandin (PG) E2 in healthy parous women at term (gestational age at least 37 weeks). METHODS: An open randomized study was conducted with 100 parous women; 50 were treated conservatively for 24 hours, and 50 were managed actively using PGE2 gel (1 mg), administered at admission and repeated 6 hours later if labor was not established. Both groups received intravenous oxytocin if labor did not start within 24 hours after admission. RESULTS: The use of PGE2 gel led to a significant reduction in the mean interval (+/- standard error of the mean) from SROM to onset of labor: 17.26 +/- 1.51 hours in the conservative group versus 6.50 +/- 1.23 in the PGE2 group. A significantly smaller proportion of subjects required oxytocin in the PGE2 group (12 versus 38%, P < .02). The two groups were comparable with respect to analgesic requirements. Within 24 hours of SROM, 80% of the women in the PG group and 56% in the conservative group had delivered (P < .02). Most women delivered vaginally, 96% of those managed conservatively and 100% of those managed actively with PGE2. CONCLUSION: Active management using PGE2 gel in parous women with pre-labor SROM significantly improves the time to delivery without influencing the cesarean rate or fetal-maternal infective morbidity.

Postoperative pain management in preverbal children: the prescription and administration of analgesics with and without caudal analgesia.

A retrospective chart review was conducted to examine the prescription and administration of analgesics with and without caudal analgesia to inpatient preverbal children within the first 48 hours after surgery. The 75 subjects were between birth and 24 months of age and had undergone various operative procedures. Seventy (93%) of these subjects were prescribed analgesics, but 8 of them had only acetaminophen prescribed. Of the 70 subjects who had a medication prescribed, 64 (91%) patients received analgesics. Morphine was the most frequently administered analgesic. The prescribed and administered mean dosages were less than the minimum recommended dosage for morphine. The mean prescribed and administered dosage for other analgesics exceeded the minimum recommended dosage. Preverbal children who had caudal analgesia during surgery were more likely to receive fewer dosages of analgesics and to receive lower dosages of narcotics even after 24 hours postoperatively than children who had not had caudal analgesia.

Preterm infants in pain: nurses' and physicians' perceptions.

Within the past few years, the assumption that preterm infants experience little or no pain has been challenged in nursing and medical literature. It is not clear to what extent changes have taken place in the practice area. The purpose of this qualitative study was to explore the beliefs of NICU nurses and physicians about the existence and treatment of pain in preterm infants. Respondents to the open-ended interviews were 5 neonatologists and 10 nurses at two regional referral neonatal intensive care units in North Carolina. Interviews took from 20 to 40 minutes and were analyzed using the Ethnograph program. All respondents agreed that preterm infants experience pain. Both groups identified behavioral and physiological cues to pain recognition. There were differences in initial approaches to treatment. However, both groups indicated that the nurse has the pivotal role in recognition and initiation of treatment to reduce or eliminate pain.

Burnout in doctorally prepared nurse faculty.

This correlational study examined burnout in doctorally prepared nurse faculty and its relationships to management style, collegial support, and workload. The Matthews Burnout Scale and the Maslach Burnout Inventory were used to measure burnout of 400 doctorally prepared American Nurses Association (ANA) members employed as faculty in schools of nursing. Analysis of 236 (59%) returns revealed that 39% of the faculty experienced moderate to high levels of burnout. Significant negative relationships (p < .05) were found between burnout and participative management, presence of collegial support, and time spent in research and in clinical practice. Multiple regression indicated that management style was the strongest predictor of burnout, with collegial support the second predictor.

Breech delivery and epidural analgesia.

OBJECTIVE: To examine the effect of epidural analgesia on the progress and outcome of spontaneous labour in women with a singleton breech presentation at term (greater than or equal to 37 weeks). DESIGN: A retrospective study. SETTING: Data Bank, Aberdeen Maternity Hospital. SUBJECTS: 643 women (273 primiparae and 370 multiparae) with a singleton breech presentation and spontaneous onset of labour at term. OUTCOME MEASURES: Duration of labour; augmentation of labour with oxytocin infusion; caesarean section rates. RESULTS: Epidural analgesia was associated with a significantly increased need for augmentation of labour with oxytocin infusion (P less than 0.001) and longer duration of labour (P less than 0.001), irrespective of parity. Comparing women who had epidural analgesia with those who did not, there was no significant difference in caesarean section rates in the first stage of labour in primiparae (odds ratio 1.79; 95% CI 0.88-3.63) or multiparae (odds ratio 0.97; 95% CI 0.48-1.96). Epidural analgesia was associated with a significantly increased likelihood of caesarean section in the second stage of labour, both in primiparae (odds ratio 5.43; 95% CI 2.46-11.95) and multiparae (odds ratio 5.37; 95% CI 2.07-13.87). The increased likelihood of caesarean section in the second stage in primiparae with epidurals was independent of the extent of cervical dilatation (less than 3 cm or greater than or equal to 3 cm) on admission. However, in multiparae with epidurals, the difference in second stage caesarean section rate was significant only when initial cervical dilatation was less than 3 cm (odds ratio 3.65; 95% CI 1.14-11.65). CONCLUSION: Epidural analgesia was associated with longer duration of labour, increased need for augmentation of labour with oxytocin infusion and a significantly higher caesarean section rate in the second stage of labour.

Role of prostaglandin in the management of prelabour rupture of the membranes at term.

OBJECTIVE: To compare conservative versus prostaglandin management of prelabour rupture of the membranes (PROM) in healthy primigravid women at term. DESIGN: A prospective randomized study. SETTING: Labour Ward, Aberdeen Maternity Hospital. SUBJECTS: 230 primigravidae at terms with PROM, 115 allocated to be treated conservatively and 115 to be managed with prostaglandin treatment. INTERVENTIONS: In the conservatively managed group the women were observed for up to 24 h after hospital admission with PROM. The actively managed group had PGE2 gel (2 mg) instilled into the posterior fornix and if contractions had not commenced, a further dose of PGE2 gel (1 mg) was instilled 6 h later. In both groups, if labour had not established 24 h after admission, intravenous oxytocin was given in escalating doses. MAIN OUTCOME MEASURES: PROM to delivery interval, oxytocin augmentation, mode of delivery, maternal and neonatal infective morbidity. RESULTS: There was a significant reduction in the PROM to delivery interval in the women managed actively with PGE2 gel and fewer women in the PGE2 group required oxytocin augmentation (31% vs 51%). The two managements groups were comparable for intrapartum analgesia, antibiotic treatment, babies requiring admission to the special care nursery unit and delivery by caesarean section. CONCLUSION: The early use of prostaglandin is associated with a significant reduction in PROM to delivery interval without a significant increase in infective morbidity or caesarean section rate. However, the advantages of the conservative approach should not be overlooked. More work is still needed in the management of those women where uterine activity fails to establish within 24 h after PROM.