Thickness and volume dependence of dielectric strength in advanced nanodielectric materials allowing for further size reduction of ultrahigh voltage capacitor prototypes.

We have developed a high dielectric, nanocomposite material, MU100, for use in pulsed power applications that include dielectric loaded antennas and ultra-high voltage capacitors. This paper presents the electrical properties of the first full-scale capacitor prototype along with sub-element modules. Additionally, refinements in the development process have sparked interest in a third-generation capacitor that would use similar dimensions as the initial small-scale samples that recorded breakdown fields of 225 kV/cm on average with peak breakdown fields of 328 kV/cm. The dielectric constant of these large-scale capacitors was 160. These capacitor prototypes have demonstrated voltage hold off of 500 kV. Similarly, thin samples that operated at 35-40 kV had lifetimes without failure in excess of 800 000 discharges at 80% of their maximum rated field strength.

Quantum superposition at the half-metre scale.

The quantum superposition principle allows massive particles to be delocalized over distant positions. Though quantum mechanics has proved adept at describing the microscopic world, quantum superposition runs counter to intuitive conceptions of reality and locality when extended to the macroscopic scale, as exemplified by the thought experiment of Schrödinger's cat. Matter-wave interferometers, which split and recombine wave packets in order to observe interference, provide a way to probe the superposition principle on macroscopic scales and explore the transition to classical physics. In such experiments, large wave-packet separation is impeded by the need for long interaction times and large momentum beam splitters, which cause susceptibility to dephasing and decoherence. Here we use light-pulse atom interferometry to realize quantum interference with wave packets separated by up to 54 centimetres on a timescale of 1 second. These results push quantum superposition into a new macroscopic regime, demonstrating that quantum superposition remains possible at the distances and timescales of everyday life. The sub-nanokelvin temperatures of the atoms and a compensation of transverse optical forces enable a large separation while maintaining an interference contrast of 28 per cent. In addition to testing the superposition principle in a new regime, large quantum superposition states are vital to exploring gravity with atom interferometers in greater detail. We anticipate that these states could be used to increase sensitivity in tests of the equivalence principle, measure the gravitational Aharonov-Bohm effect, and eventually detect gravitational waves and phase shifts associated with general relativity.

Designing Endocrine Disruption Out of the Next Generation of Chemicals.

A central goal of green chemistry is to avoid hazard in the design of new chemicals. This objective is best achieved when information about a chemical's potential hazardous effects is obtained as early in the design process as feasible. Endocrine disruption is a type of hazard that to date has been inadequately addressed by both industrial and regulatory science. To aid chemists in avoiding this hazard, we propose an endocrine disruption testing protocol for use by chemists in the design of new chemicals. The Tiered Protocol for Endocrine Disruption (TiPED) has been created under the oversight of a scientific advisory committee composed of leading representatives from both green chemistry and the environmental health sciences. TiPED is conceived as a tool for new chemical design, thus it starts with a chemist theoretically at "the drawing board." It consists of five testing tiers ranging from broad in silico evaluation up through specific cell- and whole organism-based assays. To be effective at detecting endocrine disruption, a testing protocol must be able to measure potential hormone-like or hormone-inhibiting effects of chemicals, as well as the many possible interactions and signaling sequellae such chemicals may have with cell-based receptors. Accordingly, we have designed this protocol to broadly interrogate the endocrine system. The proposed protocol will not detect all possible mechanisms of endocrine disruption, because scientific understanding of these phenomena is advancing rapidly. To ensure that the protocol remains current, we have established a plan for incorporating new assays into the protocol as the science advances. In this paper we present the principles that should guide the science of testing new chemicals for endocrine disruption, as well as principles by which to evaluate individual assays for applicability, and laboratories for reliability. In a 'proof-of-principle' test, we ran 6 endocrine disrupting chemicals (EDCs) that act via different endocrinological mechanisms through the protocol using published literature. Each was identified as endocrine active by one or more tiers. We believe that this voluntary testing protocol will be a dynamic tool to facilitate efficient and early identification of potentially problematic chemicals, while ultimately reducing the risks to public health.

Precision angle sensor using an optical lever inside a Sagnac interferometer.

We built an ultra-low-noise angle sensor by combining a folded optical lever and a Sagnac interferometer. The instrument has a measured noise floor of 1.3 prad/√Hz at 2.4 kHz. We achieve this record angle sensitivity using a proof-of-concept apparatus with a conservative N=11 bounces in the optical lever. This technique could be extended to reach subpicoradian/√Hz sensitivities with an optimized design.

Oxindole-based inhibitors of cyclin-dependent kinase 2 (CDK2): design, synthesis, enzymatic activities, and X-ray crystallographic analysis.

Two closely related classes of oxindole-based compounds, 1H-indole-2,3-dione 3-phenylhydrazones and 3-(anilinomethylene)-1,3-dihydro-2H-indol-2-ones, were shown to potently inhibit cyclin-dependent kinase 2 (CDK2). The initial lead compound was prepared as a homologue of the 3-benzylidene-1,3-dihydro-2H-indol-2-one class of kinase inhibitor. Crystallographic analysis of the lead compound bound to CDK2 provided the basis for analogue design. A semiautomated method of ligand docking was used to select compounds for synthesis, and a number of compounds with low nanomolar inhibitory activity versus CDK2 were identified. Enzyme binding determinants for several analogues were evaluated by X-ray crystallography. Compounds in this series inhibited CDK2 with a potency approximately 10-fold greater than that for CDK1. Members of this class of inhibitor cause an arrest of the cell cycle and have shown potential utility in the prevention of chemotherapy-induced alopecia.

Prevention of chemotherapy-induced alopecia in rats by CDK inhibitors.

Most traditional cytotoxic anticancer agents ablate the rapidly dividing epithelium of the hair follicle and induce alopecia (hair loss). Inhibition of cyclin-dependent kinase 2 (CDK2), a positive regulator of eukaryotic cell cycle progression, may represent a therapeutic strategy for prevention of chemotherapy-induced alopecia (CIA) by arresting the cell cycle and reducing the sensitivity of the epithelium to many cell cycle-active antitumor agents. Potent small-molecule inhibitors of CDK2 were developed using structure-based methods. Topical application of these compounds in a neonatal rat model of CIA reduced hair loss at the site of application in 33 to 50% of the animals. Thus, inhibition of CDK2 represents a potentially useful approach for the prevention of CIA in cancer patients.

Guidelines for evaluating tools for clinical decision making.

Managed care is designed to reduce healthcare costs by controlling use of services and by improving quality outcomes. Preparation of nurses to practice in a health management environment mandates clear understanding of this new environment Nursing educators should focus on the spectrum of health services and enhance the nurses'ability to assess patients independently, implement health plans, and be responsible for outcomes. Nurses must understand how clinical decision-making tools facilitate planning care to maximize use of resources. The authors describe the construction and evaluation of a learning strategy that involves the use of guidelines to evaluate clinical decision-making tools. Two examples are presented: evaluating clinical pathways in a case management project and evaluating algorithm (practice guideline) outcome data from a prenatal population case study from a local health maintenance organization.

A prodrug approach to the design of cRaf1 kinase inhibitors with improved cellular activity.

Earlier we reported potent cRaf1 kinase inhibitors with a key acidic phenol pharmacophore that had, at best, adequate cellular efficacy. To improve the cellular potency, phenol isosteres and prodrugs were investigated. Many phenol isosteres were synthesized and tested, but failed to provide adequate enzyme potency. A prodrug approach resulted in a 2- to 17-fold improvement over the parent compound in cell-based efficacy.

Therapeutic connection: help seeking on the Internet for persons with implantable cardioverter defibrillators.

PURPOSE: The goal of this study was to understand common themes and shared meanings of help seeking on the Internet for persons with implantable cardioverter defibrillators (ICDs). SETTING: The study took place over an on-line, informal, public, electronic bulletin board for persons with ICDs. SAMPLE: The sample included 469 postings by 75 users during 15 months. RESULTS: Four related themes and 1 constitutive pattern were constructed. Themes included seeking and giving meaningful information; sharing personal perspectives; storytelling as common grounding; and supportive interacting. The constitutive pattern is "therapeutic connection." IMPLICATIONS: Persons with ICDs are proactive, using Internet bulletin boards to seek practical information and support in coping with daily anxieties of living with an ICD. This form of self-directed patient education focuses on common experiences of illness versus information obtained from health care providers.

Native American graduate nursing students' learning experiences.

PURPOSE: To identify learning experiences of Native American graduate nursing students in a university-based nurse practitioner program. DESIGN: The phenomenological approach of Heideggerian hermeneutics. METHOD: A purposive sample of 11 Native American graduate students in a nurse practitioner program were given the choice of participating in a focus group or completing an individual interview to elicit common meanings and shared experiences. FINDINGS: Four themes and two constitutive patterns: (a) Native American students' worldviews reflected unwritten knowledge that served as a background of common understanding, (b) academic environment as a rigid environment with only one way to learn and constant evaluation, (c) faculty-student relationship barriers to establishing a supportive learning environment, and (d) strategies to survive, including a commitment to succeed, conforming to unwritten rules, helping each other, and ultimately changing themselves. Constitutive patterns were: (a) value conflicts when students' values conflicted with academic behavioral values, and (b) on the fringe, when students felt isolation from the main student body, and open to attack (evaluation). Students struggled to be successful in their commitment to complete the degree, but often questioned the applicability of the program in their cultural setting. CONCLUSIONS: A more flexible supportive environment is needed to support students' goals to attain degrees, as well as to encourage dialogue on differing cultural values. Faculty who teach culturally diverse students may need to examine rigid behavioral standards that mandate an assertive practitioner persona and may be a barrier to attainment of goals.

Who talks? The social psychology of illness support groups.

More Americans try to change their health behaviors through self-help than through all other forms of professionally designed programs. Mutual support groups, involving little or no cost to participants, have a powerful effect on mental and physical health, yet little is known about patterns of support group participation in health care. What kinds of illness experiences prompt patients to seek each other's company? In an effort to observe social comparison processes with real-world relevance, support group participation was measured for 20 disease categories in 4 metropolitan areas (New York, Chicago, Los Angeles, and Dallas) and on 2 on-line forums. Support seeking was highest for diseases viewed as stigmatizing (e.g., AIDS, alcoholism, breast and prostate cancer) and was lowest for less embarrassing but equally devastating disorders, such as heart disease. The authors discuss implications for social comparison theory and its applications in health care.

Help seeking in a support group for recipients of implantable cardioverter defibrillators and their support persons.

PURPOSE: To understand shared meanings of help-seeking experiences in support groups of people with implantable cardioverter defibrillator (ICD) and their support persons. SETTING: ICD support group at an urban medical center. SAMPLE: Fifteen individuals with ICD and 9 support persons. RESULTS: Six related themes and 1 constitutive pattern emerged. Themes included hearing and telling stories, help seeking encouraged by triggers, seeking meaningful information, forming a therapeutic friendship through group camaraderie, gaining assistance from the facilitator, and the sharing of a similar view by support persons. The constitutive pattern is coping with the possibility of death. IMPLICATIONS: Health care providers may recommend storytelling as the central mechanism of interactions in support groups that assist in coping with daily anxieties of living with an ICD. Nurses would be appropriate facilitators to guide discussion, to provide technical information, and to promote anticipatory guidance in coping with potential firing events.

Faculty experiences teaching Native Americans in a university setting.

Nursing faculty told their stories about the beginnings of a Native American Family Nurse Practitioner Recruitment Program. Through hermeneutical analysis, the authors' findings reveal a strong academic worldview, active in maintaining professional standards. This traditional view tends to override efforts to provide individualized programs that are culturally relevant to the Native American worldviews. By understanding the value conflicts active in this study, nursing faculty can begin dialogue to create new learning experiences that are more culturally relevant.

Active learning strategies to teach case management.

Changes in healthcare delivery require a new understanding of the concepts of case management in managed care. The authors describe the construction and evaluation of a learning module that encourages active engagement and skill development. Students develop an understanding of how to plan for care of populations in an effort to meet managed care demands. This approach to teaching case management can be effective in an educational setting and possibly in clinical settings as well.

Cardiac spouses' help-seeking experiences.

The purpose of this study was to investigate the phenomenon of help seeking by spouses of cardiac rehabilitation patients by eliciting their verbal description of the experience. A phenomenological approach was used to collect data that consisted of individual interviews and focus group interviews. The exhaustive description of the phenomenon of help seeking described how the spouses' views of the illness affected initiation of help seeking. Spouses' stories revealed three time periods when spouses needed help: diagnosis, a time of uncertainty and loss of control; hospitalization, a time of information seeking and vigilance; and homecoming, a time of active help seeking because control is regained. To manage the uncertainty, spouses sought meaningful information to contend with difficulties. Spouses told of the individuals who assisted most, of barriers to seeking help, and availability of resources for support. This study increases health care providers' understanding of spouses' experiences, which may facilitate design of interviews that maximize supports for spouses. Assisting spouses will subsequently improve patients' recovery and facilitate lifestyle changes.

Implementation of gel column technology, including comparative testing of Ortho ID-MTS with standard polyethylene glycol tube tests.

With the intent to increase laboratory efficiency and according to the Clinical Laboratory Improvement Act of 1988 (CLIA '88), a parallel testing program comparing traditional tube technology with the gel system technology was undertaken. Test tube indirect antiglobulin tests were performed using polyethylene glycol (PEG) as the antibody enhancement medium. Gel (GEL) column technology used the ID-Micro Typing System, using predispensed anti-IgG and low-ionic- strength saline for antibody enhancement. Tests were performed as described in the manufacturer's guidelines and the current edition of the Technical Manual of the American Association of Blood Banks. Testing included antibody detection, antibody identification, direct antiglobulin tests (DATs), antigen phenotyping (K, Fya, Fyb, S, and s), and elution studies. These procedures were evaluated for sensitivity, specificity, and efficiency. Sixty-six samples that had been tested for antibody activity by PEG tube techniques were evaluated by GEL. These samples included 49 that were nonreactive and 17 with a positive antibody detection test. Within the latter were 19 antibodies, 17 with specificities considered to be clinically significant and 2 usually considered clinically insignificant for red cell transfusion. GEL was nonreactive with the 49 PEG negative samples as well as with the 2 samples containing insignificant antibody. All 17 antibodies of probable clinical significance were detected. Antibody identification studies were performed on these latter samples, with GEL results consistent with PEG tube results in all cases. Concordant results were obtained with 10 of 10 DATs (7 negative, 3 positive), all 77 antigen phenotyping tests (37 negative, 40 positive), and the 6 parallel elution studies (4 negative, 2 positive). GEL testing was found to be comparable or better when compared with PEG tube testing in all procedures evaluated.

Is a case study approach effective in altering the attitudes of student nurses toward AIDS?

The effect of a case study approach on attitudes of sophomore nursing students toward caring for patients with AIDS was examined. Pre- and post-program attitudes of 36 students were measured using an AIDS questionnaire. No significant differences were found between pre- and post-program scores on the questionnaire. An examination of change scores for individual items on the questionnaire indicated that the case study approach may have been helpful in making the students more aware of the multifaceted problems facing patients with AIDS.

Shared experiences and meanings of military nurse veterans.

OBJECTIVE: To determine the shared perceptions, feelings, and experiences of U.S. military nurse veterans. DESIGN: Phenomenological based on Heideggerian philosophy. POPULATION, SAMPLE, SETTING: The population was of military nurse veterans in the U.S.A. from World War II, Korea, Vietnam, and Operation Desert Storm. The convenience sample was 22 nurses recruited from local and national veterans' groups who volunteered to be interviewed. METHODS: Transcribed interviews with team members producing written interpretations; the team produced consensus about themes. Each interview was summarized and validation from the research team and respondents was sought. CONCLUSIONS: Five common themes or shared meanings emerged: reacting personally to the war experience, living in the military, the meaning of nursing in the military, the social context of war, and images and sensations of war. CLINICAL IMPLICATIONS: A coherent review of wartime nursing.

Images and sensations of war: a common theme in the history of military nursing.

We analyzed interviews with 22 military nurses who had served in wars or conflicts since World War II, up to and including Operation Desert Storm. Using a method of hermeneutic phenomenology, we found several common themes in the interviews. In this article, we report on the theme Images and Sensations of War. Within that theme, the subcategories sights, sounds, and other sensations (climate and weather, taste, smell, and comfort) were discovered. We categorized the images and sensations as pleasant, unpleasant, and horrible. The findings from this analysis may be useful to professionals who recruit military nurses, provide ongoing military training, help military nurses return to civilian life, and treat posttraumatic stress syndrome. Furthermore, the findings could be used as a basis for future quantitative studies to determine how widespread this theme is in larger groups of military nurses.