Eliminating health inequities: national goals and developing programs.

In the 20th century, infant and maternal mortality declined dramatically and the life span and quality of life for women and infants increased. At the end of the century, the rate of decline slowed and policy makers began to look for new ways to address the problem. A significant challenge now is to eliminate the persistent disparities in maternal and infant health among various racial and ethnic groups, particularly between black and white women and infants. To improve perinatal outcomes, programs are needed that focus on community-based interventions that reduce infant mortality across all racial and ethnic groups. Two promising programs that are expected to receive additional federal funding through the Children's Health Act are the Fetal and Infant Mortality Review Program and home visiting programs. Expansion of these programs may provide the vehicle to reduce disparities in maternal and infant mortality and morbidity. New programs are needed to meet the ambitious goals of Healthy People 2010.

Noise transmission from a curved panel into a cylindrical enclosure: analysis of structural acoustic coupling.

Much of the research on sound transmission through the aircraft fuselage into the interior of aircraft has considered coupling of the entire cylinder to the acoustic modes of the enclosure. Yet, much of the work on structural acoustic control of sound radiation has focused on reducing sound radiation from individual panels into an acoustic space. Research by the authors seeks to bridge this gap by considering the transmission of sound from individual panels on the fuselage to the interior of the aircraft. As part of this research, an analytical model of a curved panel, with attached piezoelectric actuators, subjected to a static pressure load was previously developed. In the present work, the analytical model is extended to consider the coupling of a curved panel to the interior acoustics of a rigid-walled cylinder. Insight gained from an accurate analytical model of the dynamics of the noise transmission from the curved panels of the fuselage into the cylindrical enclosure of an aircraft is essential to the development of feedback control systems for the control of stochastic inputs, such as turbulent boundary layer excitation. The criteria for maximal structural acoustic coupling between the modes of the curved panel and the modes of the cylindrical enclosure are studied. For panels with aspect ratios typical of those found in aircraft, results indicate that predominately axial structural modes couple most efficiently to the acoustic modes of the enclosure. The effects of the position of the curved panel on the cylinder are also studied. Structural acoustic coupling is found to not be significantly affected by varying panel position. The impact of the findings of this study on structural acoustic control design is discussed.

A curved piezo-structure model: implications on active structural acoustic control.

Current research in Active Structural Acoustic Control (ASAC) relies heavily upon accurately capturing the application physics associated with the structure being controlled. The application of ASAC to aircraft interior noise requires a greater understanding of the dynamics of the curved panels which compose the skin of an aircraft fuselage. This paper presents a model of a simply supported curved panel with attached piezoelectric transducers. The model is validated by comparison to previous work. Further, experimental results for a simply supported curved panel test structure are presented in support of the model. The curvature is shown to affect substantially the dynamics of the panel, the integration of transducers, and the bandwidth required for structural acoustic control.

Women with HSV and HPV: a strategy to increase self-esteem.

This study tested the impact of the use of a self-help module on knowledge of disease and the cognitive perceptual variables of self-esteem, self-concept, satisfaction with intimate relationships and body image in young adult women with herpes simplex virus (HSV) or human papillomavirus (HPV) infections. In this prospective, experimental study, 40 HSV-positive and 58 HPV-positive women were randomly assigned to the intervention or routine counseling groups. Analysis of covariance was used to test for treatment differences. The HSV intervention groups had greater satisfaction with intimate relationships after the intervention and a greater increase in self-esteem, but no effect of the intervention was found for the HPV groups. Pre- and posttest mean change scores were compared for the separate groups using t-test analysis. Although scores on the knowledge of disease tests were high for the subjects, they reported engaging in risky sexual behaviors. The findings indicate that the use of a self-help module to assist HSV-infected women with the psychological impact of this disease may be an effective strategy to enhance adjustment, but knowledge did not deter risk-taking behavior.

Nursing and alternative medicine. Legal and practice issues.

The burgeoning interest in alternative medicine in the past decade has created a demanding health care climate for professional nursing. Rising consumer consciousness and the cost of traditional Western medicine have together influenced an environment in which individuals and payers seek low-cost, high-value remedies. This article presents a definition of alternative medicine and an overview of related research initiatives. In addition, legal and practice considerations for professional nursing are discussed. The language of current nurse practice acts neither prohibits nor actively promotes alternative medicine practices. However, differences in the regulation of health care professionals, specifically physicians and nurses, create challenges for nurses as they respond to both consumer demand and the need for consumer protection, and work with physician colleagues in alternative medicine. Accompanying these challenges is the need to protect nurses' regulatory freedom and autonomy.

"Bridging the information gap" for Virginia public health nurses.

This project was designed to increase the public health nurse's knowledge and use of health science information resources available from the National Library of Medicine's databases through the use of the Grateful Med software program. In 1994, the Tompkins-McCaw Library located on the Medical College of Virginia Campus (MCV) of Virginia Commonwealth University (VCU) was awarded a Nursing Information Access Grant from the Southeastern/Atlantic Region of the National Network of Libraries of Medicine (NN/LM). This project was a collaboration of the Tompkins McCaw Library, the VCU School of Nursing, and The Virginia Department of Health. Sixty public health nurses received Grateful Med training. Session evaluations were conducted and indicate that although public health nurses received training and had access to health science information resources through Grateful Med, subsequent use of the resources was very limited. Similar to reports on information-seeking behaviors of physicians, public health nurses seek information from colleagues, personal collections, and other resources locally available. Reasons for the project's limited success in changing the health science information seeking and utilization practices of public health nurses are discussed, and potential solutions are proposed.

Community nursing centers: models of nurse managed care.

Changes in health care that have resulted in an increase in community-based nursing practice and new models for nurse managed care are developing. One of these models is the academic community nursing center. The development and characteristics of academic community nursing centers are described, using examples from one academic nursing center. Strategies for development, administration, collaboration, and funding are outlined, including the changes needed in nursing education to prepare nurses for new roles in community-based care.