Traditional methods for managing illness in newborns and infants in an Arab society.

AIM: This study explored self-management practices in relation to traditional methods for managing illness in newborns and infants and the implications of these practices on infant health. BACKGROUND: Self-medication with folk remedies is believed to have short- and long-term impacts on well-being. Little is known about how mothers in Arab societies used their traditional beliefs and practices in self-managing their newborns' and infants' health. METHODS: Data were collected from five focus groups using open-ended questions with 37 mothers. Participants were selected using snowball sampling and were recruited from four different cities in Jordan between June 2016 and August 2016. ETHICAL APPROVAL: All identifying information regarding the study participants has been omitted, and this study was approved by the Academic Research Committee at the University of Jordan. FINDINGS: Mothers were more willing to try herbal remedies, traditional massage and certain foods to self-manage their infants' health. Folk remedies were not restricted to traditions handed down through generations, but included a representation of newly emerged trends towards 'safety' or 'nature'. CONCLUSIONS: While the use of folk remedies have been handed down generations as customs, today, virtual support groups and social media provide modern resources for folk remedies' promotion in care and self-management. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing and health policymakers can use our findings for planning and developing strategies and health policies that increase public awareness about adverse health effects associated with herbal remedies. Such strategies are likely to be facilitated through partnerships between nursing and midwifery education institutions, antenatal clinics and social media in the region.

Dynamin-related protein 1 is required for normal mitochondrial bioenergetic and synaptic function in CA1 hippocampal neurons.

Disrupting particular mitochondrial fission and fusion proteins leads to the death of specific neuronal populations; however, the normal functions of mitochondrial fission in neurons are poorly understood, especially in vivo, which limits the understanding of mitochondrial changes in disease. Altered activity of the central mitochondrial fission protein dynamin-related protein 1 (Drp1) may contribute to the pathophysiology of several neurologic diseases. To study Drp1 in a neuronal population affected by Alzheimer's disease (AD), stroke, and seizure disorders, we postnatally deleted Drp1 from CA1 and other forebrain neurons in mice (CamKII-Cre, Drp1lox/lox (Drp1cKO)). Although most CA1 neurons survived for more than 1 year, their synaptic transmission was impaired, and Drp1cKO mice had impaired memory. In Drp1cKO cell bodies, we observed marked mitochondrial swelling but no change in the number of mitochondria in individual synaptic terminals. Using ATP FRET sensors, we found that cultured neurons lacking Drp1 (Drp1KO) could not maintain normal levels of mitochondrial-derived ATP when energy consumption was increased by neural activity. These deficits occurred specifically at the nerve terminal, but not the cell body, and were sufficient to impair synaptic vesicle cycling. Although Drp1KO increased the distance between axonal mitochondria, mitochondrial-derived ATP still decreased similarly in Drp1KO boutons with and without mitochondria. This indicates that mitochondrial-derived ATP is rapidly dispersed in Drp1KO axons, and that the deficits in axonal bioenergetics and function are not caused by regional energy gradients. Instead, loss of Drp1 compromises the intrinsic bioenergetic function of axonal mitochondria, thus revealing a mechanism by which disrupting mitochondrial dynamics can cause dysfunction of axons.

Cell survival and DNA damage in normal prostate cells irradiated out-of-field.

Interest in out-of-field radiation dose has been increasing with the introduction of new techniques, such as volumetric modulated arc therapy (VMAT). These new techniques offer superior conformity of high-dose regions to the target compared to conventional techniques, however more normal tissue is exposed to low-dose radiation with VMAT. There is a potential increase in radiobiological effectiveness associated with lower energy photons delivered during VMAT as normal cells are exposed to a temporal change in incident photon energy spectrum. During VMAT deliveries, normal cells can be exposed to the primary radiation beam, as well as to transmission and scatter radiation. The impact of low-dose radiation, radiation-induced bystander effect and change in energy spectrum on normal cells is not well understood. The current study examined cell survival and DNA damage in normal prostate cells after exposure to out-of-field radiation both with and without the transfer of bystander factors. The effect of a change in energy spectrum out-of-field compared to in-field was also investigated. Prostate cancer (LNCaP) and normal prostate (PNT1A) cells were placed in-field and out-of-field, respectively, with the PNT1A cells being located 1 cm from the field edge when in-field cells were being irradiated with 2 Gy. Clonogenic and γ-H2AX assays were performed postirradiation to examine cell survival and DNA damage. The assays were repeated when bystander factors from the LNCaP cells were transferred to the PNT1A cells and also when the PNT1A cells were irradiated in-field to a different energy spectrum. An average out-of-field dose of 10.8 ± 4.2 cGy produced a significant reduction in colony volume and increase in the number of γ-H2AX foci/cell in the PNT1A cells compared to the sham-irradiated control cells. An adaptive response was observed in the PNT1A cells having first received a low out-of-field dose and then the bystander factors. The PNT1A cells showed a significant increase in γ-H2AX foci formation when irradiated to 20 cGy in-field in comparison to out-of-field. However, no significant difference in cell survival or colony volume was observed whether the PNT1A cells were irradiated in-field or out-of-field. Out-of-field radiation dose alone can have a damaging effect on the proliferation of PNT1A cells when a clinically relevant dose of 2 Gy is delivered in in-field. Out-of-field radiation with the transfer of bystander factors induces an adaptive response in the PNT1A cells.

Family-centred care for children in hospital.

BACKGROUND: Family-centred care (FCC) is a widely used model in paediatrics, and is felt instinctively to be the best way to provide care to children in hospital. However, its effectiveness has not been measured. OBJECTIVES: The primary objective of this review was to assess the effects of family-centred models of care for hospitalised children when compared to standard or professionally-centred models of care, on child, family and health service outcomes. SEARCH STRATEGY: We searched: MEDLINE (1966 to February 2004); the Cochrane Central Register of Controlled Trials (CENTRAL), (The Cochrane Library, Issue 2, 2004); CINAHL (1982 to February 2004); PsycINFO (1972 to February 2004); ERIC (1982 to February 2004); Sociological Abstracts (1963 to February 2004); Social Work Abstracts (1977 to February 2004); and AMI (Australasian Medical Index) (1966 to February 2004). SELECTION CRITERIA: We searched for randomised controlled trials (RCTs) or quasi-randomised controlled trials including cluster randomised trials and controlled clinical trials (CCTs), and controlled before and after studies (CBAs), in which family-centred care models are compared with professionally-centred models of care for hospitalised children (aged up to 12 years). Studies also had to meet criteria for family-centredness and methodological quality. In order to assess studies for the degree of family-centredness, this review utilised a modified rating scale based on a validated instrument. DATA COLLECTION AND ANALYSIS: Two review authors undertook the searches, and three authors independently assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS: No studies met inclusion criteria, and hence no analysis could be undertaken. Five studies came close to inclusion. Three of these studies were excluded primarily because of inadequate or unclear blinding of outcome assessment, while for one study the age group was outside the parameters of this review. One study met most criteria, but the children were aged up to 18 years. We contacted the study authors who kindly provided a subset analysis, but on further examination the study also proved to have inadequate blinding procedures and so was not included. It was not possible to undertake any subset analysis of populations. Of the other studies identified through the search, 13 met some of the inclusion criteria but were reports of qualitative research and are reviewed elsewhere. AUTHORS' CONCLUSIONS: This review has highlighted the dearth of high quality quantitative research about family-centred care. A much more stringent examination of the use of family-centred care as a model for care delivery to children and families in health services is needed.

Bilateral primary choroidal melanoma treated with bilateral plaque radiotherapy: a report of three cases.

PURPOSE: To report three cases of bilateral primary choroidal melanoma treated with bilateral plaque radiotherapy. METHODS: Retrospective, single-center case series. RESULTS: Case 1: In 1981, a 50-year-old man was diagnosed with a 5-mm-thick choroidal melanoma in the right eye (OD) and treated with plaque radiotherapy. In 1994, a 6.8-mm-thick choroidal melanoma in the left eye (OS) was treated with plaque radiotherapy. Final visual acuity was light perception OD and 20/20 OS at 24 years follow-up. Case 2: In 1983, a 53-year-old woman was diagnosed with a 3.5-mm-thick choroidal melanoma OS and treated with plaque radiotherapy. In 2001, an enlarging 2.5-mm-thick choroidal melanoma OD was treated with plaque radiotherapy. Final visual acuity was 20/30 OD and 20/20 OS at 22 years follow-up. Case 3: In 2001, a 92-year-old man was diagnosed with a 7.9-mm-thick choroidal melanoma OD treated with plaque radiotherapy. In 2003, an enlarging 2.8-mm-thick juxtapapillary choroidal melanoma was treated with plaque radiotherapy. Final visual acuity was 20/70 OD and 20/60 OS at 2.5 years follow-up. No patient showed ocular melanocytosis. Stable tumor regression was achieved in all six eyes. Metastatic disease did not develop in any case over 16 years of follow-up. CONCLUSIONS: Monitoring of both eyes of patients with uveal melanoma is important for the remote possibility of melanoma in the second eye. In these three patients, plaque radiotherapy allowed for preservation of the globes and some vision.

Selective reduction of multifetal pregnancy using high-intensity focused ultrasound in the rabbit model.

OBJECTIVE: High-order multifetal pregnancies carry a significant risk of obstetric complications and poor pregnancy outcome. Selective reduction has traditionally been performed using transabdominal and transvaginal ultrasound-guided intracardiac injection of potassium chloride. We have previously shown that high-intensity focused ultrasound (HIFU) can create a coagulative tissue necrosis in the sheep fetus. The objective of this study was to investigate the feasibility of non-invasive selective fetal reduction using HIFU in a rabbit model. METHODS: A protocol for HIFU-induced tissue coagulation was developed in the rabbit model. The fetal heart was targeted with ultrasound-guided tissue ablation by a HIFU beam. Five time-mated does between 20-29 days' gestation underwent transabdominal fetal cardiac ablation in a total of 11 fetuses. The HIFU system consisted of a 7-MHz high-power transducer, operated at 2000 W/cm2. The fetal heart rate was observed using real-time ultrasound with Doppler flow velocimetry. All lesions were assessed macroscopically and by histological analysis. RESULTS: Severe bradycardia leading to asystole was observed in all targeted fetuses with ultrasound examination. Dissection of fetuses demonstrated a necrotic intrathoracic lesion similar in size to the HIFU focus (approximately 1 x 9 mm). None of the surrounding fetuses was found to have bradycardia during the procedure or a macroscopic lesion on dissection. CONCLUSION: In this pilot study HIFU seems promising to ablate even highly vascularized tissue in the fetus.

Chimerism analysis by sex determining region Y (SRY) and major histocompatibility complex markers in non-human primates using quantitative real-time polymerase chain reaction.

The ability to discriminate and further quantify the proportion of donor and host cells is essential in hematopoietic stem cell transplant protocols. In human sex-mismatched transplants, this can be easily accomplished by the use of commercially available fluorescent in situ hybridization (FISH) probes. In many animal models, including non-human primates, this methodology is not possible due to the lack of commercially available FISH probes. In animal models, donor cell detection could be accomplished if there is a known species-specific sex determining region Y (SRY) (male) or other unique DNA sequence using either semiquantitative or quantitative real-time polymerase chain reaction (PCR). The use of real-time quantitative PCR has the obvious advantage of providing detailed enumeration of the percentage of donor cells present. We report the development of extremely sensitive primer and probe combinations for male (SRY) and major histocompatibility complex (MHC)-DQA sequences in the macaque and baboon non-human primate models. This assay has a sensitivity of a five-log range and can detect less than four target cells in the presence of 10(5) background cells (approximately 0.001%) and fetal DNA obtained from maternal serum from Macaca nemestrina. The SRY (male) primer and probe combination has similar sensitivity in Macaca fasicularis, Macaca mulatta, and Papio cynocephalus anubis.

The effect of war on children: the children of Europe after World War II.

In war, children are inevitably innocent victims. In the carnage that was World War II, more children were killed or orphaned than at any other time in history. This article gives a brief history of the place of children within the conflagration, then describes the effects of war on the children. We concentrate on postwar life, placing children in the context of the environment in which they were living at the time. Our article outlines the work carried out by relief agencies and how Europe began to rebuild itself, how the children were fed and made healthy, and how, where possible, they were reunited with their families. We report briefly on the physical and psychological damage children suffered, both during the war and in its aftermath. History such as this is relevant to nurses in the 21st century, as it provides insight upon which nursing care for both our present ageing population and for children of the future can be based.

John Bowlby and James Robertson: theorists, scientists and crusaders for improvements in the care of children in hospital.

AIMS: John Bowlby and James Robertson, two men who were extremely influential in the latter part of the 20th Century, combined scientific theory with evangelism to bring about changes in the way in which children were cared for in hospitals and other institutions. This paper discusses their work together, their theories and their influence on the care of children and paediatric nursing. BACKGROUND: Bowlby and Robertson collaborated early in their working relationship on research about separation of mother and child. Bowlby was the scientist who developed classic theories about maternal separation. Robertson focused his research on separation of mother and child due to hospital admission. Between the two of them, they derived a classic theory about the phases of 'protest', 'despair' and 'denial' (Bowlby called this last stage 'detachment') through which small children pass when isolated from their mothers for a length of time. DISCUSSION: Bowlby became an internationally recognized theorist, widely acclaimed and considered an expert in the field of maternal care and child development. Robertson, with his wife, Joyce, not only continued Bowlby's work investigating children separated from their mothers, but also took on the role of campaigner for the welfare of children in hospital. James Robertson, with his impressive speaking powers, established an international reputation proselytizing the need to admit parents to hospital with their children. The work of Bowlby and Robertson coincided with new knowledge about cross-infection, which had been one of the reasons for excluding parents from hospital wards. At the same time, and influenced by their work, community groups, which championed the idea of admitting parents with their children, developed. The combination of these factors provided a catalyst for changes within the health systems of many developed countries. Because of the theoretical work of Bowlby and Robertson's missionary zeal, government policies, staff attitudes and parents' expectations changed. Children's wards and hospitals in developed countries today admit parents as part of normal routine and actively involve them in the planning and implementation of their child's care.

Qualitative analysis of the care of children in hospital in four countries-Part 2.

As part of a large study of the care of children in Australian, British, Indonesian, and Thai hospitals, qualitative methods were used to examine differences influenced by culture. Two groups were surveyed: parents of hospitalized children, and staff caring for them. Vignettes were used to invoke discussion, and content analysis was used to examine the data. Subjects were interviewed singly, or in focus groups. These interviews were audiotaped and transcribed for analysis. This article is the second of a two-part series, and includes results of the staff's interviews and discussion. The parents' results and discussion were published in Part 1 (Shields & King, 2001). Staff in all the countries considered communication with parents to be an important part of care of the hospitalized child, and this was consistent with the parents' responses. Staff were mindful of safe practices, though more so in Australia and Britain than Indonesia and Thailand. Cost of treatment for the parents was an important consideration for staff in Indonesia and Thailand when they were planning care for the child. Cultural constructions were more likely to be considered by the Australian and British staff than the Indonesian and Thai staff, and this may have been influenced by the prevailing culture of medical dominance in those countries.

Abnormal fetal cerebral and umbilical Doppler measurements in fetuses with intrauterine growth restriction predicts the severity of perinatal morbidity.

PURPOSE: This prospective study was performed to determine if the ratio of the middle cerebral artery (MCA) S/D ratio (ratio of peak systolic blood flow velocity to diastolic velocity) to the umbilical artery (UA) S/D ratio (MCA/UA S/D ratio) predicts the degree of neonatal morbidity in fetuses suspected of having intrauterine growth restriction (IUGR). METHODS: Sixty-one fetuses were identified prospectively by sonography as having an estimated fetal weight below the 10th percentile for gestational age. The 61 fetuses underwent Doppler sonography in the third trimester and then were stratified into 3 groups based on the MCA/UA S/D ratio: group A, MCA/UA S/D ratio > 1.0 (controls; n = 37); group B, MCA/UA S/D ratio < or = 1.0 (intracerebral blood flow redistribution; n = 16); and group C, reversed or absent UA diastolic flow (n = 8). Outcome variables assessed included gestational age at delivery, birth weight, UA pH, mode of delivery, respiratory distress syndrome requiring intubation, and intracranial hemorrhage. RESULTS: The mean MCA/UA S/D ratios in groups A and B were 1.69 + /- 0.61 and 0.59 + /- 0.24, respectively (p < 0.01). The mean gestational ages at delivery for groups A, B, and C were 34.7, 33.2, and 29.0 weeks, respectively. The mean birth weights were below the fifth percentile for age for groups B and C and significantly related to the severity of abnormal Doppler findings (p < 0.01) after correction for age. Mean UA pHs were 7.25 + /- 0.01, 7.19 + /- 0.01, and 7.14 + /- 0.13 for groups A, B, and C, respectively, with significant differences between groups A and B (p < 0.05) and groups A and C (p < 0.05). Respiratory distress syndrome and intracranial hemorrhage were not associated with abnormal Doppler findings after correction for gestational age. The interval between the abnormal Doppler examination and delivery (p < 0.001) and the occurrence of fetal distress requiring cesarean section (p < 0.001) were significantly related to the severity of Doppler findings. CONCLUSIONS: In fetuses with suspected IUGR, abnormal MCA/UA S/D ratios are strongly associated with low gestational age at delivery, low birth weight, and low UA pH. Abnormal MCA/UA S/D ratios are also significantly associated with shorter interval to delivery and the need for emergent delivery.

A review of the literature from developed and developing countries relating to the effects of hospitalization on children and parents.

There is a literature base about the care of children in hospital in developed nations, but little from, or about, developing countries. The aim of this review was to critically examine publications relating to the effect of hospitalization on children and their parents. 'Parents', in this context, were considered as the child's natural or adoptive parents, step-parents or any other context of parent-child relationship, in other words, the primary care-giver to the child. Most of the work reviewed from developed countries was sourced from the nursing literature, while in developing countries, the available literature was largely from medicine. Conclusions from developed countries indicated that parents should be allowed to stay in hospital with their child, and that care must be developmental-stage appropriate. Furthermore, staff need to be educated about special needs of children, children should be prepared for hospital admission (if possible) and parents' needs met. In developing countries, the meagre literature available suggested that recognition of the important role parents play in a child's hospitalization is starting to become recognized.

Qualitative analysis of the care of children in hospital in four countries-Part 1.

As part of a large study of the care of children in Australian, British, Indonesian, and Thai hospitals, qualitative methods were used to examine differences influenced by culture. Two groups were surveyed: parents of hospitalized children, and staff caring for them. Vignettes were used to invoke discussion, and content analysis was used to examine the data. Subjects were interviewed singly, or in focus groups. These interviews were audiotaped and transcribed verbatim. The data were explored by using content analysis to extract themes of understanding of cultural experiences. This article is the first of a two-part series, and includes a review of the literature, description of the methods used, and results of the parents' interviews. The staff results and discussion will be published in Part 2. Analysis revealed that parents in all countries were primarily concerned with treating the child's illness and the child's recovery. Parents were concerned with their work (employment), but this was a much larger consideration in Indonesia and Thailand, where no social security systems exist, than in Australia and Britain. Communication with staff was the most commonly mentioned theme for parents, indicating that irrespective of the culture in which the care was given, good communication between parents and staff was of paramount importance.

Karyotyping for isolated neural tube defects. A report of two cases.

BACKGROUND: Neural tube defects occur in approximately 1 in every 1,000 live births. In the United States, chromosomal abnormalities have been noted in 2-10% of fetuses with neural tube defects; however, there is no consensus on whether to offer karyotype analysis to patients with isolated neural tube defects found on ultrasound. CASE: We reviewed the prenatal diagnosis database for the University of Washington between 1985 and 1997. We report on two fetuses who, on ultrasound, were found to have "isolated" neural tube defects. Karyotype analysis revealed trisomy 18 in both fetuses. The pregnancies were subsequently terminated, and autopsy revealed subtle syndromic findings that were not identified on ultrasound. CONCLUSION: Fetuses with isolated neural tube defects also appear to have a high risk of chromosomal abnormalities, so patients should be offered fetal karyotyping to define recurrence risks for future pregnancies.

Highly efficient gene transfer into preterm CD34 hematopoietic progenitor cells.

OBJECTIVE: Retrovirus-mediated gene transfer has been shown to transduce CD34(+) cells from term gestation umbilical cord blood with relatively high efficiency. The purpose of this study was to compare the efficiencies of retrovirus-mediated gene transfer into early (23-28 weeks' gestation) and term (37-41 weeks' gestation) umbilical cord blood CD34(+) hematopoietic progenitor cells. STUDY DESIGN: CD34(+) cells were purified from cyropreserved early (23-28 weeks' gestation) and term (37-40 weeks' gestation) umbilical cord blood specimens with fluorescence-activated cell sorting. The CD34(+) cells were then transduced in virus-containing medium (gibbon ape leukemia virus pseudotype vector LAPSN [PG13]) in wells coated with the recombinant human fibronectin fragment CH-296 and in the presence of multiple hematopoietic growth factors (interleukin 6, stem cell factor, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor, and megakaryocyte growth and development factor) and protamine sulfate. The LAPSN (PG13) virus-containing medium was changed every 12 hours for 48 hours, after which time colony-forming cells were assayed in soft agar. The gibbon ape leukemia virus pseudotype vector LAPSN (PG13) contains the human placental alkaline phosphatase and neomycin phosphotransferase (neo ) genes. The efficiency of gene transfer was assessed by histochemical staining of colony-forming cells in agar for expression of heat-stable alkaline phosphatase. RESULTS: Gene transfers, as assessed by alkaline phosphatase staining of colony-forming cells (granulocyte-macrophage colony-forming units and erythroid burst-forming units), were similar for CD34(+) hematopoietic progenitor cells from early (58.4% +/- 11.8%) and term (63.2% +/- 12.5%) gestation fetal umbilical cord blood. CONCLUSION: CD34(+) hematopoietic progenitor cells from midgestation fetal blood can be transduced with high efficiency using techniques optimized for postnatal samples with a gibbon ape leukemia virus pseudotype vector. The early fetus may be a preferable target for gene therapy because of the higher number of circulating CD34(+) and CD38(-) cells relative to term cord blood, their greater proliferative capacity, and the rapid expansion of the fetal hematopoietic system that occurs from the second trimester to delivery. Because in vitro studies of gene transfer into hematopoietic progenitor cells and long-term culture-initiation cells have not been predictive of the efficiency of gene transfer into marrow-repopulating cells in vivo, studies that examine clinically applicable approaches to in utero gene therapy in appropriate animal models are still needed.

Ultrasonography for cervical length measurement: agreement between transvaginal and translabial techniques.

OBJECTIVE: To assess agreement between transvaginal and translabial ultrasonography for measuring cervical length in the second and third trimesters. METHODS: Eighty-four obstetric patients at 14-40 weeks' gestation were enrolled. Three images of the cervix were obtained by translabial (3.5-MHz curvilinear transducer) and transvaginal (6.5-MHz endovaginal probe) ultrasonography. The mean cervical length obtained by using each method was used for data analysis. The McNemar chi(2) test was used to assess the difference between techniques in their ability to obtain a measurement. The paired t-test was used to evaluate the differences between the measurements. The mean difference and SD for the differences were used to calculate the limits of agreement. An acceptable difference was defined as less than 0.5 cm. RESULTS: Cervical length measurements were obtained in 84 patients (100%) by using the transvaginal technique and in 80 patients (95%) by using the translabial technique (P =.1). Eighty patients had both transvaginal and translabial measurements for comparison. The mean difference in cervical length was 0.37 cm (P <.001; 95% confidence interval [CI] 0. 21, 0.52). The upper and lower limits of agreement were 1.75 cm (95% CI 1.48, 2.02) and -1.01 cm (95% CI -0.74, -1.28), respectively. The differences between the two measurements were within these limits 95% of the time. These limits of agreement were greater than the acceptable difference of 0.5 cm. CONCLUSION: Transvaginal and translabial techniques should not be used interchangeably for clinical assessment of cervical length because agreement between the methods is not within an acceptable range.