Acute respiratory failure and the kinetics of neutrophil recovery in pediatric hematopoietic cell transplantation: a multicenter study.

In this multicenter study, we investigated the kinetics of neutrophil recovery in relation to acuity and survival among 125 children undergoing allogeneic hematopoietic cell transplantation (allo-HCT) who required invasive mechanical ventilation (IMV). Recovery of neutrophils, whether prior to or after initiation of IMV, was associated with a significantly decreased risk of death relative to never achieving neutrophil recovery. A transient increase in acuity (by oxygenation index and vasopressor requirements) occurred among a subset of the patients who achieved neutrophil recovery after initiation of IMV; 61.5% of these patients survived to discharge from the intensive care unit (ICU). Improved survival among patients who subsequently achieved neutrophil recovery on IMV was not limited to those with peri-engraftment respiratory distress syndrome. The presence of a respiratory pathogen did not affect the risk of death while on IMV but was associated with an increased length of IMV (p < 0.01). Among patients undergoing HCT who develop respiratory failure and require advanced therapeutic support, neutrophil recovery at time of IMV and/or presence of a respiratory pathogen should not be used as determining factors when counseling families about survival.

Correction to: Acute respiratory failure and the kinetics of neutrophil recovery in pediatric hematopoietic cell transplantation: a multicenter study.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Internally displaced human resources for health: villager health worker partnerships to scale up a malaria control programme in active conflict areas of eastern Burma.

Approaches to expand malaria control interventions in areas of active conflict are urgently needed. Despite international agreement regarding the imperative to control malaria in eastern Burma, there are currently no large-scale international malaria programmes operating in areas of active conflict. A local ethnic health department demonstrated that village health workers are capable of implementing malaria control interventions among internally displaced persons (IDPs). This paper describes how these internally displaced villagers facilitated rapid expansion of the programme. Clinic health workers received training in malaria diagnosis and treatment, vector control and education at training sites along the border. After returning to programme areas inside Burma, they trained villagers to perform an increasingly comprehensive set of interventions. This iterative training strategy to increase human resources for health permitted the programme to expand from 3000 IDPs in 2003 to nearly 40,000 in 2008. It was concluded that IDPs are capable of delivering essential malaria control interventions in areas of active conflict in eastern Burma. In addition, health workers in this area have the capacity to train community members to take on implementation of such interventions. This iterative strategy may provide a model to improve access to care in this population and in other conflict settings.

Genotypic and allelic frequencies of SULT1A1 polymorphisms in women receiving adjuvant tamoxifen therapy.

Human sulfotransferase 1A1 (SULT1A1) is involved in the metabolism of a number of substances including 4-hydroxytamoxifen. It has been shown that patients who are homozygous for the variant SULT1A1 *2/*2 have lower catalytic activity. Previous data has suggested that patients with this particular genotype may be at a greater risk of developing breast cancer or not responding to tamoxifen therapy. To date, there is no data within the Hispanic population on the genotypic and allelic frequencies of the SULT1A1 gene. Two hundred and ninety-six patients were genotyped by either restriction fragment length polymorphism (RFLP) or Pyrosequencing for the SULT1A1 exon 7 polymorphism. The genotypic frequency was 0.47 (*1/*1), 0.40 (*1/*2) and 0.13 (*2/*2) in Caucasians and 0.37 (*1/*1), 0.45 (*1/*2) and 0.18 (*2/*2) in Hispanics. Although Hispanics have a higher genotypic frequency of variant genotypes this difference was not statistically significant (p=0.26). SULT1A1 genotype did not correlate with any prognostic or predictive markers associated with breast cancer. Future evaluations will assess the functional significance of this polymorphism on survival.

Catechins are bioavailable in men and women drinking black tea throughout the day.

Tea consumption has been associated with reduced risk of both cancer and cardiovascular disease in population studies, but clinical data demonstrating bioavailability of the individual catechins and other polyphenolic components of tea are limited. This study assessed the apparent bioavailability of the prominent catechins from black tea in humans drinking tea throughout the day. After 5 d of consuming a low flavonoid diet, subjects drank a black tea preparation containing 15.48, 36.54, 16.74, and 31.14 mg of (-)-epigallocatechin (EGC), (-)-epicatechin (EC), (-)-epigallocatechin gallate (EGCG) and (-)-epicatechin gallate (ECG), respectively, at four time points (0, 2, 4 and 6 h). Blood, urine and fecal specimens were collected over a 24- to 72-h period and catechins were quantified by HPLC with coularray detection. Plasma concentrations of EGC, EC and EGCG increased significantly relative to baseline (P < 0.05). Plasma EGC, EC and EGCG peaked after 5 h, whereas ECG peaked at 24 h. Urinary excretion of EGC and EC, which peaked at 5 h, was increased relative to baseline amounts (P < 0.05) and fecal excretion of all four catechins was increased relative to baseline (P < 0.05). Approximately 1.68% of ingested catechins were present in the plasma, urine and feces, and the apparent bioavailability of the gallated catechins was lower than the nongallated forms. Thus, catechins were bioavailable. However, unless they are rapidly metabolized or sequestered, the catechins appeared to be absorbed in amounts that were small relative to intake.

Mentoring benefits and issues for public health nurses.

New public health nurses (PHNs) move from novice to expert status with enormous expectations from their organization, their peers, and themselves. These expectations lead to stress that may be beyond the level of endurance. Mentoring is an important answer to this problem. Mentoring is the greatest gift PHNs can give to each other, especially for PHNs who self-identified themselves as minority cultural group members. This article describes definitions, roles, benefits, and responsibilities of mentors and mentees and includes mentoring concerns, current and proposed mentoring programs, and mentoring issues for gender and race. Organizational mentoring programs can be created that will facilitate the development of mentoring relationships. These programs help experienced PHNs bridge the gap between the theory and reality of nursing for themselves and inexperienced colleagues.

Health of America's newcomers.

Newcomer health and health care are policy issues with major outcomes of cost shifting and enormous consequences for newcomers and the community health nurses who promise them care. Newcomers are persons entering U.S. borders who could be asylees, refugees, immigrants, legal or illegal aliens, migrants, international adoptees, and others. Described in this article are the role federalism has played on the interplay among policymakers regarding newcomer health. Also addressed is newcomer health policy, including immigration policies, and newcomer health issues such as infectious diseases and questionable health care. Additional newcomer health issues such as newcomers at high risk for health problems, issues of access to care for newcomers, and welfare reform policies are discussed. Newcomer health and special interest group activities such as those from medicine and nursing are also addressed. Finally, meaningful options and possible solutions for newcomer health care concerns are identified and shared.

Evaluation of an educational intervention to increase cultural competence among registered nurses.

The purpose of this two group intervention study (N = 94) was to determine if RNs who participated in "culture school" improved levels of cultural competence to a greater extent than RNs who attended nursing informatics classes. The Giger and Davidhizar Transcultural Assessment Model/Theory (GDTAMT) was the study's theoretical foundation (Giger & Davidhizar, 1995). A sample of 94 participants, was identified from a randomized group of all Jefferson County, Alabama RNs. Randomly assigned participants (stratified by race) experienced 8.5 hours of either culture school or nursing informatics classes and completed survey tools in three phases (pre-intervention, immediate post intervention, three week follow-up). The Cultural Self-Efficacy Scale (CSES) by Bernal and Froman (1987), knowledge base questions by Rooda (1990), and demographic profiles were used. Concepts empirically measured using these tools were analyzed by transcultural nursing experts for their congruence with GDTAMT. Using repeated measures analyses of convariance (race), significant differences between groups for both scales were found. Culture school participants demonstrated significantly more cultural self-efficacy and cultural knowledge, and these improvements remained during phase three. Further research is recommended to allow for greater generalizability of findings, an examination of client perceptions, and actual nurse behaviors.

Micromultiplane transesophageal echocardiographic probe for intraoperative study of congenital heart disease repair in neonates, infants, children, and adults.

This study reports the development of a micromultiplane 8.2-mm transesophageal echocardiographic probe. The probe is applicable to newborn infants and can deliver diagnostic images in adults.

SPIKEII: an integrate-and-fire AVLSI chip.

We present the SPIKEII chip, an integrate-and-fire neural network chip with programmable synapses implemented in analogue VLSI. It is the successor to the SPIKEI chip. We describe the circuitry, and show some results using networks of integrate-and-fire neurons.

Silicon cellular morphology.

We describe a design technique for neuromorphic engineering that exploits both Mead's notion of physical equivalence between transistors and ion channels and the intrinsic properties of the materials of which transistors are composed. This is in contrast to the "algorithmic" design technique in common use. A "physical" design technique allows us to emphasise the morphology of cells. We hope to use this in an exploration of the effect of cell morphology upon function.

Trends in multiculturalism in health care.

Materiel managers are faced with a shrinking world and changing work environment. The needs and expectations of the customer have shifted because of the increasing number of multicultural groups. These groups will continue to assert their right to culturally sensitive care. Materiel managers also need to learn to support and enhance the skills of a multicultural work force. One important tool for change will be technology. However, technology that brings the world closer together also creates new challenges for managers, who will have to deal with multicultural colleagues, buyers, sellers, and manufacturers of goods and services.

Concept analysis: cultural competence.

To evaluate theory, concepts with that theory must be identified, analyzed and defined. The aim of this concept analysis of cultural competence is to clarify and differentiate the term as it is used in health care and nursing literature and to separate cultural competence from its measurement. Before the question of what is cultural competence can be answered, culture and competence--as separate terms--must be understood. Components of the cultural competence concept are identified along with its antecedents and consequences. Additionally, terms closely related to cultural competence are described and differentiated from the cultural competence concept. To add meaning to the analysis, a cultural competence model case and contrary case are supplied along with outcome measures and empirical referents for cultural competence. Finally, a concluding definition based on extensive review of literature sources such as archeology, anthropology, history, psychology, policy, criminal justice, occupational therapy, medicine, nursing, and education is provided.

Cultural competence for nurses: canonical correlation of two culture scales.

As the diversity of the US residential population increases, healthcare professionals need to recognize the importance of culturally competent care on health outcomes of individuals and communities. The purpose of this descriptive correlational pilot study (N = 51) was to describe the relationship among scores and sub-scores on scales measuring concepts of cultural competence. An additional purpose was to develop reliability and validity data on each of three culture scales for the population of hospital based registered nurses. Each of the scales had previously reported reliability and validity data but were administered to populations potentially different from southern-based, hospital-employed RNs. A large medical center located in Southeastern US was chosen as the study's site due to its diverse staff and client base. The Giger and Davidhizar Transcultural Assessment Model and Theory was the theoretical foundation for the study and Cultural Self-Efficacy Scale (CSES), Cultural Attitude Scale as developed by Bonaparte (1977, 1979) and modified by Rooda (1990, 1992) (CAS-Modified), and knowledge base questions (Rooda, 1990) were the chosen instruments. For this group of hospital based RNs, the reliability analysis--scale (Alpha) for the 58 item CSES was .9778. The reliability analysis (Alpha) for the 22 knowledge base questions was .6038 and .6412 for the 40 item CAS-M. Canonical correlation analysis was performed between a set of attitude variables and a set of self efficacy variables using SPSS (1995). Both sets of variables demonstrated statistically significant relationships (at an a priori alpha of .05) to each other (with an approximate Eta squared value for practical significance of .336), providing sufficient evidence to reject the non-relationship null hypothesis. For this sample and for these data, cultural self-efficacy toward Asian, Black, Hispanic clients, and self-efficacy regarding nursing skills when caring for diverse clients related to cultural attitudes and cultural self-efficacy. Nursing care, cultural health beliefs, and cultural health attitudes related to attitudes toward care of diverse clients. Both sets of variables related to each other as qualities of culturally competent nursing care.