A phase I study of adenovirus-mediated transfer of the human cystic fibrosis transmembrane conductance regulator gene to a lung segment of individuals with cystic fibrosis.

A third-generation adenoviral vector containing recombinant human cystic fibrosis transmembrane conductance regulator (CFTR) gene was delivered by bronchoscope in escalating doses to the conducting airway of 11 volunteers with cystic fibrosis. Assessments of dose-limiting toxicity (DLT), efficiency of gene transfer, and cell-mediated and humoral immune responses to vector administration were performed. DLT, manifest by flulike symptoms and transient radiographic infiltrates, was seen at 2.1 x 10(11) total viral particles. A highly specific assay for gene transfer was developed using in situ hybridization with an oligoprobe against unique vector sequence. Detectable gene transfer was observed in harvested bronchial epithelial cells (<1%) 4 days after vector instillation, which diminished to undetectable levels by day 43. Adenovirus-specific cell-mediated T cells were induced in most subjects, although only mild increases in systemic humoral immune response were observed. These results demonstrate that gene transfer to epithelium of the lower respiratory tract can be achieved in humans with adenoviral vectors but that efficiency is low and of short duration in the native CF airway.

A developmental model of recipients' reactions to aid.

A developmental model of recipients' reactions to aid, which is based on the threat-to-self-esteem model (the dominant theoretical framework in the field), is presented. Various refinements of the threat-to-self-esteem model are proposed to extend its range of applicability and heuristic value to encompass the study of children's reactions to aid. The moderating influences of developmental changes in cognitions regarding self and others, as well as in children's social environment, are examined. Literature from a variety of sources that is relevant to children's reactions to aid, or to processes that may be involved, is reviewed and discussed in light of our model.

Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants.

OBJECTIVE: To describe 13 neurologically normal infants with chronic respiratory symptoms who had swallowing dysfunction with silent chronic aspiration without gastroesophageal reflux (GER) as the cause of their respiratory symptoms. BACKGROUND: Infants with neurologic disorders and infants with GER are known to have chronic respiratory symptoms. Isolated swallowing dysfunction and aspiration without GER in neurologically normal infants have not been widely reported. DESIGN: Retrospective chart review. SETTING: A tertiary pulmonary-care center at a children's hospital. PATIENTS: One hundred twelve otherwise healthy infants referred for respiratory symptoms who underwent esophageal pH studies and videofluoroscopic swallow studies (VSSs). METHODS: The records of infants referred between January 1997 and December 1999 to the Department of Pediatric Pulmonology who underwent 24-h esophageal pH monitoring and VSS as part of an evaluation for recurrent stridor and/or wheezing were reviewed. Significant GER was diagnosed if the percentage of time with esophageal pH < 4 was > 6%. Infants included in the study presented with recurrent respiratory symptoms, were born at term, were neurologically normal, had normal results of esophageal pH studies, but had abnormal results of VSSs (n = 13). RESULTS: All 13 infants presented with a variety of recurrent respiratory symptoms including wheezing and intermittent stridor. Ten of 13 infants had spitting and/or choking episodes with feeding. The mean (+/- SD) age at the onset of symptoms was 2.0 +/- 1.6 months, and the mean age at VSS was 5.9 +/- 3.4 months. All 13 infants had normal results of 24-h esophageal pH studies but had abnormal results for VSSs. All infants had evidence of swallowing dysfunction and direct silent aspiration of liquids with thin consistency. Six infants also were aspirating liquids with thick and/or semi-thick consistencies. None of the infants had evidence of structural anomalies on esophagograms. Nine infants were treated with thickened food, and in four infants oral feedings were stopped. Three of these infants required nasojejunal feeding, and one infant required gastrostomy tube feeding. VSSs were repeated every 3 months. In all infants, swallowing dysfunction resolved within 3 to 9 months. All infants tolerated the resumption of oral feeding. Videofluoroscopic documentation of the resolution of aspiration was followed by the resolution of respiratory symptoms in all infants. CONCLUSION: There is a subgroup of otherwise healthy infants, presenting with wheeze and/or stridor, who have isolated swallowing dysfunction and silent aspiration as the cause of their respiratory symptoms.

Compression of the trachea by the innominate artery in a 2-month-old child.

SUMMARY. We utilized improved methods for assessing airway structure and function to define the clinical significance of the innominate artery syndrome. Both infant pulmonary function tests (IPFT) and noninvasive controlled ventilation computed tomography (CVCT) were used, along with traditional diagnostic techniques in a 2-month-old child with compression of the trachea by the innominate artery. These tests provided objective documentation of functional impairment before surgery and improvement postoperatively. These tests should aid in the understanding of this controversial syndrome and help to further define treatment options.

Consistency-based compliance: when and why do children become vulnerable?

This study examines the nature and development of behavioral consistency pressures in children. Specifically, we examined the effectiveness of the foot-in-the-door procedure in producing consistent prosocial behavior and self-attributions in kindergartners and second and fifth graders. Children were either induced to comply with a request to share prize coupons or were not given this initial prosocial experience. Those who complied either were labeled as helpful by an adult or were not. Later, children were given the opportunity to help under public or private circumstances. Moreover. children's understanding of trait stability, their internal preference for consistent behavior, and their belief that adults prefer behavioral consistency were assessed. Consistent responding began to occur within the foot-in-the-door procedure in the second grade, and this developmental shift was paralleled by a shift in children's understanding of trait stability. Furthermore, once the foot-in-the-door effect appeared among the second and fifth graders, its strength was significantly affected by the children's internal preference for consistency.

Personality and socialization correlates of vicarious emotional responding.

The relations of personality and family characteristics to adults' negative vicarious emotional responses to sympathy and distress films were examined. Ss reported more sympathy and less personal distress and exhibited less skin conductance as well as heart rate deceleration when viewing a sympathy-evoking film. Dispositional emotional intensity and fantasy empathy were associated with greater self-reported emotional responding and higher skin conductance. Dispositional perspective taking and personal distress were positively and negatively correlated, respectively, with reported vicarious responding to the sympathy film when Ss were administered instructions to imagine the emotions of those in the films. Family cohesiveness was associated with reported sympathy and sadness in reaction to the sympathy film, whereas the expression of negative subordinate and positive emotional states in the home of origin was associated with women's reported responsivity.

Relation of sympathy and personal distress to prosocial behavior: a multimethod study.

Assessed sympathy and personal distress with facial and physiological indexes (heart rate) as well as self-report indexes and examined the relations of these various indexes to prosocial behavior for children and adults in an easy escape condition. Heart rate deceleration during exposure to the needy others was associated with increased willingness to help. In addition, adults' reports of sympathy, as well as facial sadness and concerned attention, were positively related to their intention to assist. For children, there was some indication that report of positive affect and facial distress were negatively related to prosocial intentions and behavior, whereas facial concern was positively related to the indexes of prosocial behavior. These findings are interpreted as providing additional, convergent support for the notion that sympathy and personal distress are differentially related to prosocial behavior.

Development of a model practice for pediatric residents. Economic and administrative considerations.

A model pediatric residents' group practice which functions independently of the hospital administration and, to a large extent, of the university administration was developed for the specific purpose of training pediatric residents. During the second year of operation (1981), the residents' group practice met 91 per cent of all expenses, including faculty and resident salaries. The residents' group practice shares many characteristics of private practice (e.g., continuity of physician-patient relationship, appointment keeping, efficient patient flow, and physician participation in practice management). Through their involvement in the management of the practice, residents learn about socioeconomic aspects of pediatric practice and learn how to provide affordable primary care of high quality. Suggestions for developing similar models elsewhere are described.

Commitments to help by children: effects on subsequent prosocial self-attributions.

Children of both sexes and at several ages were or were not induced to make a commitment to help hospitalized children by sorting papers. The commitments occurred under either public or private circumstances. Later, the children discovered that the commitment to help would require that they give up their recess times (i.e. breaks). The willingness of subjects to live up to their commitments and the altruistic self-attributions resulting from those commitments were measured. It was found that, regardless of conditions, virtually all subjects were willing to give up recess time to help. However, their self-attributions differed systemically with condition: only after making a private commitment to help did subjects come to see themselves as more altruistically oriented. Further, this effect appeared earlier for girls than for boys and persisted at least one month after the initial commitment. No such effects occurred for public commitments, suggesting that children as young as eight years were able to discount the self-relevant implications of prosocial commitments made under public scrutiny.

A multi-level incentive model for service organizations.

Incentive programmes for production employees have been used for many years. However, more recently, there has been an increasing desire to use incentive programmes in service applications, particularly with the advent of electronic performance monitoring. This paper summarizes the methodology for developing a model that incorporates the parameters of quality (customer and supervisor evaluations), quantity of production, sales and individual goals. The model was used to compute incentive bonus payments for customer service employees who performed above standard. Employees were motivated by the incentive bonus, and thus productivity was increased. The model could be applied to any service organization. The model was developed to assist a customer service department where performance standards, quality measures or customer feedback were not firmly established. It measured objectively employee performance and rewarded the employee with individually calculated incentive bonuses through an electronically monitored system. The internal working of the model is a combination of the above parameters. Customized software was used to collect and tabulate customer feedback regarding a recent inquiry to the customer service department. This made up the first part of the quality measure for the department. The second part of the quality parameter was a regular evaluation by the supervisor. The quantity of production was measured by the number of inquiries handled per unit time. Sales were also calculated on a per-unit-time basis. The individual goals were the result of regular employee-supervisor meetings where past and future employee performance was discussed and mutually agreed upon. The five model parameters of quality (customer and supervisor), quantity, sales and individual goals are combined through the use of a linear equation. It was found that this form of employee evaluation worked very well in an electronic monitoring environment and was accepted by the participating work group. Overall, monthly productivity gains exceeded 15%.

A review and reappraisal of electronic performance monitoring, performance standards and stress allowances.

There is a growing trend toward electronic performance monitoring (EPM) to track the performance of workers engaged in computer-based tasks. Despite the possible productivity advantages of this approach to work management, the use of EPM may produce stress through work overload, negative computer feedback, loss of incentive pay and threat of job loss. These stress effects are most likely to occur among workers who have difficulty meeting work standards (eg, forms processed per hour) enforced through EPM. A stress allowance is proposed as a new category of work allowance for adjusting EPM work standards so as to minimize imbalances between task demands and the worker's resources to adapt.

On the investigation of the neurophysiological correlates of knowledge worker mental fatigue using the EEG signal.

Technological trends and advances in automation have underscored the importance of task performance of certain jobs requiring mental functions such as information processing and decision analyses. Most experts agree that such work environments produce increased mental activities, with profound implications for mental fatigue and stress. Consequently, productivity measurement and improvement for white collar or 'knowledge worker' occupations remains a major challenge and concern. This investigation defines an experimental approach that examines the neurophysiological correlates of white collar worker mental fatigue using the EEG signal. A 6 h laboratory experiment was conducted to simulate work output. The methods of assessing fatigue employed were mental tests and physiological measurements. The experiment involved reading of standardized texts, finding solutions to arithmetic-logical problems and a combination of both task types. Two primary performance measures were obtained, work output and brain waves. Fast Fourier transform and correlation analyses are used to quantify the relationship between certain brain waves and mental fatigue. This research is a major step towards the development of a model that explores the relationship between mental fatigue and factors associated with output performance, optimal recuperation periods and related variables. Such a model would be useful in human reliability prediction based on task parameters and worker profiles.

Antidepressant prescribing practices of nurse practitioners.

Depression continues to be seriously underdiagnosed and undertreated in primary care settings. Many studies have observed antidepressant prescribing practices of nonpsychiatric physicians to discover why inadequate depression detection and treatment is pervasive. This article describes the first large, randomized study to investigate the antidepressant prescribing practices of NPs. This quantitative, descriptive study sought to determine the factors NPs consider when choosing an antidepressant, antidepressant prescribing frequency by NPs, types of antidepressants prescribed by NPs, and health problems that NPs are treating with antidepressants. The study's findings indicate that NPs should adhere more closely to established practice guidelines.

Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa.

HIV/AIDS is taking a heavy toll on South African youth. Reducing their risk for HIV requires an understanding of the determinants of their HIV risk behaviours that are amendable to intervention-induced change. This study draws upon the theory of planned behaviour to identify the modifiable determinants of the intention to use condoms among Xhosa-speaking South African adolescents. The participants were 390 Xhosa-speaking 6th grade students (mean age = 12.1 years) in public schools in the township of Mdantsane, South Africa who completed an anonymous questionnaire. Multiple regression revealed that attitude and perceived behavioural control were significantly related to the intention to use condoms, whereas subjective norm was not, controlling for sexual experience, gender, and language preference. Consistent with this were additional analyses using beliefs as predictors: Hedonistic behavioural beliefs and control beliefs about condom-use negotiation and technical skills predicted intention, whereas normative beliefs did not. The theory of planned behaviour may be a useful model of condom use among Xhosa-speaking South African adolescents. An emphasis on beliefs about the adverse effects of condom use on sexual enjoyment, the ability to negotiate condom use, and the ability to use condoms correctly might improve the efficacy of HIV/STD interventions for such adolescents.

Perceived barriers to teaching for critical thinking by BSN nursing faculty.

The ability to think critically is considered an essential skill of nursing graduates and competent nursing practice. Yet, the literature reports that teachers are having difficulty teaching for critical thinking and that critical thinking is lacking in new nursing graduates. This research study sought to identify barriers to the implementation of critical thinking teaching strategies by nursing faculty currently teaching in generic baccalaureate programs in Tennessee. Surveys were mailed to 262 nursing faculty; 194 were returned, and 175 were usable. Students' attitudes and expectations represented the single greatest barrier to the implementation of critical thinking teaching strategies, followed by time constraints and the perceived need to teach for content coverage. Recommendations to support and encourage faculty to teach for critical thinking are outlined.

Children's reactions to the receipt of direct and indirect help.

First, third, and fifth graders' (N = 201) reactions to 2 types of aid (direct help [answers] and indirect help [hints]) commonly used by helpers to assist children were examined. The children were randomly assigned to receive either direct or indirect help on a task, and then were asked to try a similar task immediately and again a few days later. Direct help was expected to elicit dependency, whereas indirect help was expected to elicit independent reactions. Age and/or sociocognitive level were predicted to moderate the effects of help. Direct help resulted in feelings of threat, low perceived control, and high dependency help-seeking for girls, but not for boys. Boys who received indirect help and understood the notion of consistency of personality requested less dependent help than did boys with less of this sociocognitive skill. Moreover, children high in the understanding of consistency of personality were more autonomous (i.e., helped themselves more) in the indirect than in the direct help condition.

Antidepressant prescribing practices of nurse practitioners.

Depression is considered a highly treatable illness, yet often it is inadequately treated by physicians in primary care settings. The economic and human cost of inadequate treatment is well documented. The purpose of this pilot study was to explore the antidepressant prescribing practices among a convenience sample of nurse practitioners (NPs) and to use the findings to refine the antidepressant therapy questionnaire for further use. A self-administered questionnaire was completed by 26 NPs. Results of the survey revealed that NPs in primary care settings frequently treat a wide variety of common mental health problems and prescribe antidepressant medications for a number of these disorders as well as for nonpsychiatric problems. Factors that influence the NPs' decision-making process in the selection of a particular antidepressant were found to vary among the NPs surveyed. Although 65% of the NPs felt that they were sufficiently informed about the available antidepressants to select the most appropriate drug for their clients, 77% believed they needed additional education on antidepressant medications, and all but one respondent reported willingness to attend continuing educational offerings on antidepressant medications.

Impact of added rest breaks on the productivity and well being of workers.

The impact of frequent short rest breaks on the productivity and well being of a group of 30 workers in a meat-processing plant was studied. Two rest break schedules were tested, both of which provided 36 min of extra break time over the regular break schedule (30-min lunch and two 15-min breaks). In the first experimental rest break schedule, workers were given 12 3-min breaks evenly distributed over the workday (3-min break for every 27 min of work). In the second schedule, workers were given four 9-min breaks evenly distributed over the workday (9-min break every 51 min of work). Outcome measures included production rate and discomfort and stress ratings. Results showed that neither of the two experimental rest break schedules had a negative effect on production, and the 9-min break schedule improved discomfort ratings for the lower extremities. The workers in the study mostly preferred the 9-min rest break schedule, indicating that workers in general might not as readily accept fragmentation of break time into short, frequent breaks.

The cross-ethnic equivalence of parenting and family interaction measures among Hispanic and Anglo-American families.

Recently there has been concern over the need for developmental research within ethnic minority populations and interest in family processes within, and variability across, ethnic groups. Unfortunately, most of the research using standard scales of family processes has sampled middle-class Anglo-Americans, and the potential absence of cross-ethnic measurement equivalence threatens the validity of the research using these scales with ethnic minority populations. This study reports confirmatory factor analyses and construct validity coefficients for several parenting and family interaction scales among Anglo-American and Hispanic 8-14-year-old children and mothers. The findings indicate that the Children's Report of Parental Behavior Inventory (except the hostile control subscale), the Parent-Adolescent Communication Scale (open communication subscale only), and the Family Adaptability and Cohesion Evaluation Scales II appear to have sufficient cross-ethnic equivalence for English-speaking Hispanic samples. Further, the Family Routines Inventory and the problem communication subscale could benefit from additional scale development.