Introduction of an Alcohol-Related Electronic Screening and Brief Intervention (eSBI) Program to Reduce Hazardous Alcohol Consumption in Namibia's Antiretroviral Treatment (ART) Program.

Alcohol is the most widely abused substance in Namibia and is associated with poor adherence and retention in care among people on antiretroviral therapy (ART). Electronic screening and brief interventions (eSBI) are effective in reducing alcohol consumption in various contexts. We used a mixed methods approach to develop, implement, and evaluate the introduction of an eSBI in two ART clinics in Namibia. Of the 787 participants, 45% reported some alcohol use in the past 12 months and 25% reported hazardous drinking levels. Hazardous drinkers were more likely to be male, separated/widowed/divorced, have a monthly household income > $1000 NAD, and report less than excellent ART adherence. Based on qualitative feedback from participants and providers, ART patients using the eSBI for the first time found it to be a positive and beneficial experience. However, we identified several programmatic considerations that could improve the experience and yield in future implementation studies.

Subsurface damage in precision ground ULE(R) and Zerodur(R) surfaces.

The total process cycle time for large ULE((R)) and Zerodur((R))optics can be improved using a precise and rapid grinding process, with low levels of surface waviness and subsurface damage. In this paper, the amounts of defects beneath ULE((R)) and Zerodur((R) )surfaces ground using a selected grinding mode were compared. The grinding response was characterised by measuring: surface roughness, surface profile and subsurface damage. The observed subsurface damage can be separated into two distinct depth zones, which are: 'process' and 'machine dynamics' related.

Thoracoscopic versus open partial pericardectomy in dogs: comparison of postoperative pain and morbidity.

OBJECTIVE: To evaluate postoperative pain and morbidity in dogs undergoing open thoracotomy and partial pericardectomy versus thoracoscopic pericardectomy. STUDY DESIGN: Research study in normal dogs. ANIMALS OR SAMPLE POPULATION: Fourteen mixed breed healthy dogs. METHODS: Seven dogs had a partial pericardectomy through a standard left lateral thoracotomy at the fifth intercostal space. The remaining seven dogs underwent selective lung ventilation and thoracoscopic partial pericardectomy. Surgery sites in both groups were bandaged and each dog received a single postoperative dose of morphine (0.2 mg/kg, intramuscularly [i.m.]). Postoperative pain was evaluated using a standard pain score table at 1, 5, 9, 17, 29, and 53 hours after surgery. Dogs receiving a pain score of six or greater received an additional dose of morphine. At each observation point, blood samples were taken to measure blood glucose and plasma cortisol concentrations. Pain scores, blood glucose, and plasma cortisol concentrations were compared between the two groups using two-way ANOVA. RESULTS: Blood glucose concentrations, plasma cortisol concentrations, and pain scores were significantly different between the two groups, with the thoracotomy dogs having higher values at 1, 5, and 9 hours postoperatively. Three of the open thoracotomy dogs required additional analgesia after the initial dose of morphine. In addition, two dogs that underwent open thoracotomy were lame in the left forelimb and two others developed dehiscence of their wounds. CONCLUSIONS AND CLINICAL RELEVANCE: Thoracoscopic partial pericardectomy has several advantages over open partial pericardectomy including decreased postoperative pain, fewer wound complications, and more rapid return to function.

Lokomaika'i (inner health) in a remarkable hospital.

Seven years ago, The Queen's Medical Center in Honolulu, Hawaii embarked on a journey of rediscovery, one that would explore the past, present and future of the health care environment. In an effort to provide the best care and services to the people of Hawaii, Queen's embraces a philosophy of care that incorporates the physical, emotional, social and spiritual needs of its patients.

Advancing social work practice in health care settings: a collaborative partnership for continuing education.

This article describes a model for social work education and research established by a school of social work and the social work department of a metropolitan medical center. Social workers in the health care setting were surveyed on the knowledge and skills they needed to help them respond to new directions for the department. Results of the study identified a number of themes for staff development and research. Implications of the study, together with a description of the education and research programs developed to respond to these themes, are presented.

An interview with Duane D. Walker. Interview by Connie R Curran.

Duane D. Walker, MS, RN, FAAN, is vice president of patient services and the executive director of the Nursing Institute at The Queen's Medical Center, Honolulu, Hawaii. In this interview he discusses the history of The Queen's Medical Center, multidisciplinary care, accountability, and careers in nursing management.

The Queen's Medical Center Honolulu, Hawaii.

The Queen's Medical Center created and almost fully realized a vision of professional nursing practice. This vision was mission-driven and philosophically oriented in that our Hawaiian heritage and commitment to a patient-centered focus dictated the direction taken. Utilizing the nursing process, we listened to our patients in identifying the nursing model to best meet their needs: primary nursing. In order to achieve that, the nurse at the bedside had to be empowered to make decisions directly impacting patient care. We further committed to treating the whole patient and considering complementary therapies. We have established an evaluation baseline and are committed to a process that will carry us into the year 2000.

"Cross-talk" in recording evoked potentials.

When two potentials having large amplitude differences are simultaneously recorded, the large amplitude potential contaminates the small amplitude response. The small, early potentials generated by this contamination resemble far-field potentials. Although scalp-recorded SEP was contaminated by waves similar to the peripheral potential, peak latencies and wave form were not identical. Experiments simulating the recording situation verified the presence of "cross-talk." Capacitive coupling would shift peaks and alter the wave forms. Other possible mechanisms for the cross-talk and methods of minimizing it are offered. One should be cautious interpreting the results when potentials of large amplitude differences are simultaneously recorded.

Psychological factors and return to work.

Return to work is considered to be a criterion of a good outcome after a myocardial infarction or coronary revascularisation procedure. In general, return to work is not necessarily correlated with cardiac state; a variety of psychological, social and economic factors influence whether or not the individual will return to gainful employment. Psychological variables to be considered include the reactions of patient and family, their understanding of the illness, the personality and behavioural characteristics of the patient, expectations of the results of treatment and attitudes towards disability. These will be influenced by aspects of the job itself or the working environment as perceived by the patient. Physicians' attitudes are strong factors in influencing the final decision on whether or not the patient goes back to work. Employers and fellow employees, by their attitudes to the illness, will also influence the decisions. It follows that assessment and management of psychological problems must be part of total patient care after a coronary event if the optimal number of patients are to return to work, confidence of their ability to cope with its demands. Though the actual way in which assessment is made and appropriate treatment undertaken may vary considerably, a study of available knowledge enables general guidelines on these aspects to be given.

Barbash strain spotted fever group rickettsia is a strain of Rickettsia conorii and differs from Rickettsia sibirica.

The Barbash strain of spotted fever group rickettsia was reexamined in this study by the microimmunofluorescence test with mouse antisera and with monoclonal antibodies. Protein immunoblotting was performed for comparison of purified antigens of R. rickettsii, R. sibirica, R. conorii and Barbash strain. Comparison of Barbash strain, R. rickettsii (Sheila Smith strain), R. conorii (Malish 7 strain), and R. sibirica (strains 232, 246 and Jinghe-74) of the spotted fever group in the microimmunofluorescence test of Philip et al. revealed that Barbash strain has antigens that yield homologous titers with the R. conorii strains and differ from R. sibirica and R. rickettsii. Monoclonal antibodies specific for R. conorii react at identical titres with the Barbash strain, and a monoclonal antibody specific for R. sibirica does not react with the Barbash strain. Likewise, T-cell hybridomas reactive with R. conorii but not R. sibirica yield a strong response when stimulated by Barbash strain antigens. Western immunoblotting with the same polyclonal and monoclonal antibodies confirmed the presence of specific protein antigens of R. conorii and different protein antigenic composition of R. sibirica when compared with Barbash strain. Thus, Barbash strain is a strain of R. conorii.

A study of white finger in the gas industry.

Men engaged in breaking or reinstating road surfaces are exposed to vibration from mechanical tools. In view of the lack of epidemiological information on vibration white finger in such a population, a survey was carried out to identify the prevalence of symptoms of white finger in a sample of men using these tools in the gas industry and to compare the prevalence with that found in a control group not occupationally exposed to vibration. Altogether 905 men (97%) in the gas industry and 552 men (92%) in the control group were interviewed, using a questionnaire from which the presence or absence of white finger symptoms from all causes was noted. The prevalence of white finger was 9.6% in the group exposed to vibration at work compared with 9.5% in the control group. The prevalence in the former group when adjusted for age differences between the survey and control populations was 12.2%, but this difference did not reach statistical significance. In case the approach of comparing prevalences of white finger from all causes might have obscured any contributory effect of vibration, the prevalence of white finger was examined in relation to the number of years vibrating tools had been used, this being the only measure of exposure to vibration available. No direct association was found between the prevalence of symptoms and number of years vibrating tools had been used. In view of this and the absence of a significant excess of white finger symptoms in the group using vibratory tools, the authors conclude that vibration white finger is not a special problem in the gas industry. Nevertheless, experimental tests carried out on the different types of roadbreakers used in the industry and on different road surfaces indicate that the vibration levels exceed the standards advocated in the draft international standard DIS 5349 (1979) at the lower end of the frequency spectrum. That no particular problem has been found may be due to the relatively short exposures to vibration experienced by the operators or the fact that they are able to grip the tools lightly, or even, possibly, that the standards suggested in DIS 5349 do not accurately reflect the risk of vibration white finger when they are exceeded at the lower end of the frequency spectrum for vibrating tools such as roadbreakers.

Nursing consortium approach to increase research in service settings.

Nursing administrators urgently need objective, tested information on which to base crucial decisions regarding quality and cost in all areas of nursing service. Such information can be obtained only through research, but the scarcity of credentialed nurse-researchers limits the possibility of meeting this need. As an alternative approach, a consortium of nine nursing service agencies was established to prepare nurses to study their concerns. This article describes the consortium's background and function.