Wavelength resolved specific optical rotations and homochiral equilibria.

The fundamental expressions governing specific optical rotations (SORs) of homochiral systems exhibiting monomer-dimer equilibria are presented. These equations are then utilized with the experimental measurements of wavelength resolved circular birefringence for (R)-(-)-α-hydroxy-ß,ß-dimethyl-γ-butyrolactone, to determine the wavelength resolved SORs of monomer and dimer components for the first time. Density functional theory predictions on the corresponding dispersion properties of monomer and dimer are found to match with experimentally determined quantities within a factor of ∼2. The wavelength resolved circular birefringence in the liquid solution phase thus provides a powerful means to investigate the molecular properties involved in homochiral equilibria.

Force output during fatigue with progressively increasing stimulation frequency.

There is currently a controversy over whether stimulation frequencies should increase or decrease to optimize force output over time. This study compared changes in thenar muscle force and M-wave amplitude during progressively increasing (20-40 Hz), decreasing (40-20 Hz) and constant (20 Hz) frequency stimulation of the median nerve continuously for 3 min. Twenty-three individuals participated in three sets of experiments. There was no significant difference in the force-time integrals between the three fatigue tasks. The rate of fatigue was not correlated to the number of stimulation pulses delivered (20 Hz: 3,600, 20-40 and 40-20 Hz: 5,400). All fatigue tasks caused a significant reduction in M-wave amplitude and the reduction was largest for the 20-40 Hz protocol. However, multiple linear regression analysis revealed that the M-wave amplitude could not predict the changes in force over time for the 20 Hz or 20-40 Hz protocols. Thus during sustained evoked contractions with stimulation frequencies within the physiological range, frequencies can vary significantly without changing the overall force-time integral.

Prenatal cocaine exposure and child behavior.

OBJECTIVE: The aim of this study was to evaluate previous teacher reports that children exposed to cocaine prenatally have more problem behaviors. METHODS: A historical, prospective design was used. Maternal subjects (n = 116) of 6-year-old singleton, term (>/=36 weeks) children, and the children's first-grade teachers (n = 102) agreed to participate. The child's first-grade teacher, blinded to study design and exposure status, rated the child's behavior with the Conners' Teacher Rating Scales (CTRS) and an investigator-developed scale, the Problem Behavior Scale (PROBS 14), measuring behaviors reported by educators to be specific to cocaine exposure. Mothers were interviewed by telephone regarding demographic and socioeconomic factors. RESULTS: Although the cocaine-exposed group had higher (more problem behaviors) for each of the CTRS subscales, the overall multivariate analysis of variance for the CTRS was not significant. Children exposed to cocaine prenatally had higher scores (more problem behaviors) for 11 of the 14 PROBS items and the overall multivariate analysis of variance relating prenatal cocaine exposure to the PROBS was significant (Wilkes' lambda =.775), even after controlling for gender and prenatal exposure to alcohol and cigarettes. CONCLUSIONS: This pilot study supports that teachers blinded to exposure status of early elementary students did rate the cocaine-exposed group as demonstrating significantly more problem behaviors than control children. Although an important first step, postnatal factors that also may influence behavior were not evaluated; hence, causation is not addressed.

Single daily bottle use in the early weeks postpartum and breast-feeding outcomes.

A prospective study of breast-feeding mothers was undertaken to determine the effects of limited bottle use and infant temperament on breast-feeding outcomes. White, married, primigravida women who were committed prenatally to breast-feeding for at least 6 weeks (n = 121) were randomly assigned to one of two groups: a planned bottle group that would offer one bottle daily between the second and sixth weeks postpartum and a total breast-feeding group that would avoid bottles during the same period. Group assignment had no effect on the occurrence of breast-feeding problems, on mothers' achievement of 90% of their prenatal breast-feeding duration goals, or on weeks to weaning across the study period. At 6 months postpartum, 59% of the planned bottle group and 69% of the total breast-feeding group were still breast-feeding. No main or interactive effects of infant temperament on breast-feeding outcomes were found.

Prenatal cocaine and neonatal outcome: evaluation of dose-response relationship.

OBJECTIVE: The aim of this study was to evaluate the hypothesis that prenatal cocaine exposure would negatively affect newborn behavior. METHODS: A prospective observational study of term infants recruited from the low-risk nursery used a structured, standardized interview to obtain maternal data. Cocaine exposure was determined by radioimmunoassay of the infant's meconium stool. An examiner blinded to the infant's cocaine status administered the Brazelton Neonatal Behavioral Assessment Scales. RESULTS: The sample was composed of 23 exposed and 29 nonexposed infants. On six of the seven Brazelton Neonatal Behavioral Assessment Scale clusters, cocaine-exposed infants performed less well than control infants, with significant differences observed for autonomic stability. In addition, a dose-response relationship was suggested. Significant negative, within-group relationships were evident in the exposed group, indicating poorer performance with increasing meconium cocaine concentration for orientation (r = -.40) and regulation of state (r = -.40). Regression model testing of the influence of meconium cocaine concentration on neurobehavioral outcomes, after controlling for significant confounders, identified a significant independent, negative effect of meconium cocaine concentration on two clusters-motor and regulation of state. CONCLUSION: In otherwise healthy full-term infants, prenatal cocaine exposure identified by quantitative analysis of cocaine concentration in meconium had a significant, independent negative association with motor and regulation of state that remained after controlling for other significant confounders. A dose-response relationship was evident.

Prenatal coke: what's behind the smoke? Prenatal cocaine/alcohol exposure and school-age outcomes: the SCHOO-BE experience.

Despite media reports and educators' concerns, little substantive data have been published to document or refute the emerging reports that children prenatally exposed to cocaine have serious behavioral problems in school. Recent pilot data from this institution have indeed demonstrated teacher-reported problem behaviors following prenatal cocaine exposure after controlling for the effects of prenatal alcohol use and cigarette exposure. Imperative in the study of prenatal exposure and child outcome is an acknowledgement of the influence of other control factors such as postnatal environment, secondary exposures, and parenting issues. We report preliminary evaluation from a large ongoing historical prospective study of prenatal cocaine exposure on school-age outcomes. The primary aim of this NIDA-funded study is to determine if a relationship exists between prenatal cocaine/alcohol exposures and school behavior and, if so, to determine if the relationship is characterized by a dose-response relationship. A secondary aim evaluates the relationship between prenatal cocaine/alcohol exposures and school achievement. Both relationships will be assessed in a black, urban sample of first grade students using multivariate statistical techniques for confounding as well as mediating and moderating prenatal and postnatal variables. A third aim is to evaluate the relationship between a general standardized classroom behavioral measure and a tool designed to tap the effects thought to be specific to prenatal cocaine exposure. This interdisciplinary research team can address these aims because of the existence of a unique, prospectively collected perinatal Database, funded in part by NIAAA and NICHD. The database includes repeated measures of cocaine, alcohol, and other substances for over 3,500 births since 1986. Information from this database is combined with information from the database of one of the largest public school systems in the nation. The final sample will be composed of over 600 first grade students for whom the independent variables, prenatal cocaine/alcohol exposures, were prospectively assessed and quantified at the university maternity center. After informed consent, the primary dependent variable, school behavior, is assessed, using the PROBS-14 (a teacher consensus developed instrument), the Child Behavior Check List, and the Conners' Teacher Rating Scale. The secondary dependent measure, school achievement, is measured by the Metropolitan Achievement Text and the Test of Early Reading Ability. Control variables, such as the environment and parenting, are measured by several instruments aimed at capturing the child and family ecology since birth. All analyses will be adjusted as appropriate for prospectively gathered control variables such as perinatal risk, neonatal risk, and other prenatal drug and cigarette exposures. Further adjustment will be made for postnatal social risk factors which may influence outcome. Of particular concern are characteristics of the home (adaptation of HOME), parent (depression, stress), and neighborhood (violence exposure). Finally, postnatal exposure to lead and other drugs is being considered.

Presence of carotenoid, an anticarcinogenic marker, in nipple aspirates postlactation.

Case-controlled studies have identified a protective effect of lactation against breast cancer; however, little is known about the nature of this protective mechanism. The purpose of this study was to examine postweaned, nipple aspirate fluid (NAF) from women, ages 18 to 45, for carotenoid, a known antioxidant and anticarcinogenic marker, and compare carotenoid availability in NAF with that reported in colostrum. Women who had lactated at least 6 months and weaned for at least 6 months were recruited into the study A prestudy and poststudy serum prolactin level was obtained. NAF was obtained through a nipple aspirator method. Total carotenoid ranged from 0.4 to 4.0 microg/mL, with a mean level of 1.9+/-1.2 (SD). Women who had weaned earlier (<12mo) had significantly more carotenoids than those who had lactated longer (>12mo) (P = 0.04). These levels were similar to those known to occur in colostrum. This research elucidates possible mechanisms of the protective effect of lactation on the microenvironment of the breast.

Fast Track in the emergency department: a one-year experience with nurse practitioners.

The use of a Fast Track system in the emergency department is becoming increasingly popular in order to provide fast and efficient service to patients with minor emergencies. In this paper we describe the one-year results of our system staffed by nurse practitioners. During the first year of operation, a total of 4468 patients were seen in Fast Track. Approximately 28% of patients are triaged to Fast Track during its hours of operation. The average patient seen in Fast Track was ready for discharge 94.4 minutes after presentation. Fewer than 1% of patients required admission to the hospital. Overall, patients and medical staff were highly satisfied with the Fast Track system. Our experience demonstrates that nurse practitioners can effectively and efficiently staff a Fast Track in an academic emergency department.

Back to the future of women's health and perinatal nursing in the 21st century.

Trends in women's health and perinatal nursing practice in the 21st century can be projected through looking back at our profession's history. Highlighted in this preview of nursing's future are the societal influences predicted to promote the essence of professional practice, influence our educational processes, and guide our research investigations. Most important among these influences is that of ritual-busting nursing research, which is predicted to elucidate outcomes of practice and provide the groundwork for change. However, research-driven change endorses the shedding of an antiquated maternity nurse image and practice. A call is made for accountability, ethical thinking, and reciprocal nurse trust for professional survival in the future.

Family care related to alpha-fetoprotein screening.

A family's coping repertoire may be challenged when the result of a standard prenatal maternal serum alpha-fetoprotein screening is not within a normal range. Abnormal screening results can cause families to experience anxiety and confusion at a time when they may need to make difficult decisions. The nurse's role is to provide information and emotional support and to coordinate health care services for optimal family coping.

Parent consultants in the health-care system: a new approach in the care of children with special needs.

A unique and innovative role for parents has emerged from the recent emphasis on family-centered, community-based health care for children with special health-care needs. The role of parent consultant is described in the following article. Identified are the characteristics of the consultant role, benefits as well as challenges, how the role is enacted, and ways to finance the position. Nurses can serve to support and nurture the parent consultant role to ensure positive role development. Parent consultants have a unique and important perspective to offer in the delivery of a family-centered approach.

Expressive language development of children exposed to cocaine prenatally: literature review and report of a prospective cohort study.

It was hypothesized that prenatal exposure to cocaine and other substances would be related to delayed expressive language development. Speech and language data were available for 458 6-year olds (204 were exposed to cocaine). No significant univariate or multivariate differences by cocaine exposure group were observed. Classification and regression tree modeling was then used to identify language variable composites predictive of cocaine exposure status. Meaningful cut points for two language measures were identified and validated. Children with a type token ratio of less than 0.42 and with fewer than 97 word types were classified into a low language group. Low language children (n = 57) were more likely to be cocaine exposed (63.1%), with cocaine-exposed children 2.4 times more likely to be in the low language group compared with control children after adjustment for covariates. Prenatal cigarette, but not alcohol exposure, was also significantly related to expressive language delays.

Predictors of cigarette smoking among adolescents.

Cigarette smoking among adolescents was predicted by age, race, involvement in activities with peers and family, peer smoking, family's smoking, and peers' acceptance of smoking. A random sample of 1,826 South Carolina public school students served as subjects. Multiple regression analysis indicated that 43% of the variance in reported cigarette smoking could be explained by these variables. Older, white subjects and subjects with friends and family members who smoked were more likely to smoke themselves. Adolescents who reported low family involvement and high peer involvement were more likely to smoke. High peer involvement and peers' approval of smoking were also associated with greater reported smoking.

Purposive aspects of the erotic transference.

This paper illustrates the erotic transference of a male patient towards his female analyst and the pressures and resistances within the transference and counter-transference to act out sexually. The patient's desire to act out sexually is seen both as a form of repetition compulsion within the transference and, in its purposive aspect, as an expression of the patient's need to find a loving breast and an empathic father. The patient's confused sexual identity is seen as a narcissistic defence against the experience of unbeatable frustration in the pre-Oedipal stage. Through internalizing a new primal scene, the patient is able to separate from his past and to work through the Oedipus complex within the transference.

Opening the mind to reality.

The author shows, through the use of clinical material, how an early failure in love can give rise to a severely crippling superego. The experience of a hateful relation with the mother is not simply internalized as a persecuting internal object, but is grafted onto the very roots of superego formation. As a result, the development of other parts of the psyche are affected--specifically the relation between the ago and self and the development of sexuality. The alienation between ego and self impairs thinking and the perception of external reality, which is modified and denied in the service of maintaining a pathological superego. By allowing the patient's hateful feelings to come out in the transference, without making him feel guilty, he is then able to risk expressing his loving feelings without the fear of rejection or abandonment. Through this process, the pathological superego can be dismantled and a more benign superego constructed.

The future of analysis.

The aim of analysis is to enable our patients to differentiate themselves from their past. The question we face as analysts is whether we are in fact neurotically bound to repeat the past. This paper addresses this question by considering some of the reasons that there is a 'crisis in analysis'. Two central problems within the practice of analysis are identified as contributing to this 'crisis': 1) a view of the patient as 'enemy', or as innately destructive; and 2) a trend towards here-and-now interpretations within the transference which disregards history and the role of external reality. The danger of such an approach is that it does not allow patients to separate from their hateful primal scenes and to become free of neurotic guilt. When we are anxious about our own destructiveness and aggression and do not link this to a failure to form a loving relation, we run the risk of fostering compliance and conformity within our patients and within our own professional societies. In contrast, it is the recognition of the past and its influence on the present that makes analysis a tool for revolution.