Y2O3 optical constants between 5 nm and 50 nm.

We report optical constants of e-beam evaporated yttrium oxide Y2O3 thin films as determined from angle-dependent reflectance measurements at wavelengths from 5 to 50 nm. Samples were measured using synchrotron radiation at the Advanced Light Source. The experimental reflectance data were fit to obtain values for the index of refraction and thin film roughness. We compare our computed constants with those of previous researchers and those computed using the independent atom approximation from the CXRO website. We found that the index of refraction near 36 nm is much lower than previous data from Tomiki as reported by Palik. The real part of the optical constants is about 10% to 15% below CXRO values for wavelengths between 17 nm and 30 nm. Films were also characterized chemically, structurally, and optically by ellipsometry and atomic force microscopy.

Acceptability of a mobile health unit for rural HIV clinical trial enrollment and participation.

Few rural minorities participate in HIV clinical trials. Mobile health units (MHUs) may be one strategy to increase participation. We explored community perceptions of MHU acceptability to increase clinical trial participation for rural minorities living with HIV/AIDS. We conducted 11 focus groups (service providers and community leaders) and 35 interviews (people living with HIV/AIDS). Responses were analyzed using constant comparative and content analysis techniques. Acceptable MHU use included maintaining accessibility and confidentiality while establishing credibility, community ownership and control. Under these conditions, MHUs can service rural locations and overcome geographic barriers to reaching major medical centers for clinical trials.

HIV interventions to reduce HIV/AIDS stigma: a systematic review.

We reviewed the literature to determine the effectiveness of HIV-related interventions in reducing HIV/AIDS stigma. Studies selected had randomized controlled trial (RCT), pretest-posttest with a non-randomized control group, or pretest-posttest one group study designs in which HIV-related interventions were being evaluated, and in which HIV/AIDS stigma was one of the outcomes being measured. A checklist was used to extract data from accepted studies, assess their internal validity, and overall quality. Data were extracted from 19 studies, and 14 of these studies demonstrated effectiveness in reducing HIV/AIDS stigma. Only 2 of these 14 effective studies were considered good studies, based on quality, the extent to which the intervention focused on reducing HIV/AIDS stigma, and the statistics reported to demonstrate effectiveness. Future studies to reduce HIV/AIDS stigma could improve by designing interventions that pay greater attention to internal validity, use validated HIV/AIDS stigma instruments, and achieve both statistical and public health significance.

Maternal role attainment with medically fragile infants: Part 1. measurement and correlates during the first year of life.

The purpose of this study was to extend scholarship on maternal role attainment (MRA). We used a triangulation of behavioral and self-report variables to measure MRA-identity, presence, and competence-with mothers of medically fragile infants (n = 81), and explored characteristics that influenced MRA longitudinally. Competence and presence were best measured using both self-report and observational methods, whereas identity was best measured with a questionnaire. Mothers with less worry reported higher levels of identity. Presence was higher with less alert infants, whereas competence was higher with more alert infants, lower parental role stress, higher education, and being married. Mothers with more illness-related distress and less alert infants, and unmarried and less educated mothers may need interventions to enhance MRA.

Maternal role attainment with medically fragile infants: Part 2. relationship to the quality of parenting.

We examined which components of maternal role attainment (identity, presence, competence) influenced quality of parenting for 72 medically fragile infants, controlling for maternal education and infant illness severity. Maternal competence was related to responsiveness. Maternal presence and technology dependence were inversely related to participation. Greater competence and maternal education were associated with better normal caregiving. Presence was negatively related although competence was positively related to illness-related caregiving. Mothers with lower competence and more technology dependent children perceived their children as more vulnerable and child cues as more difficult to read. Maternal role attainment influenced parenting quality for these infants more than did child illness severity; thus interventions are needed to help mothers develop their maternal role during hospitalization and after discharge. © 2010 Wiley Periodicals, Inc. Res Nurs Health 34:35-48, 2011.

Silent endurance and profound loneliness: socioemotional suffering in African Americans living with HIV in the rural south.

We explored how community responses to HIV contribute to distress in African Americans living with HIV in the rural South of the United States. We listened to the voices of community members through focus groups and African Americans with HIV through interviews. Community avoidance of HIV, negative views of HIV, and discriminatory behavior powerfully affected the distress of people living with HIV (PLWH). Ongoing distress, coupled with limited support, led to a life in which many PLWH endured their pain in silence and experienced profound loneliness. We conceptualized their experiences as socioemotional suffering--the hidden emotional burden and inner distress of not only living with HIV, a complex serious illness, but also with the societal attitudes and behaviors that are imposed on the illness and on PLWH. To improve the quality of life and health of PLWH, we cannot focus solely on the individual, but must also focus on the local community and society as a whole.

A conceptual model exploring the relationship between HIV stigma and implementing HIV clinical trials in rural communities of North Carolina.

BACKGROUND: HIV/AIDS disproportionately affects minority groups in the United States, especially in the rural southeastern states. Poverty and lack of access to HIV care, including clinical trials, are prevalent in these areas and contribute to HIV stigma. This is the first study to develop a conceptual model exploring the relationship between HIV stigma and the implementation of HIV clinical trials in rural contexts to help improve participation in those trials. METHODS: We conducted focus groups with HIV service providers and community leaders, and individual interviews with people living with HIV/AIDS in six counties in rural North Carolina. Themes related to stigma were elicited. We classified the themes into theoretical constructs and developed a conceptual model. RESULTS: HIV stigma themes were classified under the existing theoretical constructs of perceived, experienced, vicarious, and felt normative stigma. Two additional constructs emerged: causes of HIV stigma (e.g., low HIV knowledge and denial in the community) and consequences of HIV stigma (e.g., confidentiality concerns in clinical trials). The conceptual model illustrates that the causes of HIV stigma can give rise to perceived, experienced, and vicarious HIV stigma, and these types of stigma could lead to the consequences of HIV stigma that include felt normative stigma. LIMITATIONS: Understanding HIV stigma in rural counties of North Carolina may not be generalizeable to other rural US southeastern states. CONCLUSION: The conceptual model emphasizes that HIV stigma--in its many forms--is a critical barrier to HIV clinical trial implementation in rural North Carolina.

Life course theory as a framework to examine becoming a mother of a medically fragile preterm infant.

Life course theory, a sociological framework, was used to analyze the phenomenon of becoming a mother, with longitudinal narrative data from 34 women who gave birth prematurely after a high-risk pregnancy, and whose infant became medically fragile. Women faced challenges of mistimed birth and mothering a technologically dependent infant. Before social ties were established, legal and biological ties required mothers to make critical decisions about their infants. Liminality characterized mothers' early involvement with their infants. The mothers worked to know, love, and establish deeper attachments to this baby. The infant's homecoming was a key turning point; it decreased liminality of early mothering, increased mothers' control of infants' care, and gave them time and place to know their infants more intimately.

Building nursing research capacity to address health disparities: engaging minority baccalaureate and master's students.

In order to decrease health disparities, nursing needs to promote opportunities for minority nursing students to incorporate the conduct, as well as the utilization, of research into their professional careers. This article describes a model program to facilitate minority research career development, the Research Enrichment and Apprenticeship Program (REAP). REAP was developed and implemented by a federally funded partnership between 2 historically Black universities and a research-intensive university. Fifty-five (N = 55) baccalaureate and master's nursing students and 35 faculty members from the 3 schools participated in an intensive research mentorship program guided by learner-centered pedagogical approaches that culminated in the public presentation of students' research projects at a scientific poster session. Student, faculty, and institutional achievements, as well as challenges, were identified and addressed as the partnership evolved. Recognizing and building upon the strengths of both minority-serving and research-intensive institutions allowed the development of an exemplar program. While process measures provided many indicators of success, long-term evaluation of research career-related outcomes are needed.

Effects of maternal depressive symptoms and infant gender on the interactions between mothers and their medically at-risk infants.

OBJECTIVE: To examine the effects of maternal depressive symptoms and infant gender on interactions between mothers and medically at-risk infants. DESIGN: Longitudinal, descriptive secondary analysis. SETTING: Neonatal intensive care unit, intermediate care unit, and infectious disease clinic of the tertiary medical centers in the Southeast and East. PARTICIPANTS: One hundred and eight preterm infants and their mothers, 67 medically fragile infants and their mothers, and 83 infants seropositive for HIV and their primary caregivers were studied in their homes between 6 and 24 months. MAIN OUTCOME MEASURES: Observation and the Home Observation for Measurement of the Environment Inventory were used to assess the interactions of mothers and their medically at-risk infants. Maternal depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. RESULTS: The level of depressive symptoms did not differ between the mothers of boys and mothers of girls in the three groups. Mothers of medically fragile infants had higher levels of depressive symptoms than mothers of preterm infants at 6 months corrected age and similar levels of depressive symptoms as HIV-positive mothers at 12 months. Mothers of medically fragile infants with elevated depressive symptoms were less attentive and more restrictive to their infants. HIV-positive mothers with elevated depressive symptoms were less attentive to their infants. The effects of gender on mother-infant interactions were not moderated by maternal depressive symptoms. CONCLUSION: Maternal depressive symptoms had a somewhat negative effect on the interactions of mothers and medically at-risk infants.

Spirituality: a cultural strength for African American mothers with HIV.

The purpose of this study was to describe how spirituality affected the lives of African American mothers with Human Immunodeficiency Virus (HIV) in the context of coping. This qualitative descriptive study used secondary data of interviews from a larger longitudinal study of parental caregiving of infants seropositive for HIV. Participants were 38 African American mothers with HIV. Data from longitudinal semi-structured interviews were analyzed using content analysis. The women dealt with the stresses of HIV through a relationship with God. Two domains explain this relationship: God in control and God requires participation. The benefits of their relationship with God were a decrease in stress and worry about their own health and that of their infants. It is important for nurses working with mothers with HIV to acknowledge their spirituality and assess how spirituality helps them cope with and manage their illness.

Depressive symptoms in mothers of prematurely born infants.

OBJECTIVE: This longitudinal, descriptive study described the level of depressive symptoms in mothers of preterm infants from birth through 27 months corrected age and examined factors associated with depressive symptoms. The framework for the study was guided by an ecological developmental systems perspective and an adaptation of the Preterm Parental Distress Model. METHODS: In this model, we hypothesize that a mother's emotional distress to the birth and parenting of a prematurely born child is influenced by personal and family factors, severity of the infant's health status, and illness-related stress and worry. Participants were 102 mothers of preterm infants who were off the ventilator and not otherwise dependent on major technology at enrollment. RESULTS: Mean depressive symptoms scores on the Center for Epidemiologic Studies Depression Scale (CES-D) during hospitalization were high and more than half the mothers (63%) had scores of > or =16 indicating risk of depression. Depressive scores declined over time until 6 months and then were fairly stable. Unmarried mothers, mothers of infants who were rehospitalized, and mothers who reported more maternal role alteration stress during hospitalization and worry about the child's health had more depressive symptoms through the first year. Mothers who reported more parental role alteration stress during hospitalization (odds ratio [OR] = 1.570, 95% confidence interval [CI]: 1.171-2.104) and more worry about the child's health (OR = 2.350, 95% CI: 1.842-2.998) were more likely to experience elevated CES-D scores that put them at risk of depression. Also, mothers of rehospitalized infants had decreasing odds of elevated CES-D scores over time (OR = 0.982 per week, 95% CI: 0.968-0.996). CONCLUSIONS: Findings have implications for the support of mothers during hospitalization and in the early years of parenting a preterm infant.

Spirituality in African Americans with diabetes: self-management through a relationship with God.

The purpose of this study was to develop a theoretical model about how the spirituality of African Americans affects their self-management of diabetes. The sample consisted of 29 African American men and women, ages 40 to 75, with type 2 diabetes. The authors used a grounded theory design and collected data using minimally structured interviews. The method of analysis was constant comparison. The core concept identified was Self-Management Through a Relationship With God. Participants fell into one of three typologies: (a) Relationship and Responsibility: God Is in Background; (b) Relationship and Responsibility: God Is in Forefront: (c) Relationship and Relinquishing of Self-Management: God Is Healer. These typologies varied according to how participants viewed their relationship with God and the impact of this relationship on their self-management. The spirituality of these African Americans was an important factor that influenced the self-management of their diabetes.

Searching for "the dying point:" providers' experiences with palliative care in pediatric acute care.

To improve care of children who die in acute care settings there is a need to develop a clearer understanding of the barriers to provision of palliative care. The purpose of this study was to describe the experiences and views of health care providers in giving care to children who have undergone intensive therapies for life-threatening illnesses. A qualitative, descriptive design was conducted in the intensive care nursery, pediatric intensive care unit, and pediatric blood and marrow transplant unit at a southeastern US medical center. Purposive sampling with variation on role, years of experience, ethnicity, and gender was used to select the 17 health care providers. Findings were organized into three broad categories: (a) Palliative Care as an Added Dimension in the Illness Trajectory, (b) Palliative Care Moves Away From Curative Treatment, and (c) Professional Issues. Relevant themes were identified within each category. Most participants viewed palliative care as a changed dimension of care that is instituted once it is known that a child is dying. Three challenges in employing palliative care to acutely ill infants and children were identified: (a) finding the true dying point, (b) making the transition to palliative care, and (c) turning care over to an outside palliative care team at a critical juncture of caring. Professional issues in providing palliative care included inadequate preparation and, especially for nurses, the crossing of professional boundaries. An integrated model of palliative care is needed that is initiated at diagnosis and allows for the bidirectional transitioning across the illness and treatment trajectories.

Emotional distress in African American women with HIV.

This study identified factors associated with emotional distress in 109 African American women with HIV. The relationship of personal factors (demographic, social conflict, social support, and spirituality), health-related factors (perception of health, physical and mental health problems, and years diagnosed), and cognitive/coping responses (stigma, worry, and emotion focused coping) on depressive symptoms and mood state was examined. Younger age, more social conflict, less social support, lower perception of health, and more HIV worry were associated with higher depressive symptom scores. Variables most often affecting various mood states included personal factors (public housing, unemployment, and social conflict) and worry about having HIV worry.

Fathers' support to mothers of medically fragile infants.

OBJECTIVE: To examine mothers' perceptions of support from fathers over the 1st year after birth of a medically fragile infant. DESIGN: A descriptive, correlation design based on an ecologic systems view of the family. It was hypothesized that the levels of paternal support would be influenced by factors within the two subsystems: the mother-father system (marital status) and the child subsystem (health and gender). SETTING: A tertiary care children's hospital. PARTICIPANTS: Sixty-four mothers of medically fragile term and preterm infants, who were married or living with the father. MAIN OUTCOME MEASURES: The Stress Support Scale assessed maternal perceptions of helpfulness and satisfaction with paternal support at enrollment, after discharge, and around 1 year of age. RESULTS: Mothers reported high levels of help from fathers at enrollment. Married mothers did not differ from unmarried mothers in their perceptions of helpfulness of support but were more satisfied with support. Mothers of female infants received more help from fathers than mothers of male infants, and this difference increased over time. However, mothers of female infants were not more satisfied with paternal support. Neither number of technologies nor birthweight related the maternal perceptions of paternal support. CONCLUSIONS: Family systems factors were more significant in maternal perceptions of paternal support than the health status of the infant.

Being there for my baby: early responses of HIV-infected mothers with an HIV-exposed infant.

INTRODUCTION: The purpose of this study was to explore and describe the early responses of human immunodeficiency virus (HIV)-positive mothers to the birth of an HIV-exposed infant during the first 8 months of life. METHOD: This descriptive, qualitative study was part of a larger prospective longitudinal study of HIV-exposed infants born to HIV-infected women. Participants in the present study were 26 HIV-positive biologic mothers recruited from one of two Southeastern tertiary pediatric infectious disease clinics where infants were being monitored to determine their HIV status. RESULTS: "Being there for my baby" was the central theme that captured the critical importance of the baby in the lives of these mothers. Three sub-themes characterized their stories: (a) giving the baby a chance, (b) taking care of the baby, and (c) parenting as a reason to live. DISCUSSION: Pediatric nurse practitioners have the unique opportunity to use the mother-infant relationship as a medium for health care delivery. They are a critical source of support for infants and their caregivers during the first year of life. They can assess the development of trust and attachment between infants and caregivers and implement a plan to strengthen family support and resources to provide a physically and emotionally secure environment.

Patterns of physical symptoms and relationships with psychosocial factors in adolescents.

OBJECTIVES: Physical symptoms are common in otherwise healthy adolescents. This study sought to identify meaningful patterns of multiple physical symptoms and to examine relationships between the patterns and psychosocial factors. One-year stability of symptom patterns and factors contributing to stability were also examined. METHODS: This secondary data analysis used longitudinal data from a nationally representative sample of adolescents in grades 7 through 12 (n = 9,141) who participated in the National Longitudinal Study of Adolescent Health during 1994 to 1996. Ten selected physical symptoms (i.e., headache, stomachaches, fatigue) were used to construct clusters. Each cluster was compared in regard to demographic factors, psychological adjustment and interpersonal relationships. RESULTS: K-means in combination with Ward method clustered the sample into 4 groups according to the overall patterns of the 10 symptoms: nonsymptom (41%), moderate symptom (38%), high symptom (19%) and extreme symptom (2%). Adolescents in higher symptom clusters were more likely to be girls, nonwhites, or from families on welfare and reported high depressive symptoms, low self-esteem, and poor perceptions of parental affection and friendship quality. About 16% in clusters with lower symptom patterns develop somatizing patterns in Wave II; new onset was predicted by gender, younger age, and depressive symptoms. CONCLUSION: Symptom patterns characterized by overall high frequencies of multiple symptoms may indicate somatization. This study also suggests that adolescents with a somatizing tendency are more likely to experience psychological and interpersonal difficulties, and girls and younger adolescents are more vulnerable. Targeted prevention programs are needed for these vulnerable individuals by addressing their psychosocial functioning.

Spirituality and self-management of diabetes in African Americans.

Attention to spirituality is especially important for nurses when providing care to African Americans. Spirituality is deeply embedded in their rich cultural heritage. For many African Americans, spirituality is intertwined into all aspects of life, including beliefs about health and illness. Therefore, it is imperative that nurses understand the relationship between African American spirituality, health, and self-management of illness to provide culturally competent care to African Americans. The purpose of this article is to summarize the research literature on African American spirituality, health, and self-management as it relates to Type 2 diabetes, an illness that involves complex self-care management. Recommendations for holistic nursing practice and research related to this literature are also identified.

Prevalence of recurrent physical symptoms in U.S. adolescents.

PURPOSE: To estimate the prevalence of 10 recurrent physical symptoms and to examine how prevalence differs by gender and age in healthy American adolescents. METHOD: Cross-sectional analysis used survey data from the National Longitudinal Study of Adolescent Health (Add Health), a school-based probability sample of over 20,000 adolescents in grades 7 through 12. FINDINGS: Headache was the most frequently reported symptom (29%), closely followed by musculoskeletal pain (27%), fatigue (21%), and stomachache (18%). About one third of the adolescents reported multiple symptoms. Nonlinear age trends were found for musculoskeletal pain, fatigue, and dizziness with peaks between ages 16 and 17. Prevalence was higher in girls for most symptoms except musculoskeletal pain. Multiple symptoms were also prevalent and varied according to age and gender. CONCLUSIONS: The findings provide a database for studying health problems in adolescents. The high prevalence of physical symptoms underscores the importance of incorporating symptom assessment into adolescent physical check-ups at schools and communities as well as during sick office visits. This helps nurses strategize screening of adolescents.