Duchenne Muscular Dystrophy (DMD), characterized by the lack of dystrophin, results from a mutation in the Xp21 gene which encodes for the protein dystrophin that links the extracellular matrix to the actin cytoskeleton in skeletal, cardiac and smooth muscle. Slow colonic transit and chronic constipation are common in DMD patients due to the weakening of the abdominal wall muscles and gut smooth muscle. However, the cause of this hypocontractility in DMD patients and the expression of contractile proteins in smooth muscle are unknown. Expression of contractile proteins is regulated by the signaling pathways activated by excitatory (e.g., acetylcholine, ACh) and inhibitory transmitters (e.g., nitric oxide). Hydrogen sulfide (H2S) is well-known for its anti-oxidant effects; however, its utility to restore DMD-induced effects is unknown. Aim: To investigate the expression of contractile proteins and smooth muscle function in the colon of wild type mice and models of DMD (mdx and mdx/mTR mice) and the effect of H2S on these in mdx mice. Methods: Contraction of colonic segments was measured in the longitudinal orientation from 3-month old control and mdx mice, and 9-month old control and mdx/mTR mice, (mdx/mTR exhibit increased disease severity). The effect of SG1002, an orally active slow releasing H2S agent, was tested in mdx/mTR mice (40 mg/kg body weight in chow/every 3 days starting from 3 weeks to 9 months). Expression of contractile proteins was measured by qRT-PCR and western blot. Results: Expression of smoothelin, caldesmon, calponin and tropomyosin was decreased in colonic smooth muscle of mdx mice compared to control. This decrease was associated with a decrease in ACh-induced contraction in colonic segments (21 ± 3 mN/100 mg tissue in control and 3 ± 1 mN/100 mg tissue in mdx mice). To identify the specific involvement of smooth muscle dysfunction in the decrease in contraction, colonic muscle cells were isolated and contraction in response to ACh was measured by scanning micrometry and expressed as the percent decrease in cell length from control cell length. ACh-induced contraction was also inhibited in muscle cells isolated from mdx mice compared to control (43±5% in control and 27±3% in mdx mice). ACh-induced contraction was decreased in colonic segments from mdx/mTR mice (12 ± 2 mN/100 mg tissue in control versus 4 ± 1 mN/100 mg tissue in mdx/mTR) and the decrease was partly reversed by SG1002 treatment (9 ± 1 mN/100 mg tissue). mRNA expression of thin filament associated proteins was also decreased in colonic smooth muscle from mdx/mTR mice and the decrease was reversed by SG1002. These results suggest that H2S restores contractile protein mRNA expression and contraction in mdx/mTR mice. Conclusion: The data indicate that the lack of dystrophin in mdx mice adversely affects colonic smooth muscle contractility through the down regulation of contractile protein mRNA expression. Treatment of mdx/mTR mice with H2S restores contractile phenotype. Thus, H2S treatment would be an area of study in therapeutic control of DMD-induced gastrointestinal motility disorders.

Ineffective pain management can prolong a patient's length of stay and increase cost of care. Inadequate pain control decreases the patient's quality of life and contributes to poor health outcomes. A recent record audit showed that documentation of pain reassessments occurred only 20% of the time within an hour after administering pain medication. Furthermore, nurses may have insufficient knowledge regarding pain assessments and reassessments or hold irrational fears about addiction leading to inadequate treatment of pain. The purpose of this quality improvement project was to evaluate the effectiveness of an educational program for acute care nurses for the assessment and management of the adult hospitalized patient experiencing pain. Guided by Knowles theory of adult learning, nurses' knowledge regarding pain, assessments, and pain reassessments were evaluated before and after the pain management education program using the Knowledge and Attitude toward Pain Survey (KAPS). A convenience sample of 34 nurses completed the KAPS before and after an educational program addressing pain assessments. Results of the t-test analysis revealed a statistically significant (t = -15.8, df = 33, p<0.00) increase in KAPS scores, from an average pretest score of 70% to an average posttest score of 94%. The results of this project are consistent with the literature, and they illustrate the importance of improving nursing practice by providing nurses with education regarding pain assessments and reassessments as a strategy to improve the management of patients' pain and, resultantly, increase patients' quality of life.

The purpose of this study was to compare out patient laboratory utilization patterns of active duty and retired military personnel and their dependents before and after the implementation of TRICARE. A stratified random sample was taken of patient test results over a two year period resulting in a sample size of 104 observations. The Complete Blood Count (CBC) results were used as indicators for the study. Data was gathered on the patient's rank, active duty/retiree status, age, dependent status, and gender. Additionally, the total number of tests were recorded for the year prior to the introduction of TRICARE and after implementation of TRICARE at Ireland Army Hospital in Fort Knox, Kentucky. It was determined that there was a dramatic decrease in the utilization patterns of the retiree population. The mean age of the year 2 group was much younger, and changes in enlisted personnel utilization were noted. A decrease in the number of tests performed was also noted. These results are relevant to the Laboratory Director and the Commander of the installation.

No description available.

The purpose of this study was to examine the knowledge and perceptions of Eastern African refugees regarding HIV/AIDS and its interventions in metropolitan Atlanta, Georgia. The study was guided by the following research questions 1) What did Eastern African refugees know about HIV/AIDS and its importance? 2) How did Eastern African refugees and their families learn about HIV/AIDS prevention and treatment? 3) How did Eastern African refugees perceive HIV/AIDS and those suffering from HIV/AIDS in their families and communities? 4) What were the perceptions of Eastern African refugees regarding participation in the interventions offered by public and private organizations? Study participants were refugees from Somalia and southern Sudan who had settled in metropolitan Atlanta The sample of 80 participants was selected based on age, immigration status, and willingness to share information about sex and sexuality. To collect data, the researcher used a structured survey instrument that was administered in a face-to-face interview format with the 80 participants. Qualitative and quantitative analyses of participant responses were conducted Six themes emerged from the qualitative analysis, namely: Knowledge, Openness, Stigma, Attitude, Willingness, and Trust. Participants indicated basic knowledge of HIV/AIDS and its transmission. They also exhibited openness in discussing HIVIAIDS. However, participant responses manifested strong stigma against HIV/AIDS and its victims. Participants who had lived longer in the United States showed negative attitudes towards HIV/AIDS treatment, the healthcare system, and service providers. There was willingness to contribute towards HIV/AIDS interventions and community services. Participants exhibited mistrust towards health institutions, sources of HIV/AIDS information, and the context of the HIV/AIDS information. Results from the quantitative analysis indicated a strong and positive correlation between knowledge and openness Stigma against HIV/AIDS disease and victims was strongly correlated with knowledge, openness, and attitude. Attitude positively correlated with openness and with knowledge, while trust was moderately correlated to knowledge. The study findings confirm previous research among similar populations that reported limited knowledge of HIV/AIDS, entrenched stigma about the disease and its victims, negative attitudes and mistrust towards health institutions and service providers as well as the potency of the duration factor regarding immigrants resettlement process.

<p>Massage therapy is often used to treat musculoskeletal symptoms and to promote wellness. While evidence regarding its effectiveness is increasing, research related to actual practice and studies seeking to understand the mechanisms of massage therapy are needed. The purpose of this research was to describe the characteristics of massage therapists and their clients and to understand the role of communication in massage therapy outcomes. The first study examined the outcome expectations, expectancies, and behaviors of a random sample of massage therapists in Iowa (n=151) using a cross-sectional survey. The second study used a practice-based research design incorporating two samples of massage therapy clients (n=320 and n=321) to develop and validate a measure of client expectations of massage, the Client Expectations of Massage Scale (CEMS). The third study examined the influence of client expectations and massage therapists' interpersonal attractiveness on pain and satisfaction following massage. Social Cognitive Theory and Expectancy Violation Theory were used as frameworks to demonstrate how health behavior and communication theories can provide insight to massage therapy research. Results indicated that massage therapists had high expectations regarding the benefits of massage therapy and engaged in a variety of behaviors that reflect the clinical, educational, and interpersonal nature of massage therapy. In addition to using a variety of manual therapies, the massage therapists educated their clients in areas such as diet, stress management, and exercise to improve client health. Similarly, clients had positive expectations as measured by the outcome, clinical, educational, and interpersonal subscales of the CEMS. Positive outcome expectations predicted significant improvements in pain and serenity. High interpersonal expectations were related to negative changes in serenity. The third study revealed that high satisfaction was influenced by positive interpersonal attractiveness but more research is needed to understand the influence of client expectations being met on satisfaction. Initially high educational expectations, exceeded educational expectations, violated interpersonal expectations, and positive interpersonal attractiveness were related to less pain following massage. In conclusion, this research demonstrated that client expectations and massage therapist interpersonal attractiveness are important constructs to consider when evaluating the effects of massage therapy.

The purpose of this study was to develop a theory in order to explain the meaning and process of learning the role of the midwife from midwives in the clinical setting. To achieve the depth and detail required in the absence of literature on this topic, the grounded theory approach was adopted. The sample consisted of twenty student midwives and seventeen midwives. Data were collected by means of unstructured interviews which were tape-recorded. Each participant was interviewed on a minimum of two separate occasions. The constant comparative method was used to analyse the data. The findings of the research contribute to knowledge by making explicit how the role of the midwife is interpreted and enacted, the effect this has on what role students learn, how it is learned and hence how the role is transmitted from one generation of midwives to the next. The `emic' perspective facilitated the emergence of a number of theoretical ideas. Central to these are the rules of practice. When midwives rigidly follow written and unwritten rules they prescribe midwifery care which corresponds to the medical model. In doing so they act as obstetric nurses or handmaidens to the doctor. When everything is interpreted as rules to be followed prescriptive midwives appear to be uncaring and detached from the experience of childbirth. The individual needs of women are not met and the relationship between midwife and client is superficial. Midwives who rigidly follow the rules inhibit the growth and development of students providing them with few opportunities to achieve beyond the level of their role model. Midwives are flexible when they interpret the rules for the benefit of women and provide a woman-centred model of care. These midwives therefore act as autonomous practitioners. When rules are interpreted and adapted to meet the needs of women, flexible midwives demonstrate involvement in women's experiences and are empathic, supportive and caring. Midwives who use professional judgement to interpret the rules provide an environment in which senior students can become autonomous practitioners. When midwives demonstrate the role of autonomous practitioner, practise a woman-centred model of care and meet the learning needs of students, they are appropriate role models and teachers. There is conflict in the clinical setting when practitioners who hold opposing attitudes, values and beliefs practice together. Conflict can be avoided when flexible midwives adopt strategies that involve becoming prescriptive or practising by subterfuge. In accordance with Bandura's social learning theory students learn by observing and emulating the example of their role models. Learning is vicarious when students observe the consequences of their role models' actions. When learning the role from a role model is interpreted as a passive process, a behaviourist and pedagogical approach to learning and teaching ensures perpetuation of the obstetric nurse role that is no longer considered acceptable. Role modelling serves as a vehicle for transmitting new behaviour when learning is perceived to be an active process. In this case a humanistic, andragogical and cognitive approach to learning and teaching is adopted giving students the freedom to determine their own role. Practice from a number of role models is emulated. In this way each midwife acquires a unique identity which is derived from an abstract role model rather than a particular person. Students are prepared for the autonomous role of the midwife, and it is this role they wish to emulate.

An in-shoe laser Doppler sensor for assessing plantar blood flow in the diabetic foot. Jonathan Edwin Cobb Plantar ulceration is a complication of the diabetic foot prevalent in adults with type 11 diabetes mellitus. Although neuropathy, microvascular disease and biornechanical factors are all implicated, the mechanism by which the tissue becomes pre-disposed to damage remains unclear. Recent theories suggest that the nutritional supply to the tissue is compromised, either by increased flow through the arteriovenous anastomoses ('capillary steal' theory) or through changes in the micro vascu I ature (haemodynamic hypothesis). Clinical data to support these ideas has been limited to assessment of the unclad foot under rest conditions. A limitation of previous studies has been the exclusion of static and dynamic tissue loading, despite extensive evidence that these biornechanical factors are essential in the development of plantar ulceration. The present study has overcome these problems by allowing assessment of plantar blood flow, in-shoe, during standing and walking. The system comprises a laser Doppler blood flux sensor operating at 780nm, load sensor, measurement shoe, instrumentation, and analysis software. In-vitro calibration was performed using standard techniques. An in-vivo study of a small group of diabetic subjects indicated differences in the blood flux response between diabetic neuropaths, diabetics with vascular complications and a control group. For example, following a loading period of 120s, relative increases in response from rest to peak were: Control (150% to 259%), Vascular (-70% to 242%), Neuropathic (109%-174%) and recovery times to 50% of the peak response were: Control (33s to 45s), Vascular (43s to >120s), Neuropathic (>120s). Dynamic re-perfusion rates (arbitrary units per millisecond) obtained for the swing phase of gait were: Control (6.1 a. u/ms to 7.9 a. u/ms), Vascular (4 a. u/ms to 6.2 a. u/ms), Neuropathic (2.3 a. u/ms to 4.5 a. u/ms).

Thesis (M. P. H.)--University of Hong Kong, 2006. / Also available in print.

Thesis (M.P.H.)--University of Hong Kong, 2006.