Though innovative approaches to working with substance-abusing parents of maltreated children have emerged within the last few years, child welfare agencies continue to be challenged by the chronic nature of addictive diseases. This article discusses the often ignored element of spirituality as a critical component of recovery for parents. It also highlights how the regulation of spirituality by parents has a significant influence on their ability to responsibly care for their children.

Child↗

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In vivo detection of postictal perturbations of cerebral metabolism by use of proton MR spectroscopy: preliminary results in a canine model of prolonged generalized seizures.

BACKGROUND AND PURPOSE: Biochemical studies of seizures in patients and laboratory animals have monitored postictal perturbations in cerebral metabolism with either invasive techniques or with such noninvasive techniques as nuclear medicine, MR imaging, in vivo phosphorus MR spectroscopy (MRS), and in vivo proton MRS at field strengths of 1.5 T or above. We investigated postictal metabolic changes in a generalized seizure model with in vivo proton MRS at 0.5 T, in which the combination of glutamate and glutamine resonances (denoted glx) can be modeled as a singlet. METHODS: Five adult mongrel dogs underwent control and postictal experiments in which single-voxel proton MR spectra were obtained from the right frontal lobe cortex with a point-resolved spectroscopy technique approximately every 20 minutes for 3 hours. N-acetylaspartate (NAA), glx, and creatine (Cr) were quantified in absolute millimolar units with a cerebral water-referenced algorithm. Inter- and intrasubject differences in mean metabolite concentrations collected throughout the 3-hour period were compared using an unpaired, two-tailed Student's t test at a.05 level of significance. RESULTS: We found a significant increase (15.4%) in the postictal intersubject mean glx concentration, as well as a 23.7% postictal decrease in the intersubject mean Cr concentration. A trend toward a subtle decrease in postictal intersubject mean NAA concentration was not statistically significant. We also observed a substantial qualitative increase in the combination of postictal lactate and free fatty acid peaks. CONCLUSIONS: The glx, NAA, lactate, and free fatty acid results are in general agreement with previous studies of postictal perturbations in cerebral metabolism measured with invasive biochemical or noninvasive high-field-strength in vivo MRS detection assays. Given a high sensitivity for glx at 0.5 T relative to 1.5 T, further studies of postictal mesial temporal lobe structures are warranted in chronic animal preparations that model temporal lobe epilepsy.

Animals↗

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Child behavior during three dental visits.

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Analysis of Variance↗

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Pharmacokinetics and pharmacodynamics of topotecan in patients with advanced cancer.

Topotecan, a semisynthetic water-soluble analog of camptothecin, is the first topoisomerase I-directed drug to enter clinical trial in the United States in over 20 yr. In this study, 30-min infusions of topotecan were administered daily for 5 days every 3 weeks at doses ranging from 0.5 to 2.5 mg/m2. Topotecan is reversibly hydrolyzed in a pH-dependent reaction in aqueous solutions to the ring-open hydroxy acid. The disposition of the closed ring lactone has been studied in 26 patients, and the disposition of both lactone and hydroxy acid has been studied in 12 patients. The clearance rate for topotecan lactone was 1220 ml/min/m2, with a range of 300-4760 ml/min/m2. The clearance rate for total topotecan (lactone and hydroxy acid) was 493 ml/min/m2, with a range of 163-815 ml/min/m2. A model for the disposition of lactone and hydroxy acid incorporating both reversible hydrolysis and elimination was developed. We have shown that topotecan is partially hydrolyzed prior to administration in parenteral solutions, and that clearance of the parent compound proceeds in vivo by conversion to hydroxy acid and elimination. Renal clearance accounted for 30 +/- 18% of drug elimination in patients. The relationship between topotecan dose and myelotoxicity is well fit by a sigmoidal Emax model, as is the relationship between total topotecan area under the concentration-time curve and myelotoxicity. The disposition of topotecan was also studied in mice. The clearance rate for total topotecan in mice was 330 ml/min/m2 after administration of topotecan lactone.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

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Bottomley's plans to improve PRHOs' training.

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Education, Medical, Graduate↗

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A clinical study of ferric sulfate as a pulpotomy agent in primary teeth.

Pulpotomies were performed on 83 primary molars in 62 patients. Ferric sulfate or formocresol was placed on the pulpal stumps, and teeth were followed for 3-, 6-, and 12-month periods. After the one-year follow-up, 28 of 29 teeth treated with ferric sulfate (FS group) were considered successful and 21 of 27 teeth treated with formocresol (FC group) were judged to be successful. The FS group demonstrated greater combined clinical and radiographic success than the FC group at the one-year recall (P < 0.05). Although the results of this study are promising, further study with longer observation periods is warranted before this technique can be recommended.

Chi-Square Distribution↗

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HIV seroprevalence surveys in sexually transmitted disease clinics.

The Centers for Disease Control, in cooperation with State and local health departments, is conducting human immunodeficiency virus, type 1 (HIV), seroprevalence surveys, using standard protocols, in sexually transmitted disease (STD) clinics in selected metropolitan areas throughout the United States. The surveys are blinded (serologic test results not identified with a person) as well as nonblinded (clients voluntarily agreeing to participate). STD clinics are important sentinel sites for the surveillance of HIV infection because they serve persons who are at increased risk as a result of certain behaviors, such as unprotected sex, homosexual exposure, or intravenous drug use. HIV seroprevalence rates will be obtained in the sentinel clinics each year so that trends in infection can be assessed over an extended period of time. Behaviors that place clients at risk for infection, or protect against infection, are being evaluated in voluntary, nonblinded surveys to define groups for appropriate interventions and to detect changes in response to education and prevention programs. Although inferences drawn from the surveys are limited by the scope of the clinics and clients surveyed, HIV trends in STD clinic client populations should provide a sensitive monitor of the course of the acquired immunodeficiency syndrome (AIDS) epidemic among persons engaging in high-risk sexual behaviors.

Adolescent↗

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Hepatitis B vaccination programs for health care personnel in U.S. hospitals.

A random sample of 232 U.S. hospitals was surveyed. Of those hospitals, 75 percent had hepatitis B vaccination programs. The presence of a program was associated with hospital size (60 percent of those with 100 beds, 75 percent with 100-499 beds, 90 percent with 500 or more beds; P = 0.0013) and hospital location (urban 86 percent; rural 57 percent; P less than 0.001). The frequency of needlestick exposures per month among hospital personnel and hospital location were directly related to and best predicted the existence of hepatitis B vaccination programs. All hospitals with programs offered vaccine to high-risk personnel (as defined by the hospital). Seventy-seven percent of hospitals paid all costs for vaccinating high-risk personnel; 19 percent paid for any employee to be vaccinated regardless of risk status. Forty-six percent of hospitals with programs were estimated to have vaccinated more than 10 percent of all eligible personnel, and 13 percent to have vaccinated more than 25 percent of eligible personnel. The highest compliance rates were associated with hospitals paying for the vaccine and requiring vaccination of high-risk personnel. Fifty-four percent of hospitals attributed noncompliance to concern regarding vaccine safety and effectiveness. The reasons why there was no vaccination program in 58 hospitals were (a) low incidence of hepatitis B virus infections among personnel, (b) cost of vaccine, and (c) vaccination being offered as part of a needlestick protocol. Full utilization of hepatitis B vaccine could eliminate the occupational hazard that hepatitis B virus presents to health care personnel.

Economics, Hospital↗

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Pulse rate and oxygen saturation in children during routine dental procedures.

To understand the state of hypoxemia and how it occurs, one must first understand the concepts of blood oxygen tension, arterial oxygen saturation, and the blood's methods for carrying oxygen and delivering it to body tissues. One device that allows detection of decreases in patients' oxygenation levels, before a dangerous situation is reached, is the pulse oximeter. It is easy to apply and remains secure, and will not interfere with dental procedures. The purpose of this study was to examine the effect routine dental procedures have on heart rate and SaO2 in unsedated children, ranging in age from five to seven years old.

Analysis of Variance↗

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Infant restraints.

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Humans↗