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Consequences of congenital hearing loss - a longterm view.

Responsibility for detection of hearing loss at the earliest possible age rests on the shoulders of the medical profession. Early detection and presentation of language through all available sensory channels, most notably the visual, are essential since deaf children of hearing parents, the vast majority of the deaf, characteristically remain grossly deficient linguistically despite years of special schooling. The deaf children of deaf parents, who are not as deprived linguistically since they learn a manual language at the normal age of language acquisition, tend to be less severely handicapped than the deaf children of hearing parents. Deafness is a hidden handicap in infancy although lack of vestibular function may delay motor milestones like sitting and walking but does not constitute a serious problem after they are achieved. The average 18 year old deaf student achieves a reading level comparable to that of a hearing fourth grader and the mathematical skills of a sixth grader. He is also deficient in science, social studies, and general information despite his average scores on nonverbal intelligence tests. Although many deaf students drop out of school before graduation and few go on to higher education, congenitally deaf adults are usually self-supporting and independent. Eighty per cent of the deaf marry hearing impaired persons. The deaf are greatly assisted by the cohesive deaf community existing in every sizable city which provides a social, recreational, and economic framework to their lives. As a result, delinquency and psychiatric illness are not higher among the deaf than the hearing, despite the difficulties they have dealing with the complexities of the hearing society.

Adolescent↗

Readiness for return to work following injury or illness: conceptualizing the interpersonal impact of health care, workplace, and insurance factors.

Return to work after injury or illness is a behavior influenced by physical, psychological, and social factors. Disability research lacks a conceptual framework for combining these factors in the study of the return-to-work process. Two extant theoretical models within the social context are considered as they apply to the behavior of returning to work: 1) the Readiness for Change Model originating from the field of health promotion and addressing the issue of motivation for behavior change, and 2) the Phase Model of Disability developed for the epidemiological study of occupational disability addressing the developmental and temporal aspects of disability. A new Readiness for Return-to-Work Model is proposed focusing on the interpersonal context of the work-disabled employee. Employee interactions with the workplace, the health care, and insurance systems are considered as they impact the three defining dimensions of change--decisional balance, self-efficacy and change processes. The evidence for their impact on return-to-work is examined within the framework of the Phase Model of Disability, which puts forth the phase-specificity of symptoms, risks, and interventions for disability. The Readiness for Return-to-Work Model has the potential to account for individual variation in optimal stage-specific timing of interventions based on an individual's readiness for return-to-work. The model therefore complements the Phase Model of Disability by allowing for an individual-level staging of the disability and recovery process within the broader group-level-derived framework of occupational disability phases. This link between the two models needs to be empirically tested in future research.

Accidents, Occupational↗

A comparison of health locus of control beliefs in low-back patients from the U.S. and New Zealand.

In order to study differences in health control attitudes between chronic low-back patients from the U.S. and New Zealand, the Health Locus of Control (HLC) was administered to 284 consecutive admissions to pain clinics in those countries: 96 patients seen at the Auckland (New Zealand) Pain Clinic and 188 seen at the University of Virginia (U.S.) Pain Clinic. The HLC is an 11-item instrument [23] that assesses general control over health matters. Principal component factor analyses indicated 3 distinct subscales for the low back patients: (a) personal health control, (b) external health control, and (c) control by powerful others (physicians). HLC responses were analyzed with univariate analyses of variance using subscale scores as dependent measures and country and sex as independent variables. New Zealanders rated themselves as less dependent on physicians' orders (F (1,280)=3.92, P less than 0.05), and women were seen as having less personal control over their pain conditions than men (F (1,280)=6.29, P less than 0.02). The differences related to sex and country are discussed within a social learning framework. Suggestions are made for future cross-cultural research, especially related to issues of dependency on others for health control and outcomes in the treatment of chronic pain.

Adult↗

Long-term developmental outcomes of method of delivery.

OBJECTIVE: In the general framework of relating birthing events to later mental development, this study addresses the hypothesis that uneventful non-vertex delivery is associated with higher intelligence than uneventful vertex delivery. STUDY DESIGN: In the course of a developmental obstetrical survey, data was gathered prospectively on families having a non-vertex birth at Huron Road Hospital during the 1950s and early 1960s. The intelligence quotient (IQ) scores and school success ratings for the cohort of 658 children who had been delivered uneventfully by specific non-vertex methods of birth (viz. elective section, breech and internal podalic version) are compared with those of 1151 of their own siblings and peers delivered by cephalic presentation without complication. Intrafamily comparisons allow the control of genetic and socioeconomic factors. RESULTS: The one-sided 95% confidence intervals (using the t-statistic) for mean values do not overlap. They are: IQ > 112.1 (non-vertex) vs. < 110.1 (vertex) and school success scores > 2.64 (non-vertex) vs. < 2.54 (vertex). These findings are confirmed for IQ when the analysis is restricted to only those 434 children in the families allowing intrafamily comparisons (i.e. comparable siblings born by both non-vertex and vertex deliveries). The one-sided 95% confidence intervals for mean values do not overlap. They are: IQ > 112.89 (non-vertex) vs. < 112.86 (vertex). CONCLUSIONS: Speculation is given as to the reasons for this phenomenon. It is unclear whether these differences are due to physical phenomena related to delivery or to effects due to differing levels of anesthesia-analgesia or whether these differences in intellectual potential are associated with the cause of obstetrical difficulties.

Delivery, Obstetric↗

Measuring quality of life in cardiac spouses.

The purpose of this study was to develop an objective instrument to measure changes in quality of life of spouses of post-myocardial infarction (MI) patients, and to determine its responsiveness and validity. A 70-item list of potential areas of concern was compiled; the 25 most frequent and important concerns comprised the framework of the final questionnaire. The questions on the Quality of Life Questionnaire for Cardiac Spouses (QL-SP) were categorized into the Emotional Function Dimension (EFD), and the Physical and Social Function Dimension (PSFD). Subjects (n = 39) completed the QL-SP and a battery of established questionnaires at home, 1-2 weeks post-hospital discharge for the patient, and 8 weeks later. Scores on the QL-SP between visits were improved for both the EFD (t = 5.56, p less than 0.001), and the PSFD (t = 6.11, p less than 0.001). The agreement between predicted and observed relationships between the dimension changes and other index changes, as measured statistically by a kappa with Cicchetti weights, was significant (kappa w = 0.43, p = 0.0012). The QL-SP appears to be responsive and valid, and may be useful in evaluating clinical and research intervention strategies.

Activities of Daily Living↗

Quality of life and coping with schizophrenia symptoms.

The question addressed in this paper is whether different coping styles mediate the relationship between psychopathology and related distress and the quality of life (QOL) among patients with schizophrenia. In a cross-sectional design, 161 schizophrenia inpatients were comprehensively evaluated with standardized measures of QOL, psychopathology, psychological distress and coping styles. Correlations and regression analyses were performed to examine the relationship among parameters and to estimate the mediating effect of coping styles on QOL in the framework of a distress/protection model. Life quality correlated positively with task- and avoidance-oriented coping styles and slightly negatively with emotion-oriented coping. Emotion-oriented coping mediated the relationship between the severity of activation, anxiety/depression symptoms, and QOL, while avoidance-oriented (distraction) coping was mediated between QOL and paranoid symptoms. Coping styles accounted for 25% of the variance in subjective QOL scores compared with 15% for psychological distress, and only 3% for clinical variables. The ability to cope with symptoms and associated distress substantially contributes to QOL appraisal in schizophrenia. Thus, different coping strategies may reduce the negative influence of specific symptoms and related distress on the subjective QOL of schizophrenia patients.

Adaptation, Psychological↗

Personality correlates of attributional style.

Previous research, much of it based on the learned helplessness model of depression, suggested that a wide variety of personality variables might be related to attributional style. The Attributional Style Questionnaire (ASQ; Peterson et al., 1982) and Comrey Personality Scales (CPS; Comrey, 1970) were administered to 329 subjects, and their scores were subjected to correlational and multiple regression analysis. The CPS scales were also factor analyzed, and the resulting scores were correlated with ASQ scores. Results indicated that a variety of personality variables have statistically significant relationships with attributional style, that these variables show significant positive relationships with internal, stable, and global attributions for positive events and significant negative relationships with these same attributions for negative events, and that an Activity-Extraversion-Stability factor demonstrates the strongest relationships with attributional style. Findings are interpreted within a revised theoretical framework, and emphasis is placed on understanding the personality correlates of attributional style for adequate interpretation of the concept.

Adult↗

Absence of ear advantage on the consonant-vowel dichotic listening test in adolescent and adult dyslexics: specific auditory-phonetic dysfunction.

The present study investigated auditory-phonetic processing in a group of adolescent and adult reading disabled subjects. Right- and left-handed dyslexic subjects were compared with an age, sex, and handedness matched control group. All subjects were studied with a consonant-vowel version of the dichotic listening task with repeated presentations of dichotically presented pairs of CV-syllables. Left and right ear correct scores were compared for ear advantage in each of the different subgroups of subjects. The main finding was the absence of an expected right-ear advantage (REA) in the right-handed dyslexic group as compared to the right-handed normal readers. Both the dyslexic and normal left-handed groups did not show a REA. The findings are discussed within a theoretical framework that focuses on a basic auditory-phonetic processing dysfunction in developmental dyslexia that persists into adulthood.

Adult↗

TAMO: a flexible, object-oriented framework for analyzing transcriptional regulation using DNA-sequence motifs.

SUMMARY: TAMO (Tools for Analysis of MOtifs) is an object-oriented computational framework for interpreting transcriptional regulation using DNA-sequence motifs. To simplify the application of multiple motif discovery programs to genome-wide data, TAMO provides a sophisticated motif object with interfaces to several popular programs. In addition, TAMO provides modules for integrating motif analysis with diverse data sources including genomic sequences, microarrays and various databases. Finally, TAMO includes tools for sequence analysis, algorithms for scoring, comparing and clustering motifs, and several useful statistical tests. Recently, we have applied these tools to analyze tens of thousands of motifs derived from hundreds of microarray experiments.

Algorithms↗

Generalized manifold-ranking-based image retrieval.

In this paper, we propose a general transductive learning framework named generalized manifold-ranking-based image retrieval (gMRBIR) for image retrieval. Comparing with an existing transductive learning method named MRBIR [12], our method could work well whether or not the query image is in the database; thus, it is more applicable for real applications. Given a query image, gMRBIR first initializes a pseudo seed vector based on neighborhood relationship and then spread its scores via manifold ranking to all the unlabeled images in the database. Furthermore, in gMRBIR, we also make use of relevance feedback and active learning to refine the retrieval result so that it converges to the query concept as fast as possible. Systematic experiments on a general-purpose image database consisting of 5,000 Corel images demonstrate the superiority of gMRBIR over state-of-the-art techniques.

Algorithms↗

A comparative genetic map of the turkey genome.

Genetic markers (microsatellites and SNPs) were used to create and compare maps of the turkey and chicken genomes. A physical map of the chicken genome was built by comparing sequences of turkey markers with the chicken whole-genome sequence by BLAST analysis. A genetic linkage map of the turkey genome (Meleagris gallopavo) was developed by segregation analysis of genetic markers within the University of Minnesota/Nicholas Turkey Breeding Farms (UMN/NTBF) resource population. This linkage map of the turkey genome includes 314 loci arranged into 29 linkage groups. An additional 40 markers are tentatively placed within linkage groups based on two-point LOD scores and 16 markers remain unlinked. Total map distance contained within linkage groups is 2,011 cM with the longest linkage group (47 loci) measuring 413.3 cM. Average marker interval over the 29 linkage groups was 6.4 cM. All but one turkey linkage group could be aligned with the physical map of the chicken genome. The present genetic map of the turkey provides a comparative framework for future genomic studies.

Animals↗

Psychometric properties of the Life Regard Index-Revised: a validation study of a measure of personal meaning.

A validation study of the English version of the 28-item Life Regard Index-Revised was undertaken with a sample of 91 participants from the general population. All previous studies of the Index have examined the Dutch version. The test-retest reliabilities at 8 wk. for the total Index (r =.87), Framework (r =.82), and Fulfillment (r =.81) subscales were very high. Cronbach alphas were .92, .83, and .87, respectively. A significant restriction of range was observed at the high-meaning end of the scale. Factor analysis only weakly supported the theorized two-factor structure. A very high disattenuated correlation between the Framework and Fulfillment subscales was observed (r=.94). The Index appeared to have adequate evidence supporting its concurrent and discriminant validity when compared with measures of hopelessness, spiritual well-being, and other measures of personal meaning. A significant positive association was found between the index and the Marlowe-Crowne Social Desirability Scale (r=.38). The Index was also significantly associated with sex (women scoring higher) and marital status (divorced people scoring lower). Revisions of the English version may address the restriction of range problem by employing a 5-point rating scale, instead of the current 3-point scale, or by adding more discriminating items. Further factor-analytic studies with larger samples are needed before conclusions can be drawn regarding this scale's factor structure.

Adaptation, Psychological↗

The effect of an innovative clinical teaching method on nursing students' knowledge and critical thinking skills.

The purpose of this quasi-experimental study was to determine the effect of an experimental clinical teaching method on nursing students' knowledge and critical thinking skills during clinical rotations in psychiatric nursing. Ausubel's Assimilation Theory of Learning provided the theoretical framework for this research. The subjects (N = 83) were from the baccalaureate nursing graduating classes of 1992 and 1993 of a medium-sized state university in the mid-atlantic region of the United States. The experimental clinical teaching method used computer-assisted instruction (CAI) throughout and a collaboration model (student-faculty-service) during initial clinical experiences. Knowledge was measured by the score for the psychiatric nursing component of the Mosby Assess Test and two parts of the National League for Nursing's (NLN) Psychiatric Exam (theory and total scores). Critical thinking was measured by two parts of the NLN's Psychiatric Nursing Exam (the score for assess, analyze, and evaluate as one measure and planning and implementation for the other measure). The comparison group scored significantly higher than the control group on assessing, analyzing, and evaluating (t = 2.15; p < .03), as well as planning and implementation (t = 2.33; p < .02), measures for critical thinking skills. However, there was no significant difference between the study groups with respect to knowledge. The findings support the appropriateness of Ausubel's Assimilation Theory with this clinical teaching method. Discussion relevant to the application of the study findings to nursing education and future research is presented.

Adult↗

A multidimensional analysis of the epistemic origins of nursing theories, models, and frameworks.

The purpose of this article is to introduce our notion of epistemic space and to demonstrate its utility for understanding the origins and trajectories of nursing theory in the 20th century using multidimensional scaling (MDS). A literature review was conducted on primary and secondary sources written by and about 20 nurse theorists to investigate whether or not they cited 129 different scholars in the fields of anthropology, biology, nursing, philosophy, psychology, and sociology. Seventy-four scholars were identified as having been cited by at least two nurse theorists (319 citations total). Proximity scores, quantifying the similarity among nurse theorists based on proportions of shared citations, were calculated and analyzed using MDS. The emergent model of epistemic space that accommodated these similarities among nurse theorists revealed the systematic influence of scholars from various fields, notably psychology, biology, and philosophy. We believe that this schema and resulting taxonomy will prove useful for furthering our understanding of the relationships among nursing theories and theories in other fields of science.

Anthropology, Cultural↗

Bayesian semi-parametric ROC analysis.

This paper describes a semi-parametric Bayesian approach for estimating receiver operating characteristic (ROC) curves based on mixtures of Dirichlet process priors (MDP). We address difficulties in modelling the underlying distribution of screening scores due to non-normality that may lead to incorrect choices of diagnostic cut-offs and unreliable estimates of prevalence of the disease. MDP is a robust tool for modelling non-standard diagnostic distributions associated with imperfect classification of an underlying diseased population, for example, when a diagnostic test is not a gold standard. For posterior computations, we propose an efficient Gibbs sampling framework based on a finite-dimensional approximation to MDP. We show, using both simulated and real data sets, that MDP modelling for ROC curve estimation closely parallels the frequentist kernel density estimation (KDE) approach.

Adolescent↗

Psychological sequelae in adult females reporting childhood ritualistic abuse.

The present study sought to increase current scientific knowledge about the controversial issue of subjectively reported childhood ritualistic abuse by addressing several key unresolved issues. In particular, the possibility that those reporting ritualistic abuse may be characterized primarily by the severity of their abuse histories or the severity of their present psychological symptoms, rather than the veridicality of the ritualistic events, was explored. Adult female outpatients reporting childhood sexual abuse with ritualistic features were compared with a second group of women who reported childhood sexual abuse without ritualism. Measures included characteristics of childhood sexual and physical abuse, current posttraumatic stress disorder (PTSD) diagnostic status and symptom severity, and severity of current dissociative experiences. Women reporting ritualistic features scored significantly higher on measures of childhood sexual and physical abuse. Neither PTSD diagnostic status nor severity for PTSD nor dissociative experiences were significantly different between the groups. While preliminary in nature, these results suggest that it may be helpful to conceptualize reported childhood ritualistic abuse as indicative of the need to assess carefully for severe abuse and its predictable sequelae within existing traumatic victimization conceptual frameworks.

Adolescent↗

Definitive management of severe facial trauma utilizing free tissue transfer.

OBJECTIVE: Severe ballistic or avulsion injuries to the face create complex, composite defects. We report the results of an aggressive management algorithm to optimize facial form and function: (1) the initial encounter, (2) definitive reconstruction with vascularized tissue, and (3) aesthetic and prosthetic refinement. STUDY DESIGN AND SETTING: Retrospective case series of 49 patients in 2 tertiary care institutions. Patients were evaluated for age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, and functional outcomes. RESULTS: Forty defects were gunshot wounds, 9 resulted from major avulsive trauma. Involved sites included 13 oromandibular, 21 midface/upper face, and 15 combined sites; 54 free flaps were utilized, 21 were soft tissue and 33 contained bone. No flap failures occurred. Function and cosmesis were best in the oromandibular only group, and worst in the combined group with nasal and/or orbital tissue loss. CONCLUSION: Treatment of severe facial trauma requires early tissue debridement with bony repair and/or stenting to minimize scar contracture. Free tissue transfer techniques allow simultaneous reconstruction of the bony framework and overlying tissues. Multiple secondary procedures are frequently required for optimal aesthetic restoration. EBM RATING: C.

Adolescent↗

Nurse aide empowerment strategies and staff stability: effects on nursing home resident outcomes.

PURPOSE: This study examines the moderating effect of staff stability on the relationship between management practices used to empower nurse aides and resident outcomes in a multistate sample of nursing homes. An adaptation of Kanter's theory of structural power in organizations guided the framework for the model used in this study. DESIGN AND METHODS: Management practices and nurse aide staff stability measures were taken from a survey of directors of nursing (n = 156) and day-shift charge nurses (n = 430) in a stratified random sample of nursing facilities in Maine, Mississippi, New York, and Ohio (n = 156). Facility risk-adjusted pressure ulcer incidence rates and social engagement scores, taken from the Minimum Data Set, served as resident outcome measures. A hierarchical linear regression model was used to test the moderating effect of staff stability. RESULTS: The situation in which higher numbers of rewards were given to nurse aide staff was associated with lower incidence of pressure ulcers, whereas the situation in which nurse aides had more influence in resident care decisions was associated with higher aggregate social engagement scores. The inclusion of nurse aide staff stability in the regression model provided additional explanatory information for the relationship between management practices and resident outcomes. Facilities experiencing low turnover and high retention were associated with lower pressure ulcer incidence, whereas facilities with high turnover and high retention were associated with higher social engagement scores. IMPLICATIONS: This study suggests that certain management practices used to empower nurse aides can influence resident outcomes. Further, effects of nurse aide staff stability vary with respect to the physical versus psychosocial nature of the outcome.

Nursing Assistants↗