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Homosexual identity formation as a developmental process.

Homosexual identity is conceptualized as a life-spanning developmental process that eventually leads to personal acceptance of a positive gay self-image and a coherent personal identity. Habermas' theory of ego development is utilized to provide a synthesis and understanding of the literature on the construction and maintenance of the homosexual identity. It is concluded that the homosexual identity generally emerges in a three-stage process in which the person progresses from: (1) an egocentric interpretation of homoerotic feelings to (2) an internalization of the normative, conventional assumptions about homosexuality to (3) a post-conventional phase in which societal norms are critically evaluated and the positive gay identity is achieved and managed. Developmental tasks associated with each stage are outlined in terms of their ego-integrative functions. Although the stages in the process of homosexual identity formation are theoretically the same for females and males, because of the paucity of research on the homosexual identity in females, this paper deals chiefly with males.

Adolescent↗

Development of a quality assurance program as an integral part of the physical therapy system.

The purposes of this article are to describe the conditions that must be met and the process that must be carried out to develop, implement, and evaluate a quality assurance program. The conditions to be met are administrative support for the program; knowledge of quality assurance theories and components (including structure, process, and outcome standards); and a commitment of the department members to quality assurance. The participative approach to program development is essential to the acceptance and implementation of the program. The process is cyclical in nature with the actual program design based on the needs of the people to be served. The department's policies and procedures manual provides the appropriate place for the documentation of the program standards so they are easily accessible to all staff and are an integral part of the delivery system. External peer review is used in measuring the potential for success of the program's structure.

Activities of Daily Living↗

Procedural validity of an abbreviated version of the SADS/RDC diagnostic process.

Formal diagnostic systems such as the Research Diagnostic Criteria (RDC) and standardized diagnostic interviews such as the Schedule for Affective Disorders and Schizophrenia (SADS) have enhanced clinical psychiatric research over the past decade. Because of the cost and time factors, however, they are not routinely used in most clinical settings. The availability of reliable alternatives compatible with clinical practice would encourage more psychiatrists to engage in clinical research. This study describes the nature and procedural validity of two such alternatives based on the RDC. Acceptably accurate, less costly research diagnostic processes can be incorporated into clinically oriented short-term acute inpatient units.

Alcoholism↗

Delay in processing porcine whole blood affects cytokine expression.

Quantification of cytokine messenger ribonucleic acid (mRNA) in blood samples has become an important tool in the investigation of immune cell activation in a variety of clinical settings. It has been shown that the method of sample collection and processing influences the levels of several cytokine mRNAs. Therefore, it is generally accepted that blood samples for analysis of cytokine expression be processed as soon as possible and under standardised conditions. Since immediate sample processing is not always possible, we investigated the effect of different storage conditions (room temperature (Rt) and 4 degrees C) and storage times (1, 2, 4, 6 and 24 h) on the mRNA level of different cytokines (IL-1alpha, IL-2, IL-6, IL-8, IL-10, IFN-gamma), as well as the IL-2 receptor (IL-2R) in porcine whole blood samples (n=8). Quantification of cytokine expression was performed using simultaneous reverse transcription PCR (RT-PCR) combined with the expression of the housekeeping gene glyceraldehyde-3-phosphate dehydrogenase (GAPDH) as a reference. Our data demonstrate that delays in sample processing longer than 1 h result in significant changes of the mRNA levels of individual cytokines. Expression of the monokines IL-1alpha, IL-6 and IL-10 were increased by storage at both room temperature and 4 degrees C. Expression of IL-8 was increased only in the samples stored at room temperature, and expression of IFN-gamma was raised exclusively in the samples stored at 4 degrees C. We conclude that porcine blood samples should be processed within 2 h to prevent undesired stimulatory effects on the cytokine expression pattern. However, if only selected cytokines are investigated, the undesired effects of prolonged storage can be selectively suppressed by choosing the appropriate temperature of sample storage.

Animals↗

Homologous complement activation on drug-induced apoptotic cells from a human lung adenocarcinoma cell line.

Activation of the alternative pathway of homologous complement (C) was observed in a human lung adenocarcinoma cell line, CADO 43, after the cells had become apoptotic following treatment in vitro with vincristine and predonisolone. Deposition of C3b and C3bi on the serum-treated apoptotic cells was revealed by flow cytometry with anti-C3b and -C3bi-specific antibodies and immunoblotting with anti-C3 antibody immunoprecipitates extracted from solubilized fractions of serum-treated apoptotic cells. Two molecular mechanisms were found to be responsible for this post-apoptotic C-activation. Firstly, all C regulators, decay accelerating factor (DAF), membrane cofactor protein (MCP) and C3b/C4b receptor (CR1), were diminished on the cell surface concomitantly with the apoptotic process. Secondly, unidentified molecules which potentially activate homologous C and accept C3b/C3bi fragments became expressed on the cell surface during the apoptotic process. These findings may explain the mechanism whereby tumor cells are efficiently eliminated through chemotherapy.

Adenocarcinoma↗

An analysis of the concept facilitation.

This paper is an analysis of the concept facilitation. The analysis is based on a model suggested by Wilson (1969) cited in Walker & Avent (1988). The literature review shows the term used in physiological, educational, counselling/psychotherapy, social and theological contexts. The analysis leads to the compilation of the defining attributes of the concept facilitation which are: a process of enabling change; a climate for learning (mutual trust, acceptance and respect); and factors which relate to the nature of the process (student-centred, negotiated and collaborative). The antecedents relate to the facilitator qualities (realness, caring and empathy), access to a learning situation and the effects of motivation and social influences; the consequences of effective facilitation being reciprocal change (learning and understanding), reciprocal feedback and increased independence. To a limited extent the empirical referents have been discussed. Cases have been constructed to provide examples of the term facilitation used in a model, borderline, related and contrary situations. The analysis will be of particular interest to those in nurse education.

Concept Formation↗

Real-time patient satisfaction survey and improvement process.

The purpose of this article is to describe how one multidisciplinary hospital responded to patient-satisfaction issues and improved communication throughout its organization by implementing a real-time assessment of patient and staff satisfaction for a faster and better-focused improvement process. The survey process is based on eliciting information from several different sources in a manner that allows corrective action plans to be made and implemented within 4 to 8 weeks of patient encounters. Organized groups can then review feedback from the implemented action plans within 9 to 16 weeks of patient encounters. This 4-month process is repeated on a quarterly basis, as lessons learned from the previous cycle are fed into the upcoming survey process for continuous patient-satisfaction improvement. Employees, faculty, and administrators have accepted the Real-Time Patient Satisfaction Survey and Improvement Process as a routine activity within the normal operating structure at the Moffitt Cancer Center. This activity of problem identification-action-feedback has been well integrated in the system and will continue to rotate throughout all patient care clinical services at the Moffitt Cancer Center. The program has become a method for goal-setting and establishing management accountability. As an adaptation of continuous quality improvement, The Real-Time Patient Satisfaction Survey and Improvement Process at the Moffitt Cancer Center is applicable for use in other hospitals and cancer centers in the United States. The general design, materials, and analysis plan can be directed toward the needs of the specific institution (and are available for distribution by contacting the authors).

Cancer Care Facilities↗

Using formative research to lay the foundation for community level HIV prevention efforts: an example from the AIDS Community Demonstration Projects.

The AIDS Community Demonstration Projects provided community-level HIV prevention interventions to historically hard-to-reach groups at high risk for HIV infection. The projects operated under a common research protocol which encompassed formative research, intervention delivery, process evaluation, and outcome evaluation. A formative research process specifically focusing on intervention development was devised to assist project staff in identifying, prioritizing, accessing, and understanding the intervention target groups. This process was central to the creation of interventions that were acceptable and unique to the target populations. Intended to be rapid, the process took 6 months to complete. Drawn from the disciplines of anthropology, community psychology, sociology, and public health, the formative research process followed distinct steps which included (a) defining the populations at high-risk for HIV; (b) gathering information about these populations through interviews with persons who were outside of, but who had contact with, the target groups (such as staff from the health department and alcohol and drug treatment facilities, as well as persons who interacted in an informal manner with the target groups, such as clerks in neighborhood grocery stores and bartenders); (c) interviewing people with access to the target populations (gatekeepers), and conducting observations in areas where these high-risk groups were reported to gather (from previous interviews); (d) interviewing members of these groups at high risk for HIV infection or transmission; and (e) systematically integrating information throughout the process. Semistructured interview schedules were used for all data collection in this process. This standardized systematic method yielded valuable information about the focal groups in each demonstration project site. The method, if adopted by others, would assist community intervention specialists in developing interventions that are culturally appropriate and meaningful to their respective target populations.

Acquired Immunodeficiency Syndrome↗

Emotional adjustment to a chronic illness.

The emotional reaction to the diagnosis of a chronic illness can be a greater challenge than coping with the physical manifestations of the illness. This article describes and explains the determinants of the emotional reaction to the diagnosis of a chronic illness: (1) personality before the illness; (2) unresolved anger or grief from the past; (3) the suddenness, extent, and duration of life-style changes mandated by the illness; (4) familial and individual resources for dealing with stress; (5) stages of individual and family life cycle; (6) previous experience with illness or crisis; and (7) codependency in the family system. Also discussed are the stages of integrating grief process with the benefits and pitfalls of each stage and signs of acceptance. The benefits and necessity of going through the grief process are explored. People who receive diagnoses of chronic illness may find their emotional reaction more disabling than the illness itself until they go through the adjustment process to embrace the new person they have become through the illness.

Adaptation, Psychological↗

PACS workstation design.

This paper covers some of the recent concepts in designing a digital imaging workstation in a multimodality Picture Archiving and Communications Systems (PACS) network. A workstation in a multimodality PACS network must access, display, and analyze digital images from different imaging modalities with very different formats. The user interface should allow clinicians with minimal or no computer manipulation skills to use complex analysis tools. General guidelines of a graphics oriented user interface, based on windows and icons, are proposed. Instantaneous (real-time) response in the primary display and processing functions is vital for user acceptance. The hardware architectural concepts to achieve such a performance speed are described. Finally, a workstation environment conducive to comfortable viewing by the radiologists is discussed.

Computer Graphics↗

Accommodating the stranger en casa: how Mexican American elders and caregivers decide to use formal care.

Mexican American elders have higher levels of functional impairment and chronic illness, yet they use formal home care services less than do non-Hispanic White elders. This article describes the processes by which Mexican American elders and their caregivers decide to use home care services. Interviews were conducted with Mexican American elders (n = 11) and family caregivers (n = 12) for a sample of 23 individuals. The emerging substantive grounded theory included three stages that described the process of deciding to use home care services: Taking Care of our Own, Acknowledging Options, and Becoming Empowered. The processes describe how Mexican American families eventually accept home care services while maintaining their cultural norm of taking care of elders. The theory gives voice to both elders and caregivers in this process, adds to extant knowledge, and shapes interventions to support traditional Mexican American family values such as elders' staying at home as long as possible. The theory meets nursing's goals of reducing health care disparities by improving or sustaining elders' health and functional ability, decreasing the caregiving burden, and reducing health care costs.

Aged↗

Screening for cognitive impairment in older African-Caribbeans.

BACKGROUND: There are increasing numbers of older African-Caribbeans in the United Kingdom. Screening instruments are commonly used in the detection of cognitive impairment, but have not been assessed within this population. This study aimed to develop culturally modified versions of screening instruments for cognitive impairment (Mini-Mental State Examination (MMSE) and Abbreviated Mental Test (AMT)) and to determine their sensitivity and specificity in the diagnosis of dementia. METHODS: The instruments were modified using a process involving a community group of African-Caribbeans and an academic group of health professionals. They were used in a two-stage study involving community resident African-Caribbeans aged 60 years or over in inner-city Manchester, comparing the screening instruments against a computerized diagnostic interview. RESULTS: One hundred and thirty people completed the study. The results for the largest subgroup, the Jamaicans (N = 96) were analysed. Effects of gender, age and education on the MMSE and AMT scores were evaluated. The correlations between the screening instruments and diagnostic interview were highly significant (P < 0.001). At appropriate cut-offs both screening instruments demonstrated high sensitivity and acceptable specificity levels. CONCLUSIONS: A defined process with lay input has assisted in producing culturally modified versions of the MMSE and AMT that perform well compared with a diagnostic interview, if an appropriate cut-off is used. They are easy to administer and acceptable to older African-Caribbean people. The results need to be viewed within the limitations of the current study.

Black or African American↗

Creating a culture of medication administration safety: laying the foundation for computerized provider order entry.

BACKGROUND: Computerized provider order entry (CPOE) systems are recognized as an effective tool for reducing preventable adverse drug events; however, implementation is a complex process that involves much more than installing new software. The literature addresses the use of these systems in large tertiary care hospitals and university settings; yet there is little information on their implementation and use in smaller hospitals. Beaver Dam Community Hospital, a small, rural hospital, set about laying the foundation for implementing CPOE. Actions were taken in terms of context (the culture and attitude, acceptance, and importance regarding the change), process (roles, workflow, and policies relating to the change), and content (how-to, such as procedural steps and rules). USE OF THE RAPID-CYCLE IMPROVEMENT PROCESS: The team elected to use the rapid-cycle improvement process for implementation to allow it to move ahead quickly, adjusting changes as necessary for maximum success. Each change was considered an individual Plan-Do-Check-Act cycle, with its own action plan and measurement for successful implementation. PLANNING ACTUAL IMPLEMENTATION: The Patient Safety Committee has begun the planning of actual implementation--Phase II. Issues addressed include how to phase in the system--in which units to bring up first, how to structure the transitional period, how to redesign workflow, and how to plan role changes. SUMMARY: The changes already implemented contribute to medication safety and are important from that perspective alone, without the use of CPOE. The addition of an electronic system will enhance the organization's ability to provide safe, accurate medication administration.

Clinical Pharmacy Information Systems↗

Access in health services research: the battle of the frameworks.

BACKGROUND: Access is an important concept in the study of the organization, financing and delivery of healthcare services. It is also an important political symbol and policy goal. PURPOSE: This article reviews the major theoretical frameworks that have been used to support the study of access and measure the degree to which healthcare systems have met standards of access. METHOD: The article uses a critical review of the major works of the leading theorists in the field of access studies. DISCUSSION: Theories of access accept that it is a dynamic process where there is the potential for individuals and families to learn and modify their behavior. That learning and adaptation is less often explored in empirical research of access to health care. CONCLUSION: Researchers should consider the more dynamic aspects of access as they attempt to understand how to improve the health care delivery system. Access models can be used to direct the formulation of better health policy if they reflect real world processes.

Community Health Planning↗

Prospects for expanded mohair and cashmere production and processing in the United States of America.

Mohair from Angora goats has been produced in the United States since the introduction of these animals from Turkey in 1849. Cashmere on Texas meat goats was reported in 1973, but domestic interest in commercial production did not occur until the mid-1980s. Since 1982, the average prices of U.S.-produced mohair and cashmere (de-haired) have ranged from $1.81 to $9.48/kg and approximately $55 to $200/kg, respectively. However, return to producers from mohair has been relatively constant, averaging $10.21/kg, due to the federal incentive program. Because this program is scheduled to terminate with final payment in 1996, the future of mohair profitability is questionable. Prospects for expanded mohair and cashmere production and processing in the United States are influenced by numerous interacting factors and potential constraints. These include the prospect that the goat and textile industries may no longer be profitable in the absence of clear government policies. Although selection may have slightly increased fiber production by Angoras (long term) and domestic meat goats (short term), availability of genetic resources may prove to be a constraint to increased fiber production by cashmere goats and improved meat production by both types of goat. Land resources are plentiful unless new government policies prohibit goats from vast tracts of rangeland and forest because of environmental concerns. Future demand is an unknown, but with increasing world population and affluence, prospects for long-term improved demand for luxury fibers seem good. Competition from foreign cashmere growers is expected, whereas, in the short term, mohair production overseas is declining. However, increased processing of cashmere in its country of origin is expected to result in shortages of raw materials for European and U.S. processors. The amount of scouring, worsted, and woolen equipment in the United States is adequate to accommodate major increases in domestic processing of goat fibers. However, the absence of specific processing knowledge and skills may be constraints. Similarly, the absence of acceptable small-scale dehairing equipment for cashmere will limit cashmere processing on a cottage industry scale. Purely practical considerations such as the effects of predation and cost of fencing could become major constraints to expanding the goat fiber industry. Likewise the success (or lack thereof) of industry promotion of fiber and goat meat could be an overriding factor. To emerge from the uncertainty of erratic raw material prices and to better control profitability, domestic goat-fiber producers are encouraged to consider innovative, cooperative, retained ownership business ventures that will permit them to profit-share up to the retail level.

Animal Husbandry↗

A home-based method to reduce phytate content and increase zinc bioavailability in maize-based complementary diets.

This study aimed to develop and assess the feasibility of a home-based method to reduce the phytate content of maize and improve zinc bioavailability from maize-based complementary diets in rural Malawi. A method of extracting phytate through the soaking of pounded maize was developed, and found to reduce phytate content to 49% of unrefined maize. An educational program was used to teach the processing method to mothers of children receiving complementary foods in rural Malawian communities. Samples of maize flour prepared by this process by participants were collected and analysed for phytate and zinc content. Of these, 70% of samples were found to be adequately prepared; mean phytate content of these samples was 48% of unprocessed, unrefined maize flour controls. Most participants found the cooked product to have an acceptable taste (99%) and texture (68%), and felt the processing method took little or no extra time (86%) and was culturally acceptable (96%). The phytate and zinc content of the processed maize flour samples analysed from community prepared samples was substituted into the dietary analysis of complementary foods for 9- to 11-month-old children (n = 31). The bioavailability of zinc from the complementary diet would predict an increase from low (24%) to moderate (33%) levels.

Biological Availability↗

[Analysis of thermal images].

Broad introduction of thermovision systems in medical practice, and their multifunctional intension make it necessary to find new, more effective ways to processing and analysis of thermal patterns. Acception of these methods in medicine should provide higher diagnostic accuracy and informativeness of thermovision. Solution of this problem can be achieved by different approaches. One, that seems to be promising, is based on employing the programmed electronic-computational aids of limited output in thermovision systems. This will offer a possibility to solve several questions, associated with display of initial pattern in a form convenient for further processing, with some conversions for detecting informative signs and obtaining their quantitative estimates.

Diagnosis, Computer-Assisted↗

Uncertainty analysis in a mechanistic model of bacterial regrowth in distribution systems.

The first generation of mechanistic models of bacterial regrowth in distribution systems (DS) provides insight into cause-and-effect relationships. However, the state of knowledge about the processes included in these models is insufficient to warrant deterministic predictions. Even if the process descriptions are reasonable, the uncertainty in values of key system constants limits predictions of bacterial growth. A new mechanistic model was developed to incorporate the accepted knowledge of physical, chemical, and biological processes with the hydraulic features in order to capture the unsteady state behavior of the DS. Sensitivitytesting showed that the extent of bacterial regrowth was affected mainly by the rate constants for chlorine decay reactions in bulk water and on the pipe wall and by the maximum growth rate constant of attached bacteria. A simple hypothetical network was used to evaluate the effects of uncertainty in these three system constants by running 100 Monte Carlo simulations. Cumulative probability plots showed a wide range of predictions for concentrations of bacteria and chlorine in bulk water at various nodes in the DS. The magnitude of these concentrations and the range of values were greatly affected by water residence time to each node. Once the chlorine residual is depleted, bacterial growth is mainly influenced by the amount of substrate available. However, high values of the coefficients for the maximum growth rate of attached bacteria, the chlorine decay in bulk water, and the chlorine decay by wall reaction did not necessarily lead to the maximum bacterial growth at a given location.

Bacteria↗