RelEx: Visualization for Actively Changing Overlay Network Specifications

We present a network visualization design study focused on supporting automotive engineers who need to specify and optimize traffic patterns for in-car communication networks. The task and data abstractions that we derived support actively making changes to an overlay network, where logical communication specifications must be mapped to an underlying physical network. These abstractions are very different from the dominant use case in visual network analysis, namely identifying clusters and central nodes, that stems from the domain of social network analysis. Our visualization tool RelEx was created and iteratively refined through a full user-centered design process that included a full problem characterization phase before tool design began, paper prototyping, iterative refinement in close collaboration with expert users for formative evaluation, deployment in the field with real analysts using their own data, usability testing with non-expert users, and summative evaluation at the end of the deployment. In the summative post-deployment study, which entailed domain experts using the tool over several weeks in their daily practice, we documented many examples where the use of RelEx simplified or sped up their work compared to previous practices.

Depression among caregivers of children with asthma and its impact on communication with health care providers

BACKGROUND

Caregiver depression is common, can negatively influence one's ability to communicate with health care providers, and may hinder appropriate care for children with asthma.

OBJECTIVE

To evaluate the impact of caregiver depression on communication and self-efficacy in interactions about asthma with their child's physician.

STUDY DESIGN

Cross sectional analysis using data from the Prompting Asthma Intervention in Rochester-Uniting Parents and Providers study.

METHODS

We enrolled caregivers of children (2-12 yrs) with persistent asthma prior to their health care visit. Caregivers were interviewed via telephone after the visit to assess depression, self-efficacy, and provider communication at the visit. Caregiver depression was measured using the Kessler Psychological Distress scale. We assessed caregiver self-efficacy using items from the Perceived Efficacy in Patient-Physician Interactions scale; caregivers rated their confidence for each item (range 0-10). We also inquired about how well the provider communicated regarding the child's asthma care. Bivariate and multivariate analyses were used.

RESULTS

We interviewed 195 caregivers (response rate 78%; 41% Black, 37% Hispanic), and 30% had depressive symptoms. Caregiver rating of provider communication did not differ by depression. Most caregivers reported high self-efficacy in their interactions with providers; however depressed caregivers had lower scores (8.7 vs. 9.4, p = .001) than non-depressed caregivers. Further, depressed caregivers were less likely to be satisfied with the visit (66% vs. 83%, p = .014), and to feel all of their needs were met (66% vs. 85%, p = .007). In multivariate analyses, depressed caregivers were >2× more likely to be unsatisfied with the visit and to have unmet needs compared to non-depressed caregivers.

CONCLUSIONS

Depressed caregivers of children with asthma report lower confidence in interactions with providers about asthma and are less likely to feel that their needs are met at a visit. Further study is needed to determine the best methods to communicate with and meet the needs of these caregivers.

Disclosure of HIV diagnosis to children: when, where, why, and how

Despite recent recommendations by the American Academy of Pediatrics that strongly encourage disclosure of human immunodeficiency virus (HIV) infection to school-age children, health care providers vary widely in their actual disclosure practices. Concrete guidelines for accomplishing disclosure are not currently available. Nondisclosure can result in a variety of problems, including anxiety, depression, phobias, and exclusion from peer support groups and medical camps. This article reviews the available literature on disclosure of HIV infection to children and describes the disclosure process used in a large, urban pediatric HIV clinic.

Rural school nurses' asthma education needs

School nurses play an important role in identifying children with asthma and providing care during school hours. Educational programs designed to improve nurses' asthma knowledge and practices have concentrated on urban settings. The purpose of this investigation was to determine asthma-related practices and educational needs of rural school nurses. A survey about asthma was mailed to school nurses in all counties of the state of Maryland and in Washington, D.C. Responses were compared between rural Maryland counties and counties from the remainder of Maryland and Washington, D.C. The survey addressed attitudes and beliefs, function and roles, medication administration, and educational needs about asthma. We found that rural nurses used peak flow meters less often to assess and monitor asthma, requested fewer referrals for asthma, had fewer interactions with health room assistants, and had reduced access to asthma educational resources. Also, they provided less asthma education in the schools than other school nurses. These results suggest a need for comprehensive asthma educational programs in rural areas that are based on national guidelines, and that address the unique needs of rural school nurses. These programs should also emphasize the need for open communication between rural school nurses, health room assistants, primary care providers, and parents/caregivers.

Asthma education in rural communities

Asthma is a common disease of airway obstruction in school-aged children. Adequate management of asthma in children leads to fewer missed school days, fewer hospitalizations, fewer emergency room visits, and an increase in quality of life. Most asthma educational programs and evaluations have focused on urban rather than rural populations. The purpose of this study was to identify parental asthma needs, develop rural asthma education materials, and evaluate the effectiveness of these educational materials in improving the knowledge and asthma care effectiveness of parents of children with asthma in a rural community. Seven parents were contacted by telephone and administered a pre- and posttest questionnaire analyzing their level of knowledge about asthma and their quality of life. Asthma educational materials were mailed to all parents in the study before administering the posttest. Results indicated that all parents needed additional education about asthma, especially regarding medications. Pre- and posttest scores showed improvements in three areas of knowledge: long-term asthma medications, controlling roaches in the home, and daily peak flow monitoring. There was a significant improvement between pre- and posttest results from the activity domain of quality of life. Eighty-five percent of the parents reported that they had either initiated changes in their home, or planned to in the future, from reading the educational materials. The parents' response to the educational materials that they received by mail was positive, indicating that they may not have received enough information about how to care for children with asthma before our study. The data suggest that distribution of asthma educational materials in rural communities can increase parental knowledge about asthma and lead to positive changes in behavior that can improve their children's health.

Factors associated with medication self-administration in children with asthma

This study investigated factors associated with early self-administration of inhaled asthma medications by minority children. Specifically, the study evaluated: (1) the reasons parents allow early administration of inhaled medications, (2) childhood activities associated with early medication administration, (3) parent's perception of the child's ability to use a metered-dose inhaler (MDI), (4) the child's actual ability to use an MDI, and (5) concordance/discordance between physician-parent reports and parent-child reports of asthma medications. Study results indicated that 93% of the children were taking inhaled asthma medications without adult supervision. Early self-administration of asthma medications was related to the parent's employment status and the performance of other childhood behaviors such as completion of homework independently and crossing the street alone. Only 7% of the children had effective MDI skills, but 60% of the parents rated their child's MDI skills as excellent. Twenty percent, 67%, and 50%, respectively, of the parents' reports of beta-agonists, daily inhaled steroids, and cromolyn were discordant with the physician's actual prescriptions. Sixty-two percent, 57%, and 79%, respectively, of the children's reports for inhaled beta-agonists, daily inhaled steroids, and cromolyn were discordant with their parents' reports. Implications for anticipatory guidance, future educational strategies, and supervision of MDI technique are provided.

Assessing pediatric clinical asthma practices and perceptions: a new instrument

Over the past 20 years, the most substantial increases in prevalence, morbidity, and mortality of asthma have been observed among children aged 5-14 years. A survey instrument designed to measure clinical asthma management practices of primary care physicians was developed and evaluated. Study participants included 127 practitioners providing pediatric asthma care in inner-city communities in Baltimore, MD and Washington, DC. Study results found that the instrument assessed four separate dimensions of clinical assessments and five dimensions of physician perceptions. These dimensions should be considered in future research protocols and may be used to design tailored interventions to improve asthma care.

Opinions, knowledge, and self-reported practices related to infection control among nursing personnel in long-term care settings

BACKGROUND

Because educational needs of staff in long-term care facilities regarding infection control have, not been well studied, we conducted this study to measure long-term care staff members' knowledge, self-reported practices, and opinions about infection control and handwashing.

METHODS

A pilot study was conducted with 24 staff members of one long-term care facility to examine psychometric properties of study instruments. All nursing staff members (n = 105) from two additional long-term care facilities then completed a 14-item knowledge questionnaire, 22-item opinion survey, and 26-item survey of self-reported handwashing practices.

RESULTS

Respondents were predominantly female with mean age of 46 years; most had completed high school. Mean length of employment in the study facility was 12.4 years. Registered nurses and licensed practical nurses scored significantly higher on knowledge (p = 0.0002) but significantly lower on self-reported practices (p = 0.01) than did trained nursing assistants. There was no significant correlation between self-reported practices and opinions regarding handwashing (p = 0.55). Neither level of knowledge nor positive opinion about the value of handwashing was associated with self-reported increases in handwashing practices.

CONCLUSION

We conclude that education alone is not likely to be associated with changes in handwashing behavior. Instruments developed and tested in this study can be used in further research to correlate self-reported with observed behavior and to evaluate the effects of interventions on knowledge, opinions, and self-reported handwashing behavior.

Consistency and cost of home wound management by contract nurses

The purposes of this descriptive study were to determine the consistency of wound care provided by home health care nurses with the physician's order and the agency's written wound protocol; and the type and cost of wound-management products and nursing services associated with home care. Eleven registered nurses were observed providing wound care in 117 home visits to 31 patients. In addition to the observational component, data were also collected by chart review to facilitate comparison of observed vs. documented care. There were statistically significant differences between observed care given and that which was documented in patients' records. Consistency of care for individual patients was high when care was delivered by the same nurse, but lower when different nurses were involved. The mean dollar value of supplies used for all visits was $9.40, and the average nursing charge per visit was $89.

Early diagnosis of perinatal HIV infection by detection of viral-specific IgA antibodies

OBJECTIVES

To evaluate the clinical utility of a human immunodeficiency virus (HIV)-IgA serological assay for diagnosis of perinatally acquired HIV infection.

DESIGN

Coded serum samples prospectively collected from children born to HIV-infected mothers and uninfected mothers were analyzed by HIV-IgA immunoblot.

SETTING

A university hospital in Baltimore, Md, and an outpatient clinic in Port-au-Prince, Haiti.

POPULATION

Five hundred thirty-nine serum samples were obtained sequentially from 278 children born to HIV-infected women (116 from The Johns Hopkins Hospital and 62 from Port-au-Prince) and from 42 control children born to HIV-seronegative children in Port-au-Prince.

OUTCOME MEASURES

Results from the HIV-IgA serological assays were compared with the known infection status of the child at 15 months of age as determined by the standard IgG Western blot and the clinical classification of the Centers for Disease Control. Sensitivity, specificity, and predictive values were calculated at different ages and collectively for children 3 months of age or older.

RESULTS

The HIV-IgA assay was positive in one of six specimens from HIV-infected children under 1 month of age, six of nine specimens from infected children at 3 months of age, and 160 of 161 specimens from 47 HIV-infected children 6 months of age or older. Of 334 specimens from 243 uninfected children, 333 were negative by the HIV-IgA assay. The overall sensitivity and the specificity of the IgA assay for children older than 3 months of age were 97.6% and 99.7%, and the positive and negative predictive values were 99.4% and 98.7%, respectively.

CONCLUSION

Although the HIV-IgA assay had a low sensitivity within the first months of life, the high sensitivity, specificity, and predictive values of this assay demonstrate its utility for the diagnosis of perinatally acquired HIV infection after the third month of age. Early diagnosis with this relatively simple and inexpensive serological assay should aid in the implementation of antiviral therapy and provide useful information for the care of children born to HIV-infected mothers in both developing and developed countries.

Immunoglobulins and growth parameters at birth of infants born to HIV seropositive and seronegative women

Health characteristics of neonates born to human immunodeficiency virus (HIV) seropositive (n = 63) and HIV seronegative (n = 57) women were compared. No significant differences were found between the two infant groups for sociodemographic characteristics, mode of delivery, Apgar scores, gestational age, growth parameters, or immunoglobulin levels. Furthermore, no differences were detected in a subgroup of infants later confirmed to have HIV infection (class P-2). Maternal HIV infection does not appear to affect newborn health characteristics.

Integrity of vinyl and latex procedure gloves

In a series of experiments the integrity of vinyl and latex procedure gloves were tested under in-use conditions. Both types of gloves were tested by three methods: watertight (645 samples), bacterial penetration (50), and dye exclusion (90). Results of the watertight test demonstrated visible defects in 4.1% of vinyl and 2.7% in latex gloves. Twenty percent of latex gloves and 34% of vinyl gloves which had passed the watertight test allowed penetration of Serratia marcescens when worn by volunteers. A series of manipulations designed to simulate approximately 15 minutes of clinical activity in an intensive care unit resulted in failure rates as high as 66%. Using the dye penetration test, there was a statistically significant difference between vinyl and latex procedure gloves with full manipulations, with failure rates of 53% and 3%, respectively. Both types of gloves provided some barrier protection. However, latex gloves performed better when stressed.

Postdoctoral nursing education in infection control: program description

The need to identify and evaluate those clinical practices that are efficacious in reducing risk of nosocomial infection is clear. A model of large-scale programmatic evaluation is the Study of the Efficacy of Nosocomial Infection Control. Other important clinical studies have demonstrated the effectiveness of practices such as closed urinary drainage and management of intravascular lines and the ineffectiveness of such practices as double bagging and routine gowning in the newborn nursery. Clearly, research is one essential way to direct practice in infection control. It is our goal that the Johnson & Johnson/SURGIKOS Postdoctoral Nursing Fellows in Infection Control will make a significant contribution to the knowledge base in the specialty. The need for collaboration by government, industry, and academia in addressing health care research needs has been recently emphasized. We also believe that this Program can serve as one model for such a collaborative effort.

[The equilibrium of nitrogen, potassium and phosphate and renal excretion of creatinine and creatinine over the course of 3 weeks following severe trauma]

In 19 patients after accidental trauma and with intact renal function during an observation time of 21 days we found a cumulated negative balance of nitrogen (N), phosphate (P) and potassium (K) amounting to a mean of 214g, 357 and 447 mmol, respectively. Median daily potassium balance was positive on day 2 to 5 and this was interpreted as an increased extrarenal potassium deposition due to increased levels of circulating catecholamines. Median renal creatinine excretion was about 120% of predicted normal till day 10 and continuously decreased thereafter to values lower than predicted normal. Three patients did not show creatinuria (greater than 200 mg/day) during the whole observation time. In 15 patients after a "free interval" with a mean duration of 7 days creatinuria frequently developed rather quickly and maximal excretion of creatine was as high as 4 g/day. In 7 patients creatinuria persisted to the end of the 21 days observation time. During the phase of creatinuria the median cumulated excretion of creatine amounted to 14.4 g. The "free interval" of creatinuria after severe trauma is remarkable. Most of the N, K and P, which is lost from the body during this time obviously stems from tissues other than sceletal muscle. During the phase of creatinuria, however, the negative balance of N, K and P seems to be mainly due to muscle wasting. Hypophosphatemia was prominent during the first 5 days after trauma and obviously was caused by a decrease in renal phosphate threshold (TmPO4/GFR). The underlying mechanism of this primary change in renal function after severe trauma could not yet be identified.