High strain sensitivity controlled by the surface density of platinum nanoparticles

We report a controllable strain gauge factor obtained using a two-dimensional nanoparticle layer formed from platinum nanoparticles. A vacuum technique is used for room temperature nanoparticle deposition that allows control of the electrical resistance of the film, exhibiting semiconducting-like behavior when nanoparticle arrays cover the surface below a threshold value while above it a metallic behavior is prevalent. The highest sensitivity is obtained for intermediate density values of the nanoparticle assemblies, which could be explained using a tunneling and hopping current expression. The device, which exhibits more than one order of magnitude higher strain sensitivity than continuous metallic films, is fabricated at room temperature through standard lithographic processing allowing for miniaturization and easy integration in silicon technology or flexible substrates.

The prenatal visit

In their role as advocates for children and families, pediatricians are in an excellent position to support and guide parents during the prenatal period. Prenatal visits allow the pediatrician to gather basic information from parents, provide information and advice to them, and identify high-risk situations in which parents may need to be referred to appropriate resources for help. In addition, prenatal visits are the first step in establishing a relationship between the pediatrician and parents and help parents develop parenting skills. The prenatal visit may take several possible forms depending on the experience and preferences of the parents, competence and availability of the pediatrician, and provisions of the health care plan.

Parental refusal to immunize a 2-month-old infant

At a 2-month health supervision visit, Monica's pediatrician was surprised by her mother's wish to withhold immunizations. At prior encounters with her parents, including a prenatal visit, the meeting after Monica's birth, and the 2-week health supervision visit, there was no indication that standard immunizations would be refused. Monica's parents informed her pediatrician that the potential side effects from the immunization led them to think that their healthy child should not be immunized. After talking with other parents in the neighborhood, watching a television program on "children who were brain damaged after getting their shots," and looking at several web sites for parents on the Internet, they concluded that it was safer to withhold the immunizations. "Monica is so healthy.....why give her shots that may make her very sick?" Monica was the first child born to these college-educated parents who had been married for 5 years. The pregnancy was full term and notable for two transient episodes of spotting in the first trimester. Both parents looked forward to Monica's birth. There were no perinatal problems, breast feeding was successful with an appropriate weight gain, and the physical examination was normal. The pediatrician explained to the parents that she understood their concerns. "Most of the things we give children for prevention or treatment of disease may be associated with possible side effects. In the case of immunizations, the chance of a serious side effect is much less than the risk that Monica might acquire one of the diseases we can prevent with an immunization. I have seen a few unimmunized infants who were hospitalized with a very serious case of whooping cough, one of the diseases we can prevent by immunizing Monica." The parents thanked the pediatrician for the information and agreed to read several pamphlets about immunizations. The pediatrician observed that her interchange with the parents was cordial but stressful, for both herself and Monica's parents. As the parents left the office, she wondered if there was a more effective way to talk about immunizations with parents who refuse to immunize their children.

Do women's provider-role attitudes moderate the links between work and family?

The authors examined the links between mothers' work qualities and their individual well-being and marital quality, as well as adolescent daughters' and sons' gender-role attitudes, as a function of mothers' provider-role attitudes, in 134 dual-earner families. In home interviews, mothers described their work, provider-role attitudes, family relationships, and mental health; their offspring reported gender-role attitudes. Women's attitudes about breadwinning were coded into main-secondary, coprovider, and ambivalent coprovider groups. Mothers' provider-role attitudes moderated the links between status indicators and mothers' depression, marital conflict, and daughters' gender-role attitudes. For example, depression and marital conflict were negatively related to coprovider mothers' earnings and occupational prestige. The same was not true for main-secondary and ambivalent coprovider mothers. These findings underscore the importance of considering employed women's interpretation of their work roles when exploring work-family links.

The effect of a self-monitoring tool on self-efficacy, health beliefs, and adherence in patients receiving hemodialysis

OBJECTIVE

Assess the effectiveness of a self-monitoring tool on perceptions of self-efficacy, health beliefs, and adherence in patients receiving hemodialysis.

DESIGN

A monthly intervention using a pretest, posttest design over a 6-month period. Both the treatment and control groups were randomly selected and received surveys to assess health beliefs, perceptions of self-efficacy for performing specific healthful behaviors, and renal diet knowledge at baseline, before intervention, and 6 months later. The treatment group also received monthly feedback of monthly phosphorus levels and interdialytic weight gains.

SETTING

A university hospital-based 43-chair ambulatory dialysis center.

SUBJECTS

Forty patients with end-stage renal disease (25 men and 15 women, age 26 to 78 years), on chronic hemodialysis for at least 2 months and with a history of noncompliance with phosphorus and/or fluid restrictions for 1 or more months.

MAIN OUTCOME MEASURES

Self-efficacy, health beliefs, knowledge, biochemical, and demographic variables were analyzed. Analysis of variance tests of repeated measures were used to examine relationships between adherence with phosphorus and fluid restrictions to health beliefs and perceptions of self-efficacy after training in self-monitoring.

RESULTS

Overall, there were no significant improvements in adherence with phosphorus and fluid restrictions between the two groups, although a comparison within the groups revealed the treatment group had a statistically significant decrease in mean phosphorus levels of 7.14 to 6.22 mg/dL (P = .005) from baseline to month 3. However, because this value was not maintained, it was not statistically significant. No significant differences existed between the two groups for health beliefs and perceptions of self-efficacy. Knowledge scores in the treatment group, however, improved significantly as compared to the control group (P = .008) and was a significant increase from baseline (P = . 002). In the control group, all scores fell slightly but this difference was not significant.

CONCLUSIONS

The benefits of patient self-monitoring and behavioral contracting upon adherence in patients on hemodialysis are inconclusive, as serum phosphorus and interdialytic weight gains did not differ between the two groups. The interventional tools also appeared to have little effect on perceptions of self-efficacy and health beliefs. Trends of improvement, however, did exist for phosphorus within the treatment group and subjects in this group had a statistically significant increase in knowledge scores over time. Additional research using repeated measures design is needed to explore the effects of increased frequency and duration of an intervention on the attainment of patient clinical outcome measures.

Growing up with a facial hemangioma: parent and child coping and adaptation

OBJECTIVE

To better understand the experiences, challenges, and adaptations of parents with children who have disfiguring facial hemangiomas.

DESIGN

Qualitative, descriptive.

METHODS

In-depth interviews were performed with the parent(s) of 25 children, aged 5 months to 8 years. Each child was referred to the Pediatric Dermatology Practice, Department of Dermatology, University of California, San Francisco, with a facial hemangioma of 1 cm diameter or greater. Interviews were ethnographic in style, centering on the description by parents of the particular challenges faced, supports received, and adaptive strategies developed in coping with their child's hemangioma. Analysis was by open coding of interview transcripts. Coded statements were organized within common categories and these further gathered into 4 principal themes: 1) parental emotion and adaptation; 2) experiences with public reactions; 3) issues related to parent-child interactions; and 4) expressed satisfaction/dissatisfaction with medical care.

RESULTS

Disfiguring facial hemangiomas were found to be associated with parental reactions of disbelief, fear, and mourning, particularly during the growth phase. Reactions of strangers forced parents to confront varied aspects of social stigmatization. A broad array of effects on the parent-child interaction were observed, often connected with variables extrinsic to the hemangioma, including especially the support and acceptance by the extended family. Half of those studied expressed substantial dissatisfaction with aspects of their medical care.

CONCLUSIONS

Disfiguring facial hemangiomas in young children are frequently associated with parental reactions of loss and grief, despite the generally benign nature of the lesion and the prognosis for eventual involution. Physicians are faced with specific challenges in providing effective anticipatory guidance and support to parents.

Training for family-oriented pediatric care. Issues and options

Pediatrics is by its nature a family-oriented medical specialty, and pediatricians gain a great deal of knowledge regarding the strengths and vulnerabilities of families in the course of traditional training and practice. The biomedical focus of pediatric training has resulted, however, in relatively little directed teaching about the contextual aspects of pediatrics. This lack is most notable with respect to training for effective work with families. Over the past 2 to 3 decades, the family systems model has developed. The perspective and applications gained through this model have provided important potential skills and knowledge for medical and psychological professionals. Pediatricians who wish to enhance their skills with families need to take an active role in designing, selecting, and integrating the training that best fits their practice and their interests. This requires a process of realistically assessing the level of work with families that they wish to implement and finding the training and supervision experiences that will support such goals. This training often brings with it particular challenges to traditional practice methods. The effectiveness of continuing education programs in family-oriented care may be gauged, in part, by their ability to assist pediatricians in meeting these challenges. A variety of training options and resources are described in the appendix of this article.

Predicting physician utilization

Previous research on physician utilization has shown that variables found significant in many traditional social psychologic studies (process models) often lack predictive strength if utilized in multivariate research (prediction models). To address this problem, a variable was created that measures both the presence of symptoms and the person's own evaluation of the necessity for medical care for the symptoms experienced. This variable is a relatively strong predictor of physician utilization. Analysis of findings suggests that future multivariate research on physician utilization consider a focus upon respondent evaluated symptoms (RES) and type of health care facility available.