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Objective To investigate if magnetic resonance imaging (MRI) is an accurate predictor for death or moderate-severe disability at 18-22 months of age among infants with neonatal encephalopathy in a trial of cooling initiated at 6-24 hours. Study design Subgroup analysis of infants ≥36 weeks of gestation with moderate-severe neonatal encephalopathy randomized at 6-24 postnatal hours to hypothermia or usual care in a multicenter trial of late hypothermia. MRI scans were performed per each center's practice and interpreted by 2 central readers using the Eunice Kennedy Shriver National Institute of Child Health and Human Development injury score (6 levels, normal to hemispheric devastation). Neurodevelopmental outcomes were assessed at 18-22 months of age. Results Of 168 enrollees, 128 had an interpretable MRI and were seen in follow-up (n = 119) or died (n = 9). MRI findings were predominantly acute injury and did not differ by cooling treatment. At 18-22 months, death or severe disability occurred in 20.3%. No infant had moderate disability. Agreement between central readers was moderate (weighted kappa 0.56, 95% CI 0.45-0.67). The adjusted odds of death or severe disability increased 3.7-fold (95% CI 1.8-7.9) for each increment of injury score. The area under the curve for severe MRI patterns to predict death or severe disability was 0.77 and the positive and negative predictive values were 36% and 100%, respectively. Conclusions MRI injury scores were associated with neurodevelopmental outcome at 18-22 months among infants in the Late Hypothermia Trial. However, the results suggest caution when using qualitative interpretations of MRI images to provide prognostic information to families following perinatal hypoxia–ischemia. Trial registration Clinicaltrials.gov: NCT00614744 .

Purpose Community engagement (CE) and community-engaged research (CEnR) are increasingly recognized as critical elements in research translation. Process models to develop CEnR partnerships in rural and underserved communities are needed. Method Academic partners transformed four established Community Health Improvement Partnerships (CHIPs) into Community Health Improvement and Research Partnerships (CHIRPs). The intervention consisted of three elements: an academic-community kickoff/orientation meeting, delivery of eight research training modules to CHIRP members, and local community-based participatory research (CBPR) pilot studies addressing childhood obesity. We conducted a mixed methods analysis of pre-/postsurveys, interviews, session evaluations, observational field notes, and attendance logs to evaluate intervention effectiveness and acceptability. Results Forty-nine community members participated; most (78.7%) attended five or more research training sessions. Session quality and usefulness was high. Community members reported significant increases in their confidence for participating in all phases of research (e.g., formulating research questions, selecting research methods, writing manuscripts). All CHIRP groups successfully conducted CBPR pilot studies. Conclusions The CHIRP process builds on existing infrastructure in academic and community settings to foster CEnR. Brief research training and pilot studies around community-identified health needs can enhance individual and organizational capacity to address health disparities in rural and underserved communities.

gantz n.r., sherman r., jasper m., choo c. gek, herrin-griffith d. & harris k. (2012) Journal of Nursing Management 20, 433–443 Global nurse leader perspectives on health systems and workforce challenges Aim As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA. Background Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent. Evaluation Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies. Key issues Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems. Conclusion There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing’s future. Implications for nursing management Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies.

By 2004, only organizations whose institutional operating strategies are built on a continual state of readiness and include performance improvement practices throughout the organization are going to successfully meet Joint Commission on Accreditation of Healthcare Organizations standards. As stewards of patient care, nurses maintain a unique role in identifying and guiding the intervention processes central to quality care, which prepares them to become key players/designers of a paradigm that demonstrates commitment to establishing and maintaining quality care. However, without recognition and support from organization leadership and physicians, the opportunity to effectively use the capabilities of nursing may be lost. The collaborative perspectives offered here attest to the fact that mutual belief and vision, coupled with creativity, strategic planning, and implementation, can effectively mobilize resources to establish priority measures and achieve quality patient/safety outcomes within the organization. Shifting the paradigm from just meeting the standards to continual readiness and performance improvement throughout the organization then becomes mission and mantra.

It is my honor to interview Dr. Marla Weston, chief executive officer of the American Nurses Association (ANA) in Silver Spring, Maryland, just outside of Washington, DC. Her impressive influence within the nursing profession and diverse management experience have placed her as a leader who is defined by her passion and exceptional values.

The Community Health Improvement Partnership (CHIP) model has supported community health development in more than 100 communities nationally. In 2011, four rural Oregon CHIPs collaborated with investigators from the Oregon Rural Practice-based Research Network (ORPRN), a component of the Oregon Clinical and Translational Research Institute (OCTRI), to obtain training on research methods, develop and implement pilot research studies on childhood obesity, and explore matches with academic partners. This article summarizes the experiences of the Lincoln County CHIP, established in 2003, as it transitioned from CHIP to Community Health Improvement and Research Partnership (CHIRP). Our story and lessons learned may inform rural community-based health coalitions and academicians who are engaged in or considering Community-based participatory research (CBPR) partnerships. Utilizing existing infrastructure and relationships in community and academic settings provides an ideal starting point for rural, bidirectional research partnerships.

As part of the 2011 annual American Organization of Nurse Executives conference held in San Diego, California, a session was presented that focused on nursing workforce and health systems challenges from a global perspective. This article includes content addressed during the session representing nurse leader perspectives from the UK, Singapore and the USA.Recent events in global economic markets have highlighted the interdependence of countries. There is now a global focus on health-care costs and quality as government leaders struggle to reduce budgets and remain solvent.Finding solutions to these complex problems requires that nurse leaders adopt more of a world view and network with one another as they look for best practices and creative strategies.Nursing leadership challenges such as staffing, competency development, ageing populations, reduced health-care funding and maintaining quality are now common global problems.There is a need for innovation in nursing practice to accommodate the enormous challenges facing nursing's future.Opportunities on an international scale for nurse leaders to have dialogue and network, such as the conference presentation discussed in this article, will become increasingly more important to facilitate the development of innovative leadership strategies.

Purpose: Practice-based research networks (PBRNs) provide an important approach to implementing primary care research at the community level, thus increasing the relevance and utility of research findings for routine primary care practices. PBRNs expend considerable time and energy in the recruitment, engagement, and retention of network clinicians and practices to establish this community-based primary care research laboratory. This study assessed factors motivating PBRN clinicians to participate and stay involved in practice-based research in their primary care office setting. Methods: We invited practicing clinicians across the United States who are affiliated with a PBRN to share their stories regarding motivations to participate in practice-based research. Using qualitative methods, we categorized the stories into the main motivation for participation and the perceived impact of participation. Results: We collected 37 stories from clinicians affiliated with 12 PBRNS located in 14 states. Motivations for participation in practice-based research included themes associated with personal satisfaction, improving local clinic-based care, and contributing to community- and system-level improvements. Sources of personal satisfaction corresponded to the 3 psychological needs postulated by Deci9s and Ryan9s Self-Determination Theory: competence, autonomy, and relatedness. Conclusions: These stories from PBRN clinicians describe the values, motivations, and unique paths that clinicians took as they chose to participate and stay active in a PBRN. Their voices have the potential to influence others to participate in practice-based research.

Summary: A neonate with semilobar holoprosencephaly was studied with diffusion tensor imaging and fiber tracking. Fiber tracking showed that the frontooccipital fasciculi were in continuity across the ventral midline, interposed between fused caudate and dysplastic fornices. Tractography of the posterior limbs of the internal capsules showed fibers arching ventrally toward the expected location of the motor cortex; some fibers also coursed dorsally, presumably to the sensory cortex. There was a posterior commissural white matter bundle representing a callosal splenium. Diffusion tensor imaging and fiber tracking revealed white matter structures not apparent on routine imaging sequences, which are in agreement with pathologic descriptions of the holoprosencephalic brain.

Summary: Lissencephaly is a rare brain malformation characterized histologically by arrested neuronal migration such that the brain resembles that of a fetus before 23–24 weeks gestation. We studied a neonate with lissencephaly by using diffusion tensor imaging and suggest the dysplastic densely cellular layer IV is visible as a band of anisotropic diffusion. Fiber tracking showed lack of connectivity between the cortex and deep white matter and an abnormal limbic system.

BACKGROUND AND PURPOSE: Acute lymphocytic leukemia (ALL) is a common malignancy of childhood treated with methotrexate (MTX), which is associated with acute neurotoxicity. We evaluated diffusion-weighted (DW) and conventional MR images in children with ALL and acute MTX-induced neurotoxicity, with clinical correlation. METHODS: Five patients aged 12–15 years underwent fluid-attenuated inversion recovery (FLAIR), T2-weighted fast spin-echo and gradient-echo, T1-weighted gadolinium-enhanced spin-echo, and DW imaging within 24 hours of symptom onset. Records were reviewed for the temporal relationship to MTX administration, strokelike symptoms, and neurologic outcome. RESULTS: Six strokelike events were temporally related to intrathecal MTX given 6–11 days before symptom onset. FLAIR images showed abnormal hyperintensity in the callosal splenium in one patient but were otherwise normal. Diffusion abnormalities were frontoparietal in three events and frontal in one; nonfluent aphasia was seen in all. Bilateral frontoparietal diffusion abnormalities were associated with bilateral upper-extremity weakness, right-sided hemiparesis, or left-sided hemiparesis (one patient each); one patient had mild facial droop. Unilateral precentral subcortical diffusion abnormality was associated with contralateral motor deficit and ipsilateral upper-extremity sensory loss. Strokelike symptoms resolved rapidly and were not associated with other signs of encephalopathy. Subsequent intrathecal MTX administration was not associated with recurrence in four patients. CONCLUSION: Diffusion abnormalities in acute MTX neurotoxicity indicated cerebral dysfunction but not necessarily overt structural injury to the cerebrum. Subsequent demyelination or gliosis could not be predicted on the basis of diffusion abnormalities. A single strokelike episode with diffusion abnormalities should not necessarily prompt modification of potentially curative chemotherapeutic regimens.

The multicultural team clearly is a part of the landscape in many work environments today. This article focuses on the opportunity for leaders to create a climate in which people of diverse cultures are invited into full participation as their unit contributes its very best to the achievement of the mission and goals of the organization. Within this environment, members are valued for who they are and what they share, without bearing on race, religion, ethnicity, and orientation or physical limitations.

The pathogenesis of the periventricular intraparenchymal echodense lesion (IPE) observed in association with germinal matrix-intraventricular hemorrhage (GM-IVH) in premature neonates is unclear. The objectives of this study were to determine (1) the temporal characteristics of GM-IVH and IPE, (2) the basic characteristics of the IPE, and (3) the relationship of clinical events, including surfactant administration, to IPE. One hundred twenty-four neonates of less than 1250 g birth weight were prospectively evaluated. IPE was defined as an echodensity greater than 1 cm in diameter by cranial sonography. Fifteen (12%) neonates developed IPE in association with GM-IVH (group 1); 33 neonates developed GM-IVH only (group 2) and 76 neonates without GM-IVH served as comparison group (group 3). IPE was essentially an asymmetrical lesion; both sides of cerebrum were equally affected. The lesion was diffuse in 9 neonates and focal in 5. IPE occurred both early, at 36 hours or before (n = 8), and later, ie, between 48 and 96 hours (n = 6). In one neonate IPE was diagnosed at autopsy. GM-IVH and IPE were noted simultaneously in neonate with the earlier onset IPE (diagnosed within 36 hours); GM-IVH preceded the IPE by 6 to 48 hours when the lesion was of a later onset. Surfactant was administered to 13 (87%) group 1, 24 (73%) group 2, and 35 (46%) group 3 neonates. Pulmonary hemorrhage developed in 9 (60%) of group 1, 3 (9%) group 2, and no group 3 neonates. Symptomatic patent ductus arteriosus occurred in 12 (75%) group 1, 15 (45%) group 2, and 15 (20%) group 3 neonates. The onset of symptoms associated with patent ductus arteriosus was earlier in group 1 vs group 2 or group 3 neonates, ie, 70 vs 172 hours. Nine (60%) group 1 neonates, 6 (18%) group 2, and 5 (7%) group 3 neonates died. The cranial sonogram was markedly abnormal in all 6 group 1 survivors. Stepwise polytomous logistic regression indicated that birth weight, gestational age, and emergent cesarean section were the best predictors of GM-IVH + IPE. These data indicate that (1) the large IPE observed with GM-IVH remains a major problem of the very low birth weight neonate, despite surfactant administration; (2) complications during labor that lead to emergent cesarean section appear to increase the risk for IPE; and (3) IPE was frequently associated with PH, but the precise mechanism(s) that link these two lesions are unclear. Attempts at prevention of IPE need to consider both perinatal and postnatal provocative factors.

Fifty-six patients hospitalized for anorexia nervosa were studied at follow-up, two or more years after discharge. Detailed quantitative findings are presented on 35; 69% of the 35 were medically much improved or recovered; 79% demonstrated no or minimal psychosocial impairment; 34% were rehospitalized for anorexia, and 2 of 35 needed re-hospitalizations for other psychiatric disorders; 64% established their menses. A positive and significant relationship was found between a favorable medical outcome and the anorectic's perception of contact with other patients in the hospital as helpful.

Diagnostic criteria for anorexia nervosa developed from our clinical experience are compared with those of two other groups, chosen as accepted and representative investigators. The three sets of criteria were applied to 30 successive patients admitted to the Psychosomatic Unit with the presumptive diagnosis of anorexia nervosa. Considerable variation was found in the percentage of patients diagnosed anorexia nervosa by each set of criteria. The discussion focuses on the inclusiveness of the three sets of criteria, anorexia nervosa as a developmental deviation of adolescence, and out concept of the essential psychopathology which differs from that of other investigators.

This study explores some relationships between culture, adolescent personality styles, and psychopathology in the USA and the USSR. The broader macrosocial level includes characteristics of the epoch. The more restricted macrosocial level includes one sociopolitical system and cultural features. In Soviet society, the conformist type of personality is prevalent; in the United States, “Protean man” is common. Soviet and American youth diverge in their attitudes toward technology and achievement. These personality styles are related to the restricted macrosocial level, while the broader epochal level is related to prevailing types of psychopathology. In the USSR, the distinction between normality and psychopathology is sharper than it is in the USA.

(1955). Emotional Impact of Nearness and Separation for the Asthmatic Child and His Mother. The Psychoanalytic Study of the Child: Vol. 10, No. 1, pp. 353-375.

Soviet investigators have moved from criticism of psychoanalytic concepts to development of a theory of the unconscious that represents the convergence of set theory, neurophysiology, and cybernetics. One accepted Soviet definition of the unconscious is the continuous processing of information and the regulation of adaptive behavior through the formation of sets. Consciousness operates intermittently, when a problem must be solved by objectivization, with a change in sets. Conscious and unconscious processes act synergistically, not antagonistically, as Freud suggested. Dissociation, psychosomatic relationships, and psychotherapy are briefly discussed to illustrate the Soviet approach to the unconscious in psychiatry.