Assessing Needs and Resources for the Home Visiting System in Alabama: A Mixed Methods Approach

The purpose of this article is to describe the initial assessment for the development of a home visiting (HV) system in a state with no existing system. We outline a mixed methods process where the quantitative component was used to identify the communities that possess “at-risk” profiles, and the qualitative component explored the resources and gaps in existing HV services. We employed a mixed methods approach, using six categories of indicators from quantitative secondary data sources to identify “at-risk” profiles for Alabama’s 67 counties. A weighted score for each indicator was calculated and counties were ranked. Surveys and focus groups were conducted to further define resources and gaps of existing HV programs. The composite indicator scores identified 13 counties as having the highest level of risk. Five of these 13 communities had no HV home visitation services. Areas of focus for future HV system development include trust, communication, availability, cost, and timeliness. In this assessment related to the Alabama HV system, we used quantitative data to apply criteria to the indicators being measured and qualitative data to supplement the quantitative findings. We examined resources, gaps, program quality, and capacity of the existing HV programs in order to assist in the future development of the HV system and early childhood system. The methods presented in this paper have potential applications beyond HV programs and systems, including broader examinations of complex systems for service provision to the maternal and child health populations.     

Female Orgasm(s): One,Two, Several

IntroductionThere is general agreement that it is possible to have an orgasm thru the direct simulation of the external clitoris. In contrast, the possibility of achieving climax during penetration has been controversial.MethodsSix scientists with different experimental evidence debate the existence of the vaginally activated orgasm (VAO).Main Outcome MeasureTo give reader of The Journal of Sexual Medicine sufficient data to form her/his own opinion on an important topic of female sexuality.ResultsExpert #1, the Controversy's section Editor, together with Expert #2, reviewed data from the literature demonstrating the anatomical possibility for the VAO. Expert #3 presents validating women's reports of pleasurable sexual responses and adaptive significance of the VAO. Echographic dynamic evidence induced Expert # 4 to describe one single orgasm, obtained from stimulation of either the external or internal clitoris, during penetration. Expert #5 reviewed his elegant experiments showing the uniquely different sensory responses to clitoral, vaginal, and cervical stimulation. Finally, the last Expert presented findings on the psychological scenario behind VAO.ConclusionThe assumption that women may experience only the clitoral, external orgasm is not based on the best available scientific evidence. Jannini EA, Rubio‐Casillas A, Whipple B, Buisson O, Komisaruk BR, and Brody S. Female orgasm(s): one, two, several. J Sex Med 2012;9:956–965.     

Hospital Stress and Patient Reports of Pain and Physical Status

Abstract

The Hospital Stress Rating Scale was used to measure stress due to the experience of hospitalization for 535 medical and surgical patients in a community hospital. Patients were also asked to rate the pain they experienced on a pain thermometer, and a recovery inventory was used to score patient self-reports of their physical status, both during hospitalization and subsequent to discharge. With statistical control for patient characteristics correlated with self-reports of pain and physical status, associations between hospital stress and these variables were observed. Patients scoring high in hospital stress tended to report more pain, lower physical status during hospitalization, and less improvement after discharge than patients scoring low in hospital stress.     

From the Cover: Strain history dependence of the nonlinear stress response of fibrin and collagen networks

We show that the nonlinear mechanical response of networks formed from un–cross-linked fibrin or collagen type I continually changes in response to repeated large-strain loading. We demonstrate that this dynamic evolution of the mechanical response arises from a shift of a characteristic nonlinear stress–strain relationship to higher strains. Therefore, the imposed loading does not weaken the underlying matrices but instead delays the occurrence of the strain stiffening. Using confocal microscopy, we present direct evidence that this behavior results from persistent lengthening of individual fibers caused by an interplay between fiber stretching and fiber buckling when the networks are repeatedly strained. Moreover, we show that covalent cross-linking of fibrin or collagen inhibits the shift of the nonlinear material response, suggesting that the molecular origin of individual fiber lengthening may be slip of monomers within the fibers. Thus, a fibrous architecture in combination with constituents that exhibit internal plasticity creates a material whose mechanical response adapts to external loading conditions. This design principle may be useful to engineer novel materials with this capability.     

BECOMING BICULTURAL: CHINESE AMERICAN WOMEN AND THEIR DEVELOPMENT

Ethnic and racial diversity in the United States has led to increasing interest in research on biculturalism, yet the meaning and underlying processes of biculturalism in the context of development in young adults are not well understood. Fifteen interviews were conducted with second-generation Chinese American women to explore how being bicultural fit into their lives. Data analysis yielded a developmental map that reflected their experiences throughout life as minority women. Findings suggest that biculturalism is more than being functionally competent in two cultures, it is both a behavioral and psychological orientation in life. From the findings of this study, we have increased our knowledge of Asian American women's development and provided a foundation for nursing research with minority women.     

Medical management of Cushing’s disease

Cushing’s disease (CD), caused by excess adrenocorticotropin secretion from tumorous pituitary corticotrophs, is associated with substantial morbidity and mortality. The primary, definitive therapy for patients with CD is selective pituitary adenomectomy, generally performed via a transsphenoidal approach. Medical therapy has an important adjunctive role in the management of patients with CD, including preoperative patient preparation in patients with severe disease, and temporizing management of hypercortisolism while awaiting the effects of radiation therapy to occur in patients who are not in remission postoperatively. Medical therapy can also be used in patients with hypercortisolism of unclear origin or in the few patients who decline or are unfit for surgery. Available medical options for patients with CD include centrally acting agents (cabergoline and pasireotide), steroidogenesis inhibitors (ketoconazole, metyrapone, mitotane and etomidate) and a glucocorticoid receptor antagonist (mifepristone). Pasireotide and mifepristone have been recently granted regulatory approval in some countries for use in patients with CD, whereas other medications are used “off label” in this patient population. As clinical trials using comparator agents have not been reported, the choice between different medications is based on patient characteristics and preference. Despite impressive advances in pharmacotherapy for patients with CD, much remains to be done. The long term efficacy and safety of medical therapies for hypercortisolism need to be evaluated and the role of combination therapy must be further characterized. As the pathogenesis of CD becomes better understood at the molecular level, it is likely that novel, targeted medical therapies will be developed to treat CD.