Effectiveness of a publicly-funded demonstration program to promote management of dryland salinity.

Community and catchment-based approaches to salinity management continue to attract interest in Australia. In one such approach, Catchment Demonstration Initiative (CDI) projects were established by the Western Australian (WA) Government in 2000 for targeted investment in large-scale catchment-based demonstrations of integrated salinity management practices. The aim was to promote a process for technically-informed salinity management by landholders. This paper offers an evaluation of the effectiveness of one CDI project in the central wheatbelt of WA, covering issues including: its role in fostering adoption of salinity management options, the role of research and the technical requirements for design and implementation of on-ground works, the role of monitoring and evaluation, the identification and measurement of public and private benefits, comparison and identification of the place and value of plant-based and engineering-based options, reliance on social processes and impacts of constraints on capacity, management of governance and administration requirements and an appreciation of the value of group-based approaches. A number of factors may reduce the effectiveness of CDI-type approaches in facilitating landholder action to address salinity, many of these are socially-based. Such approaches can create considerable demands on landholders, can be expensive (because of the planning and accountability required) on the basis of dollars per hectare impacted, and can be difficult to garner ownership from all involved. An additional problem could be that few community groups would have the capacity to run such programs and disseminate the new knowledge so that the CDI-type projects can impact outside the focus catchment. In common with many publicly-funded approaches to salinity, we found that direct benefits on public assets are smaller than planned and that results from science-based requirements of monitoring and evaluation have long lead times, causing farmers to either wait for the information or act sooner and take risks based on initial results. We also found that often it is a clear outline of the process that is of most importance in decision making as opposed to the actual results. We identified limitations in regulatory processes and the capacity for local government to engage in the CDI. The opportunities that CDI-type approaches provide centre around the value of its group-based approach. We conclude that they can overcome knowledge constraints in managing salinity by fostering group-based learning, offer a structured process of trialling options so that the costs and benefits can be clearly and transparently quantified, and avoid the costly mistakes and "learning failures" of the past.

L-arginine metabolites regulate DNA synthesis and nitric oxide synthase activity in cultured human dermal microvascular endothelial cells--potential positive and negative regulators of angiogenesis derived from L-arginine.

Human dermal microvascular endothelial cell (HDMVEC) growth and proliferation is important for skin angiogenesis. Our data support the hypothesis that a regulatory switch from an angiogenic to a nonangiogenic stimulus involves a change in l-arginine metabolism from polyamines (PAs) to nitric oxide (NO) and, conversely, a change to an angiogenic stimulus is expected to drive l-arginine metabolism in favor of PA synthesis. Current studies with cultured HDMVECs demonstrated that NO inhibited, whereas the PA putrescine stimulated DNA synthesis. The nitric oxide synthase (NOS) inhibitor NG-nitro l-arginine methyl ester stimulated DNA synthesis with a significant increase from control at 2.5 and 5 mM (p < 0.05); in contrast, the ornithine decarboxylase (ODC) inhibitor alpha-difluoromethyl ornithine (DFMO) inhibited DNA synthesis with a significant decrease from control at 19.65, 29.48, and 39.48 microM (p < 0.05). NO donors sodium nitroprusside dihydrate, S-nitroso-N-penicillamine, and l-hydroxy-2-oxo-3(3-aminopropyl)-3-propyl-triazine all inhibited DNA synthesis. There was a significant increase in NOS activity with DFMO treatment (p < 0.05) and a less pronounced decrease in NOS activity with direct PA treatment. In summary, NO and PAs are important mediators of HDMVEC growth and PAs downregulate NOS activity in these cells. NOS and ODC enzyme products may not only be important components in the regulation of angiogenesis in the skin but they may also regulate their own synthesis via feedback mechanisms.

Quality management in nursing.

Nursing care is the number one criterion patients use to measure the quality of care at hospitals. With the trend toward a more integrated institutionwide approach to quality, nursing must adapt its traditional approach to complement an institutionwide quality management strategy. Although written standards have been the cornerstone of nursing quality management, they have not always stood up to objective measurement techniques. Only recently has nursing been using automated data for measuring nursing quality. This article provides an example of how nursing can use automated data to measure and manage the quality of nursing services.

Maintaining high quality patient care while controlling costs.

New evidence shows that high quality care costs less than poor quality care. High quality care encompasses the elimination of unnecessary or inappropriate services while providing better clinical outcomes, fewer avoidable complications, and greater patient satisfaction. Poor quality care results in adverse outcomes and patient dissatisfaction, both of which can prove costly to a hospital in a competitive market. Hospitals are developing sophisticated data-bases to monitor the quality of care provided to patients.

Clinical profiles manage quality, cost of hospital product.

This series of articles explores the bottom line of patient classification systems--their ability to measure the consumption and the quality of healthcare services. In these articles, the use of clinical profiles, severity measures, and nursing dependency factors are discussed as methods of measurement to help healthcare organizations manage the cost and quality of their services.

Laboratory data on ICU admission. Its relationship to mortality.

One hundred and seventeen patients admitted to an intensive care unit were studied, to determine whether there is any relationship between laboratory data taken on admission to the unit and the final outcome (survival or non-survival) of the stay within the intensive care unit. Discriminant analysis of the data shows that patients could be allocated to one of two groups (survival or non-survival) using the two parameters of age and serum phosphate, and that this allocation proves correct in 70% of cases, irrespective of the admitting disease and treatment. The validity of this discriminant function was tested in a further 53 cases and the allocation of patients to survival or non-survival groups was found to be correct in 70% of cases, supporting the first estimate of the discriminant function.

Nurse practitioners in primary care iv. Impact of an interdisciplinary team on attitudes of a rural population.

Attitudes toward the expanded role of nurse practitioners in primary care (family practice nurses) have been determined for persons from a semirural area who chose as their principal souce of care an interdisciplinary family medical centre (FMC) incorporating two nurse practitioners, and those for whom the FMC was not the usual source of care. Data were obtaine using"before-and-after" structured interviews of a random sample of persons living in a southern Ontario township. Slowly evolving, nonsignificant trends of greater acceptance were observed among patiens who had dealth with family practice nurses. The greatest change observed was an increased acceptance of the nnurse by FMC users as the person who would be contacted as a second choice if theirfirst choice, usually a physician, could not be reached in specific worrry-inducing situations. FMC users depended more on nurses to provide information. A conclusion of increased general acceptance of the family practive nurse by FMC users is supported by a 34 per cent higher use of nurses by FMC patients compared to other persons of comparable characteristics living in the same community.