Dispersal of fungal spores on a cooperatively generated wind.

Because of their microscopic size, the forcibly ejected spores of ascomycete fungi are quickly brought to rest by drag. Nonetheless some apothecial species, including the pathogen Sclerotinia sclerotiorum, disperse with astonishing rapidity between ephemeral habitats. Here we show that by synchronizing the ejection of thousands of spores, these fungi create a flow of air that carries spores through the nearly still air surrounding the apothecium, around intervening obstacles, and to atmospheric currents and new infection sites. High-speed imaging shows that synchronization is self-organized and likely triggered by mechanical stresses. Although many spores are sacrificed to produce the favorable airflow, creating the potential for conflict among spores, the geometry of the spore jet physically targets benefits of the airflow to spores that cooperate maximally in its production. The ability to manipulate a local fluid environment to enhance spore dispersal is a previously overlooked feature of the biology of fungal pathogens, and almost certainly shapes the virulence of species including S. sclerotiorum. Synchronous spore ejection may also provide a model for the evolution of stable, self-organized behaviors.

Cameras and community health.

Photography projects are an alternative teaching method that can be easily integrated into community programs with adolescents and children. This article provides a brief review of the use of photography in documenting social and health issues. Two examples of community photography projects with easily ignored populations are described. These projects gave a voice to participants and allowed them to demonstrate their creativity with cameras. An implementation guide is presented to provide concrete suggestions for implementing community photography projects.

Qualitative research: what does it have to offer to the gerontologist?

The growing challenges of promoting health and managing illness in an ever-changing health care system require an arsenal of research approaches. Qualitative methods have a long tradition in disciplines such as sociology and anthropology and are being used with greater frequency as interdisciplinary health-related disciplines attempt to understand and explain complex problems. The purpose of this article is to define and describe the main features of qualitative research and to examine ways in which this methodology is relevant and useful in gerontological studies. A concise comparison of quantitative and qualitative methods is made, and suggestions are provided for when qualitative approaches are useful. A review of the three most common approaches is provided. Most important, references are provided for those gerontologists interested in learning more about qualitative research methods.

Faculty-agency partnering for improved client outcomes.

Implications for practice and education include recognition of the value of clinical outcome studies to clinicians and administrators in clinical agencies, as well as to nursing education. This project provides an example of the opportunity for mutually beneficial education and practice partnerships. Faculty, staff, and students demonstrated their ability to use the basic model for outcome studies developed by the United Way of America (1996). Teams of staff, faculty, and students were able to design small scale outcome studies that provided valuable information for clinicians and administrators about evaluating and improving the quality of clinical services, as well as for seeking continued funding. It is anticipated that further benefits may be discovered when faculty work with agencies to target program outcomes that will yield the most powerful effect for these agencies.

Management of a paraplegic patient with a full thickness ischial pressure ulcer.

Betty was a 72-year-old paraplegic patient with a full thickness ischial pressure ulcer. After an overview of the care delivered in hospital, this case study will focus not on the management of the wound but on the attempts made towards safe discharge home of the patient after an initial failed discharge. The diversity of problems encountered over a period of 18 months proved extremely challenging for all disciplines involved and required the development of close working relationships to achieve an eventual successful outcome. On reflection there are many aspects of this case that would undoubtedly be now managed differently. I had been in post for only a short time when my involvement with the patient began and my links with other members of the multidisciplinary team were tenuous. However the relationships fostered over this period of time have ensured that future cases have been dealt with efficiently and effectively. The case study concludes with a happy ending for the patient when successful surgery to repair the ulcer was initiated, not by medical or nursing personnel but by the patient herself.

The nursing management of enterocutaneous fistulae: a challenge for all.

This article focuses on the principles of managing patients with enterocutaneous fistulae. Successful management involves comprehensive assessment, planning, implementation and evaluation of care and involves all members of the multidisciplinary team in both primary and secondary care. The main challenge for the nursing team is effective containment of the effluent to prevent excoriation of the skin thereby ensuring patient comfort. The article includes suggestions for choice and application of suitable appliances which have been successfully used by the authors. Early involvement in of patient and carer in all aspects of management is recommended for successful discharge of patients into the community.

Assessing clinical pathways use in a community hospital: it depends on what "use" means.

BACKGROUND: Many benefits have been associated with the use of clinical pathways, yet developing them can be costly, and implementing them is not always successful. A 300-bed Midwestern community hospital began a clinical pathways program in 1995, and by fall 1998, 15 pathways were in various stages of implementation, with 3 under development. Many challenges had been encountered, but hospital leaders were eager to find ways to increase pathway use. METHODS: A qualitative case study design was used to investigate four clinical pathways, two perceived as being "used" and two that were perceived as "not used". Each pathway was analyzed as a separate case, followed by cross-case analysis. Qualitative data were collected in 65 semistructured interviews with administrators, physicians, physicians' office staff, nurses, and allied health professionals at the hospital. Data were also collected through observation and document analysis. RESULTS: The two used pathways had been introduced as part of a larger change in care, whereas the two pathways not used had been introduced as stand-alone innovations. Confusing and inadequately developed aspects of the hospital's clinical pathways program included its purposes, the definition of pathway use, pathway procedures, accountability, education, and incentives. A new case management department, ongoing administrative support, and a sophisticated medical information system were viewed as supports for continued growth in the program. CONCLUSIONS: Implementation of clinical pathways was delayed and complicated by the varied perceptions of the program among stakeholders. Lack of clarity and consistency in how information about the program was communicated made it difficult for clinicians to develop a shared understanding of clinical pathways.

Barriers to successful implementation of a clinical pathway for CHF.

Clinical pathways represent a strategy for responding to the current healthcare environment with a focus on managing care, reducing costs, increasing patient satisfaction, and improving quality. However, many healthcare organizations have found that implementing clinical pathways is not entirely successful even when they are based on sound evidence. The purpose of this case study was to describe and explain factors related to the success or failure of implementing a clinical pathway for congestive heart failure (CHF) patients in a 300-bed community hospital. The key factors involved in the nonadoption of the CHF pathway were inconsistencies in procedures and the work group culture.