Above- and below-ground morpho-physiological traits indicate that biochar is a potential peat substitute for grapevine cuttings nursery production.

The growing demand for grapevine planting materials, due to growing global viticulture, is promoting research studies to improve vineyard sustainability. In greenhouse nurseries, peat is the most common growing medium component used although is an expensive and non-renewable material. Indeed, the reduction of peat exploitation is receiving great attention, and currently, several materials are being investigated as peat substitutes for composing the cultivation substrates. Biochar, a carbon-rich, recalcitrant charred organic co-product of the pyrolysis or gasification process, has emerged as a potentially promising replacement for soilless substrates in nursery plant material propagation. Although several studies carried out at greenhouse nurseries have shown that biochar, can improve plant growth, only a few studies have focused on the production of grapevine plant material. To fulfil this knowledge gap and push forward the sustainability of the nursery sector, we evaluated above and below-ground morpho-physiological traits of one-year-old potted grapevine cuttings growing with 30% volume of four different biochar types (i.e., from pyrolysis and gasification) mixed with commercial peat. The present study shows that biochar can be used in growing media mixes without adverse effects on roots, improves soil water retention and leaf water potential, and improves the effects on soil microbiology.

Endoneural abscess of common popliteal nerve as first clinical manifestation of leprosy: the first reported case in history in a low-incidence country.

A migrant from Palestine came to our attention for weakness of dorsiflexion of the left foot and hypoesthesia of the homolateral common peroneal nerve territory. Skin biopsies from skin lesions in the hypoesthetic area were not diagnostic. Radiological investigation showed focal nerve enlargement with a possible focal lesion. At this time, and given the uncertainty of the diagnosis, we had to choose between medical therapy with steroid and a surgical exploration of the nerve. We decided for the latter option. Intraoperatively, we found a focal round enlargement of the nerve. Epineurotomy was performed at that level, revealing a round caseous granulomatous mass that was excised. Microbiological examination revealed presence of Mycobacterium Leprae allowing diagnosis of leprosy. Medical therapy was then started, leading to resolution of clinical symptoms. Endoneural lepromatous abscesses are uncommon lesions that should be suspected in patients presenting with peripheral nerve dysfunction with anamnesis of travel in leprosy endemic regions or contacts with people from endemic regions with or even without skin lesions. Detection of endoneural abscesses is of critical importance because prompt surgical excision in conjunction with medical therapy leads to improvement of symptoms and permits correct diagnosis. In times of large human migrations from leprosy endemic areas, knowledge of this uncommon presentation of leprosy and its management will help lead to the best management of these patients.

Mechatronic design and implementation of a bicycle virtual reality system.

The aim of this study is to design and implement a virtual reality bicycle system based on a functional-based mechatronic design approach. The development of virtual reality technologies with haptic systems demands a proper integration of the involved disciplines to provide immerse experiences for users. The proposed design approach provides a formal manner to gather the subsystems in the mechatronic device. The developed system is divided in a Virtual Reality System (VRS) and a Physical System (PS) for the design process. The former includes an interactive virtual environment in which an Avatar is animated using a simple kinematic bicycle model. The latter includes an adapted mountain bicycle with haptic feedback mechanisms to interact with the user and to produce the corresponding inputs for the bicycle model. Both systems are integrated by a control behavior system that works under two operation modes, where the user carries out virtual tours and gets feedbacks from a stereoscopic display system, audio cues, and haptic mechanisms. A multibody simulation validates the consistency and the integration of the physical system. In addition, a set of experimental results show the performance of instrumentation elements, control strategies, and feedback mechanisms, to provide the user with an immersive experience in the virtual environment. A brief survey was carried out to assess the opinion of users about the virtual bicycle tours, providing feedback for future improvements. The different designed modules and sub-systems allow modifying and enhancing the VRS without major modifications of the PS, or allow enhancing the physical platform without affecting the functionality of the virtual environment.

[Interregional mobility for total knee arthroplasty]. / Mobilità interregionale e chirurgia protesica del ginocchio.

45.049 primary total knee replacements were performed in Italy in 2005, with large distribution all over the country. However referral to centers of excellence far from the area of residency is still common with massive interregional mobility. Aim of this study is to define this issue both in quantitative and qualitative terms. For the timeframe 2001-2005 the SDO database was used to calculate the number of discharges of both residents and non residents for each Region and for each year and the ability of each region to attract patients from other regions or the tendency of the resident population to migrate. Only 8 Regions present an attraction index better than the escape index. Among those 4 are located in the North of Italy, 2 in the Center and 2 in the South. Migration from the North or Center to the South was never observed. Interregional mobility for knee replacement is noteworthy. Such phenomenon is comparable to migration for other major procedures, especially the steady tendency of a south to north mobility. An accurate analysis of potential causes of migration as well as the empowering of southern and central centers is needed.

Screening for C677T and A1298C MTHFR polymorphisms in patients with epilepsy and risk of hyperhomocysteinemia.

Hyperhomocysteinemia can result from decreased methylenetetrahydrofolate reductase (MTHFR) enzyme activity, owing to genetic polymorphisms andor inadequate folate intake. This study was aimed at investigating the prevalence of C677T and A1298C MTHFR polymorphisms, and their impact on hyperhomocysteinemia in 95 epileptic patients and 98 controls. Double gradient-denaturing gradient gel electrophoresis screening revealed that the frequency of T677 polymorphic allele was similar between cases and controls (46.3% vs 42.3%), whereas that of C1298 allele was significantly higher in patients (30.5% vs 19.4%, p < 0.05). Significant differences between the two groups were also found for the frequencies of genotypes AA1298 (46.3% in cases vs 67.3% in controls, p < 0.01) and AC1298 (46.3% in cases vs 26.6% in controls, p < 0.01). Other genotype frequencies did not show any statistically significant differences. Haplotype frequencies significantly differed between the two groups. The CT677/AC1298 diplotype was significantly more frequent in epileptic patients than in controls (32.6% vs 18.4%, p < 0.05). Patients treated with enzyme-inducing antiepileptic drugs, having this diplotype and concomitant low folate concentration (i.e., < 3.4 nmol/L), exhibited plasma homocysteine levels significantly higher than normal values (27.1 +/- 2.44 micromol/L, p < 0.001). This increase, however, was lower than that observed in folate-deficient patients with diplotype TT677/AA1298 (41.3 +/- 3.41 micromol/L, p < 0.001). Indeed, these two diplotypes could be regarded as risk factors for hyperhomocysteinemia. Conversely, we found that the CC677/AA1298 diplotype was significantly more frequent in controls (p < 0.01), suggesting a protective role. Our study suggests that both C677T and A1298C MTHFR polymorphisms should be examined when assessing genetic risk factors of hyperhomocysteinemia in epilepsy.

Autoregulation of cortical blood flow during surgery for ruptured intracranial aneurysms.

BACKGROUND: Little information is available about the extent and the time course of possible impairment of cerebral circulation occurring after aneurysmal subarachnoid haemorrhage (SAH). The aim of this study was to correlate cerebral autoregulation, neurological impairment at surgery and timing of surgery in patients with ruptured intracerebral aneurysms. METHODS: Cortical blood flow (CoBF) was measured intraoperatively by a thermal diffusion probe in 77 patients during surgery for ruptured supratentorial aneurysms, who were operated on at different time intervals after bleeding. An autoregulation index (AI), expressed as the ratio between the change in CoBF and the change of mean arterial blood pressure at the time of rising the systemic blood pressure after occlusion of the aneurysm(s), was determined in each case. RESULTS: Among good-grade patients (WFNS grade I-II), those operated on days 0-2 after SAH had a significantly better autoregulatory response, compared either with patients who underwent surgery on days 3-7 after bleeding (p<0.01), or with those whose aneurysm was occluded more than 7 days after rupture (p<0.03). The mean AI of poor-grade patients (WFNS grade IV-V), who received surgery on days 0-2 after SAH, was significantly higher (p<0.01) compared with the corresponding value of good-grade patients. No significant difference was found between the mean AIs of patients who subsequently did, or did not, develop symptomatic vasospasm. CONCLUSIONS: It is concluded that good-grade patients operated on within 48 hours after bleeding take advantage of a preserved autoregulatory function during controlled hypotension.

Multichannel syllabic compression for severely impaired listeners.

Two listeners with congenital hearing losses characterized by flat audiograms and dynamic ranges of 18-33 dB were tested with three compression systems and one (reference) linear amplification system. The compression systems placed progressively larger amounts of speech energy within the listener's residual dynamic range, by raising to audibility and compressing 25, 50, and 90 percent of the short-term input amplitude distribution in each of 16 frequency bands. The comparison linear system was defined by adjusting six octave-wide bands of speech to comfortable levels. System performance was evaluated with nonsence CVC syllables presented at a constant input level and spoken by two talkers. Extensive training was provided to ensure stable performance. The results were notably speaker-dependent, with compression consistently providing better performance for one speaker, linear amplification for the other. Averaged over speakers, however, there was no net advantage for any of the compression systems for any listener. The use of high compression ratios and large input ranges tended to degrade perception of initial consonants and vowels. Under some conditions, however, final consonant scores were higher with compression than with linear amplification. Compression generally enhanced the distinction between stops and fricatives, but degraded spectral-concentration and relative-intensity cues required to identify place of articulation.

Anxiety and problem-solving ability in mothers of premature infants.

A study was conducted to examine factors associated with anxiety in mothers of premature infants. Demographic information was obtained from 40 mothers of premature infants who were then tested for anxiety and problem-solving ability with the State-Trait Anxiety Inventory and the Means-Ends Problem-Solving Procedure. Neither the mother's past pregnancy outcomes nor her current infant's physical status had an effect on maternal anxiety levels. The difference in the level of anxiety experienced by mothers grouped according to problem-solving ability (t = 2.94; P = 0.0053) was significant. Mothers with good problem-solving ability acknowledged experiencing higher levels of anxiety than did mothers with lower problem-solving abilities.

Research utilization: an overview.

Nursing practice needs to be research based, not only to provide the best possible care to patients but also to ensure that nursing as a profession continues to grow. Criteria to help nurses determine how and when to implement research-based practice changes are presented. Forces that facilitate research utilization are discussed, as are barriers to research utilization. Areas of research that are ready to be implemented in women's health, obstetric, and neonatal nursing are presented.

Postdischarge services for low-birth-weight infants.

Efforts to improve infant mortality and morbidity should focus on preventing low birth weight and improving infant care. Although preventing low birth weight is the ultimate goal, nurses also must improve the care of infants who are born with low birth weights. This article examines postdischarge care for these infants and the nurse's role in providing follow-up services. Nurses have unique opportunities to influence infant well-being directly through continued contact with families and through interventions that support infant caregivers. However, continued research is needed to provide nurses with information about how follow-up for low-birth-weight infants can be best provided.

Health promotion and risk reduction in Malawi, Africa, village women.

OBJECTIVE: A train-the-trainer intervention was evaluated in which village leaders in Malawi, Africa, taught other villagers how to improve their health. DESIGN: Health knowledge and reported health practices were compared before and after the educational intervention in 15 villages in Chimutu, Malawi, Africa. SETTING: Surveys were completed by trained data gatherers in the village setting. PATIENTS/PARTICIPANTS: All men and women of childbearing age who were present in the village when data collection occurred were asked to participate. There were 187 participants in the preintervention survey and 175 participants in the postintervention survey. INTERVENTION: Seventy-six village women were trained, using low literacy techniques, to provide content on health promotion and risk reduction in pregnancy. Over 20,000 persons have received at least one health teaching session from the village trainers. RESULTS: The intervention resulted in reported changes in prenatal and postpartum care and in more births occurring in the hospital or clinic. Some positive nutritional changes were reported, although few changes in beliefs about use of herbal medicines or about the use of witchcraft were reported. CONCLUSIONS: A train-the-trainer approach is a sustainable intervention that appears to have positive benefits on the health of village women living in Malawi, Africa.

Maternal fatigue: implications of second stage labor nursing care.

The parameters of fatigue have been studied in recent years in relation to women's health and the childbearing period. Less research emphasis has been placed on second stage labor, a period of time that can encompass considerable physiologic and psychologic fatigue. Consideration to minimizing second stage labor fatigue by altering conventional support practices is needed. This includes minimizing long periods of strong pushing or bearing down efforts in conjunction with sustained breath holding, particularly for women receiving epidural anesthesia. The potential sequelae of second stage labor fatigue, recommendations for practice changes, and new research directions are discussed.

Perinatal nurse practitioners and health care reform.

Health care delivery for pregnant women at high risk is changing in response to the nation's need to contain costs and improve care. Perinatal nurse practitioners can provide specialized care to women at high risk in a wide variety of settings. They provide quality, cost-effective care and can improve access to prenatal care for families at risk for untoward pregnancy outcomes.

Childbearing in Malawi, Africa.

Malawi is a small, landlocked country in South Eastern Africa that faces many challenges in providing health care to childbearing women. Through a partnership between the faculty of the University of Pennsylvania, School of Nursing, faculty of the Kamuzu College of Nursing in Malawi, and the Malawi Ministry of Health and Population, an ongoing collaboration has led to research and demonstration projects designed to improve the health of women and children in Malawi. To underscore the cultural context within which childbearing occurs, care of the childbearing family in Malawi is described, as is research that has documented some of the similarities and differences between childbearing in Malawi and the United States.

PIP: An ongoing partnership between the University of Pennsylvania (US) School of Nursing, Kamuzu College of Nursing in Malawi, and the Malawi Ministry of Health and Population has led to research and demonstration projects intended to improve the health of women and children in Malawi. Essential to this collaboration has been an understanding of the similarities and differences between childbearing in Malawi and the US. Malawi has a maternal mortality rate of 620/100,000 live births and a child mortality rate of 234/1000 live births, largely as a result of socioeconomic factors. This article details the cultural context of pregnancy and childbirth in Malawi. It also describes the results of a survey conducted in 15 villages in Malawi in 1996 to evaluate the efficacy of an educational program aimed at empowering women to make safe choices during the childbearing process. The survey indicated a need for information about taking iron and antimalarials during pregnancy, the importance of seeking help as soon as problems develop during pregnancy, and the role of postpartum care. A train-the-trainer program is being conducted so local women leaders can provide health education to childbearing women in their villages.

Clinical specialist pre- and postdischarge teaching of parents of very low birth weight infants.

This study examined the pre- and postdischarge teaching needed by parents of very low birth weight infants (less than or equal to 1,500 g). The sample consisted of 36 families observed from the births of their infants to 18 months' postdischarge. Content analyses yielded five major teaching categories of infant, mother, family, home, and resources. Major predischarge teaching included feeding, recognition of infections, and growth and development. Major postdischarge teaching included feeding, current health problems, growth and development, and managing within the health-care system.

[Asthma in pregnancy. Physiopathological, clinical, and therapeutic aspects]. / Asma in gravidanza. Aspetti fisiopatologici, clinici e terapeutici.

The constantly increasing frequency of asthmatic pathologies in the general population has consequently led to a greater number of cases of bronchial asthma in pregnant women. In normal conditions the respiratory function undergoes numerous modifications in pregnancy, above all increased ventilation/minute and oxygen consumption. Likewise, asthma has a number of obviously negative effects both on the pregnant woman and the developing foetus. The clinical course of asthma may also be influenced by the start of pregnancy in various unforeseeable ways. All these aspects highlight the considerable difficulties of treating bronchial asthma during pregnancy, not to mention the medicolegal responsibility which the obstetrician and doctor must assume. In this respect it is vitally important to emphasize that pregnant women suffering from asthma must be treated in the same way as those who are not pregnant, and both prophylactic and anti-dysreactive pharmacological treatment must be administered at an early stage right up until the time of birth. Since these drugs are above all of the aerosol type, their potential secondary and/or teratogenic effects is considered extremely low and to all extents absolutely favourable in relation to the cost/benefit ratio. In fact, it is certainly less damaging for the pregnant woman to take these drugs, even in the first trimester of pregnancy, rather than run the risk of an attack of asthma with unforeseeable results. It is therefore enormously important to ensure that both the doctor and pregnant woman are adequately informed regarding preventive and pharmacological strategies for bronchial asthma.

Extra-articular localized nodular synovitis (giant cell tumor of tendon sheath origin) attached to the subtalar joint.

A large soft tissue mass of the left ankle was documented by ultrasonography in a 24-year-old man. Histologic examination of biopsy samples was consistent with pigmented villonodular synovitis. Magnetic resonance, performed to establish the extension of the mass, revealed an extra-articular lesion involving the posteromedial extra-articular soft tissues, which, by means of a thin peduncle, extended into the subtalar joint space. The mass was excised; gross and microscopic examinations were characteristic of localized nodular synovitis. Bone and cartilage abnormalities were not revealed by either preoperative imaging or surgery. At 15-month follow-up, the patient was free of recurrences. This case is an uncommon example of localized nodular synovitis of the subtalar joint, characterized by the absence of bone and articular cartilage abnormalities. In addition, this case reveals that the pattern of growth (i.e., the shape of the lesion) is an important factor in determining secondary lesions of bone and cartilage.

Anxiety and depression in mothers of low birthweight and very low birthweight infants: birth through 5 months.

The purpose of this study was to compare two common psychologic stress responses, anxiety and depression, in 27 mothers of very low birthweight (VLBW; less than or equal to 1500 grams) preterm infants and 35 mothers of low birthweight (LBW; 1501-2500 grams) preterm infants from the time of the infant's birth until the infants reached 5 months adjusted gestational age. There were significant differences in the patterns of anxiety and depression experienced by mothers of LBW and VLBW infants over time. Mothers of VLBW infants had higher anxiety and depression until 2 months adjusted gestational age while mothers of LBW infants had higher anxiety and depression at 3 and 4 months. Nursing interventions designed to decrease stress during the first postpartal week and to counsel mothers about patterns of anxiety and depression they may experience over time may be useful.

International nursing: the past 25 years and beyond.

International nursing has grown substantially in the last 25 years. Once practiced only during war time, with immigrant populations, or in peace time in consultative roles, international nursing is now common, with direct practice, education, consultation, and research collaboration as the roles in which nurses work across borders. A brief history of international nursing, forces that have influenced its growth, and an assessment of its future are discussed.

Immune alterations associated with epidural analgesia for labor and delivery.

PURPOSE: Epidural analgesia is frequently used for the laboring woman and commonly regarded as safe. The association of epidural analgesia with fever, in the absence of infection, in this population can result in unnecessary sepsis workups in both neonates and mothers. Studies in other populations of patients have found that epidural anesthesia may be associated with alterations in white blood cell count parameters. This study was designed to determine if epidural analgesia is associated with alterations in immune profile or immune function in healthy afebrile postpartum women. DESIGN: This prospective quasi-experimental study examined a convenience sample of normal afebrile postpartum women in two groups for differences in immune profile and immune function based on whether they received epidural analgesia during labor and delivery. METHODS: Mothers who agreed to participate in the study and met inclusion criteria had blood drawn for immune profile and immune function studies within 24 hours of their delivery. This study looked at immune phenotypic profile, lymphocyte proliferative response, and NK lysis assays. RESULTS: No differences in immune profile or immune function were found based on administration of epidural analgesia. CLINICAL IMPLICATIONS: Nurses can be confident that the white blood cell count and other phenotypic measures of leukocytes are not affected by epidural analgesia. Thus the epidural analgesic technique appears not to alter immune measures of infection in postpartum women. In evaluating fever in postpartum mothers and neonates, nurses should consider prior receipt of epidural analgesia and measures of immune profile. In addition to fever and white blood cell counts, other signs and symptoms of infection should also be evaluated in postpartum women when infection is suspected.