Effects of species composition, land surface cover, CO2 concentration and climate on isoprene emissions from European forests.

Emissions of isoprene from terrestrial vegetation are known to affect atmospheric chemical properties, like its oxidation capacity or the concentration of tropospheric ozone. The latter is of concern, since besides being a potent greenhouse gas, O(3) is toxic for humans, animals, and plants even at relatively low concentrations. Isoprene-emitting forests in the vicinity of NO(x) pollution sources (like cities) can contribute considerably to O(3) formation, and to the peak concentrations observed during hot summer weather. The biogenic contribution to O(3) concentrations is generally thought to increase in a future, warmer climate--pushing values beyond health thresholds possibly even more frequently and over larger areas--given that emissions of isoprene are highly temperature-dependent but also because of the CO(2) fertilisation of forest productivity and leaf growth. Most projections of future emissions, however, do not include the possible CO(2)-inhibition of leaf isoprene metabolism. We explore the regional distribution of emissions from European woody vegetation, using a mechanistic isoprene-dynamic vegetation model framework. We investigate the interactive effects of climate and CO(2) concentration on forest productivity, species composition, and isoprene emissions for the periods 1981-2000 and 2081-2100. Our projection of future emissions includes a direct CO(2)-isoprene inhibition. Across the model domain, we show that this direct effect has the potential to offset the stimulation of emissions that could be expected from warmer temperatures and from the increased productivity and leaf area of emitting vegetation. Changes in forest species composition that may result from climate change can play a substantial additional role in a region's future emissions. Changes in forest area or area planted in woody biofuels in general are not noticeable in the overall European forest isoprene budget, but--as was the case for changes in species composition--may substantially affect future projections in some regions of the continent.

Cardiac rhabdomyoma presenting as left ventricular outflow tract obstruction in a neonate.

A case of congenital cardiac rhabdomyoma presenting as left ventricular outflow tract obstruction is reported. Congenital cardiac tumours are rare. Rhabdomyomas are the most common. Fifty-one to 86% of them are associated with tuberous sclerosis. They have a tendency for spontaneous regression. The indications for surgery include haemodynamic compromise and intractable arrhythmias.

Evaluating physical therapists' perception of empowerment using Kanter's theory of structural power in organizations.

BACKGROUND AND PURPOSE: Little is known about physical therapists' perceptions of empowerment. In this study, Kanter's theory of structural power in organizations was used to examine physical therapists' perceptions of empowerment in a large Canadian urban teaching hospital. Kanter's theory, which has been studied extensively in the nursing profession, proposes that power in organizations is derived from access to information, support, resources, opportunity, and proportions. SUBJECTS AND METHODS: A convenience sample of physical therapists who had been working in the hospital longer than 3 months was used to determine the scores for the physical therapists' ratings of empowerment using the Conditions of Work Effectiveness Questionnaire. RESULTS: Physical therapists' scores were similar to reported staff nurses' scores for access to support, information, resources, and opportunity (mean=2.89, 2.91, 2.62, 3.25, respectively). Physical therapists' scores were higher than the majority of reported staff nurses' and nurse managers' scores for access to sources of informal and formal power structures (mean=2.81 and 3.29, respectively). There was a relationship between the empowerment score and the physical therapists' global rating of empowerment. Unlike studies of nurses, there were no relationships when demographic attributes and empowerment scores were examined. DISCUSSION AND CONCLUSION: Evidence for the validity of Kanter's theory of empowerment was found. Kanter's theory can provide physical therapists and their managers with a useful framework for examining critical organizational factors (access to information, support, opportunity, and resources) that contribute to employees' perceptions of empowerment. A baseline measure for comparing future empowerment scores of this sample is available. Further work to examine the application of Kanter's theory to other samples of physical therapists appears to be warranted.

Nurse-physician collaboration in an intensive care unit.

BACKGROUND: Collaborative interaction between nurses and physicians on critical care units is significantly related to mortality rates and length of stay in the units. For this reason, collaborative interaction should be an integral part of quality improvement programs. OBJECTIVES: To examine perspectives of nurses and physicians on collaborative interaction in an intensive care unit, to examine differences between groups in perceptions of collaborative interaction in the unit, and to compare this unit with units examined in a national study. METHODS: A modification of the ICU Nurse-Physician Questionnaire was used to collect data from 35 nurses and 45 physicians. Descriptive statistics and analysis of variance were used to determine group scores and to examine differences between groups. RESULTS: The level of collaborative interaction in the unit was high. However, nurses and physicians and all other staff groups examined except one had significant differences in perceptions of collaborative interaction. The high level of collaborative interaction was confirmed by a comparison of the results with the results from a national sample. CONCLUSIONS: Critical care units can use this example to incorporate an assessment of the level of collaborative interaction into their quality improvement program.

Design and biological activity of (S)-4-(5-([1-(3-chlorobenzyl)-2-oxopyrrolidin-3-ylamino]methyl)imidazol-1-ylmethyl)benzonitrile, a 3-aminopyrrolidinone farnesyltransferase inhibitor with excellent cell potency.

The synthesis, structure-activity relationships, and biological properties of a novel series of imidazole-containing inhibitors of farnesyltransferase are described. Starting from a 3-aminopyrrolidinone core, a systematic series of modifications provided 5h, a non-thiol, non-peptide farnesyltransferase inhibitor with excellent bioavailability in dogs. Compound 5h was found to have an unusually favorable ratio of cell potency to intrinsic potency, compared with other known FTIs. It exhibited excellent potency against a range of tumor cell lines in vitro and showed full efficacy in the K-rasB transgenic mouse model.

End-of-life care in the intensive care unit: a challenge for nurses.

Results from several research studies combined with increasing public tensions surrounding physician-assisted suicide have fueled a growing awareness of the inadequacies of end-of-life care. Investigators also suggest that intensive care unit nurses have a limited role in end-of-life decision making and care planning. This article explores cultural issues influencing end-of-life care in intensive care units, explores factors surrounding the limited involvement of critical care nurses in end-of-life decision making and care planning, and offers recommendations for changing nursing practice. Because improving end-of-life care will require cultural changes, an understanding of the cultural issues involved is needed. Recommendations for changing nursing practice include a model of end-of-life care that incorporates the goals of both cure and comfort care, as well as a shared decision-making process. Nurses are essential to improving end-of-life care in today's intensive care units.

Early results of right ventricular-pulmonary artery conduits in patients under 1 year of age.

OBJECTIVES: Management strategies for the repair of many complex heart defects require the implantation of a valved conduit between the right ventricle (RV) and the pulmonary artery (PA), often using aortic or pulmonary homograft valves. Their limited availability, however, has led to the development and use of new conduits. We retrospectively compared our experience with small homografts in patients of less than 1 year of age with the TissueMed bioprosthetic valved conduit. METHODS: From March 1994 to November 1997 29 patients in their first year of life underwent conduit implantation for complex heart defects. These were retrospectively reviewed in order to determine the incidence of death or conduit stenosis. Seventeen patients received homografts and 12 TissueMed conduits. RESULTS: Diagnoses and operative details including conduit size were similar in the two groups and in all cases complete repair of the underlying defect was carried out. Early post-operative mortality was 4/17 (23.5%) in the homograft group and 3/12 (25%) in the TissueMed group. Echo Doppler evaluation within 1 month of operation showed no right ventricular outflow tract (RVOT) obstruction in any of the survivors. In the TissueMed group 8/9 (77%) survivors have gone on to develop significant RVOT obstruction within 12 months of operation. There have been three late deaths in this group all related to severe RVOT obstruction. Two patients died during an attempt at balloon dilatation and one patient died of progressive right heart failure. Five patients had successful replacement of the TissueMed conduit. One child remains well with no evidence of RVOT obstruction. At operation to replace conduit, or at autopsy, the stenoses were related to the deposition of fibrous tissue at the anastomotic suture lines. In the homograft group none of the survivors developed RVOT obstruction during the first 12 months post-operatively. There was one late death (non-cardiac in origin) and one child is awaiting conduit replacement 40 months after initial implantation for obstruction. CONCLUSIONS: The homograft is a satisfactory conduit for re-establishment of RV-PA continuity in infancy. Further work needs to be undertaken in order to elucidate the mechanisms of early graft failure in bioprosthetic conduits if these are to be a suitable alternative for RV outflow reconstruction in infants.

The role of occupational therapy in dementia-C.O.P.E. (Caregiver options for practical experiences).

Occupational therapy is a profession that enables individuals to regain, maintain or promote function after an illness, injury or disability occurs. The basis of the profession's philosophy derives from a recognition of the importance of meaningful activity (occupation) in people's lives to support function, quality of life and the debilitating effects of inactivity. Occupational therapy enhances the abilities of individuals to engage in the following performance areas: (1) activities of daily living (eg eating, bathing, toileting, functional mobility) and instrumental activities of daily living (eg meal preparation, shopping, managing one's finances); (2) work and productive activities (eg care of others, educational and vocational activities); and (3) leisure to meet a variety of needs that are culturally meaningful to individuals and their significant others. In order to determine the etiologies of dysfunction in one or more performance areas, occupational therapists assess the following components of performance: sensorimotor, neuromusculoskeletal, motor, cognitive, and psychosocial. This assessment becomes the basis for tailoring treatment to individuals' needs and interests. When deficits and strengths in performance components and performance areas have been identified, occupational therapists work with clients/patients and their caregivers to reduce the barriers in daily functioning and facilitate maximum engagement in their environments, the human and physical context for daily living.

Signatures of chaos in the entanglement of two coupled quantum kicked tops.

We investigate the rate at which two initially decoupled quantum kicked tops become entangled upon the introduction of an interaction between them. We find that the entanglement eventually increases linearly in time. Moreover, we find that the rate of this linear increase is itself a linear function of the sum of the positive Lyapunov exponents when averaged over initial points drawn from the classical distributions corresponding to the initial quantum product state. The entanglement measure that is used allows us to identify entanglement with sensitive dependence on initial conditions.

Support systems of nurses recovering from chemical dependency: a pilot study.

Chemical dependency among nurses is a complex professional and ethical dilemma confronting the nursing profession. The article reports a descriptive study conducted to identify the support systems perceived to be supportive to nurses recovering from chemical dependency. Attitudes, beliefs, and identified support systems were examined using the Norbeck Social Support Questionnaire, the Miller Recovering Nurse Self-Report Questionnaire, and the Miller Targeted Sociogram. Recovering registered nurses identified counselors/ therapists and friends as most supportive during recovery. Conversely, family members/relatives were perceived as least supportive by recovering nurses.

Children's bicycle helmet attitudes and use. Association with parental rules. The Pediatric Practice Research Group.

BACKGROUND: Previous studies have assessed the attitudes of parents and children toward bicycle helmet ownership and use in various settings, but they have not addressed the role of parental rules in promoting bicycle helmet use by children. OBJECTIVES: To further explore the attitudes of parents and children at pediatric practices toward bicycle helmet ownership and use by children and to assess the role of parental rules in promoting bicycle helmet use by children. DESIGN: One hundred sixty-nine 5- to 14-year-old children who owned bicycles and their parents were surveyed during well-child visits at 5 general pediatric practices in the Chicago, Ill, area. One hundred twenty-nine families were represented. Of the children, 60% were aged 5 to 9 years, and 50% were girls. RESULTS: Forty-eight children (28%) reported helmet ownership. Of the helmet owners, 21 (45%) reported helmet use; thus, the overall percentage of helmet use was 12%. Helmet ownership by children was significantly (P < .05) related to parental characteristics: educational level, race, perceived effectiveness of bicycle helmets, seat belt use, and parental helmet ownership. The most common reasons parents gave for lack of helmet ownership by children were "never thought about purchasing" a helmet (35%), "never got around to purchasing" a helmet (29%), "child wouldn't wear it anyway" (26%), and the bicycle helmet was "too expensive" (16%). Only 33% of the parents reported hearing about helmets from their children's pediatrician, but 40% of these parents regarded pediatricians as their most important information source. Of the children who did not own helmets, 64% said they would wear a bicycle helmet if they had one, a more frequent comment for 5- to 9-year-old children than 10- to 14-year-old children (76% vs 49%, P < .01). The most common reasons for not wearing a helmet among owners were as follows: forgot or lost it and not needed. The most common reasons for not wearing a helmet among nonowners were as follows: uncomfortable and appearance or perception of others. Children who owned helmets and whose parents had a strict rule about wearing helmets were more likely to always wear their helmets than helmet owners whose parents had a partial rule or no rule (88% vs 19%, P < .001). CONCLUSIONS: Parental rules are associated with bicycle helmet use by children. Pediatricians may increase helmet use rates by promoting strict parental helmet rules as part of their anticipatory guidance regarding bicycle safety. More research about the effectiveness of this strategy is needed.

Coping socialization in middle childhood: tests of maternal and paternal influences.

A theoretical model of parental socialization of children's coping behavior is described and tested with 310 elementary school children (M age = 10.5 years). Mothers and fathers reported on the coping suggestions they made to their children, their own coping strategies, and their perceptions of the family environment. Children reported on their relationships with their parents and on their usual coping behavior. Children's coping efforts were associated with family environment, the quality of the parent-child relationship, parent's own coping, and parent coping suggestions, though these relationships differed by gender and were quite specific. Maternal data were more strongly associated with children's coping than paternal data, and active and support coping were predicted more successfully than avoidance strategies. Analyses supported a model of direct, rather than mediated, effects on children's coping. There was modest support for the interactive effects of maternal coaching and modeling on girls' active coping and boys' avoidant coping.

Workload measurement tracking system.

Managing a single-room maternity care unit in today's declining length of stay climate is challenging due to the rapid change in acuity and census. Managers must validate staffing patterns used to meet the patient's requisite needs from admission to discharge. This tool was developed to determine proper staffing based on patient days, number of anticipated deliveries and patient care hours.

Imaging of abdominal hernias.

Abdominal hernias are a common clinical problem. The main types of abdominal hernias are external or abdominal wall hernias, which involve protrusion of abdominal contents through a defect in the abdominal wall; internal hernias, which involve protrusion of viscera through the peritoneum or mesentery and into a compartment in the abdominal cavity; and diaphragmatic hernias, which involve protrusion of abdominal contents into the chest. Clinical diagnosis of abdominal hernias can be difficult. However, plain radiography, radiography performed after administration of barium, and computed tomography allow evaluation of suspected abdominal hernias and detection of those that are clinically occult. The anatomic location of the hernia, the contents, and complications such as incarceration, bowel obstruction, volvulus, and strangulation can be demonstrated with radiologic examination. Occasionally, complications such as neoplasms or inflammatory conditions can be identified in the hernial contents. With abdominal imaging modalities, a variety of abdominal hernias can be confidently diagnosed.

Status of functional assessment in occupational therapy with the elderly.

The purpose of this article is to describe the status of functional assessment in occupational therapy with older persons and its applications to the health care team. First, the traditional approach to functional assessment of older persons is reviewed, followed by several challenges directed toward this process. Second, a multidimensional assessment appropriate for use by trained allied health professionals is described. Finally, two recent assessments are presented as examples for the future.