Impacts of Contrasting Alfalfa Production Systems on the Drivers of Carabid Beetle (Coleoptera: Carabidae) Community Dynamics.

Growing concerns about the environmental consequences of chemically based pest control strategies have precipitated a call for the development of integrated, ecologically based pest management programs. Carabid or ground beetles (Coleoptera:Carabidae) are an important group of natural enemies of common agricultural pests such as aphids, slugs, and other beetles. Alfalfa (Medicago sativa L.) is one of the most common forage crop species in the semi-arid western United States. In 2011, Montana alone produced 4.0 × 10(6 )Mg of alfalfa on 8.1 × 10(5 )ha for gross revenue in excess of US$4.3 × 10(8), making it the third largest crop by revenue. We conducted our study over the 2012 and 2013 growing seasons. Each year, our study consisted of three sites each with adjacent systems of monoculture alfalfa, alfalfa nurse cropped with hay barley, and an uncultivated refuge consisting of a variety of forbs and grasses. Carabid community structure differed and strong temporal shifts were detected during both 2012 and 2013. Multivariate fuzzy set ordination suggests that variation in canopy height among the three vegetation systems was primarily responsible for the differences observed in carabid community structure. Land managers may be able to enhance carabid species richness and total abundance by creating a heterogeneous vegetation structure, and nurse cropping in particular may be effective strategy to achieve this goal.

Chronic nonprogressive headaches in children and adolescents.

Chronic nonprogressive headaches (CNPHA) are common in children and increase in frequency in adolescents. Features are usually, but not always, distinct from those of migraine. CNPHA have also been called chronic daily headaches, tension-type headaches, muscle contraction headaches, and psychogenic headaches. These headaches represent a diagnostic and therapeutic challenge to family physicians, pediatricians, and pediatric neurologists. The evaluation is time-consuming and the treatment frustrating and often unsuccessful. They are a significant cause of school absences. This review addresses the epidemiology classification, pathogenesis, clinical characteristics, evaluation, and treatment of this disorder.

Factors influencing the antibiotic-prescribing decisions of nurse practitioners.

Decision-making about treatment options is a complex process that is influenced by many variables. An instrument for studying this decision-making process and the factors influencing it was designed. A survey of the antibiotic-prescribing practices of nurse practitioners (NPs) was then conducted via mail and the World Wide Web. NPs who treat adult patients were presented with scenarios in which antibiotic prescription would be an appropriate choice. Participants were asked to evaluate the clinical scenarios and describe their decision-making about treatment and the rationale for treatment. Responses were analyzed to determine the factors that played a role in antibiotic decision-making and their relative importance in that process. The ranks of categories of factors by the respondents were similar across the 4 scenarios. Antibiotic-prescribing patterns and the rationale of the antibiotic-prescribing decision of the respondents for the presented scenarios are also described.

Nurse practitioners and the Internet.

This article describes the Internet as an easily accessible, up-to-date, and valuable information system that nurse practitioners must master to keep up with the needs of their patients and today's healthcare system. It contains a comprehensive review of the multiple uses of the Internet that include education, communication, clinical decision making, and research, and can serve as an update to the information in the healthcare and nursing literature. Strategies are suggested to incorporate the Internet into practice.

A holistic interdisciplinary health care research model.

Collaboration, when viewed as a nonhierarchic endeavor based on a sharing of power and authority, may not be an ideal model for interdisciplinary research. A cooperative venture in which participants willingly join in planning, making decisions about, and implementing a project supervised by a principal investigator is historically the successful structure for interdisciplinary research. A holistic model of mutually respectful cooperation in a hierarchic team is a more realistic goal for interdisciplinary research efforts.

Acute hand burns in children: management and long-term outcome based on a 10-year experience with 698 injured hands.

OBJECTIVE: To document long-term results associated with an coordinated plan of care for acutely burned hands in children. SUMMARY AND BACKGROUND DATA: Optimal hand function is a crucial component of a high-quality survival after burn injury. This can be achieved only with a coordinated approach to the injuries. Long-term outcomes associated with such a plan of care have not been previously reported. METHODS: Over a 10-year period, 495 children with 698 acutely burned hands were managed at a regional pediatric burn facility; 219 children with 395 injured hands were followed in the authors' outpatient clinic for at least 1 year and an average of >5 years. The authors' approach to the acutely burned hand emphasizes ranging and splinting throughout the hospital stay, prompt sheet autograft wound closure as soon as practical, and the selective use of axial pin fixation and flaps. Long-term follow-up, hand therapy, and reconstructive surgery are emphasized. RESULTS: Normal functional results were seen in 97% of second-degree and 85% of third-degree injuries; in children with burns involving underlying tendon and bone, 70% could perform activities of daily living and 20% had normal function. Reconstructive hand surgery was required in 4.4% of second-degree burns, 32% of third-degree burns, and 65% of those with injuries involving underlying bone and tendon. CONCLUSIONS: When managed in a coordinated long-term program, the large majority of children with serious hand burns can be expected to have excellent functional results.

Cryptococcal myositis: a case report and review of the literature.

Only rare cases of cryptococcal myositis have been previously reported in the literature. All of these cases have occurred in the setting of human immunodeficiency virus (HIV) infection. We report a case of cryptococcal myositis diagnosed premortem on a needle biopsy in a heart transplant patient undergoing immunosuppressive therapy.

The clinical experience of novice students in nursing.

The learning experience of nursing students in their first clinical laboratory in a hospital was examined in a qualitative investigation. Graduate students in a nursing research seminar course participated as co-investigators in the study of clinical learning among sophomore nursing students. Findings revealed that sophomore students in nursing reflected on their role in the clinical setting and in nursing; pursued ways to learn in clinical settings; actively sought mentors; made connections to staff, patients, and peers; and searched for ways to validate the competence of their beginning skills. Parallels of the students' behaviors to the novice-to-expert paradigm were found. The study was valuable for both undergraduate and graduate students involved in the investigation.

Choosing reconstruction after mastectomy: a qualitative analysis.

PURPOSE/OBJECTIVES: To describe women's perspectives on factors that influenced their decision to have reconstructive surgery after a breast cancer diagnosis. DESIGN: Exploratory, descriptive, qualitative study. SETTING: A comprehensive cancer center in an urban setting. SAMPLE: Eleven women who underwent mastectomy and reconstruction. Six participants had autologous transverse rectus abdominis musculocutaneous-flap reconstruction, four had saline implants, and one had a silicone implant. All but one reconstruction was performed at the time of mastectomy. METHODS: Open-ended, face-to-face interviews using an interview guide were conducted within one month of reconstruction. One to two follow-up interviews were conducted approximately six months later. MAIN RESEARCH VARIABLES: Decision making about reconstruction, perceptions of information needs and sources, sources of support, and factors important to decision making. FINDINGS: The main theme identified was Getting My Life Back. The participants described this in terms of the themes of Information Seeking, Talking It Over, and Seeking Normality. The interactive skills of the healthcare provider played an important role in the women's decision making. CONCLUSIONS: Reconstruction minimized the negative consequences of breast cancer and its treatment for the women in the study. The decision-making process was aimed at getting the person's life back as close to what it was before the diagnosis as possible or improving it. The three themes of decision making are interactive in nature, with participants returning to information Seeking and Talking It Over as necessary to increasing their understanding and clarifying their "normality goals." IMPLICATIONS FOR NURSING PRACTICE: Healthcare professionals should determine how a woman wants to participate in decision making as well as the kind, amount, and sources of information the individual with breast cancer wants to have to make her decisions. Healthcare providers are key sources of information about treatment options, and they are critical to patient satisfaction with the decision-making process and with the final results of the surgical procedure. Family members, friends, and other women with breast cancer play a crucial role in talking it over.

Update: Assessment of gastric pH in the critically ill.

The purpose of this manuscript is to update a review of the measurement of intraluminal gastric pH in the critically ill. Intraluminal gastric pH is readily measured by aspirates tested with litmus paper or a nasogastric tube with an antimony or glass electrode tip. Significant variations of intragastric pH have been shown in different stomach locations. Significant variations in the accuracy of pH readings have also been demonstrated. Prophylactic therapy in the critically ill is aimed at maintaining a gastric pH greater than 4.0 by drug therapy that 1) neutralizes acid, 2) interrupts the signal to produce acid, 3) reduces the amount of acid produced, or 4) enhances the mucosal barrier of the stomach lining. The critically ill patients at risk of respiratory failure or coagulopathy are the patients most at risk of gastrointestinal bleeding and are, therefore, the ones most likely to benefit from prophylactic therapy. Multiple pH readings are more reliable indicators of gastric pH than are individual readings. Continuous prophylaxis is more effective than intermittent.

Factors that influence plastic surgeons' advice about reconstruction to women with breast cancer.

The purpose of this pilot study was to describe the factors that influence the advice of plastic surgeons who offer reconstructive surgery to women with breast cancer. Answers to the following question were sought: What anatomical, technical, and personal factors are considered by plastic surgeons in their recommendations for reconstruction to women with breast cancer? Five themes emerged that explained approaches used with these patients: (1) technical issues and challenges, (2) patient-centered challenges, (3) aids to patient decision-making, (4) illusion of no loss, and (5) age.

Enhancing critical thinking with case studies and nursing process.

Challenged to enhance critical thinking concepts in a sophomore nursing process course, faculty expanded the lecture format to include group explorations of patient case studies. The group format facilitated a higher level of analysis of patient cases and more sophisticated applications of nursing process. This teaching strategy was a positive learning experience for students and faculty.

Coprolite assessment in nursing research and practice.

A reliable assessment of stools without the use of metabolic assays of stool content has not previously existed. The Wanger Stool Assessment Instrument (WSAI) was initially conceived as an efficacy outcome measure for a clinical investigation of enteral feedings. The WSAI is a descriptive tool that has three scales: a seven-category color scale, an ordinal scale that describes amount, and an ordinal scale that ranks consistency of stools. Instrument testing and development were conducted in stages. Nursing staff using the instrument reported that its use improved data collection as well as the patient information communicated among health care staff.

Fiber-fortified feedings in immobile patients.

The purpose of this pilot study was to test methods to measure the effects of a fiber-fortified, enteral feeding (Jevity) on the bowel habits of an immobile, tube-fed group of patients. Three experimental patients received fiber-fortified feedings for seven weeks, whereas four control patients received their usual enteral feeding. Measurements of the number of stools, the consistency of stools, the formula volume delivered, the daily water volume, the body temperature, the urinary output, and the bowel medications were made during three phases--a baseline, an adjustment, and a treatment period. Patients who receive the fiber-fortified enteral feedings had more stools and better consistency of stools than did those patients who did not receive the fiber-fortified formula. Results indicated that fiber-fortified feedings should be added gradually to immobile, tube-fed patients' diets under close supervision. Although measuring the effects of a new feeding in immobile, tube-fed patients is labor-intensive, it can be accomplished successfully.

Staphylococcus aureus meningitis associated with pyogenic infection of the sacroiliac joint.

Although we have reported the first case of Staphylococcus aureus meningitis due to pyogenic arthritis of the sacroiliac joint, this finding is actually not surprising, given the strong association between this form of meningitis and underlying bone, joint, and soft tissue infections. The physician faced with a case of meningitis due to S aureus in a patient without a history of trauma or neurosurgical manipulation must do a prompt and thorough search for underlying infectious conditions. In the case of sacroiliitis in particular, a high index of suspicion needs to be maintained, given the difficulties and delays in diagnosis associated with this infection. Radionuclide scanning with 99mTc or 67Ga is usually helpful in the early confirmation of this condition, the presence of which may be suspected on the basis of thorough physical examination.

Comparison of two methods of measuring gastric pH.

OBJECTIVE: To assess the agreement between two methods of measuring gastric pH in critically ill patients (multiple band litmus paper-tested aspirations versus a meter-read probe located in the tip of a nasogastric tube) and to compare nurse satisfaction with both methods of measuring pH. DESIGN: Prospective, correlational, nonprobability sample. SETTING: Mid-Atlantic, semirural Veterans Affairs Medical Center. SUBJECTS: 39 male, surgical, critical care patients, who were nasogastrically intubated in the operating room and received nothing by mouth. NURSES: Twenty-seven registered nurses on the medical-surgical intensive care staff. OUTCOME MEASURES: Differences in pH units as determined by two methods of measurement and nurse satisfaction scores. INSTRUMENTATION: Litmus paper-tested aspirations versus a meter-read probe located in the tip of the nasogastric tube, measured every 2 hours for 48 hours. A nurse satisfaction assessment form for both measurement methods at entry, 6 months, and 12 months. RESULTS: All measures of association, Pearson's r (0.79), the concordance coefficient (0.74), and eta (0.88), were high. The concordance coefficient measures indicated sufficient agreement between the two methods at the initial and 24 hour measurement times (Cb) = 0.97, 0.97, and 0.94), but not at 48 hours. The meter method indicated prophylaxis was needed when the paper did not, more often than did the paper method (9.3% vs 5.2%). A significant difference between methods was found only at the last reading at 48 hours (z = -2.24, p < .0249). MANOVA revealed that nurses' preference for the meter method was significant (F = 139.48, df = 1.18) and increased over time (F = 4.77, df = 2,36). CONCLUSIONS: The gastric probe method of measuring pH is an accurate substitution up to 48 hours for the litmus-paper aspiration method in the postoperative patient who is receiving nothing by mouth. Nurses prefer the gastric probe method of measuring pH over the litmus-paper method because they judge it to be safer, faster, and more accurate.

Equivalency of hydrochloric acid and distilled water extraction media for determining residual ethylene oxide in medical devices.

An alternate method for determining residual ethylene oxide (EtO) in medical devices was compared with the aqueous extraction method suggested by the Association for the Advancement of Medical Instrumentation (AAMI). Residual EtO was extracted from EtO-sterilized samples of acrylic polymer (XT250-301 glass-tinted formulation) in pellet form by immersion in 1 M HCl at 37 +/- 2 degrees C (alternate method) or immersion in distilled water (AAMI method). The EtO residuals in the extracts were determined using gas chromatography and were statistically compared using a two-sample t test. Results obtained using the alternative method agreed within 10% of those obtained using the AAMI method.