Who wants to work in geriatrics: Findings from a national survey of physicians and nurse practitioners.

BACKGROUND: As the United States population is aging, there is a chronic shortage of geriatrics- and gerontology- trained clinicians despite a variety of incentives. With primary care clinicians also in short supply, health systems are trying to cope with the increasing demand for care for older adults PURPOSE: The purpose of this study was to examine respondents' willingness to recommend their career to others and beliefs about changes necessary to enhance the supply of appropriately prepared clinicians METHODS: This study used a national survey of a stratified sample of 276 physicians and 134 nurse practitioners working in primary care and geriatric practices. FINDINGS: Among nurse practitioner respondents, 29% would "definitely" recommend a career as a geriatrician vs. seventeen percent of physicians; thirteen percent of physicians would "definitely" recommend a career as a nurse practitioner specializing in adult/gerontology vs. 42% for nurse practitioners. Those trained in geriatrics were more likely to recommend a career in the field. DISCUSSION: Nurse practitioners and physicians differ in their willingness to recommend careers in in gerontology and geriatrics, but less than a majority would strongly recommend careers in either specialty. Based on clinical reports, substantial reforms in payment and reimbursement for services may be necessary to bolster the geriatric field's attractiveness, and better prepare the workforce to care for older adults.

Long-term relationships among atmospheric CO2, stomata, and intrinsic water use efficiency in individual trees.

Leaf-level responses to increases in atmospheric carbon dioxide (CO(2)) concentrations could have large implications for water and carbon cycles. We investigated whether stomatal density, guard cell length, and intrinsic water use efficiency (iWUE) of 27 individual trees growing at the Arnold Arboretum in Boston, Massachusetts have responded to changing environmental conditions over the last 100 years. We examined leaves from 74 herbarium specimens collected from three genera-Acer (maples), Quercus (oaks), and Carpinus (hornbeams)-from 1893 to 2006. During this period, global average atmospheric CO(2) concentrations increased by approximately 29% (86 ppm), and temperatures in Boston increased by 1.8°C. Stomatal density and guard cell length were negatively correlated in oaks and hornbeams. Although stomatal density declined and guard cell length increased over time, the changes were not dependent on the magnitude of changes in CO(2) concentrations. Intrinsic WUE did not change significantly over time. Our findings suggest that iWUE may not respond to changes in CO(2) concentrations over the lifetimes of individual trees, possibly because of compensating changes in stomatal density and guard cell size. We provide an example of a method that can enable researchers to differentiate between genetic and plastic responses to global change in long-lived trees.

Photographs and herbarium specimens as tools to document phenological changes in response to global warming.

Global warming is affecting natural systems across the world. Of the biological responses to warming, changes in the timing of phenological events such as flowering are among the most sensitive. Despite the recognized importance of phenological changes, the limited number of long-term records of phenological events has restricted research on the topic in most areas of the world. In a previous study in Boston (American Journal of Botany 91: 1260-1264), we used herbarium specimens and one season of field observations to show that plants flowered earlier as the climate warmed over the past 100 yr. In our new study, we found that two extra years of data did not strengthen the explanatory power of the analysis. Analysis of herbarium specimens without any field data yielded results similar to analyses that included field observations. In addition, we found that photographs of cultivated and wild plants in Massachusetts, data similar to that contained in herbarium specimens, show changes in flowering times that closely match independent data on the same species in the same locations. Dated photographs of plants in flower represent a new resource to extend the range of species and localities addressed in global-warming research.