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We submerged map turtles (Graptemys geographica) from Wisconsin in water equilibrated with air (normoxic) and in water equilibrated with nitrogen (anoxic) at 3 [degrees] C. Before submergence and for periods up to 150 days of submergence, plasma [PO.sub.2], [PCO.sub.2], pH, [[Cl.sup.-]], [[Na.sup.+]], [[K.sup.+], total Mg, total Ca, lactate, glucose, and osmolality were measured; hematocrit and body mass were determined, and plasma [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] was calculated. Turtles in anoxic water developed a severe metabolic acidosis, accumulating lactate from a predive value of 1.7 to 116 mmol/L, associated with a fall in pH from 8.010 to 7.128. Total calcium and magnesium rose from 3.5 and 2.0 to 25.7 and 7.6 mmol/L, respectively, helping to buffer the accumulating lactate. Plasma [MATHEMATICAL EXPRESSION NOT REPRODUCIBLE IN ASCII] was titrated from 44.7 to 4.3 mmol/L in anoxic turtles. Only minor disturbances occured in those turtles submerged in normoxic water; there was a marked increase in hematocrit from 31.1 to 51.9%. We suggest that map turtles have an obligatory requirment for a hibernaculum that provides well-oxygenated water and that this requirement is important in determining their distribution.

Quantum entanglement is the central resource behind quantum information science, from quantum computation and simulation to enhanced metrology and secure communication. These applications require the quantum control of large networks of qubits to realize gains and speed increases over conventional devices. However, propagating entanglement becomes difficult or impossible as the system grows in size. Here, we demonstrate the first step in a modular approach to scaling entanglement by using complementary quantum buses on a collection of three atomic ion qubits stored in two remote ion trap modules. Entanglement within a module is achieved with deterministic near-field interactions through phonons, and remote entanglement between modules is achieved with a probabilistic interaction through photons. This minimal system allows us to address generic issues in the synchronization of entanglement with multiple buses. It points the way towards a modular large-scale quantum information architecture that promises less spectral crowding and thus potentially less decoherence as the number of qubits increases. We generate this modular entanglement faster than the observed remotely entangled qubit-decoherence rate, showing that entanglement can be scaled simply by adding more modules. [ABSTRACT FROM AUTHOR]

Background: Recovery from critical illness can be prolonged and can result in a number of significant short- and long-term psychological consequences. These may be associated with the patient's perception of the intensive care experience. Aim: The aims of the study were to assess patients' perceptions of their intensive care unit (ICU) experience and the effect of these on anxiety, depression and post-traumatic stress up to 6 months after discharge. Method: One hundred and three participants were recruited from six ICUs from one Critical Care Network in the United Kingdom. A prospective, longitudinal study was designed to assess anxiety, depression, post-traumatic stress symptomatology and patients' perceptions of their intensive care experience. Data were collected on three occasions: after intensive care discharge and before hospital discharge, and 2 months and 6 months later. Measures included the impact of events scale, hospital anxiety and depression scale and intensive care experience questionnaire. Results: Anxiety, depression, avoidance and intrusion scores did not significantly reduce over time. At hospital discharge there was a significant association between patients' perceptions of their intensive care experience and anxiety, depression, avoidance and intrusion scores at hospital discharge. Conclusion: Standardised assessment of an intensive care experience is important. It provides information about the patient experience which can inform care practice within ICU, following discharge to the ward and, in the longer term, rehabilitation. [ABSTRACT FROM AUTHOR]

Aim: The aim of the research was to understand how nurses used technology to wean patients from mechanical ventilation. Background: The literature concerned with the development of critical care centres on the role of technology with little emphasis on the nursing contribution. Design: An ethnographic approach was used to understand how nurses used technology to wean patients from mechanical ventilation. Methods: Data were gathered by participant observation and interviewing over a 6-month period. In total, 250 h of field notes were recorded. Results: Data were analysed by the content analysis method. Knowing the patient was a central theme identified. Three sub-themes were identified: ways of knowing, continuity of care and the role of the patient in the weaning trajectory. Conclusion: 'Knowing the patient' was implied during the interviews as essential to the delivery of patient-centred care. There were two main factors that needed to be present in order for nurses to know their patients: continuity of care and expertise. 'Ways of knowing' was reliant on gaining information about the patient. The role of the patient was a passive recipient of treatment. Implications for practice: Knowing the patient has been defined as a characteristic of expert nursing. To be truly patient-centred nursing needs to address the barriers that prevent nurses from getting to 'know' their patients. [ABSTRACT FROM AUTHOR]

Weaning from mechanical ventilation has attracted a growing interest recently in the medical and nursing press. Attempts have been made to determine a patient's readiness to wean, define criteria for successful weaning and enhance the weaning process through the developments of protocols. Key to this work is the role of the critical care nurse. Transferring the role and the responsibility of weaning from the traditional perspective of the intensivist to the nurse is not without challenges. Inherent is the need for skill and expertise and the willingness to accept this level of responsibility, not questioned in the medical role, but worthy of consideration when transferred to nurses. Key to successful weaning and weaning is redefined for the purposes of this paper, is continuity of care, knowing the patient and the development of patient-centred, individualized weaning plans. Critical care nurses have an important role to play. This is particularly so when the patient experience is to be understood. There is relatively little research conducted in this area, yet this is an important consideration if we are to fully understand and embrace the role of patients in their weaning. Weaning in the context of critical care can be challenging. To wean the difficult-to-wean or the long-term-weaning patient requires great skill and expertise. Expertise in this context has not been fully explored, yet research suggests that these patients are not allocated expert nurses to care for them because they are not seen as critically ill. It may be that this group of patients would benefit from a transfer to a weaning centre as suggested by the Modernisation Agency in 2002. This would greatly challenge the way we, as critical care nurses, perceive weaning in critical care. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to identify the meaning for critical care nurses of technology related to weaning from mechanical ventilation and to explore how that technology was used in practice. Background. The literature concerned with the development of critical care (intensive care and high dependency units) focuses mainly on innovative medical technology. Although this use of technology in critical care is portrayed as new, it actually represents a transfer of technology from operating theatres. Method. An ethnographic study was conducted and data were collected on one critical care unit in a large teaching hospital over a 6-month period in 2004. The methods included participant observation, interviews and the collection of field notes. Findings. The overall theme 'The nursing-technology relation' was identified. This comprised three sub-themes: definition of technology, technology transferred and technology transformed. Novice nurses took a task-focussed approach to weaning, treating it as a 'medical' technology transferred to them from doctors. Expert nurses used technology differently and saw its potential to become a 'nursing technology'. Conclusion. Nurses need to examine how they can adapt and to 'reconfigure' technology so that it can be transformed into a nursing technology. Those technologies that do not fit with nursing may have no place there. Rather than simply extending and expanding their roles through technology transfer, nurses should transform those technologies that preserve the essence of nursing and can contribute to a positive outcome for patients. [ABSTRACT FROM AUTHOR]

Nurse-led weaning can improve patient outcome. Exploration of the factors that influence the commencement of weaning. Themes of decision-making, pathophysiological and multidisciplinary team factors emerged. Experience was a key factor in the decision to wean. The use of protocol-led weaning may not be useful in the decision to wean. [ABSTRACT FROM AUTHOR]

Follow-up clinics following discharge from intensive care are not a new phenomenon - Whiston Hospital in Liverpool has been running a clinic since 1990. Its pioneering work has set a precedent and has inspired Nottingham City Hospital to set up its own clinic. The Department of Health (2000) recommended that all NHS trusts 'review the provision of follow-up services and ensure there is appropriate provision for those patients who will benefit'. Nottingham City Hospital set up a multidisciplinary follow-up clinic without funding, with great success, over a year ago. This service has been extremely valuable to patients and their carers and has helped staff understand the needs of patients once they have left intensive care. This article will describe the clinic's work and case studies are utilized in order to illustrate key points. [ABSTRACT FROM AUTHOR]