Search

Despite important progress in understanding the influence of deforestation on the bacterial α diversity and community structure at local scales, little is known about deforestation impacts in terms of spatial turnover and soil bacterial community network interactions, especially at regional or global scales. To address this research gap, we examined the bacterial spatial turnover rate and the species networks in paired primary and secondary forest soils along a 3700-km north-south transect in eastern China using high-throughput 16S rRNA gene sequencing. The spatial turnover rate of bacterial communities was higher in primary forests than in secondary, suggesting deforestation increased biotic homogenization at a large geographic scale. Multiple regression on matrices analysis revealed that both geographic distance and soil properties (especially soil pH and organic matter availability) strongly affected bacterial spatial turnover. Through the phylogenetic molecular ecological network approach, we demonstrate that the bacterial network of primary forests was more intricate than in secondary forests. This suggests that microbial species have greater niche-sharing and more interactions in primary forests as compared to secondary forests. On the other hand, the bacterial network in secondary forests was more modular, and the taxa tended to co-occur, with positive correlations accounting for 82% of all potential interactions. In conclusion, our findings demonstrate that anthropogenic deforestation has clear effects on bacterial spatial turnover and network interactions, with potential for serious consequences such as microbial diversity loss in primary forests.

STUDY OBJECTIVE: A previous single-region study has suggested that acuity varies by patient age in ways that may affect subspecialty critical care skills retention. This study seeks to independently confirm or refute these findings by using the National Hospital Ambulatory Medical Care Survey (NHAMCS), a large nationally representative database of emergency department (ED) visits. METHODS: Using 8 years of NHAMCS data composed of 288,199 ED visits, the following 6 measures of patient acuity were weighted and graphically stratified by patient age: triage category, hospital admission, critical care unit admission, death in the ED, cardiopulmonary resuscitation, and tracheal intubation. Their relative frequency was then compared between adults and children (<18 years). RESULTS: All measures of acuity increased with age and were higher in adults versus children: highest triage category odds ratio 1.3, hospital admission odds ratio 4.2, critical care unit admission odds ratio 4.5, death in the ED odds ratio 5.8, cardiopulmonary resuscitation odds ratio 4.7, and tracheal intubation odds ratio 2.5. CONCLUSION: This analysis of a large, nationally representative ED sample found substantial age-based differences in patient acuity that can inform discussion about subspecialty critical care skills retention. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE: We wish to assess whether individual or collective American College of Surgeons' 'major resuscitation' criteria accurately identify injured patients who receive emergency operative treatment. METHODS: In this observational secondary registry analysis of 8,289 consecutive trauma team activations during a 7.5-year period, we evaluated the test performance of 5 American College of Surgeons' major criteria in predicting emergency (within 1 hour) operative management by general (for adults) or pediatric (for children) surgeons. RESULTS: In adults, the individual major resuscitation criteria each predicted emergency operative management as follows (sorted from highest to lowest test performance): gunshot wounds to the neck or torso (likelihood ratio positive [LR+] 7.5; 95% confidence interval [CI] 6.2 to 9.1); confirmed hypotension (LR+ 5.3; 95% CI 4.0 to 7.1); interhospital transfers requiring blood transfusions (LR+ 4.6; 95% CI 2.6 to 8.2); respiratory compromise (LR+ 2.9; 95% CI 2.2 to 3.7), and Glasgow Coma Scale score less than 8 (LR+ 2.1; 95% CI 1.6 to 2.7). The collective strategy of using any of these 5 criteria exhibited a LR+ of 3.5 (95% CI 3.2 to 3.8), sensitivity 82% (95% CI 75% to 87%), and specificity 76% (95% CI 75% to 77%). Our findings in children were similar, but their precision was limited by the low baseline prevalence of emergency operative intervention. CONCLUSION: These 5 American College of Surgeons-mandated major resuscitation criteria vary several-fold in their individual ability to predict emergency operative management and collectively exhibit modest test characteristics for this purpose. Selective use of these criteria or revisions thereof could result in more efficient secondary trauma triage. Our results do not support the existing obligatory use of these criteria to maintain American College of Surgeons trauma center certification. [ABSTRACT FROM AUTHOR]

Aim. This paper reports a systematic review of the literature on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty between 1993 and 2003. Background. Older people with dementia commonly experience difficulty with feeding, especially in the later stages of the condition. This topic and related nursing care was reviewed in 1993 and the conclusion was that there was little research into interventions that nurses could use to alleviate feeding difficulty. Method. A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE and Cochrane databases and the search terms 'feeding', 'eating' and 'dementia' combined as follows: '(feeding or eating) and (dementia)'. A second search was carried out combining the search terms 'mealtimes' and 'dementia' as follows: 'mealtimes and dementia'. The literature search was carried out on 1 December 2003 and papers were included in the review if retrieved by 31 December 2003. English language papers only were retrieved. Results. Sixty-seven papers were retrieved, of which 13 addressed interventions aimed at helping older people with dementia to feed. All studies reported positive outcomes but only one randomized controlled trial was reported. Music was the most common intervention but there were no standardized interventions or outcomes across the studies and none reported the use of power analysis to decide on sample size. There were problems in some studies with confounding variables. Conclusions. Further research is needed into interventions aimed at how nurses can help older people with dementia to feed. There are some promising lines of enquiry, with music being one of these, but future studies need to use adequate samples and to use power calculations and account adequately for confounding variables. There is also a need to standardize interventions and outcomes across such studies to facilitate meta-analysis. [ABSTRACT FROM AUTHOR]

This article provides an overview of the mechanical properties of materials with particular emphasis placed upon orthopaedic biomaterials. Engineering concepts of stress, strain, shear, yielding and failure are introduced and through consideration of microstructural mechanisms, the behaviour of materials under loading is discussed. In providing a concise overview of the deformation of materials, the reader is introduced to fundamental concepts in engineering and materials science. [ABSTRACT FROM AUTHOR]

AIM: This paper reports a literature review describing the range of published tools available for use by nurses to screen or assess nutritional status of patients/clients, and to examine whether the validity, reliability, sensitivity, specificity and acceptability of the tool have been investigated. Tools developed specifically for use with older adults are not considered in this review. A screening/assessment tool is described as a tool that uses a questionnaire-type format, contains more than one risk factor for malnutrition and gives an assessment of risk. BACKGROUND: The incidence of malnutrition in people cared for by nurses is high and screening or assessment tools are often used to identify those with, or at risk of, malnutrition. METHODS: A comprehensive literature review methodology was employed. A range of electronic databases was searched from 1982 to 2002. Search terms incorporating 'nutrition', 'screening', assessment, feeding, instrument, tool, validity, reliability, sensitivity and specificity were combined. Manual searches were also conducted. RESULTS: Seventy-one nutritional screening/assessment tools were identified of which 35 were reviewed. Tools not reviewed included those which incorporated significant use of biochemical measures (8), included complex anthropometric measures (3), were concerned specifically with ingestion (4) or were designated for use with an older population (21). The tools reviewed use a wide variety of risk factors for malnutrition, varying from anthropometric measurements to socio-cultural aspects of eating behaviour. Some identify an action plan based on the score obtained. Many have not been subjected to validity and/or reliability testing and yet appear to be in use in clinical practice. The sensitivity, specificity and acceptability of the tools are often not investigated. CONCLUSION: There are many published nutritional screening/assessment tools available for use by nurses to screen or assess the nutritional status of patients/clients. Many have not been subject to rigorous testing. Future work should consider a more standardized approach to the use of these tools. [ABSTRACT FROM AUTHOR]

STUDY OBJECTIVE: The 15-point Glasgow Coma Scale (GCS) is extensively used in the initial evaluation of traumatic brain injury in emergency department (ED) settings. We hypothesized that the GCS might be unnecessarily complex and that a simpler scoring system might demonstrate similar accuracy in the prediction of traumatic brain injury outcomes. METHODS: We analyzed a prospectively maintained trauma registry of patients evaluated at our Level I trauma center from 1990 to 2002. We calculated the test performance of ED GCS scores relative to 4 clinically relevant traumatic brain injury outcomes (emergency intubation, neurosurgical intervention, brain injury, and mortality) using areas under their receiver operating characteristic (ROC) curves. We performed similar analyses for each of the 3 GCS components and for 2 simplified 3-point scores (simplified verbal score: oriented=2, confused conversation=1, inappropriate words or less=0; simplified motor score: obeys commands=2, localizes pain=1, withdrawal to pain or less=0). We then compared the test performance of each of these 5 to the total GCS score using a priori thresholds for clinically important differences. RESULTS: Each of the 3 GCS components alone and the 2 simplified 3-point scores demonstrated ROC areas within 9% of that of the GCS score for the 4 outcomes, with a median difference of 3.0% (interquartile range 1.6% to 4.5%). These differences were all below our a priori definitions of clinical importance. CONCLUSION: The 3 individual GCS components alone and two 3-point simplified scores demonstrated test performance similar to the total GCS score for the prediction of 4 clinically relevant traumatic brain injury outcomes. Despite the widespread use of the GCS for the initial evaluation of traumatic brain injury, this score may be unnecessarily complex for this indication. [ABSTRACT FROM AUTHOR]

Objective: To determine if 3 objective criteria - pulse oximetry, respiratory syncytial virus (RSV) testing, and age - could be used to predict which children hospitalized with bronchiolitis will have brief (<36 hour) hospitalizations and therefore be potential candidates for admission to short-stay observation units.Methods: This was a retrospective medical record review of medically -uncomplicated children 3 to 24 months of age with emergency department and hospital discharge diagnoses consistent with bronchiolitis who were admitted to a general pediatric ward in our university-based, tertiary care hospital between Jan. 1, 1992, and Nov. 12, 2002. Multiple logistic regression was used to assess the predictor variables.Results Our study consisted of 225 patients (45% female) with a median age of 7 months' (interquartile range (IQR], 4-11 mo; range, 3-22 mo). Median pulse oximetry value was 94% (IQR 91%-96%; range 76%-100%), and 71% of the patients tested positive for RSV. Thirty children (13%) had brief hospitalizations <36 hours, and the median hospital length of stay for the entire study group was 70 hours (IQR 46-108 h; range 6-428 h). None of the 3 predictor variables were independently associated with brief hospitalization.Conclusions: Pulse oximetry; RSV testing and age do not predict which -children will have brief hospitalizations and are appropriate candidates for admission to short-stay observation units. [ABSTRACT FROM AUTHOR]

Background: Obesity is increasing in prevalence in the UK. Practice Nurses (PNs) and to a lesser extent Health Visitors (HVs) may advise patients/clients on weight management. The aim of this survey was to examine HVs and PNs knowledge concerning the assessment and management of obesity by use of a questionnaire.Method: A postal questionnaire was sent to 35 HVs and 49 PNs based at 24 practices within one regional health authority. The practices had participated in a previous survey. A 54% (17 HVs and 28 PNs) response rate was achieved.Results: Responses indicated that little education concerning obesity had been received since professional registration, and a need for this was identified. Most respondents used a computer or chart to calculate BMI of patients/client. Three HVs and 21 PNs correctly identified that a BMI of > 29 or 30 indicated obesity, and six HVs and 21 PNs identified that centrally distributed obesity is associated with a greater risk of metabolic disease. Most respondents indicated they would advise a person with obesity to follow a low-fat diet; however, a low-energy diet was indicated by some. The majority were able to identify which of a number of foods were high in fat, although some low-fat foods were frequently misclassified. Most respondents mentioned the importance of lifestyle change and physical activity. Recommended weight loss generally followed current guidelines.Conclusion: Recommendations for practice are outlined. These include closer liason with dietetic services, more emphasis on the assessment of eating habits and lifestyle, greater use of a client-centred approach and use of appropriate guidelines on physical activity. Further research should be carried out to explore the results of this small-scale study. [ABSTRACT FROM AUTHOR]

Sixteen elderly nursing home residents experiencing mild to moderate depression were involved in a demonstration-cum-research project. The social work intervention was based upon an eclectic group approach to reducing depression, and the research part of the project used a pretest-posttest control group design. After the group intervention, three-fourths of those in the treatment group were free from depression, and none was in the 'moderate depression' category. The difference between the mean scores of the treatment and control groups on the Zung Self-Rating Depression Scale at posttest was also statistically significant. [ABSTRACT FROM AUTHOR]