Climate change may restrict dryland forest regeneration in the 21st century.

The persistence and geographic expansion of dryland forests in the 21st century will be influenced by how climate change supports the demographic processes associated with tree regeneration. Yet, the way that climate change may alter regeneration is unclear. We developed a quantitative framework that estimates forest regeneration potential (RP) as a function of key environmental conditions for ponderosa pine, a key dryland forest species. We integrated meteorological data and climate projections for 47 ponderosa pine forest sites across the western United States, and evaluated RP using an ecosystem water balance model. Our primary goal was to contrast conditions supporting regeneration among historical, mid-21st century and late-21st century time frames. Future climatic conditions supported 50% higher RP in 2020-2059 relative to 1910-2014. As temperatures increased more substantially in 2060-2099, seedling survival decreased, RP declined by 50%, and the frequency of years with very low RP increased from 25% to 58%. Thus, climate change may initially support higher RP and increase the likelihood of successful regeneration events, yet will ultimately reduce average RP and the frequency of years with moderate climate support of regeneration. Our results suggest that climate change alone may begin to restrict the persistence and expansion of dryland forests by limiting seedling survival in the late 21st century.

Comparison of cognitive function after carotid artery stenting versus carotid endarterectomy.

The effect of carotid artery stenting (CAS) and carotid endarterectomy (CEA) on cognitive function is unclear. Both cognitive improvement and decline have been reported after CAS and CEA. We aimed to compare the changes in postprocedural cognitive function after CAS versus CEA. A systematic qualitative review of the literature was conducted according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement for studies evaluating the changes in cognitive function after CAS compared with CEA. Thirteen studies (403 CEAs; 368 CAS procedures) comparing the changes in cognitive function after CEA versus CAS were identified. Most studies did not show significant differences in overall cognitive function or only showed a difference in a single cognitive test between the two procedures. A definitive conclusion regarding the effect of CAS versus CEA on cognitive function was not possible owing to heterogeneity in definition, method, timing of assessment, and type of cognitive tests. For the same reasons, performing a meta-analysis was not feasible. The lack of standardization of specific cognitive tests and timing of assessment of cognitive function after CAS and CEA do not allow for definite conclusions to be drawn. Larger, adequately-powered and appropriately designed studies are required to accurately evaluate the effect of CAS versus CEA on postprocedural cognitive function.

Emotional distress and health risk behaviours of mothers of United States Marines.

AIM: The aim was to explore emotional distress and health risk behaviours of mothers of servicemen. The study was inspired by the first author's clinical practice in primary care among women who reported significant emotional distress surrounding impending deployment of their sons. BACKGROUND: Thousands of US service members have been deployed in the current wars. The potentially profound effects of deployment on emotional distress of military spouses and children have been documented; however, mothers of servicemen have not been studied. METHODS: This was an exploratory descriptive study to determine self-reported levels of emotional distress and health risk behaviours in the mothers of deployed male US Marines compared with mothers of male Marines not currently deployed. Mothers were accessed via a voluntary online support organization. RESULTS: Mothers of deployed sons reported significantly higher levels of emotional distress and more health risk behaviours compared with mothers of sons not deployed. Many of the mothers in both groups reported high levels of emotional distress. DISCUSSION: As primary care providers, nurses should be alert to the high levels of emotional distress and health risk behaviours among all patients. This exploratory study highlights these dimensions in mothers of servicemen. CONCLUSIONS: This study is the first of mothers of sons serving in the military. While the focus is on mothers of sons serving in the US military, their experience is likely not unique. Mothers of military service members all over the world send their children off to war and wait for their safe return.

Measurement of velocity with a kinematic system versus a photocell system in the collection of canine ground reaction forces.

Velocities obtained from a five photocell system were compared to velocities of nine anatomical points on a handler and canine subject as reported by a kinematic system over the same distance. There was not a statistically significant difference between the velocities of the markers on the dogs' occipital protuberance and interscapular region compared with the velocity as reported by the photocell system. The average velocities of the three markers on the forelimb of the dogs and three markers on the handler's leg and one on the sacrum had statistically different values than the photocell system. Given these results, photocell systems with the same configuration in this study can be trusted to report accurate trunk velocities of canine subjects during the collection of ground reaction forces.

Measurement differences between three versus five photocells during collection of ground reaction forces in dogs.

The differences between velocities and accelerations obtained from three and five photocells were examined when obtaining ground reaction force (GRF) data in dogs. Ground reaction force data was collected 259 times from 16 different dogs in two experimental phases. The first phase compared velocities and accelerations reported by the two systems based on trials accepted by the three photocell system. The second phase accepted trials based on data from five photocells. Three photocell data were calculated mathematically in the second phase in order to compare the values of both systems. The velocity and acceleration values obtained from each system were significantly different (at the hundredth of a meter per second). Differences in measured values did not result in acceptance of data by the three photocell system that would not have been acceptable with the five photocell system (false positives), but did result in rejection of acceptable data by the three photocell system (11% false negative rate). Given the small differences between the two systems, GRF data collected should not be significantly different, though the three photocell system is less efficient in gathering data due to the number of trials rejected as false negatives.

Outcome following stabilization of type B1 periprosthetic femoral fractures.

We present results of internal stabilization of 16 type B1 periprosthetic femoral fractures following total or hemiarthroplasty of the hip. Seven patients had cemented stems, and the rest had cementless, extensively hydroxyapatite-coated stems. Fourteen were managed by a cable-grip plating system, 1 by Dynamic compression plate, and 1 had insertion of cables only. Minimum follow-up was 1 year. Four patients had a major complication: 2 had deep infection; 1 had nonunion requiring amputation; and 1 had persistent hip pain requiring removal of all metalwork, including the hip prosthesis. The average time to healing in the remaining patients was 16.3 weeks. Harris Hip Scores dropped from an average of 86.8 preoperatively to 73.4 on last follow-up. Periprosthetic fractures are a significant injury, with a high risk of complications.

Markers of experimental acute inflammation in the Wistar Han rat with particular reference to haptoglobin and C-reactive protein.

C-reactive protein (CRP), haptoglobin (Hp) and fibrinogen (Fbgn) are acute phase reactants (APRs), the blood levels of which increase during acute inflammation. However, although the levels of these APRs are used to monitor inflammation in man, their usefulness and sensitivity as markers of inflammation in rodents are less clear. We therefore wished to evaluate, in a comparative fashion, a prototype immunoassay for serum CRP, a commercial assay for serum Hp, and an automated assay for Fbgn, using a model of acute inflammation in the rat. Additionally, pro-inflammatory cytokines and serum protein fractions were also measured. The model of inflammation used was the intraperitoneal injection of Freund's complete adjuvant (FCA). In a concluding experiment, findings with Hp in the FCA rat model were validated in a toxicologically relevant study involving the induction of acute hepatic inflammation using the model hepatotoxicant carbon tetrachloride (CCl(4)). Female Wistar Han rats were treated with a single injection of FCA in a dose-response study (1.25-10.0 ml/kg, sampling at 36 h) and two time-course studies (over 40 h and 21 days). In a final experiment, rats were dosed with CCl(4) at 0.8 ml/kg and sampled over a 17-day period. In FCA and CCl(4) experiments, serum/plasma was prepared and tissues taken at autopsy for histological assessment (CCl(4) study only). In the dose-response study, serum CRP, Hp and plasma Fbgn were increased at all FCA dose levels at 36 h post-dosing. Serum alpha(2) and beta(1) globulin fractions were also increased, while albumin levels were decreased. In the 40-h time-course study, CRP levels peaked at 25-40 h post-dosing, to approximately 120% of control (as 100%). Hp levels increased to a maximum at 25 and 40 h post-dosing with values greater than 400% of control, and alpha(2) and beta(1) globulin fractions peaked at 30 and 40 h post-dosing to 221 and 187% of control, respectively. Increased serum interleukin-6 (IL-6) and interleukin-1beta (IL-1beta) levels peaked at 20 h (11-fold) and 25 h (19-fold), respectively. In a 21-day time-course study, no increased CRP levels were measured despite elevated levels of Hp, which peaked at 36 h (approximately 7-fold above control), and remained elevated up to 21 days. IL-6 and IL-1beta levels peaked at 12 h (19-fold) and 24 h (28-fold), respectively. Liver histopathology of animals treated with CCl(4) showed centrilobular hepatocellular degeneration and necrosis (most significant at 36 h) with an inflammatory response (most significant at 48 h). Resolution of the lesion was complete by 4 days post-dosing. Serum alanine aminotransferase, aspartate aminotransferase and glutamate dehydrogenase levels peaked at 36 h post-dosing. Hp levels increased maximally at 48 h (426% of control). We conclude that serum CRP is a poor marker of acute inflammation in the rat in comparison with serum Hp and plasma Fbgn. Between Hp and Fbgn, serum Hp is shown to be the most sensitive and useful marker of acute inflammation.

Haemotoxicity of thiamphenicol in the BALB/c mouse and Wistar Hanover rat.

Chloramphenicol (CAP) is haemotoxic in man, inducing two forms of toxicity. First, a commonly-occurring, dose-related, reversible bone marrow depression, which develops during treatment. Second, a rarer aplastic anaemia (AA), developing after treatment, is irreversible, and often fatal. Thiamphenicol (TAP) was developed as a replacement for CAP; however, there are no toxicological investigations in the mouse or rat on the dose-related haemotoxicity of TAP, in repeat dose gavage studies. Therefore, we have conducted a comprehensive investigation in these species, administering TAP for 7-17 days, to define haematological changes. Female BALB/c mice were gavaged with TAP, daily for 7-17 days at 400-1500 mg/kg; female Wistar Hanover rats were dosed with TAP daily at 50-375 mg/kg for 9 or 10 days. Haematological changes were studied at 1, 7 and 14 days post-dosing. In mice at day 1, TAP caused decreases in RBC, HCT and Hb; reticulocytes and platelets were reduced; changes were dose-related and reversible. Marrow cell counts were reduced; marrow was hypocellular, with erythroid depletion and progenitor cell vacuolation; the myeloid/erythroid (M:E) ratio was increased. In the rat, changes were not as clear-cut; there was anaemia with indications of reduced reticulocyte and platelet counts, and evidence of decreased neutrophils and lymphocytes. Marrow erythroid cells were decreased, precursor cells vacuolated, and the M:E ratio increased. We conclude that TAP induced haematological changes in the mouse and rat, parallelling the dose-dependent, reversible marrow depression reported in man; TAP is more haemotoxic in the rat than in the mouse.

Studies on the haemotoxicity of chloramphenicol succinate in the Dunkin Hartley guinea pig.

In man, chloramphenicol (CAP), induces two major haemotoxic effects. First, a reversible, dose-related reticulocytopenia and anaemia developing during treatment. Second, a non-dose-related aplastic anaemia (AA), developing weeks after treatment, is often irreversible and fatal. In previous studies, we developed a mouse model of the reversible reticulocytopenia/anaemia using CAP succinate (CAPS); attempts to induce AA in the mouse with CAPS were unsuccessful; in the rat, CAPS induced only minimal haemotoxicity. We therefore wished to investigate haematological changes caused by CAPS in a third rodent, particularly in relation to the induction of significant 'late stage' bone marrow depression (AA). Female guinea pigs were gavaged with CAPS in three experiments. In a dose ranging study, CAPS (at 2500 and 3500 mg/kg) was administered daily for 9 days, and blood examined at 1 day post dosing. CAPS induced increased erythrocyte values (an apparent haemoconcentration effect), and reduced reticulocytes and femoral marrow nucleated cell counts (FNCC). In a second experiment, CAPS was given at 333, 666 and 1000 mg/kg (13 days); haematological changes were compared with results from the initial study, with evidence of dose-related effects. In a final experiment, CAPS was administered (825 mg/kg, 16 days) and blood studied at 1, 12, 28 and 63 days post dosing. At day 1, erythrocyte values were decreased (NS), and reticulocytes and FNCC were reduced; the marrow was hypocellular with erythroid depletion. At 12 and 28 days, values returned towards the normal range. At 63 days, parameters were normal. Thus, CAPS (825 mg/kg for 16 days) induced changes comparable to the reversible bone marrow depression seen in man; but there was no evidence of 'late stage' (i.e. at 63 days) marrow depression, as would be seen in a developing or overt marrow aplasia (AA). The guinea pig (like the mouse) is a model for the early events, but is not a good model for CAP-induced AA in man.

Effects of cocaine on extracellular dopamine and serotonin levels in the nucleus accumbens.

RATIONALE: Although the rewarding effects of cocaine are generally attributed to its ability to increase dopamine (DA) transmission, cocaine demonstrates approximately equal affinity for dopamine and serotonin (5-HT) transporters in vitro. However, there have been few direct systematic comparisons of the effects of cocaine on DA and 5-HT transmission in vivo. OBJECTIVES: The present experiments compared the effects of systemic cocaine administration, local cocaine infusion and the systemic administration of cocaine during infusion on extracellular levels of DA and 5-HT in the nucleus accumbens (NAc). METHODS: In vivo microdialysis in awake unrestrained rats was used to measure the effects of systemic administration and local infusion of cocaine on extracellular DA and 5-HT levels simultaneously in the NAc. RESULTS: Systemic cocaine (10-25 mg/kg, IP) dose-dependently increased DA and 5-HT levels, but the increase in DA was larger than for 5-HT at 18 mg/kg. Infusion of cocaine (0.1-10.0 mM) into the NAc increased both DA and 5-HT levels, but the effect on DA was larger than 5-HT at 0.1 and 3 mM cocaine. The influence of cocaine on DA and 5-HT somatodendritic autoreceptors was examined when cocaine (25 mg/kg) was administered systemically during cocaine infusion. The increase in DA and 5-HT levels during cocaine infusion was attenuated by the systemic injection of cocaine during cocaine infusion, but the decrease of 5-HT was greater than that for DA. CONCLUSIONS: Cocaine produced a larger impact on DA than 5-HT neurotransmission under specific conditions. A series of physiological mechanisms, i.e. terminal density, neurotransmitter interactions and somatodendritic regulation, are discussed as factors responsible for facilitating cocaine's effects on DA relative to 5-HT.

An assessment of chloramphenicol and thiamphenicol in the induction of aplastic anaemia in the BALB/c mouse.

The potential of the antibiotics chloramphenicol succinate (CAPS) and thiamphenicol (TAP) to induce aplastic anaemia in the female BALB/c mouse was investigated. CAPS was administered at 2000 mg/kg, and TAP at 850 mg/kg, daily by gavage, for 17 days. At 1, 13, 22, 41, 98 and 179 days after the final dose of each antibiotic, mice (n = 4 or 5) were sampled for haematological examination and haematopoietic stem cell assays. Both CAPS and TAP induced significant reductions in red blood cell count, haematocrit and haemoglobin values at day 1 post dosing; counts of colony-forming units-erythroid and colony-forming units-granulocyte-macrophage, were similarly significantly decreased at this time. All these reduced parameters returned towards normal at days 13 and 22. At days 41, 98 and 179, results for all haematological values and stem cell assays in both CAPS- and TAP-treated mice compared with the controls; there was no evidence of a reduction in peripheral blood values or bone marrow parameters at the later sampling points, as would be expected in a developing or overt bone marrow aplasia. We therefore consider that the administration of CAPS and TAP, which have been associated with the development of aplastic anaemia in man, induce a reversible anaemia, but not a chronic bone marrow aplasia, when given at haemotoxic dose levels for 17 days in the BALB/c mouse.

The length of the second stage of labor in uncomplicated, nulliparous African American and Puerto Rican women.

The Friedman Curve of Normal Labor, based on Emanuel Friedman's studies of Caucasian women in 1954 and 1955, remains the "gold standard" for assessing progress in the second stage of labor. Clinical observation by the authors, however, suggests that the second stage of labor is shorter in African American and Puerto Rican women. This descriptive, comparative study examined the duration of the second stage of labor in nulliparous African American and Puerto Rican women with uncomplicated births. The labor and delivery records of 373 African American and 157 Puerto Rican nulliparous women were randomly selected and reviewed, and the mean durations of the second stage of labor for both groups were compared to Friedman's labor curve. The mean length of second stage of labor in the sample of African American women was 31.6 minutes with a standard deviation of +/- 22.5 minutes, significantly shorter than Friedman's duration (P < .01). The mean length of second stage of labor in the sample of Puerto Rican women was 44.32 minutes with a standard deviation of +/- 33.03 minutes. This was also shorter than Friedman's figure for the second stage of labor (P < .01). These findings provide a more appropriate curve for monitoring labor progress in women from different ethnic backgrounds.

Haemotoxicity of chloramphenicol succinate in the CD-1 mouse and Wistar Hanover rat.

1. Chloramphenicol has been widely used in the treatment of serious infections including typhoid fever and meningitis. However, the drug is haemotoxic in man inducing firstly, a reversible, dose-dependent anaemia which develops during treatment, secondly, an often fatal aplastic anaemia with pancytopenia and acellular marrow, and thirdly, leukaemia. 2. We investigated the haemotoxicity of chloramphenicol succinate (CAPS) in female CD-1 mice in repeat dose studies, to compare the response with the reversible anaemia reported in man. Studies in male Wistar Hanover rats were also carried out. 3. CAPS was gavaged daily to mice at dose levels from 800 - 2000 mg/kg for seven days. Values were significantly reduced for reticulocytes at 1700 and 2000 mg/kg, and for erythrocytes (RBC), haematocrit (HCT), and haemoglobin (Hb) at 2000 mg/kg. Platelet and white blood cell (WBC) counts were unaffected. 4. Mice were dosed with CAPS at 1400 mg/kg for 10 days and sampled at 1, 4 and 15 days after the last dose. At day 1 post dosing, RBC, HCT and Hb values were significantly reduced, but returned to normal (or above normal) by day 4 or 15. 5. CAPS from 2000 - 4000 mg/kg was gavaged to rats daily for 19 days. Hb values were significantly lower at 3600 and 4000 mg/kg; reticulocytes were not reduced. WBC and platelet counts, in general, were unaffected. 6. Levels of apoptosis in marrow mononuclear cells were increased in CAPS-treated mice, but not in CAPS-treated rats. Serum biochemistry parameters, in general, showed few changes of toxicological significance. 7. We conclude that the administration of CAPS to CD-1 mice induced haematological changes showing close parallels with the chloramphenicol-induced reversible anaemia seen in man.

The effect of epidural analgesia on the second stage of labor.

A retrospective review of 202 randomly selected records of parturient labors examined the relationship between cervical dilation at epidural analgesia administration and length of the second stage of labor. The epidural group received bupivacaine 0.11% or 0.125% with sufentanil 1 to 2 micrograms/mL using a Bard Patient Controlled Anesthesia II pump. Labor management and outcomes were compared with a nonepidural group who chose unmedicated childbirth, intravenous narcotics, or pudendal block. A significant inverse correlation was found between cervical dilation at epidural administration and second-stage length in labors that did not use oxytocin. However, linear regression explained only 13.5% of the variance, leaving 86.5% unexplained. In labors in the epidural group that used oxytocin, cervical dilation at epidural administration was not correlated with second-stage length. The epidural group experienced a significantly longer mean length of the second stage. Labors in the epidural group were 3.5 times more likely to have oxytocin induction or augmentation and 4.5 times more likely to experience instrument-assisted delivery. There were no significant differences in Apgar scores between the two infant groups.

Mother-infant interaction and breastfeeding outcome 6 weeks after birth.

OBJECTIVE: This study explored the relationship of early postpartum maternal-infant interactions to breastfeeding outcome at 6 weeks postpartum. DESIGN: Prospective, comparative descriptive study. SETTING: Women, Infants, and Children Supplemental Nutrition Program and Comprehensive Perinatal Services Programs in northern California. PARTICIPANTS: Forty-two Latina participants were recruited in the 3rd trimester of pregnancy. Eligibility criteria included age 18 years or older, primiparous at recruitment, antepartum desire to breastfeed 8 weeks or longer postpartum, planned hospital birth, full-term vaginal birth of a healthy newborn, and an uncomplicated, immediate postpartum course for mother and newborn, including being discharged together. MAIN OUTCOME MEASURES: The study examined breastfeeding dyads' early postpartum scores on Barnard's Nursing Child Assessment Feeding Scale (NCAFS) in relation to breastfeeding outcome 6 weeks postpartum. NCAFS tests were performed 28-90 hours postpartum in the participants' homes, and breastfeeding status was assessed by phone contact 6 weeks postpartum. RESULTS: Dyads continuing to breastfeed at 6 weeks postpartum had significantly higher early postpartum NCAFS scores than did dyads who had weaned from the breast by 6 weeks postpartum. CONCLUSIONS: Optimal maternal-infant interactions, as evidenced by higher scores on Barnard's NCAFS, were related to longer breastfeeding duration. Lower scores on the NCAFS, suggesting difficulties in maternal-infant interaction, were related to weaning earlier than planned.

The myelotoxicity of chloramphenicol: in vitro and in vivo studies: II: In vivo myelotoxicity in the B6C3F1 mouse.

1. Chloramphenicol continues to be widely used in many parts of the world despite its known haematotoxicity. Until now, elucidation of the mechanisms involved and any attempt at amelioration of the toxic effects have been hampered by the lack of an animal model. 2. In this study neither acute nor chronic administration of chloramphenicol as its succinate ester in the drinking water produced anaemia in mice as assessed by changes in peripheral blood parameters. 3. Chloramphenicol could not be detected in the bone marrow when the antibiotic was administered either in the drinking water or by gavage, although it was detected in the serum. 4. In marrow taken from mice after chloramphenicol succinate administration and cultured in vitro, depression of the differentiation of immature committed erythroid progenitors occurred 15 min after administration of the antibiotic by gavage. However, recovery was beginning to occur at 48 h after administration of chloramphenicol succinate at 50 and 200 mg/kg and this was then followed by an 'overshoot' response at the higher dose. A toxic effect was therefore achieved in the bone marrow but this was probably masked in the peripheral blood by enhanced proliferation. 5. Morphological evidence of apoptosis was seen in erythroid and myeloid precursors in mice treated with 200 mg/kg. 6. The data suggest that the effect of chloramphenicol was at the differentiation stage of the committed marrow progenitor cells rather than at the replication stage of the stem cells and therefore this response appears to mimic the reversible bone marrow depression seen in the treated patient.

The relationship between shoe size and mode of delivery.

This study investigates whether a woman with a small shoe size has a higher chance of being delivered by cesarean section. Data on shoe size and mode of delivery were collected by chart review and telephone survey from clients of a freestanding birth center. Purposive sampling was done to include all women transferred and delivered by cesarean section for CPD or FTP, and an equivalent number of women who had a normal spontaneous vaginal delivery. Data on twenty two first time mothers who were delivered by cesarean section and twenty three who delivered vaginally were compared. This study did not find any relationship between small shoe size and cesarean section delivery.

Assessing drug use in the workplace: a comparison of self-report, urinalysis, and hair analysis.

A random sample of 1,200 employees of a steel plant in the western United States was randomly assigned to four different self-report methods of assessing illicit drug use: individual interview in the workplace, group-administered questionnaire in the workplace, telephone interview, and individual interview off the worksite. Urine specimens were collected and analyzed on all 928 subjects participating in the study, and hair analysis was conducted on 307 of the subjects. Although self-reports produced higher prevalence rates than the chemical tests, analyses combining the results of the three assessment methods showed that the actual prevalence rate was approximately 50 percent higher than the estimate produced by self-reports alone. The group-administered questionnaire method produced prevalence rates that were roughly half those of the other self-report methods. The findings cast doubt on the validity of self-reports as means of estimating drug use prevalence and suggest the need for multiple assessment methods.

Iron pre-load for major joint replacement.

Patients undergoing total hip or knee replacement frequently receive blood transfusion. Homologous blood transfusion carries appreciable risks and should therefore be reduced to a minimum. We have investigated the use of preoperative oral iron supplements to optimize haemoglobin concentration and iron stores prior to surgery. All patients attending a preadmission clinic 4 weeks prior to primary hip or knee replacement had a haemoglobin measurement. If the haemoglobin concentration (Hb) was less than 12 g dL-1 they were given a four week course of ferrous sulphate. If it was greater than or equal to 12 g dL-1 they were randomized to a control group or given a supplementation course of ferrous sulphate. One hundred patients were seen. Of these 18 (18%) had haemoglobin less than 12 g dL-1 and 16 were treated with iron. The mean Hb was 10.8 g dL-1 and mean cell volume (MCV) 86. These patients increased their Hb by a mean 1.1 g dL-1 prior to admission (P = 0.008). MCV was the best predictor of response (r = -0.63, P < 0.02). This group dropped their haemoglobin by a mean 1.4 g dL-1 in the first post-operative week. In the study groups there was no significant preoperative rise in Hb. However, the control group dropped their Hb by a mean 1.3 g dL-1 in the week following surgery compared with 0.4 g dL-1 in the group which had received iron supplements (P < 0.001). We conclude that at least 18% of patients attending for hip or knee replacement in this region are frankly anaemic and benefit significantly from preoperative iron supplements over 4 weeks. Iron supplementation in patients without obvious anaemia protects against a fall in Hb during the immediate post-operative period, suggesting a widespread underlying depletion of iron stores in this group despite a normal Hb. Preoperative iron supplements may reduce transfusion requirements as part of a co-ordinated strategy in this group of patients.

Women for women's health: Uganda.

The primary health care model targets social, political, and economic environments as key determinants of health for populations, as well as for individuals. If nursing in Uganda is to make a difference in health care outcomes and in the health of all Ugandans, nurses must look broadly at situations and be educated to practice primary health care nursing. After 14 years of civil war, Uganda is finally experiencing a period of reconstruction and rehabilitation: the whole infrastructure is undergoing a face-lift. Ugandan nurses recognize that their educational preparation has stagnated for many years and that it was not only the political unrest in their country that put them behind professionally. They realize that, given the new directions set by the government, they must become prepared to implement primary health care. They are demanding a university education so they may take their place alongside other health care providers prepared at the university level. Some of the most convincing arguments for a university program for nurses came from doctors at the university who spoke about the need to raise the standards of nursing practice, the quality of teachers, and the morale of practitioners. One nurse said: "If we lose hope for a BScN program, I think all the nurses will quit and we won't have any new students going into the profession." This program is designed to improve the health and well-being of all Ugandans, especially the most vulnerable groups of women and children in rural areas, through strengthening and expanding health services by targeting the educational preparation of nurses. Health planners in Uganda envision the professional nurse as key to the implementation of the national health policy of primary health care. University-educated nurses should be able to assess problems, make clinically sound decisions, and act appropriately within the scope of nursing practice. They should be able to interact and consult collegially with other health care professionals. Placed in rural community sites, nurses should function independently as community leaders, health education facilitators, primary health care practitioners, and educators for nursing students. Such intervention in community health care by BScN nurses should improve health care utilization and decrease mortality and morbidity from preventable causes. BScN nurses should make an impact on health care policy, nursing education, and primary health care. The evaluation of this project needs to be as comprehensive as its development and implementation. It will focus on health outcomes, particularly for women and children in rural areas of Uganda. Measurement of the effects of the process of nursing education (the BScN curriculum) in terms of output (nurses educated and placed in rural practice, nursing education, or government policy posts), outcomes (change in health status of rural communities), and broader impacts (changes in the status of women and in government policy toward women, nurses, or health at the local, regional, and national levels) is planned. An element of sustainability is present, as an operations research structure will be left in place at the community level. Timing, as the saying goes, is everything, and this project has had good timing. Our belief in the efforts and the goals of the project also gave us the strength to get support from various funding agencies for "small" things. For example, we got support from churches in the United States for building schools in Uganda; we persisted with the women's income-generating project when other support was pulled; we got books for the library in Uganda and got clothes, books, and furnishings for the students who came to this country. The motivation for project personnel has been altruism. The services that the two consultants provided to their Ugandan colleagues have extended far beyond the scope of the project.

PIP: Ugandan health planners view the professional nurse as key to the implementation of the national primary health care strategy. In rural community sites, nurses should function independently as community leaders, health education facilitators, primary health care practitioners, and educators for nursing students. Reported in this paper is a collaboration of primary health care nurses, health planners and multiple communities in Uganda, and the Case Western Reserve University (US) School of Nursing. It was recognized that improvements in the formal education of nurses and increases in the number of primary health care nurses with midwifery training held potential for reducing infant and maternal morbidity and mortality in rural areas. Although there are several non-degree training programs, Uganda has no formal nursing education or standardized curriculum. This jeopardizes the status of nursing as a profession and results in uneven clinical capacities. A joint project, initiated in 1990, has the following five-year objectives: a bachelor of science nursing program reflecting a primary health care orientation, prepared nurse educators to implement the program, and establishment of primary health care nursing demonstration sites with a community-based teaching facility at each site.