A management framework for phosphorus use on agricultural soils using sorption criteria and soil test P.

The variation in sorption and desorption of phosphorus (P) among soil types is not captured in current agronomic advice for agri-environmentally sustainable use of P. Phosphorus use is typically based on soil test P (STP) and soils are assumed to have the same rate of response to added P, regardless of sorption properties. The development of P sorption categories, coupled with STP information could improve fertiliser decision making, by making it more site specific and soil type specific. A framework for P sorption specific advice is proposed here integrating soil P sorption dynamics with STP for agronomic and environmental management, at farm and catchment scale. Using a national population of agricultural soils, laboratory measurement of Langmuir sorption maximum (Smax50, mg kg-1) and binding energy (k50, l mg-1), were coupled with STP (Morgan P) to derive novel categories for P management advice, specifically addressing the build-up and draw-down phases of P in soils. In addition to measured values, Smax50 and k50 were predicted from MIR spectroscopy and pedotransfer functions and used to allocate soils into these new sorption categories. The allocation of soils into a P management category using predicted values indicated that pedotransfer functions offered greater reliability (90% allocation accuracy using an independent test set), however MIR spectroscopy is faster and less resource intensive (67% allocation accuracy using an independent test set). Phosphorus sorption dynamics should be interpreted alongside soil test P and P Index information so that water quality policy can consider the difference between high and very high STP soils based on sorption information. In the absence of laboratory data on P sorption, soils can be classified into P management classes using predicted values from spectroscopy (rapid and cheap) or pedotransfer functions (greater reliability). Further development of the MIR methodology is recommended along with field validation.

Colorado River flow dwindles as warming-driven loss of reflective snow energizes evaporation.

The sensitivity of river discharge to climate-system warming is highly uncertain, and the processes that govern river discharge are poorly understood, which impedes climate-change adaptation. A prominent exemplar is the Colorado River, where meteorological drought and warming are shrinking a water resource that supports more than 1 trillion dollars of economic activity per year. A Monte Carlo simulation with a radiation-aware hydrologic model resolves the longstanding, wide disparity in sensitivity estimates and reveals the controlling physical processes. We estimate that annual mean discharge has been decreasing by 9.3% per degree Celsius of warming because of increased evapotranspiration, mainly driven by snow loss and a consequent decrease in reflection of solar radiation. Projected precipitation increases likely will not suffice to fully counter the robust, thermodynamically induced drying. Thus, an increasing risk of severe water shortages is expected.

Effective communication in palliative care.

This article focuses on the definitions of communication and an examination of their relationship to palliative care nursing. The underpinning theory is analysed as a means of understanding the communication process. The communication process in nursing is considered in the context of nurse/patient/family communication. While the focus of the article is on palliative care, the principles of communication as outlined also have relevance and applicability to nurses working in a variety of other clinical settings.

Global pattern of trends in streamflow and water availability in a changing climate.

Water availability on the continents is important for human health, economic activity, ecosystem function and geophysical processes. Because the saturation vapour pressure of water in air is highly sensitive to temperature, perturbations in the global water cycle are expected to accompany climate warming. Regional patterns of warming-induced changes in surface hydroclimate are complex and less certain than those in temperature, however, with both regional increases and decreases expected in precipitation and runoff. Here we show that an ensemble of 12 climate models exhibits qualitative and statistically significant skill in simulating observed regional patterns of twentieth-century multidecadal changes in streamflow. These models project 10-40% increases in runoff in eastern equatorial Africa, the La Plata basin and high-latitude North America and Eurasia, and 10-30% decreases in runoff in southern Africa, southern Europe, the Middle East and mid-latitude western North America by the year 2050. Such changes in sustainable water availability would have considerable regional-scale consequences for economies as well as ecosystems.

Increasing risk of great floods in a changing climate.

Radiative effects of anthropogenic changes in atmospheric composition are expected to cause climate changes, in particular an intensification of the global water cycle with a consequent increase in flood risk. But the detection of anthropogenically forced changes in flooding is difficult because of the substantial natural variability; the dependence of streamflow trends on flow regime further complicates the issue. Here we investigate the changes in risk of great floods--that is, floods with discharges exceeding 100-year levels from basins larger than 200,000 km(2)--using both streamflow measurements and numerical simulations of the anthropogenic climate change associated with greenhouse gases and direct radiative effects of sulphate aerosols. We find that the frequency of great floods increased substantially during the twentieth century. The recent emergence of a statistically significant positive trend in risk of great floods is consistent with results from the climate model, and the model suggests that the trend will continue.

Microlissencephaly with cardiac, spinal and urogenital defects.

We describe two children with a brain defect similar to that described as 'microlissencephaly', as defined in Barkovich et aL [(1998) Neuroped 29: 113-119]. Concomitant malformations (cardiac, spinal, urogenital) may represent components of a wider syndrome complex; alternatively, or additionally, there may have been a valproate teratogenic effect. The inheritance is likely to be autosomal recessive, although X-linkage cannot be excluded.

Intussusception associated with bacterial meningitis.

Despite its common association with viral illnesses, intussusception has only rarely been found in the presence of bacterial infections. Two infants are described, both of whom were admitted to hospital with bilious vomiting, drowsiness, and dehydration. Both infants required urgent intravenous volume expansion. Intussusception was confirmed, and reduction was achieved by enema in both cases. Recovery was slow, and one infant developed a seizure. Evidence of meningococcal meningitis was found in both, with septicaemia in one. Neurological outcome is normal to date, and there has been no recurrence of intussusception in either case.

Pregnancy outcome and complications in women with spina bifida.

OBJECTIVE: To describe the antenatal complications, mode of delivery and outcome of pregnancy in women with spina bifida. STUDY DESIGN: Case series of women known to have attended the spina bifida clinic at the Royal Children's Hospital. Medical records, postal questionnaire and telephone interview were utilized to collect data on the effect of pregnancy on the health of women and the effect of spina bifida on pregnancy outcome. RESULTS: Of 207 women born between 1945 and 1975, 23 reported having a pregnancy, and 17 who had completed pregnancies agreed to participate. The 17 women had a total of 29 pregnancies, with 23 pregnancies progressing to births. Fourteen of 17 women had antenatal admissions, with wheelchair-dependent women requiring more-frequent and longer admissions. Recurrent urinary infections in pregnancy occurred in women with a prior history of urinary infections; stomal problems occurred but were not serious; mobility was reduced for two women during pregnancy, with full recovery afterwards; and preexisting pressure sores worsened during pregnancy. Vaginal deliveries occurred in one in five pregnancies of women who were wheelchair dependent and in ten of eighteen pregnancies in independently mobile women, including seven of eight pregnancies of independently mobile women without ileal conduits. Cesarean sections were accompanied by postoperative complications in 10 women. CONCLUSION: Women with spina bifida who become pregnant generally have a positive outcome, with relatively low complication rates.

Family experiences of palliative care in the acute hospital setting.

The study described in this article sought to gain understanding and insights into the lived experience of families who journeyed with their loved one through the palliative phase of illness as inpatients in the acute hospital setting. The study was carried out in a district general hospital which did not have the services of a palliative care team. A descriptive phenomenological approach was used as the researcher wanted the participants to describe their experience of palliative care in the acute hospital setting as they experienced it. This approach is described in detail. A purposive sample of eight family members was interviewed and data were analysed using Colaizzi's (1978) seven stages of data analysis. The results showed that the acute hospital environment had many shortcomings as a place to deliver palliative care and family members were at times left feeling isolated and helpless. The limitations of the study are discussed along with recommendations that could enhance outcomes of care for family members during this difficult period in their loved one's illness.

An audit of subcutaneous syringe drivers in a non-specialist hospital.

The use of syringe drivers as a method of drug delivery to control symptoms in palliative care is a common and accepted practice, but one which has evolved rather than been subject to close multiprofessional scrutiny and guideline formation. There is evidence that adverse incidents may arise as a result of syringe driver use (Medical Devices Agency (MDA), 1998), for example, errors in drug calculations, drug stability, equipment failure (including disconnection) and the wrong rate of infusion. Inadequate user training, poor servicing of equipment and inadequate documentation and record keeping are all thought to be contributing factors (MDA, 1998). In the hospital where this audit was carried out, syringe drivers are used to administer drugs to patients with cancer during the palliative phase of illness. The purpose of this clinical audit was to establish the standard of current practice in wards where syringe drivers were being used. A retrospective study of 13 cases of syringe driver use is presented. The results highlight many areas of unregulated practice with regard to setting up, monitoring and maintenance of syringe drivers. The choice of drugs and doses prescribed, evaluation of treatment responses and review of treatment regimens were also areas of concern. Guidelines for the use of syringe drivers in non-specialist hospitals are put forward.

Care study: providing effective care in palliative nursing.

Currently, nurses are under great pressure to demonstrate effective, evidence-based patient care. In this article a single case study will be used to demonstrate that care can be based on recent research within a palliative care setting to produce effective outcomes. Research-based interventions, which were used to provide care for a patient who will be referred to as Maria, will be discussed and evaluated to illustrate the contribution that evidence-based practice made to her nursing care. Although it is a single case study and the findings cannot be generalized, it is suggested that this article can be used to demonstrate the need for accurate interpretation of assessment data, illustrate the use of research to support nursing interventions in pain management, constipation and skin pressure damage, and show that empirical evidence alone may not be a sufficient basis for care and that moral issues must be taken into account.

Inactivation of antithrombin III in synovial fluid from patients with rheumatoid arthritis.

OBJECTIVE: To investigate the thrombin inhibitory capacity of antithrombin III in the inflamed human joint. METHODS: Thrombin inhibitory capacity was measured, using a kinetic spectophotometric method, in matched plasma and synovial fluid samples of patients with rheumatoid arthritis (n = 22) and osteoarthritis (n = 16), together with normal control plasma samples (n = 13). In the same samples, the concentration of antithrombin III was also determined by the method of radial immunodiffusion. The combination of these measurements allowed the calculation of the specific thrombin inhibitory capacity of these samples. RESULTS: An increased concentration of antithrombin III in rheumatoid compared with osteoarthritic synovial fluid was noted (p < 0.05). However, there was a significant depression in the specific activity of antithrombin III in rheumatoid synovial fluid when compared with matched plasma samples (p < 0.001) or with osteoarthritic synovial fluid (p < 0.05). CONCLUSION: In rheumatoid synovial fluid the thrombin inhibitory capacity of antithrombin III is disproportionately depressed relative to the concentration of antithrombin III, indicating the inactivation of antithrombin III in the rheumatoid joint.

Late knee problems in myelomeningocele.

This study was undertaken to assess the incidence and etiology of knee problems in a long-term follow-up of myelomeningocele patients. Of the 72 community ambulators reviewed, 17 (24%) had significant knee symptoms. A specific gait pattern was identified in symptomatic patients with low lumbar lesions, which may be explained on the basis of hip abductor and calf muscle weakness. These patients have a characteristic gait, which places abnormal stress on the knee, leading to medial and anteromedial rotary instability and eventual degenerative change. It is likely that disability resulting from knee symptoms will be the factor precluding independent ambulation in the patients reviewed in this study.

Characterization of the quaternary structure and conformational properties of the human stem cell inhibitor protein LD78 in solution.

The human LD78 protein (sometimes referred to as human macrophage inflammatory protein-1 alpha) has been shown to protect multipotential hemopoietic stem cells from the effects of cytotoxic agents. Administration of the recombinant stem cell inhibitor molecule LD78 as an adjunct to chemotherapy has potential clinical benefit in reducing or preventing the neutropenia associated with this treatment. At physiological ionic strength, the 8-kDa LD78 molecule exists as soluble, heterogeneous, multimeric complexes of mass ranging from 100 to > 250 kDa. The hydrodynamic and structural properties of LD78 have been determined in various buffer solutions using analytical ultracentrifugation, circular dichroism, and fluorescence spectroscopy. The results demonstrate that defined, homogeneous monomer and tetramer forms of LD78 can be prepared which display distinct conformational properties. The combined use of hydrodynamic and spectroscopic analysis provides an insight into the pathway and molecular mechanics of LD78 self-association.

Arousal responses in babies at risk of sudden infant death syndrome at different postnatal ages.

Hypercarbic and hypoxic arousal responses during sleep were measured in healthy term infants, infants where a previous sibling died from sudden infant death syndrome (SIDS) and infants suffering a clearly defined apparent life threatening event (ALTE) requiring vigorous or mouth to mouth resuscitation. Groups of infants were tested at approximately one, six and 13 weeks postnatally. Arousal was defined as gross body movement with eyes opening and moving or crying. Hypercarbic arousal was by step increases in F1 Co2 until arousal occurred or until endtidal (PETCO2) reached 8.7 KpA (65 mm Hg) Hypoxic arousal was by step decreases in FIO2 until arousal occurred or until an FIO2 of 0.15 had been maintained for 20 minutes. There was no difference in hypercaribic arousal threshold with age in any group. Hypercarbic arousal threshold was significantly higher in siblings (mean 53.4, 53.6, 54.7 mmHg. [7.12, 7.14, 7.29 KPA] at 0, 6, 13 postnatal weeks) compared to controls (mean 50.9, 52.3, 53.0mm Hg. [6.78, 6.97, 7.29 KPS respectively). ALTE infants differed only at 12 weeks having a significantly lower threshold (51.0mmHg. [6.80 KPA] V 53.0mm Hg. (7.06 KPA]) compared to controls. There was no difference in hypoxic arousal response with age in any group. An arousal response to hypoxia occurred in only 22% of ALTE infants and 40% of siblings compared to 67% of normal infants. Deficient sleep arousal, especially to hypoxia, is common in infants and especially those considered at increased risk from SIDS. This deficiency is present in the first postnatal week and did not vary overy the first three months of postnatal life.

Hypothermia and sudden infant death syndrome.

We recently reported an association between recurrent episodes of severe apnoea requiring vigorous resuscitation for which no cause could be found and episodic hypothermia. Two similar cases are now reported that give further evidence of a link between hypothermia and acute life threatening episodes of apnoea.