Land management shapes drought responses of dominant soil microbial taxa across grasslands.

Soil microbial communities are dominated by a relatively small number of taxa that may play outsized roles in ecosystem functioning, yet little is known about their capacities to resist and recover from climate extremes such as drought, or how environmental context mediates those responses. Here, we imposed an in situ experimental drought across 30 diverse UK grassland sites with contrasting management intensities and found that: (1) the majority of dominant bacterial (85%) and fungal (89%) taxa exhibit resistant or opportunistic drought strategies, possibly contributing to their ubiquity and dominance across sites; and (2) intensive grassland management decreases the proportion of drought-sensitive and non-resilient dominant bacteria-likely via alleviation of nutrient limitation and pH-related stress under fertilisation and liming-but has the opposite impact on dominant fungi. Our results suggest a potential mechanism by which intensive management promotes bacteria over fungi under drought with implications for soil functioning.

Using chemical, microbial and fluorescence techniques to understand contaminant sources and pathways to wetlands in a conservation site.

Nutrients and faecal contaminants can enter wetland systems in a number of ways, with both biological and potentially human-health implications. In this study we used a combination of inorganic chemistry, dissolved organic matter (DOM) fluorescence and Escherichia coli and total coliform (TC) count techniques to study the sources and multiple pathways of contamination affecting a designated sand dune site of international conservation importance, surrounded by agricultural land. Analysis of stream samples, groundwater and dune slack wetlands revealed multiple input pathways. These included riverbank seepage, runoff events and percolation of nutrients from adjacent pasture into the groundwater, as well as some on-site sources. The combined techniques showed that off-site nutrient inputs into the sand dune system were primarily from fertilisers, revealed by high nitrate concentrations, and relatively low tryptophan-like fulvic-like ratios<0.4Ramanunits (R.U.). The E. coli and TC counts recorded across the site confirm a relatively minor source of bacterial and nutrient inputs from on-site grazers. Attenuation of the nutrient concentrations in streams, in groundwater and in run-off inputs occurs within the site, restoring healthier groundwater nutrient concentrations showing that contaminant filtration by the sand dunes provides a valuable ecosystem service. However, previous studies show that this input of nutrients has a clear adverse ecological impact.

Mature cystic teratoma of both the fallopian tube and contralateral ovary: a case report.

UNLABELLED: Intratubal teratoma is a very rare condition. The authors believe to present the first case of a completely intratubal mature cystic teratoma with a contralateral intraovarian teratoma. Preoperative ultrasound examination allowed the intraoperative diagnosis of this rare condition, hence allowing appropriate surgical management. MATERIALS AND METHODS: A 19-year-old woman presented with a history of pelvic pain and severe dysmenorrhea. Ultrasound examination initially suggested bilateral ovarian dermoids. Upon laparoscopy, the distal left fallopian tube was obstructed and contained an inflammatory mass adhered to the rectosigmoid. The left ovary was entirely normal. A contralateral intraovarian dermoid was also identified. CONCLUSION: Although rare, when an intratubal mass is identified, consideration of intratubal dermoid should be given. Preoperative ultrasound can be of critical importance to the intraoperative diagnosis.

Barriers to effective palliative care of terminal patients. An international perspective.

Barriers to palliative care around the world include: underutilization of and lack of access to opiates; the separation of palliative (hospice) care from the usual health care system in much of the world; cultural barriers to discussing death and dying; and, especially for the developing countries, financial barriers to good palliative care. Palliative care education for health care providers, pain initiatives as well as flexibility and adaptation of palliative care principles to local resources may help overcome these barriers.

Biomedical and behavioral research in nursing homes: guidelines for ethical investigations.

As nursing homes become increasingly important sites for biomedical and behavioral research, researchers must address the ethical problems of increased vulnerability and the high prevalence of mental and physical disorders in the nursing home population. Obtaining valid informed consent is but one of the many difficult issues that confronts the investigator in the nursing home. Efforts should be made to involve nursing home residents, as well as family and staff members, in the review of research. The benefits and burdens of research protocols should be equitably distributed, and potential conflicts of interest for staff members and physicians should be minimized or their potential adverse impact ameliorated. Appropriate attention to these ethical concerns may facilitate nursing home research while still safeguarding vulnerable residents. We offer proposed guidelines for the ethical conduct of research in nursing homes in an effort to stimulate discussion among investigators, nursing home staff and residents, residents' families, and ethicists.

Home hospice care.

Home hospice care, which helps patients with terminal illnesses remain at home, is becoming more common and accepted in the United States. The Medicare hospice benefit reimburses hospices for the care of elderly patients. The goal of hospices is to help the patient and family remain in control of the dying process as much as possible. Palliative care rather than the extension of life is emphasized. Hospice techniques for controlling symptoms such as pain, nausea, and vomiting are discussed in this article.

Clinical management of the terminally ill.

Physicians who provide primary care for the elderly are spending more time caring for terminally ill patients. Although curing these patients' illnesses is impossible, it is often possible to improve their quality of life and give them more control over their illness. Communication with the patient and family members, advance directives, and planning for death are important. Symptoms such as pain, dyspnea, and nausea can usually be controlled. Other health care professionals and hospice care when appropriate can also be helpful.

Hospice care in America.

Hospice care, an appropriate way of caring for many terminally ill patients, now is reimbursed by Medicare and other insurance systems. However, access to hospice care is limited by unavailability, ignorance, Medicare regulations, and internally imposed restrictions. Reasons for the barriers to hospice care and other appropriate terminal care are discussed, together with potential actions that might improve care for dying patients.

KIE: The medical director of a hospice reviews the state of hospice care in the United States. Rhymes outlines the history and philosophy of the modern hospice movement and summarizes the findings of recent studies comparing the efficacy and costs of hospice care with those of conventional care of the dying. She identifies and discusses barriers to hospice care, which currently is available only to a small proportion of terminally ill patients in the United States. Rhymes concludes with suggestions of changes that could renew and expand the role of hospices and lead to more humane care for the dying.

Nonmedical complications of diagnostic workup for dementia [clinic conference].

Testing for patients presenting with dementias can lead to diagnosis of disorders that can contribute to cognitive dysfunction, and to improvement, stabilization, or slowed deterioration in some demented patients. However, possible benefits must be balanced against possible costs. The present recommendations for workup of patients with dementia includes some tests with only marginal benefits, and a more limited workup may be as effective. This case demonstrates how important it is to be sensitive as well to possible effects on family relationships of demented patients. When we evaluate and treat demented patients, the dependence of the demented patient on the caregiver and the emotional and physical stresses experienced by many caregivers make it important to consider the patient and caregiver as a system vulnerable to many potential risks.

Falls. Prevention and management in the institutional setting.

Falls are more common among nursing home than community dwelling elderly and more often result in serious injury among the nursing home population. This article reviews the epidemiology of falls in the long-term care setting, identifies risk factors associated with falling in the nursing home, and discusses possible interventions for those at high risk of falling.