Organic nitrate chemistry and its implications for nitrogen budgets in an isoprene- and monoterpene-rich atmosphere: constraints from aircraft (SEAC4RS) and ground-based (SOAS) observations in the Southeast US.

Formation of organic nitrates (RONO2) during oxidation of biogenic volatile organic compounds (BVOCs: isoprene, monoterpenes) is a significant loss pathway for atmospheric nitrogen oxide radicals (NOx), but the chemistry of RONO2 formation and degradation remains uncertain. Here we implement a new BVOC oxidation mechanism (including updated isoprene chemistry, new monoterpene chemistry, and particle uptake of RONO2) in the GEOS-Chem global chemical transport model with ∼25 × 25 km2 resolution over North America. We evaluate the model using aircraft (SEAC4RS) and ground-based (SOAS) observations of NOx, BVOCs, and RONO2 from the Southeast US in summer 2013. The updated simulation successfully reproduces the concentrations of individual gas- and particle-phase RONO2 species measured during the campaigns. Gas-phase isoprene nitrates account for 25-50% of observed RONO2 in surface air, and we find that another 10% is contributed by gas-phase monoterpene nitrates. Observations in the free troposphere show an important contribution from long-lived nitrates derived from anthropogenic VOCs. During both campaigns, at least 10% of observed boundary layer RONO2 were in the particle phase. We find that aerosol uptake followed by hydrolysis to HNO3 accounts for 60% of simulated gas-phase RONO2 loss in the boundary layer. Other losses are 20% by photolysis to recycle NOx and 15% by dry deposition. RONO2 production accounts for 20% of the net regional NOx sink in the Southeast US in summer, limited by the spatial segregation between BVOC and NOx emissions. This segregation implies that RONO2 production will remain a minor sink for NOx in the Southeast US in the future even as NOx emissions continue to decline.

Evidence for NO(x) control over nighttime SOA formation.

Laboratory studies have established a number of chemical pathways by which nitrogen oxides (NO(x)) affect atmospheric organic aerosol (OA) production. However, these effects have not been directly observed in ambient OA. We report measurements of particulate organic nitrates in Bakersfield, California, the nighttime formation of which increases with NO(x) and is suppressed by high concentrations of organic molecules that rapidly react with nitrate radical (NO(3))--evidence that multigenerational chemistry is responsible for organic nitrate aerosol production. This class of molecules represents about a third of the nighttime increase in OA, suggesting that most nighttime secondary OA is due to the NO(3) product of anthropogenic NO(x) emissions. Consequently, reductions in NO(x) emissions should reduce the concentration of organic aerosol in Bakersfield and the surrounding region.

Photochemical production and release of gaseous NO2 from nitrate-doped water ice.

Temperature-programmed NO2 emissions from frozen aqueous NaNO3 solutions irradiated at 313 nm were monitored as function of nitrate concentration and heating rate, H, above -30 degrees C. Emissions increase nonmonotonically with temperature, displaying transitions suggestive of underlying metamorphic transformations. Thus, NO2 emissions surge at ca. -8 degrees C in frozen [NO3-] > 200 microM samples warmed at H = 0.70 degrees C min(-1) under continuous irradiation, and also in the dark from samples that had been photolyzed at -30 degrees C. The amounts of NO2 released in individual thermograms, SigmaN, increase less than linearly with [NO3-] or the duration of experiments, revealing the significant loss of photogenerated NO2. The actual SigmaN proportional, variant [NO3-]1/2 dependence (at constant H) is consistent with NO2 hydrolysis: 2NO2 + H2O --> NO3- + NO2- + 2H+, overtaking NO2 desorption, even below the eutectic point (-18 degrees C for aqueous NaNO3). The increasingly larger NO2 losses detected in longer experiments (at constant [NO3-]) are ascribed to secondary photolysis of trapped NO2. The relevance of present results to the interpretation of polar NO2 measurements is briefly analyzed.

The CISQ: a tool to measure staff involvement in and attitudes toward the implementation of a clinical information system.

The Clinical Information System Questionnaire (CISQ-15) is a new 15-item tool designed to measure staff involvement in and attitudes towards CIS implementations. It was developed during a clinical trial which tested the effects of a combined managerial and IT intervention on staff attitudes and patient outcomes. The CISQ-15 appears to have high construct validity and internal consistency, although further studies are needed. Such studies are under way, and an expanded 36-item version, the CISQ-36, is now being evaluated.

A comparison of traditional approaches to hierarchical linear modeling when analyzing longitudinal data.

Longitudinal designs typically involve repeated time-ordered observations for each individual (or unit). Such designs are uniquely suited to studying changes over time within individuals, and relating these to individual characteristics to identify processes and causes of intra- individual changes and interindividual differences in physiologic and psychological development. The purpose of this paper is to compare and contrast univariate and multivariate ANOVA with repeated measures to hierarchical linear modeling as approaches to analyzing such longitudinal data. This will enable researchers to choose the approach that best meets their research needs, and it will enable them to compare research results that are reported using one analytical approach with results that are reported using the other approach.

Effect of infusing fat emulsion into extracorporeal membrane oxygenation circuits.

Our objectives were to identify problems associated with the administration of fat emulsion by extracorporeal membrane oxygenation (ECMO) circuits, and gather information from other institutions on standards of practice and the complications associated with infusion of fat emulsion by ECMO to infants and children. In vitro analysis was performed using six circuits. Fat emulsion was infused into a prereservoir port at 3 ml/hour. Circuits and blood samples collected distal to the oxygenator were inspected visually for layering (separation of fat emulsion from blood), agglutination, and phase separation (formation of an oil layer) at 0.5, 1, 2, 4, 6, 12, and 24 hours. At 24 hours, samples were reevaluated and circuits dissected. All circuits showed layering and agglutination. Blood clots were present in five circuits during the simulation. There was no evidence of phase separation in the samples. Adhesion of emulsion to the equipment was present in all circuits. Five of the membrane oxygenators contained clots. One contained long strands of fat; separation of its mesh revealed an oily residue indicating disruption of the stability of the emulsion. Survey responses from 54 centers found that 78% used fat emulsion routinely in neonatal or pediatric patients receiving ECMO. Most used both ECMO and separate venous access for the infusion, depending on availability. Twenty-two (52%) of the 42 centers using fat emulsion had a policy in place regarding site selection. Of those, 73% preferred central venous access, another 18% used a prereservoir port of the ECMO circuit. The most frequently reported problems with administration through the circuit were cracking of stopcocks, clogging and malfunction of the membrane oxygenator, agglutination of the emulsion, and increase in blood clot formation. Our results suggest that fat emulsion should be infused through a separate intravenous site whenever possible. Based on these results and current practices of most ECMO centers, a clinical trial is currently being conducted to provide additional information.

Development of a tool to measure therapeutic factors in group process.

A tool, the Therapeutic Group Interaction Factors Scale (TGIF), was developed for systematically and objectively measuring the extent to which therapeutic factors defined by Yalom are present or absent in group process. Preliminary findings suggest that the TGIF is relatively easy to learn and use by coders who are familiar with Yalom's work. Once this tool has been further developed and tested, it will permit nurses and other therapists who lead/facilitate therapeutic groups to study the relationship between Yalom's factors and therapeutic outcomes objectively, rather than by asking patients to evaluate the contribution of each factor subjectively.

Neonatal nurses' knowledge of and attitudes toward caring for cocaine-exposed infants and their mothers.

The knowledge, attitudes, and backgrounds of 215 nurses employed in the nurseries of six hospitals were studied by means of a questionnaire survey. The nurses' attitudes toward the mothers of cocaine-addicted infants were found to be generally negative and/or judgmental and their knowledge to be low. More experience with nursing cocaine-addicted infants and greater acuity of the neonatal unit in which the nurse worked correlated with more positive attitudes toward the infants but not toward their mothers. Knowledge and attitude correlated positively with formal education, inservice education, and self-education, but the correlations were weak.

Physical Chemistry of the H2SO4/HNO3/H2O System: Implications for Polar Stratospheric Clouds.

Polar stratospheric clouds (PSCs) play a key role in stratospheric ozone depletion. Surface-catalyzed reactions on PSC particles generate chlorine compounds that photolyze readily to yield chlorine radicals, which in turn destroy ozone very efficiently. The most prevalent PSCs form at temperatures several degrees above the ice frost point and are believed to consist of HNO(3) hydrates; however, their formation mechanism is unclear. Results of laboratory experiments are presented which indicate that the background stratospheric H(2)SO(4)/H(2)O aerosols provide an essential link in this mechanism: These liquid aerosols absorb significant amounts of HNO(3) vapor, leading most likely to the crystallization of nitric acid trihydrate (NAT). The frozen particles then grow to form PSCs by condensation of additional amounts of HNO(3) and H(2)O vapor. Furthermore, reaction probability measurements reveal that the chlorine radical precursors are formed readily at polar stratospheric temperatures not just on NAT and ice crystals, but also on liquid H(2)SO(4) solutions and on solid H(2)SO(4) hydrates. These results imply that the chlorine activation efficiency of the aerosol particles increases rapidly as the temperature approaches the ice frost point regardless of the phase or composition of the particles.

Home safety & older adults.

Home care workers are in a prime position to identify personal and environmental risk factors for seniors living at home. This article identifies many of these risks and offers a logical approach to alleviating some of them.

Biofeedback-assisted relaxation to reduce stress in labor.

OBJECTIVE: To test the feasibility and effectiveness of incorporating biofeedback-assisted relaxation techniques into routine instruction in Lamaze classes. DESIGN: A quasi-experimental design (static groups comparison) was used. SETTING: Lamaze classes. PARTICIPANTS: A convenience sample of 33 subjects recruited from 12 Lamaze classes. MEASURES: Duration of first-stage labor, amount of sedation and analgesia during first-stage labor, number of complications, and 1- and 5-minute Apgar scores of the neonates. RESULTS: The experimental subjects reported greater stress during labor than did the control subjects. CONCLUSIONS: Although the supplementary instruction in reducing stress seemed to promote relaxation during the prenatal classes, it did not reduce distress during labor and delivery because no mothers attempted to use the technique at that time.

Psychosocial outcome six months after heart transplant surgery: a preliminary report.

With improvement in survival of patients treated with heart transplant, evaluation of recovery with respect to psychosocial function has become an important issue. In this study, psychosocial functioning of 44 heart transplant recipients pretransplant was compared to their functioning 6 months posttransplant. Before transplantation, patients experienced considerable psychosocial distress attributable to illness. At 6 months after transplantation, the majority of patients showed significant improvement in emotional, domestic, sexual, social, and vocational functioning. However, 25% of patients showed deterioration in psychosocial adjustment and 11% showed an increase in mood disturbance. Further effort is indicated to improve psychosocial outcome of heart transplantation.

Dignity--the cornerstone of care.

At the Alzheimer's Day Center in Columbia, South Carolina, staff, families, and volunteers comprise the A-team. The team offers persons with Alzheimer's disease a homelike environment full of laughter and love, while providing respite for family caregivers.

Early sibling attachment.

A sample of 30 predominantly three- and four-year-old siblings were videotaped during their first meeting with a new sibling at the time of the mother's discharge from the hospital. The first five minutes of interaction were divided into 20, 15-second intervals, and each interval was coded for the presence or absence of 28 behaviors believed to be related to the early attachment process. The exploration behaviors of siblings showed considerable uniformity. The sibling's age, sex, or participation in sibling preparation classes produced no marked differences in behavior. Recommendations are made for further research.

Short-term memory for pictures and words by mentally retarded and nonretarded persons.

Mentally retarded and nonretarded persons were compared in a Brown-Peterson short-term memory task for the retention of words and pictures over intervals up to 30 seconds. The retarded subjects forgot more rapidly over the initial 10 seconds. They also retained pictures better than they did words; the nonretarded subjects retained these stimuli equally well. The results were theoretically interpreted as reflecting a structural memory deficit in retarded individuals, who were viewed as having greater facility with an imaginal memory code than with a verbal code. Transforming information from one code to another may also have been more difficult for retarded persons.

Structural memory deficits of mentally retarded persons.

Short-term memory of mentally retarded and nonretarded persons was compared in four experiments on the Brown-Peterson task in an attempt to relate short-term memory deficit to control or structural processes. Type of stimulus, pictures and letters, was varied along with encoding time. On pictures, with liberal encoding time, rate of forgetting did not differ. Retarded groups forgot letters more rapidly after limited encoding time. Increases in encoding time improved retention for retarded persons, but this variable did not normalize forgetting rate. In a direct comparison, retarded persons retained pictures better than letters. The converse was true for nonretarded persons. Evidence for both encoding and storage deficiencies of retarded persons was found. Differences in memory were found under conditions that precluded the use of voluntary cognitive strategies. These differences were interpreted as evidence for structural memory deficits of retarded persons.

Validation of two experimental nursing approaches using content analysis.

The purpose of this study was to analyze and compare the recorded content of two experimental nursing interventions used in a hypertensive-education program. One intervention was characterized as deliberative or high indirect, the other as task-centered or low indirect. A total of 4,149 nurse-patient interaction units was derived from 62 typed interview transcripts, equally representative of both approaches. Two trained coders categorized the interactions, based upon recurring themes of the teaching content; 24 distinct topical categories were identified. Intercoder agreement above chance for all 4,149 interaction units was k = .68, with confidence limits of 99% +/- .03, p less than .0001. A space-time unit for quantifying the relative amounts of time spent on the various categories also was developed, and analyses were conducted for space-time units as well as interaction units. The main findings showed no definable differences in the frequency of categories or the amounts of time spent in their discussion in the two approaches. These results were contrasted to results obtained when the validity of the nursing approaches was tested previously, and differences between the two interventions in attaining social and health goals were interpreted in light of the findings of the content analysis.

Factors influencing knowledge, attitudes, and compliance of hypertensive patients.

Using a factorial design, four aspects of an educational program for 160 hypertensive patients were manipulated: number of meetings, patient responsibility and participation, directiveness of the intervention, and emphasis on negative consequences of uncontrolled hypertension. Validity checks on the manipulations included content analysis of the nurse-patient interaction and interview-based measures of the patient's responsibility, participation, and awareness of dangers. Outcome variables included repeated measures of patient knowledge, assessment by the nurse of patient attainment of identified goals, and reduction of the patient's mean arterial blood pressure. High indirect interventions tended to lead to higher goal attainment, particularly in the psychosocial area. Emphasis on negative consequences tended to promote learning for patients with long standing diagnoses, but to retard learning for recently diagnosed patients. Additional meetings and emphasis on patient responsibility were not helpful alone, but in combination they tended to lead to greater learning. Although as a whole, patients in the program tended to reduce their blood pressures, there were no statistically significant main effects or interaction effects of the educational approach variables on blood pressure reduction.