A montane Mediterranean climate supports year-round photosynthesis and high forest biomass.

The mid-elevation forest of California's Sierra Nevada poses a bioclimatic paradox. Mid-elevation trees experience a montane Mediterranean climate, with near-freezing winter days and rain-free summers. The asynchrony between warmth and water input suggests low primary production, limited by photosynthetic dormancy in winter cold, and again in summer and early autumn with drought, yet this forest is characterized by tall trees and high biomass. We used eddy covariance in a mid-elevation Sierra stand to understand how winter cold and summer drought limit canopy photosynthesis and production. The trees exhibited canopy photosynthesis year-round. Trees avoided winter dormancy, and daytime CO2uptake continued despite a deep snowpack and near-freezing temperatures. Photosynthesis on sunny days continued at half of maximum rates when air temperature was 0 °C. Likewise, the vegetation avoided summer drought dormancy, and high rates of daytime CO2uptake and transpiration continued despite a 5-month period with only negligible water input. We attribute this drought avoidance to deep rooting and availability of deep soil water. Year-round photosynthesis helps explain the large biomass observed in the Sierra Nevada, and implies adaptive strategies that may contribute to the resiliency or vulnerability of Sierran vegetation to climate change.

High performance teamwork training and systems redesign in outpatient oncology.

BACKGROUND: Oncology care is delivered largely in ambulatory settings by interdisciplinary teams. Treatments are often complex, extended in time, dispersed geographically and vulnerable to teamwork failures. To address this risk, we developed and piloted a team training initiative in the breast cancer programme at a comprehensive cancer centre. METHODS: Based on clinic observations, interviews with key staff and analyses of incident reports, we developed interventions to address four high-risk areas: (1) miscommunication of chemotherapy order changes on the day of treatment; (2) missing orders on treatment days without concurrent physician appointments; (3) poor follow-up with team members about active patient issues; and (4) conflict between providers and staff. The project team developed protocols and agreements to address team members' roles, responsibilities and behaviours. RESULTS: Using a train-the-trainer model, 92% of breast cancer staff completed training. The incidence of missing orders for unlinked visits decreased from 30% to 2% (p<0.001). Patient satisfaction scores regarding coordination of care improved from 93 to 97 (p=0.026). Providers, infusion nurses and support staff reported improvement in efficiency (75%, 86%, 90%), quality (82%, 93%, 93%) and safety (92%, 92%, 90%) of care, and more respectful behaviour (92%, 79%, 83%) and improved relationships among team members (91%, 85%, 92%). Although most clinicians reported a decrease in non-communicated changes, there was insufficient statistical power to detect a difference. CONCLUSIONS: Team training improved communication, task coordination and perceptions of efficiency, quality, safety and interactions among team members as well as patient perception of care coordination.

Rapid shifts in plant distribution with recent climate change.

A change in climate would be expected to shift plant distribution as species expand in newly favorable areas and decline in increasingly hostile locations. We compared surveys of plant cover that were made in 1977 and 2006-2007 along a 2,314-m elevation gradient in Southern California's Santa Rosa Mountains. Southern California's climate warmed at the surface, the precipitation variability increased, and the amount of snow decreased during the 30-year period preceding the second survey. We found that the average elevation of the dominant plant species rose by approximately 65 m between the surveys. This shift cannot be attributed to changes in air pollution or fire frequency and appears to be a consequence of changes in regional climate.

Therapeutic touch, quiet time, and dialogue: perceptions of women with breast cancer.

PURPOSE/OBJECTIVES: To compare the perceptions of women with breast cancer to an experimental therapeutic touch (TT) plus dialogue nursing intervention with perceptions of a control quiet time plus dialogue nursing intervention. DESIGN: Qualitative study based on the Science of Unitary Human Beings. SETTING: Data collected as part of a larger experimental study of the effects of TT on pre- and postoperative anxiety and mood and postoperative pain in women with breast cancer. SAMPLE: 18 women with early-stage breast cancer. METHODS: Telephone interviews at the completion of an experimental or control nursing intervention administered in the women's homes before and after breast cancer surgery. MAIN RESEARCH VARIABLES: Women's perceptions of participation in a study of the effects of dialogue and TT or quiet time. FINDINGS: Content analysis of transcribed telephone interviews revealed few differences in participants' perceptions of experimental and control interventions. Only participants who received the experimental intervention reported body sensations, and only participants in the control group inquired about the study and its purpose. Regardless of experimental or control intervention participation, women expressed feelings of calmness, relaxation, security, and comfort and a sense of awareness. The few women who commented about the nurse who administered the experimental or control intervention indicated that the nurse was empathetic, concerned, supportive, or helpful. CONCLUSIONS: The women regarded either nursing intervention as a positive experience. Some also expressed positive regard for the research nurse. IMPLICATIONS FOR NURSING: Nurses who are not trained in the administration of TT may use quiet time and dialogue to enhance feelings of calmness and relaxation in patients with breast cancer.