Among terrestrial environments, forests are not only the largest long-term sink of atmospheric carbon (C), but are also susceptible to global change themselves, with potential consequences including alterations of C cycles and potential C emission. To inform global change risk assessment of forest C across large spatial/temporal scales, this study constructed and evaluated a basic risk framework which combined the magnitude of C stocks and their associated probability of stock change in the context of global change across the US. For the purposes of this analysis, forest C was divided into five pools, two live (aboveground and belowground biomass) and three dead (dead wood, soil organic matter, and forest floor) with a risk framework parameterized using the USs national greenhouse gas inventory and associated forest inventory data across current and projected future Köppen-Geiger climate zones (A1F1 scenario). Results suggest that an initial forest C risk matrix may be constructed to focus attention on short- and long-term risks to forest C stocks (as opposed to implementation in decision making) using inventory-based estimates of total stocks and associated estimates of variability (i.e., coefficient of variation) among climate zones. The empirical parameterization of such a risk matrix highlighted numerous knowledge gaps: 1) robust measures of the likelihood of forest C stock change under climate change scenarios, 2) projections of forest C stocks given unforeseen socioeconomic conditions (i.e., land-use change), and 3) appropriate social responses to global change events for which there is no contemporary climate/disturbance analog (e.g., severe droughts in the Lake States). Coupling these current technical/social limits of developing a risk matrix to the biological processes of forest ecosystems (i.e., disturbance events and interaction among diverse forest C pools, potential positive feedbacks, and forest resiliency/recovery) suggests an operational forest C risk matrix remains elusive.
We report a unique pediatric case of hypergranular acute myeloid leukemia with myelodysplasia-related changes. The patient presented with moderate leukocytosis with neutrophilia with left-shift maturation and dysplasia, anemia, and multiple sclerotic bone lesions. The bone marrow was hypercellular with a predominance of myeloblast cells and/or abnormal promyelocytes with hypergranular cytoplasm. Flow cytometric immunophenotyping showed that the leukemic cells were positive for CD13, CD33, and myeloperoxidase, and negative for HLA-DR and CD34. Morphology and immunophenotyping were highly suggestive of acute promyelocytic leukemia. The classic t(15;17) or other RAR? rearrangements were not detected by cytogenetic or molecular assays, ruling out acute promyelocytic leukemia. Standard cytogenetic analysis showed that the karyotype of the predominant clone was 47,XY,+6 with evidence of clonal evolution to 47,XY,+6,del(5)(q22q33). A literature and database review showed that trisomy 6 is a rare occurrence in hematological malignancies and, to our knowledge, has never been reported in association with del(5)(q22q33) in a child presenting with hypergranular acute myeloid leukemia with myelodysplasia-related changes. We present a current review of the literature and summarize the clinical features of 57 cases of trisomy 6 as the primary chromosomal abnormality in hematological disease.
Gerontological nurses who have received education and have experience in conducting systematic reviews may assume a key role in interpreting systematic reviews for policy makers. Systematic reviews offer evidence to determine the best policy and program solutions to a problem. To be successful in translating evidence from systematic reviews, gerontological nurses need to (a) understand the steps of the policy making process and where different kinds of reviews may be used, (b) assess the "technical" literacy and level of interest in gerontological issues of the intended policy maker, and (c) develop and practice skills in policy writing that distill information in policy briefs as well as shorter formats. Gerontological nurses can be powerful advocates for older adults using the systematic review of the literature as an instrument to educate policy makers.
Human health, an enigma that has been a part of human existence from its origins, is founded on the intake of food. Holistic health is concerned with issues of the body, soul/mind, and spirit. Using concepts from ecology, this article explores the relationships between food, nutrients, whole food diets, and health. An analysis of studies linking whole food to health and depressive disorders are presented in an attempt to move food and diets into mainstream mental health discussions. The purpose of this article is to demonstrate that real food matters for the health of all and is of vital consequence for improving the chronic conditions plaguing modern societys mental health.
In Asian families, where patriarchal family systems are common, living arrangements of older adults are characterized by residing with a married son. This study examines the synergic effects of intergenerational solidarity (emotional and instrumental support exchange and anticipated support) on depression of older adults from a developing country, Nepal. Gender differences are also explored in the study. This was a cross-sectional face-to-face interview study of 489 community dwelling older adults living in an urban area of Nepal. The data were analyzed using multiple regression models with each dimension of intergenerational solidarity and conflict variables entered one-by-one with the confounding variables. The results illustrate that older women receiving lower emotional and instrumental support were significantly more likely to be depressed compared to older men receiving less support from their son. Also, women reporting lower anticipated support and higher conflict with their son were more likely to be depressed than men. Regarding synergic effects, emotional support exchange buffered against the deleterious effects of conflict with depression in older adults. The results highlight a need for further research on late life intergenerational relationships (IR) and mental health of older adults in developing countries so that it can be useful for health care practitioners.
The nursing shortage presents a challenge for both nursing education programs and clinical agencies to identify creative options for increasing the supply of nurse educators, especially those who can teach vital clinical skills to future nurses. Some clinicians have voiced that they would enjoy having opportunities to share their clinical expertise through teaching, but they lack preparation for this new role. Through written narratives of nurses enrolled in a Clinical Nurse Educator Academy, this study explored the research question: How can narratives of clinicians participating in a Clinical Nurse Educator Academy enhance understanding of the unique perspectives of these individuals as they prepare for roles as clinical nurse educators? Data consisted of 135 reflective narratives from 45 participants and were analyzed using van Manens approach to human science research. One overarching pattern, "The Phenomenon of Learning to Teach:" and three themes,"Buckle Your Seatbelt," "Embracing the Novice," and "Mentoring in the Dark," emerged from the data. Implications for faculty and further research are offered.
Due to the aging population in the United States, there will be a need for a larger workforce that is prepared to provide care to an older adult population. The Institute of Medicine has noted challenges related to the preparation of a geriatric workforce due to lack of faculty, inconsistent curricula, and few training opportunities, and has made recommendations to increase the geriatric workforce. In this article, several policy initiatives are discussed that address the shortage of health professionals prepared to care for older adults. Initiatives by professional nursing organizations to improve the gerontological nursing workforce are also reviewed.
This study articulates womens lifeworld experience of unexplained and unexpected fatigue. Interpretive phenomenology situated within the perspective of Maurice Merleau-Ponty provides the study framework. Using purposive sampling, the study investigated the unexplained fatigue of 12 women in a southeastern state. Data analysis of interviews revealed a lost voice within the phenomenon of fatigue, providing new insights into this diffuse and dehumanizing experience. Ethical considerations are addressed for recognizing, hearing, and caring for women living with disabling fatigue to extend the goals of Healthy People 2010 by addressing new ethical priorities for quality of life over the next decade.
The systematic review of the literature is a valuable tool for gerontological nurses to influence policy decisions. There are several organizations that provide helpful guidelines for the conduct of systematic reviews of the literature, including the Cochrane Collaboration, the Joanna Briggs Institute, and the Evidence for Policy and Practice Information Co-Ordinating Centre at the Institute of Education, University of London. Gerontological nurses who have a strong foundation in research methodology and the skills to synthesize scientific evidence for the purpose of promoting evidence-based policy have the potential to positively influence health care outcomes for older adults. For nurses to assume a leadership role in synthesizing scientific evidence for evidence-based policy development and refinement, nursing education will need to assume a more active role in teaching systematic review methodology. This article presents an overview of resources for con-ducting systematic reviews of the literature and discusses the use of the systematic review as a tool for evidence-based policy.
Nablus mask-like facial syndrome (NMLFS) has many distinctive phenotypic features, particularly tight glistening skin with reduced facial expression, blepharophimosis, telecanthus, bulky nasal tip, abnormal external ear architecture, upswept frontal hairline, and sparse eyebrows. Over the last few years, several individuals with NMLFS have been reported to have a microdeletion of 8q21.3q22.1, demonstrated by microarray analysis. The minimal overlapping region is 93.98-96.22?Mb (hg19). Here we present clinical and microarray data from five singletons and two mother-child pairs who have heterozygous deletions significantly overlapping the region associated with NMLFS. Notably, while one mother and child were said to have mild tightening of facial skin, none of these individuals exhibited reduced facial expression or the classical facial phenotype of NMLFS. These findings indicate that deletion of the 8q21.3q22.1 region is necessary but not sufficient for development of the NMLFS. We discuss possible genetic mechanisms underlying the complex pattern of inheritance for this condition.
The patient-centered medical home (PCMH) is a comprehensive model of care that has the potential for improving primary health care for older adults. Nurse practitioners (NPs) have the potential to make a significant impact in PCMHs and to positively affect patient care outcomes. In particular, NPs with practice doctorates have the leadership skills to effectively lead PCMHs. Policies need further refinement to facilitate the leadership role of NPs within PCMHs.
The authors report a seven-year-old male, designated FR, with severe sensorineural hearing loss. Features include round face, hypertelorism, epicanthal folds, and flat nasal root. Although there were early developmental concerns, all but his speech delay resolved when he was placed in an educational program that accommodated his hearing loss. To investigate genetic causes for his hearing loss, genetic studies were performed.
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