bluuebunny/crossref_metadata_2025 huggingface dataset:
Nurses' perceptions of sexuality relating to patient care
Authors: GUTHRIE CAITRIAN
Published: March 2003

• This paper presents a research study which explores the perceptions of nurses regarding sexuality related to patient care.

• A qualitative approach was taken to the research. The methodology used was grounded theory.

• The findings illustrate that nurses had difficulty dealing with issues of sexuality, and the reasons for this were complex and interrelated. Patient care was influenced by nurses' perceptions of sexuality.

• Nurses in the study did not, generally, provide patient care relating to sexuality.

• Nurses were reluctant to discuss sexuality with their patients.

• Stereotyped images of nurses, males and homosexuals were common.

• Nurses dealt with issues of patient sexuality by employing a variety of coping strategies.
Needs of families with a relative in a critical care unit in Hong Kong
Authors: Lee Isabella Y. M. , Chien  , Mackenzie Ann E.
Published: March 2003

• The aim of this study is to explore family members’ perceptions of their immediate needs following admission of a relative to a critical care unit in Hong Kong.

• A convenience sample of 30 family members was drawn from those available during the first 96 hours of hospitalization of their relative.

• Self‐reported questionnaires, consisting of a demographic data sheet, a modified Chinese version of the 45‐item Critical Care Family Needs Inventory (CCFNI) and semistructured interviews, are the instruments used to examine family members’ perceptions of need importance and to ascertain whether or not these needs are met.

• Doctors and nurses are identified as the most suitable people to meet most immediate family needs.

• Conclusions are drawn as to the best focus of nursing interventions in order to provide quality care to patients and families.
Malnutrition in Belgian children with congenital heart disease on admission to hospital
Authors: De Staebel Odette
Published: March 2003

• In paediatrics, body weight and height are two important growth parameters. Moreover, weight for height and height for age are useful tools for evaluation of acute and chronic malnutrition during childhood. The fact that children with congenital heart disease soon deviate from their birth percentiles for weight or height is common knowledge. However, the extent of this deviation in terms of malnutrition is less well documented.

• The aim of this study was to explore the presence and the extent of malnutrition among Belgian children with congenital heart disease on admission to hospital. A retrospective chart review of 300 children (aged 0–18 years) with congenital heart disease was conducted at a large Belgian university hospital.

• Results of this study show an increase in the frequency and severity of acute and chronic malnutrition after birth; more malnutrition in children with multiple heart defects than in those with single heart defects; more chronic malnutrition in children with heart failure, cyanosis or a combination of both and in children with additional non‐cardiac anomalies; and less malnutrition in children who had never had surgery. The prevalence of malnutrition was not influenced by sex, nationality, nor reason for admission.
The nursing care of stroke patients in nursing homes. Nurses’ descriptions and experiences relating to cognition and mood
Authors: Kumlien Suzanne , Axelsson Karin
Published: March 2003

• Registered nurses working in nursing homes often care for stroke patients with impaired cognition and mood disorders. Understanding the behaviour of these patients often puts great demands on nurses.

• This study illuminates registered nurses’ descriptions and experiences of stroke patients and the nursing care given in nursing homes, with a focus on cognition and mood.

• Registered nurses responsible for the care of stroke patients in nursing homes were asked to describe the individual patient’s state of health and the nursing care given. Patients’ cognition and mood have been selected for this article. A qualitative content analysis was used to group the text into categories.

• Registered nurses’ descriptions showed great complexity and variation in patients’ disabilities, as well as uncertainty about understanding these patients and the appropriate nursing care.

• Registered nurses described the need for further education in stroke care, and adequate resources for patient activity training, as well as meeting patients’ psychosocial and communicative needs.
An evaluation of a local clinical supervision scheme for practice nurses
Authors: Cheater Francine M. , Hale Chris
Published: March 2003

•  This paper presents the findings of an evaluation of a local clinical supervision scheme for practice nurses in Leicestershire, UK.

•  A baseline and a follow‐up postal questionnaire were sent to all practice nurses (including supervisors) and general practice senior partners to find out how far the objectives of the local scheme had been met during the first year of implementation. Two focus groups gathered qualitative data about the process of implementation.

•  Twelve months after implementation 12% of practice nurses and over two thirds of GPs reported that they were unaware of the scheme. Forty‐three percent of practice nurses did not know who their local supervisor was; most reported that they would like to have known.

•  Eighteen percent of practice nurses reported uptake of supervision through the local scheme. The benefits of involvement were professional development tailored to individual learning needs and regular opportunities to share work‐related problems with peers; about a third reported benefits for the practice as well.

•  The existing availability of peer support and time needed to undertake clinical supervision were common reasons given for non‐involvement in the scheme. Misconceptions about the purpose of clinical supervision presented further obstacles.

•  At follow‐up over half of the practice nurses remained undecided about their future involvement in the scheme.

•  If the benefits associated with clinical supervision are to be realized, the obstacles that currently hinder practice nurses’ involvement need addressing.
Patterns of Japanese clinical nursing: a historical analysis
Authors: Hisama Kay K.
Published: March 2003

• One of the distinct patterns in the history of modern Japanese nursing during the past 120 years has been the uncritical acceptance of western nursing with little regard given to Japanese culture.

• The purpose of this article is to give a critical analysis of Japanese nursing in order to demonstrate how deeply culture influences nursing.

• I suggest that good communication among doctors and nurses, and among health professionals and patients is the key to the advancement of Japanese nursing.
Nurses’ experiences of research utilization within the framework of an educational programme
Authors: Kajermo Kerstin Nilsson , Nordström Gun , Krusebrant Åsa , Lützén Kim
Published: March 2003

• This paper explores nurses’ reflections on their experiences of disseminating and implementing research findings in clinical practice within the framework of an educational programme.

• Ten registered nurses, all in clinical practice, participated in a research‐orientated educational programme with the aim of facilitating the dissemination and implementation of research findings in clinical practice. Thus, the programme contained different activities designed to disseminate and implement research findings in the participants’ wards.

• Focus groups were used to collect data and a qualitative content analysis was performed. The main themes that were developed were: organizational and leadership issues; acquiring a new role; responses and reactions by others; and orientation to research.

• Organizational and leadership issues, nurses’ interest in research, nurses’ reading habits, and support and feedback from their head nurses and other managers and from their nursing colleagues and physicians were seen as important.

• This study confirms that research utilization and the change to research‐based nursing practice are complex issues which require both organizational and educational efforts.
Diagnostic reasoning processes using patient simulation in different learning environments
Authors: WONG THOMAS K. S , CHUNG JOANNE W. Y
Published: March 2003

• The purpose of the study was to explore the diagnostic reasoning process among nursing students with different learning environments.

• A case‐study design was adopted. Twenty subjects were randomly drawn from the last year of a pre‐registration nursing programme in two institutions, 10 from a university and 10 from a nursing school. They were asked to complete the Bigg's Study Process Questionnaire and identify the differential diagnosis for the three simulated scenarios.

• The results showed no significant difference in study approaches between the two groups. Two subjects from the university made an incorrect differential diagnosis, as did one from the nursing school.

• Subjects from the university showed a mix of horizontal (66.6%) and vertical reasoning patterns (33.4%), while those from the nursing school used horizontal (100%) reasoning patterns.

• The results indicated that all subjects from the nursing school adopted backward chaining strategies (horizontal) for decision‐making, i.e. hypothesis‐driven. About a third of the subjects from the university adopted forward chaining strategies (vertical), i.e. data‐driven.

• The study did not show any particular advantages from either of the two learning environments in terms of study approach. However, it highlighted the variations in decision strategies among students in the university setting.
Barriers to and facilitators of research utilization among Finnish Registered Nurses
Authors: ORANTA OLLI , ROUTASALO PIRKKO , HUPLI MAIJA
Published: March 2003

• The aim of nursing research is to produce a sound foundation for evidence‐based nursing; the job of nurses is to make the best possible use of that foundation and apply the knowledge produced to the practice of nursing.

• The purpose of this study was to identify and describe barriers to and facilitators of research utilization from the point of view of Finnish Registered Nurses.

• The BARRIERS Scale was administered to 316 nurses in two major hospitals; 253 nurses returned the questionnaire, giving a response rate of 80%. The structured data were processed with SPSS 9.0, and the unstructured data were interpreted using the method of content analysis.

• The main barriers to research utilization identified by the respondents were: the fact that most research is published in a foreign language; that physicians will not co‐operate with implementation; and that statistical analyses are difficult to understand. The facilitators mentioned most often were nurses' positive attitudes and abilities. Other important facilitators included the support and activity of a ward sister as well as encouragement, a favourable attitude and collaboration on the part of all staff members.

• The findings are discussed in relation to the Finnish healthcare context and nurse education, and evidence‐based nursing practice.
Interprofessional relations: case studies of working relationships between Registered Nurses and general practitioners in rural Australia
Authors: BLUE IAN , FITZGERALD MARY
Published: March 2003

• Interprofessional working relationships of nurses and doctors have been discussed in the literature but are less frequently the subject of research.

• A review of international research on nurse–doctor professional relationships conducted over 30 years (1966–99) shows that the relationship is of interest predominantly to nurses.

• From a series of interviews with nurses and doctors, as part of a case study of four rural health services, harmonious working relationships between nurses and doctors were examined.

• Further analysis reveals many aspects of nurse–doctor relationships that are traditional and common across many contexts. There are, however, some aspects that are specific to the rural nature of the working context and relate well to contemporary advances in nursing knowledge and confidence.
A proposal that patients be considered honorary members of the healthcare team
Authors: EDWARDS CAROL
Published: March 2003

• Most research on cross‐boundary issues in healthcare focuses on boundaries between groups of healthcare professionals, or between different healthcare settings. This paper considers the boundary between healthcare professionals and their patients, as complementary providers of care to the individual.

• Following major surgery, patients now spend the vast majority of their rehabilitation period in their own homes. This raises questions about where to draw the boundary around a healthcare intervention, and how to allocate and support responsibility for care once the patient is home.

• This paper reports the findings of a study within orthopaedic surgery that followed patients from a few weeks before their surgery to 3 months afterwards, recording their interpretations of their healthcare experiences.

• Most patients were keen to take responsibility for playing their part in trying to optimize the outcome of their surgery, but many were frustrated by lack of information and support to allow them to fulfil this role to their satisfaction.

• Reconceptualization of patients as honorary members of the healthcare team may facilitate the development of a framework within which the potential contribution of patients to their own care could be valued and supported more effectively. This would contribute towards optimizing patient outcomes and increasing patient satisfaction with care.
Refusing analgesics: using continuous improvement to improve pain management on a surgical ward
Authors: Carr Eloise C. J.
Published: March 2003

•  Despite advances in pain control many patients experience moderate to severe pain whilst in hospital. Contributory factors include inadequate assessment and documentation of pain, as well as patient and professional misconceptions.

•  A 28‐bedded surgical ward in a District General Hospital in the South of England was the setting for the project. A small preliminary audit of pain on this ward indicated that some patients experienced postoperative pain, which was not effectively controlled. A ‘continuous improvement’ framework was used to increase understanding of the problem and identify an aim for the project, which was to reduce the number of patients refusing analgesics when offered by nurses.

•  An audit to ascertain how many patients refused analgesia revealed that, of 133 patients offered, 93 (70%) refused. Using the ‘Model for Improvement’ (Langleyet al., 1996) a number of changes were introduced, including a patient information sheet, regular documented pain assessment and an innovative staff education programme. To evaluate if the changes in practice had been successful, further audit data were collected from 167 patients. Sixty‐three (44%) accepted analgesics, indicating a significant decrease in the number refusing (P = 0.005).

•  This small project demonstrated that continuous improvement methodology can improve the management of pain and quality of care for patients. Such an approach brings practitioner and patient into meaningful understanding and offers solutions which are realistic, achievable and sustainable over time. Despite finite resources and increased pressure on staff it is possible to motivate people when they feel they have ownership and change is meaningful.

•  Continuous improvement methods offer an exciting, feasible, patient‐centred approach to improving care.
Computer systems for distributed and distance learning
Authors: Anderson M. , Jackson D.
Published: March 2003

Abstract Network‐based learning is now such an important area that it would seem timely to examine progress to date and to draw conclusions regarding the direction of further research. This paper is the result of a survey of computer systems for distributed and distance learning, focusing on projects that help to illustrate the evolution of this important field. An examination such as this is important in its own right as a resource for other researchers wishing to pursue the subject further, but the survey also helps to highlight some of the major trends of past projects and to suggest some of the ways in which progress may be made in the future.
The role of self‐explanation in learning to use a spreadsheet through examples
Authors: Reimann P. , Neubert C.
Published: March 2003

Abstract  This papers describes an exploratory study into the early phase of getting to know end‐user software during which users make use of a variety of information resources, including the user interface/program itself, manuals, on‐line help, examples provided in the manuals and other sources. In particular, how do novices make use of the worked‐out examples often provided in manuals and during training? Building on earlier research on the self‐explanation effect, thinking aloud data from 10 participants were analysed to see how examples were studied and how they were used during problem solving. Important effects of self‐explaining comparable to findings in other domains were found in this study. For instance, those participants who self‐explain with the goal to discover meaning prove to be better problem solvers than those who do not self‐explain or who focus more on syntactical aspects of examples.
A social learning perspective of gambling behaviour among college students at Iowa State University, USA
Authors: Hira Tahira K. , Monson Kyra W.
Published: March 2003

This study assesses the proportion of college students who gamble and the level of their gambling involvement (i.e. frequency, scope, expenditure). In addition, a better understanding is sought of why students gamble and the factors that contribute to their gambling behaviour. The data were collected in the autumn of 1996 from 797 undergraduate students. The main outcome measures included the students' gambling status, scope, frequency and expenditure. The predictor variables were gender, age, employment status, grade point average and gambling expenditure of the mother, father and best friend of the respondents. Frequency and cross‐tabulation analyses were used to develop the respondents' demographic profile and to describe differences between characteristics of gamblers and non‐gamblers. Gamma‐statistics were used to test the strength of the relationship between predictors and outcome variables. Over half of the students gambled, and the two most frequently identified gambling activities were lottery and non‐casino cards. The majority indicated that they gambled for entertainment. On average, the students gambled three times and staked an average of 33 per month on their gambling. However, about 19% of them gambled 3–6 times and staked over 66 a month on gambling. Student gambling was found to be positively related to the gambling of their parents and the gambling of their best friend.
Consumer evaluation of five new sweet potato (Ipomea batatas) varieties
Authors: Opare‐Obisaw C. , Danquah A. O. , Doku E. V. , Boakye B. B. , Ansah‐Kissiedu D.
Published: March 2003

Five new sweet potato varieties, 91/62, 84/17, 91/198, 82/123 and Injala White, known to be less sweet were evaluated by a 15‐member panel to determine their acceptance as staple food items in Ghana. The results of the experiment revealed that there were significant differences among all the quality characteristics of the five new sweet potato varieties. However, all the varieties were accepted as staple food, with some being preferred more than others. In terms of flavour and colour, variety 91/198 was most preferred, while variety 91/62 was the most preferred with regard to texture and taste. The overall acceptability showed that variety 91/198 was the most preferred one, which also was the one with the least sugar content. In fact, varieties 91/198 and 91/62 always emerged as the best two varieties, with most of their qualities preferred among the five studied. On the whole, the Injala White variety was the least accepted.
Sources of plants colonizing experimentally disturbed patches in an acidic grassland, in eastern England
Authors: Pakeman R. J. , Attwood J. P. , Engelen J.
Published: March 2003

1 The sources of propagules for regeneration in an acidic grassland were identified from analysis of differences in colonization between plots subject to surface (0–5 cm) soil disturbance and plots where surface soil had been replaced by ‘seed‐free’ soil from deeper soil horizons (30–35 cm), and between plots with and without the removal of rabbit pellets.

2 After 1 year, 10 species had a significantly higher cover on plots where the seed bank had been left intact. These included Agrostis capillaris (the dominant species prior to disturbance), Myosotis arvensis and Veronica arvensis.

3 Five species, including Sagina apetala, Senecio jacobaea and Veronica arvensis, showed significantly higher cover on plots where rabbit pellets were left in situ.

4 From calculations it appeared that rabbit‐dispersed seeds accounted for 15% of the developing higher plant cover, other means of dispersal from outside the plot accounted for 40%, and regeneration from the seed bank accounted for 45%.

5 Similar calculations suggested that three higher plant species, Geranium molle, Myosotis arvensis and Senecio jacobaea, appeared to depend most on non‐rabbit dispersed seed for colonization of bare ground.

6 High concentrations of Urtica dioica in pellets contrasted with its poor establishment in the experiment. However, the other common species in the pellets, Sagina apetala, Senecio jacobaea and Veronica arvensis, all established in greater numbers on the plots where the pellets were not removed.

7 Seed bank content correlated well with the pattern of regeneration for Agrostis capillaris, Holcus lanatus, Myosotis arvensis and Veronica arvensis. However, removal of the seed bank did not have a significant effect on the regeneration of either of the most common species in the seed bank, Rumex acetosella and Sagina apetala.

8 No species appeared to be reliant on only one mechanism for regeneration from seed in disturbed areas in this community.
Demography of the invasive woody perennial Prosopis glandulosa (honey mesquite)
Authors: Golubov Jordan , Mandujano María Del Carmen , Franco Miguel , Montaña Carlos , Eguiarte Luis E. , Lopez‐Portillo Jorge
Published: March 2003

1 To assess the effect of annual environmental variability on the long‐term population dynamics of the invasive woody perennial Prosopis glandulosa var. torreyana (honey mesquite), we employed elasticity analyses of annual, mean and periodic matrix models. Growth, survival and reproduction were recorded for 1306 individuals in a 1‐ha plot over a 4‐year period. The volume of each individual was estimated, and transition matrices with nine size classes were constructed. Standard matrix analysis was performed, and the relative importance of individual life‐cycle components to changes in the finite rate of population increase (λ) was determined.

2 Periodic matrix analysis projected a 29% annual increase in population size (λ= 1.29), while annual projection λ‐values varied between 0.99 and 1.44. For both methods, elasticity of seedling recruitment was always very low in all 4 years, and the highest elasticities were generally associated with permanence in the same size class.

3 Periodic and annual projections predicted similar elasticity patterns, with the relative contribution to a change in λ of different demographic processes changing between ‘good’ and ‘bad’ years. However, annual matrices identified two bad years, with fecundity and growth elasticity decreasing relative to survival, whereas periodic analysis identified only one such year, and elasticity changes were seen only in fecundity and survival.
The demographic role of soil seed banks. I. Spatial and temporal comparisons of below‐ and above‐ground populations of the desert mustard Lesquerella fendleri
Authors: Cabin Robert J. , Marshall Diane L.
Published: March 2003

1 Although seed banks may often affect the colonization, succession and structure of surface plant communities, few studies have investigated the demographic relationship between seeds in the soil and above‐ground plant populations over space and time. We examined this relationship in the perennial mustard Lesquerella fendleri between 1991 and 1994 within a New Mexico desert ecosystem characterized by open patches of soil (intershrub areas) interspersed with dominant creosote (Larrea tridentata) shrubs (subshrub areas).

2 For the first 2 years of the study, Lesquerella soil seed, surface plant and seed production densities were greater in subshrub vs. intershrub areas. Within the subshrub areas, there were more Lesquerella soil seeds and surface plants in the northern and central microsites, compared with the southern and perimeter microsites, respectively. The mean density of the subshrub seed bank did not increase following large inputs of new seeds (2400 seeds m−2) in the summer of 1992. In contrast, virtually all of the relatively modest Lesquerella intershrub seed production at this time (169 seeds m−2) appeared to survive, so that for the remainder of the study most soil seeds were found in the intershrub sites. This spatial reversal of seed bank densities preceded a similar switch in the relative densities of the Lesquerella sub‐ and intershrub surface plant populations in the last 2 years of the study.

3 This study supports the hypothesis that desert seed bank patchiness contributes to surface plant patchiness, but does not support the idea that seed banks are comprised primarily of seeds produced during favourable reproductive periods. Because there was a closer spatial match between Lesquerella soil seeds and surface plants than between soil seeds and seed production, the above‐ground population may be limited to sites favourable for soil seed persistence.
Seed dynamics of the mast seeding tussock grass Ampelodesmos mauritanica in Mediterranean shrublands
Authors: Vilà Montserrat , Lloret Francisco
Published: March 2003

1 The Mediterranean perennial grass Ampelodesmos mauritanica may have the potential to expand its range. We analysed temporal variability of its reproductive components (seedfall, seed bank, seed predation, seed germination, seedling emergence, survival and growth) in three microsites (open areas, beneath Ampelodesmos and beneath shrubs) at two sites.

2 Reproductive components prior to seedling emergence were both closely linked and very similar between microsites within a site. Seedling survival and growth differed between microsites, being lowest in open areas. Recruitment patterns cannot therefore be predicted from seedfall.

3 Abundant seed production in 1996 was followed by successful germination and high seedling survival. In the following (non‐masting) year, although Ampelodesmos has a low‐density persistent seed bank, recruitment was much lower because germination was low and post‐dispersal seed predation was high.

4 Our results suggest that Ampelodesmos reproduction is episodic. Expansion of its distribution may be triggered by intermittent seedling recruitment following masting, but is otherwise constrained by seed limitation, post‐dispersal seed predation and a loss of viability in the seed bank.
Convective gas flow and internal aeration in Eleocharis sphacelata in relation to water depth
Authors: Sorrell Brian K. , Tanner Chris C.
Published: March 2003

1 The objective of this study was to examine how increasing water depth in the field affects the aeration achieved by convective gas flow in an emergent aquatic sedge (Eleocharis sphacelata).

2 We compared internal pressurization, convective gas flow, changes in internal gas composition, and differences in plant morphology at three depths (0.75–0.90 m, 1.40 m, and 2.15–2.65 m) in an oligotrophic lake.

3 Internal pressures generated in the aerial tissue of the influx culms were similar at all depths, but the convective inflows increased with depth due to lower resistances to convective flow in the plants growing in deeper water. In contrast, rates of flow returning up the efflux culms decreased with depth, due to a decrease in ratio of influx : efflux culms with depth.

4 Respiration lowered the oxygen concentration in the stagnant internal gas at night, with predawn concentrations highest at the shallowest site and lowest at the deepest site. Low oxygen concentrations also persisted longer after dawn in plants at the deep site than at the other sites due to the large volume of stagnant gas that had to be expelled relative to the flow rates.

5 By 14.00 h, the stagnant gas had been flushed from the plants at all depths, and oxygen concentrations were close to atmospheric values throughout. The two factors apparently responsible for maintaining high oxygen concentrations when convective flow was operating were (i) morphological changes at the deep site that reduced the resistance to flow, and (ii) dissolution of carbon dioxide produced in respiration into the external medium.

6 The data indicate that the average oxygen concentration maintained internally over a 24‐h cycle by convective flow decreases significantly with depth, suggesting that oxygen stress due to gas transport limitations may be one of the factors limiting depth penetration in this species and other emergent aquatic plants.
Spatial growth and population dynamics of a perennial tussock grass (Achnatherum calamagrostis) in a badland area
Authors: Guàrdia Roser , Raventós José , Caswell Hal
Published: March 2003

1 Achnatherum calamagrostis (L.) Beauv. is a perennial, tussock forming grass which is conspicuously successful as a pioneer in badlands in submediterranean areas. We analysed its population dynamics using a matrix population model that is intermediate between traditional demographic models and fully spatially explicit models.

2 Tussocks are considered as a set of spatial units, each classified according to the number and state (seedling, juvenile or adults) of the tillers it contains. The growth rate (λi) determined from the model estimates the spatial spread of A. calamagrostis as a rate of increase in the number of occupied quadrats.

3 We constructed six projection matrices from data for populations on two substrate types, in 2 years with differing climatic conditions and considering the whole life cycle or eliminating sexual reproduction or vegetative multiplication.

4 All the matrices predicted growth rates greater than one. Sexual reproduction was an important process for spatial spread in A. calamagrostis, unlike many other perennial grasses. In contrast, new colonization by vegetative reproduction contributed little to spatial growth of populations, although some expansion may still be possible in the absence of sexual reproduction.

5 A. calamagrostis, like other tussock‐forming plants, exhibits a conservative tactic of slow spread. Tiller dynamics serve mainly for consolidation and maintenance of the plant in already occupied space and sexual reproduction is the main way to ensure colonization of new safe‐sites. Climatic conditions influenced growth rates which increased during non‐drought years above the near maintenance value seen in drought years.
Primary and secondary stem growth in arctic shrubs: implications for community response to environmental change
Authors: Bret‐Harte M. Syndonia , Shaver Gaius R. , Chapin F. Stuart
Published: March 2003

1 Shrubs are among the tundra plants most responsive to environmental change. We measured primary and secondary stem growth in a retrospective analysis of ramets of three codominant shrubs (Betula nana, Salix pulchra, and Ledum palustre ssp. decumbens) exposed to long‐term field treatment with greenhouses and N + P fertilizers at Toolik Lake, Alaska.

2 Ramets of Salix had the greatest primary stem growth under control conditions, because of their relatively high branching rate. Under fertilization, however, Betula produced much more primary stem growth than the other species, because axillary buds that would have grown as short shoots in control ramets were instead stimulated to produce long shoots (structural branches). There appeared to be a trade‐off between allocation to length per stem segment and number of stem segments produced in a given year, for both Betula and Ledum.

3 Although secondary growth in stems is the largest component of above‐ground net primary production in forests, it is often ignored in shrub‐dominated ecosystems. We derived an expression for secondary growth in shrubs based on distributions of stem mass and length with age, and allowing for experimentally induced changes in secondary growth rate.

4 There was good agreement between measured ramet stem mass and calculated values for all three species, validating our mathematical analysis of secondary growth.

5 Fertilization greatly increased the relative rate of secondary growth only in Betula, consistent with observed accumulations of its stem mass in ecosystem‐level quadrat harvests. Secondary growth of Betula was a major component of ecosystem NPP in fertilized plots and probably contributes significantly to ecosystem carbon storage.

6  The increase in its secondary growth enabled Betula to become dominant under fertilization, whereas the inability of older stems of Ledum to respond in this way prevented it from growing into the canopy.
Role of dispersal in the recruitment limitation of neotropical pioneer species
Authors: Dalling J. W. , Muller‐Landau H. C. , Wright S. J. , Hubbell S. P.
Published: March 2003

We examined the importance of seed dispersal in predicting the pioneer seedling composition in recent gaps in a forest plot on Barro Colorado Island (BCI), Panama. We characterize seed dispersal for 13 taxa from seed rain data collected over 13 years in 200 mesh traps, and for an additional species from germination from soil samples collected in one year. We describe seedling distribution patterns from a complete census of all seedlings of these 14 taxa present in 36 treefall gaps.

A maximum likelihood model, incorporating both distance to adult trees and tree size, fitted observed seed rain to traps quite well for all taxa.

The ability to predict seedling recruit number per gap varied greatly among taxa. For 8 of 14 taxa, regression models incorporating predicted seed rain were significantly better predictors of seedling recruitment than models in which recruitment probability was assumed constant in all sites.

To see if variation in local dispersal patterns determined the community composition of gaps, we examined the relative abundances of these 14 pioneer taxa in the 36 gaps. We found that taxon abundances were significantly positively correlated with abundances predicted from seed dispersal models and seed–seedling regressions for 27 out of 36 gaps.

Overall, we find evidence that limited seed dispersal is an important factor contributing, together with factors affecting post‐dispersal recruitment success, to seedling distribution patterns in gaps.
Reduced colonization capacity in fragmented populations of wind‐dispersed grassland forbs
Authors: Soons Merel B. , Heil Gerrit W.
Published: March 2003

Habitat fragmentation as a result of intensification of agricultural practices decreases the population size and increases the site productivity of remnant populations of many plant species native to nutrient‐poor, species‐rich grasslands. Little is known about how this affects the colonization capacity of populations, which is highly important for regional species survival. We studied the effects on four wind‐dispersed forbs that represent two major dispersal strategies in grasslands: Cirsium dissectum and Hypochaeris radicata, which have plumed seeds and are adapted to long‐distance dispersal by wind, and Centaurea jacea and Succisa pratensis, which have plumeless seeds and are adapted to only short‐distance dispersal by wind.

Colonization capacity decreased with decreasing population size. This was due to lower seed germination ability in all species, and a lower seed production and a narrower range of seed dispersal distances in the species with plumed seeds. Inbreeding depression is the most likely cause of this. We found no evidence for a stronger selection for reduced dispersal in smaller populations.

Increasing site productivity changed the colonization capacity of all species. The capacity for colonization of nearby sites increased, due to higher seed production and seed germination ability, but the capacity for colonization of distant sites decreased, due to a lower long‐distance dispersal ability.

Seed dispersal ability and germination ability were negatively correlated in the species with plumeless seeds, but not in the species with plumed seeds. The dispersal ability of individual plumed seeds remained constant under changes in population size and site productivity. This indicates a strong selection pressure for long‐distance dispersal ability in these species.

When habitat fragmentation results in a simultaneous decrease in population size and increase in site productivity, both the local survival probability and the colonization capacity of remnant populations of wind‐dispersed grassland forbs are likely to be severely reduced. This increases regional extinction risks of the species.
Unapparent virus infection and host fitness in three weedy grass species
Authors: Remold Susanna K.
Published: March 2003

The effects of pathogens on natural plant populations are poorly understood, in part because many cause few overt symptoms. I investigated the correlations between the incidence of barley yellow dwarf viruses (BYDVs) and total panicle length, a fitness proxy, in three apparently unaffected hosts, Bromus hordeaceus (Pooideae), Setaria viridis and Setaria lutescens (Panicoideae).

Whereas B. hordeaceus individuals did not differ in fitness with respect to infection, average fitness of infected S. viridis was approximately half that of uninfected individuals, and in one out of two years, infected S. lutescens had approximately 25% higher fitness. Variability among hosts appears to contribute more than variability among BYDV serotypes to the pattern of infection outcomes.

These correlations suggest that the relationship between BYDVs and these co‐occurring host species ranges from antagonism to mutualism. If so, BYDVs can act as agents of selection in natural populations in which the symptoms of infection are unapparent.

The results also demonstrate that infections can be unapparent due to large trait variance rather than small mean effects. Because high trait variances are widespread in many natural populations, unapparent infections may be common in wild plant communities.
Litter quality and interactive effects in litter mixtures: more negative interactions under elevated CO2?
Authors: Hoorens Bart , Aerts Rien , Stroetenga Martin
Published: March 2003

The decomposition rate of litter mixtures can depend on interactions between compounds in the component species, i.e. in litter chemistry. Differences in litter N concentration are likely to lead to positive interaction (i.e. faster than expected decomposition) and differences in phenolic concentrations to a negative interaction. These interactions may become less positive (or more negative) when the litter is produced under elevated atmospheric CO2 concentrations.

We measured respiration rates of litter from two contrasting species pairs, produced under ambient and elevated CO2.

As expected, mixtures of Calamagrostis epigejos and Vicia lathyroides, which differed strongly in litter N concentration, decomposed faster than expected, but the interaction disappeared under elevated CO2.

Despite the large difference in litter N concentration between Sphagnum recurvum and Carex rostrata, no interaction was observed in the ambient CO2 litter mixtures, and under elevated CO2, there was an unexpected positive interaction.

Interactions in litter mixtures can therefore change under elevated CO2, albeit not in a predictable manner, which would require correct prediction of species‐specific litter chemistry and its response to elevated CO2.
Are fungi necessary? How fungicides affect growth and survival of the orchid Lepanthes rupestris in the field
Authors: Bayman Paul , González Eduardo J. , Fumero José J. , Tremblay Raymond L.
Published: March 2003

Mycorrhizal associations of tropical, epiphytic orchids have been studied in vitro, but the importance of the relationship has not been demonstrated in the field. We investigated the effect of fungicide treatment on seedlings and juveniles of the lithophytic orchid Lepanthes rupestris. As mycorrhizas, endophytes and pathogens coexist in orchids, fungicide treatment might have either a positive or negative effect on growth and survival of plants.

The experimental design included benomyl‐treated, propiconazole‐treated, and control plots. Each treatment consisted of about 140 2 × 2 cm plots divided among eight rocks, with one seedling or juvenile (occasionally two) per plot. Fungicides were applied every 2 weeks and plants were censused and measured every 3 months for 8–9 months.

Propiconazole‐treated plants had higher mortality, significantly fewer leaves, significantly fewer fungal colonies in their roots, and significantly fewer degraded pelotons than did control plants. Benomyl‐treated plants had significantly lower mortality than controls and significantly fewer fungi in leaves than control plants, and did not differ in number of degraded pelotons. There was little or no recruitment in any treatment.

Few potentially mycorrhizal fungi were isolated. Guignardia, Colletotrichum and Xylaria, which are generally endophytes, pathogens and/or saprotrophs, were more common. There was evidence of antagonism between Colletotrichum and Xylaria and between Colletotrichum and Guignardia.

Results suggest that fungi have both positive and negative effects on growth and survival of L. rupestris plants. However, conclusions about the importance of mycorrhizas are complicated by the simultaneous occurrence of a range of orchid–fungus interactions.
Evidence‐based medicine training in graduate medical education: past, present and future
Authors: Green Michael L.
Published: March 2003

Evidence‐based medicine (EBM) training remains a challenge to educators, particularly in graduate medical education. In this article, I trace the history of EBM in American medical education, review traditional journal clubs and contrast them to free‐standing EBM curricula, petition for the advancement of integrated EBM teaching and propose an agenda for future work. Traditional journal clubs are unsuitable to teach evidence‐based decision making because of their exclusive focus on critical appraisal. In contrast, EBM curricula cover the identification, appraisal and application of evidence in the context of individual patient scenarios. The effectiveness of some recent efforts reflects increasing attention to curriculum development principles and scientific rigour. The integration of EBM training into residents’ established clinical venues offers theoretical educational advantages and confronts the challenge of practising EBM under the imperatives of ‘real time’ patient care. Initial responses to this formidable challenge show promise, but their feasibility and effectiveness remain to be explored. A more complete understanding of the epidemiology of residents’ emerging clinical questions will inform continued curriculum development in integrated EBM training.
Evaluation of clinical information systems. What can be evaluated and what cannot?
Authors: Bürkle, Thomas , Ammenwerth, Elske , Prokosch Hans‐Ulrich , Dudeck Joachim
Published: March 2003

The evaluation of clinical information systems is essential as they are increasingly used in clinical routine and may even influence patient outcome on the basis of reminder functions and decision support. Therefore we try to answer three questions in this paper: what to evaluate; how to evaluate; how to interpret the results. Those key questions lead to the discussion of goals, methods and results of evaluation studies in a common context. We will compare the objectivist and the subjectivist evaluation approach and illustrate the evaluation process itself in some detail, discussing different phases of software development and potential evaluation techniques in each phase. We use four different practical examples of evaluation studies that were conducted in various settings to demonstrate how defined evaluation goals may be achieved with a limited amount of resources. This also illustrates advantages, limitations and costs of the different evaluation methods and techniques that may be used when evaluating clinical information systems.
Coding diagnoses and procedures using a high‐quality clinical database instead of a medical record review
Authors: Walraven Carl van , Demers Sylvie V.
Published: March 2003

A discharge abstract must be completed for each hospitalization. The most time‐consuming component of this task is a complete review of the doctors’ progress notes to identify and code all diagnoses and procedures. We have developed a clinical database that creates hospital discharge summaries. To compare diagnostic and procedural coding from a clinical database vs. the standard chart review by health records analysts (HRA). All patients admitted and discharged from general medical and surgical services at a teaching hospital in Ontario, Canada. Diagnostic and procedural codes were identified by reviewing discharge summaries generated from a clinical database. Independently, codes were identified by hospital health records analysts using chart review alone. Codes were compared with a gold standard case review conducted by a health records analyst and a doctor. Coding accuracy (percentage of codes in gold standard review) and completeness (percentage of gold standard codes identified). The study included 124 patients (mean length of stay 5.5 days; 66.4% medical patients). The accuracy of the most responsible diagnosis was 68.5% and 62.9% for the database (D) and chart review (C), respectively (P = 0.18). Overall, the database significantly improved the accuracy (D = 78.9% vs. C = 74.5%; P = 0.02) and completeness (D = 63.9% vs. C = 36.7%; P < 0.0001) of diagnostic coding. Although completeness of procedural coding was similar (D = 5.4% vs. C = 64.2%; P = NS), accuracy decreased with the database (D = 70.3% vs. C = 92.2%; P < 0.0001). Mean resource intensity weightings calculated from the codes (D = 1.3 vs. C = 1.4; P = NS) were similar. Coding from a clinical database may circumvent the need for HRAs to review doctors’ progress notes, while maintaining the quality of coding in the discharge abstract.