Changes in the timing of migration of birds in relation to climate change have received considerable attention in the northern hemisphere but there have been few studies in Australia. We examined a ...dataset of first arrival and last departure dates for breeding and non-breeding migrants at Blaxland, west of Sydney, from 1980 to 2011, for temporal trends and for relationships with climatic variables. The 16 species whose arrival dates were analysed have been arriving, on average, 4.4 days earlier per decade. Six species are now arriving significantly earlier than in the 1980s and no species is arriving significantly later. Trends in departure dates (13 species analysed) and length of stay at Blaxland (10 species analysed) varied more. Two species are now departing significantly earlier and one species is departing significantly later. Two species have increased their length of stay and two species have reduced their length of stay. Significant relationships with climatic variables were found mainly between arrival dates and temperature, especially minimum temperature. Six species showed a significant trend towards earlier arrival after periods of higher temperatures along the migration route, whereas one species showed a trend towards later arrival after higher temperatures. These results are consistent with the general trend towards earlier arrival of migratory birds that has been reported in the northern hemisphere and linked to rising temperatures from climate change. This study provides evidence that migratory birds in the southern hemisphere are responding to climate change in a similar way to birds in the northern hemisphere.
How to Get There Smith, Judy (Canadian writer)
Queen's quarterly,
06/2014, Volume:
121, Issue:
2
Journal Article, Magazine Article
Peer reviewed
I get the highest mark in class, but this is 1983 and there are no jobs for women in industry, ifa attendants also work in mills and factories. Women don't. Women aren't strong enough. We don't have ...the skills. Coveralls don't fit us. Men and women can't work together. They don't have separate locker rooms. Unless you're working within driving distance from Calgary - Cold Lake, for example - you're only there long enough to transfer planes to Edmonton. You'll need to make sure your luggage is transferred too; you don't need to lose it at this stage and certainly don't want your Martin D28 guitar left in the baggage claims area for all to see and anyone to pick up where it shouldn't have been unloaded in the first place... So when you're sitting in the Lloydminster Airport, there are a few things to understand. One thing is, the language is different. "Airport," for example, has become a small shed in the middle of a whiteout blizzard. Given these conditions, it's not a good idea to agree to rent a car with the guy sitting next to you and drive to Calgary. True, he's bushed: he's been working three months straight and this is his one weekend off before going back and doing it all over again, but that's his agenda, not yours. You might point out to him that you can't see the runway; you can't see anything past the windows of this shack. And cold? The plane has been towed into one of the hangars to thaw out. You've already boarded the plane once, and watched one propeller turn slowly once around; the other one didn't budge, frozen solid after only ten minutes of refuelling. No, it's not a good idea to drive in this weather, and the thought of spending the night in this shack with twenty sweating male bodies is not a bad one, considering the alternative.
The Virginia Tech Carilion School of Medicine (VTCSOM) is a 4-year allopathic medical school in Roanoke, VA. The curriculum is organized into four learning domains: basic science, clinical science, ...research, and interprofessionalism (IPE). A recent curriculum renewal effort allowed the school to embark upon a redesign of the IPE learning domain to incorporate new core content from health systems science (HSS). We describe how our unique approach to IPE is being preserved as we innovate to produce graduates who are future thought leaders and “systems citizens,” prepared to deliver patient care with an expanded knowledge of the health systems in which they will eventually practice.
The purpose of this study was to examine associations among nurses' behavioral intention to disinfect needleless connectors, autonomy, self-efficacy, attitudes, beliefs, perceived control, and social ...norms. A convenience sample (N = 171) of registered nurses participated in a cross-sectional study to examine factors related to "scrubbing the hub." While experienced nurses reported greater autonomy and self-efficacy, recent graduates were more likely to consistently use optimal disinfection techniques. Since practice is most influenced by peers, programs should be aimed at educational pedagogy aligning preceptor practice with empirically derived guidelines. Fostering exchange of ideas in a multigenerational work force may facilitate adherence to best practices.
AbstractObjective To determine whether setting and implementing adolescent-friendly standards improves the quality of adolescent services in clinics. Design The evaluation used a quasi-experimental ...case–control design. Setting/participants Eleven public health clinics involved in the adolescent-friendly program The National Adolescent Friendly Clinic Initiative (NAFCI) and 11 control clinics. Intervention This included implementation of a set of 10 adolescent-friendly standards and 41 corresponding criteria. Main outcome measures Percentage scores were achieved for each standard and criterion. Clinics were awarded a Gold Star if they achieved an overall clinic score (average standard score) of ≥90%, a Silver Star for a score between 60 and 89% and a Bronze Star for a score between 30 and 59%. Results The NAFCI clinics performed better than the control clinics on most criteria. The combined average overall clinic score of all the NAFCI clinics (79.9%) was significantly higher (P = 0.005) than the overall score for the control group clinics (60.9%). Results showed that the longer NAFCI was implemented at a clinic, the higher the score and the more likely that clinic would be accredited as an ‘adolescent friendly’ clinic. NAFCI clinics performed significantly better than the control clinics on criteria specific to the provision of adolescent-friendly services including knowledge of adolescent rights and non-judgmental attitudes of staff. Conclusion Setting and implementing standards and criteria improves the quality of adolescent services in clinics. The standards and criteria should be set on the basis of the characteristics of adolescent-friendly services and quality of care indicators. Best results are achieved when a facilitator trained in quality improvement methodologies supports clinics.
To identify a dose and schedule of oxaliplatin (OXP) to be safely administered in combination with protracted-infusion (PI) fluorouracil (5-FU) and external-beam radiation therapy (XRT) for patients ...with primary esophageal carcinoma (EC).
Eligibility included therapeutically naïve EC patients with clinical disease stages II, III, or IV. Initial doses and schedules for cycle 1 consisted of OXP 85 mg/m(2) on days 1, 15, and 29; PI 5-FU 180 mg/m(2) for 24 hours for 35 days; and XRT 1.8 Gy in 28 fractions starting on day 8. At completion of cycle 1, eligible patients could undergo an operation or begin cycle 2 without XRT. Postoperative patients were eligible for cycle 2. Stage IV patients were allowed three cycles in the absence of disease progression. OXP and 5-FU increases were based on dose-limiting toxicity (DLT) encountered in cohorts of three consecutive patients.
Thirty-eight eligible patients received therapy: 22 noninvasively staged as IV and 16 noninvasively staged as II and III. Thirty-six patients completed cycle 1, 29 patients started cycle 2, and 24 patients completed cycle 2. The combined-modality therapy was well tolerated, but DLT prevented OXP and 5-FU escalation. No grade 4 hematologic toxicity was noted. Eleven grade 3 and two grade 4 clinical toxicities were noted in eight patients. After cycle 1, 29 patients (81%) had no cancer in the esophageal mucosa. Thirteen patients underwent an operation with intent to resect the esophagus; five patients (38%) exhibited pathologic complete responses.
OXP 85 mg/m(2) on days 1, 15, and 29 administered with PI 5-FU and XRT is safe, tolerable, and seems effective against primary EC. The role of OXP in multimodality regimens against EC deserves further evaluation.
Abstract Background Delay in seeking timely medical care by patients with acute coronary syndrome and stroke has been well established in the literature, but less is known about delay in care-seeking ...behavior by patients with heart failure (HF). The purpose of this narrative review was to synthesize the literature regarding non–symptom-related factors that contribute to delay in seeking medical care for HF symptoms. Methods and Results A literature search of Scopus, Medline, and Pubmed was conducted for published articles from database inception to July 2009. Available evidence has shown that non–symptom-related factors, such as HF severity, HF history, age, and ethnocultural background, were related to delay in certain studies; however, null results have also been reported. Other non–symptom-related factors, such as male gender, initial contact with a primary care physician, arriving in the emergency department by means other than ambulance, and patient responses such as self-care, low anxiety, and hopelessness, may play a role in longer delay. Conclusions Although this review identified several non–symptom-related factors that may be implicated in care-seeking delay, health care professionals should be vigilant in identifying all high-risk individuals and educating them about warning signs of HF. Moreover, access to outpatient chronic disease management programs that may have potential to reduce care-seeking delay behavior should be explored.
Neuroendocrine tumors of the pancreas are rare tumors. We identified predictive factors that are associated with long-term survival (> or=5 years).
Fifty patients with a diagnosis of neuroendocrine ...tumors of the pancreas were retrospectively evaluated. The following factors were evaluated for disease-specific mortality: age, sex, primary tumor location, functional status, type of primary tumor treatment, presence or absence of liver metastases, timing of liver metastases occurrence, and type of liver metastases treatment. Aggressive treatment of the liver metastases included surgery, chemoembolization, or intrahepatic arterial infusion chemotherapy.
Twenty-three patients (47%) had tumor located in the head of the pancreas, and 29 patients (58%) had nonfunctioning tumor. Thirty-nine patients (78%) had liver metastases. The median follow-up for the entire group was 35 months (range,.76-206 months). The median survival for the entire group was 40 months, and the overall 1-, 2-, and 5-year survival rates were 84%, 69%, and 36%, respectively. Factors that had a significant favorable effect on survival included curative resection of the primary tumor, metachronous liver metastases, absence of liver metastases, and aggressive treatment of the liver metastases.
Definitive surgical resection of the primary tumor, absence of liver metastases, metachronous liver metastases, and aggressive treatment of the liver metastases were predictors of long-term survival in patients with neuroendocrine tumors of the pancreas.
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