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We know two things to be true. One is that we cannot build our way out of traffic congestion, and the other is that traffic-induced air pollution adversely affects the environment. As shown in Figure 1, the transportation sector is one of the largest contributors to greenhouse gas (GHG) emissions. According to the U.S. Environmental Protection Agency, the transportation sector accounts for 28% of such emissions.

Background: Colostomy formation can solve complications of bowel management following spinal cord injury (SCI). Newly injured patients at this spinal unit have chosen colostomy as a preferred option for bowel management. Objectives: To discover the reasons patients choose colostomy formation early following SCI and make comparison with those choosing it later, and to establish whether early colostomy is safe and advisable. Methods: Medical and nursing records of patients with SCI who chose to have a colostomy during the period 2005–2016 were examined retrospectively. Data were gathered concerning reasons for choosing a colostomy, early and later complications, the need for further surgery, and independence with bowel care before and after surgery. Patients were divided into two groups: those who chose a colostomy “early” during inpatient rehabilitation and those who chose it “later” as is traditional. Results: Reasons for choosing colostomy differed. Reducing reliance on caregiver and independence were of more importance to the early group; the later group chose colostomy to solve bowel care problems. Early complication rates in both groups were low. Longer term complications were higher in the early group, with the most common complication being rectal discharge. Parastomal hernia rates were low in both groups, as was the need for further surgery. Colostomy formation led to 20.8% of all patients gaining independence with bowel care. Conclusion: This study found colostomy to be a safe and effective option when performed early after SCI and demonstrates colostomy can be a means of gaining independence and making bowel care easier and more acceptable to the newly injured patient.

EVD is a disease of humans and other non-human primates caused by Ebola viruses , which was first discovered in 1976. Between 1976 and 2013 there had been 24 outbreaks of the disease. The recent outbreak is the 26 th and has seen more deaths than all other outbreaks from the disease combined. This outbreak in West Africa occurred in five countries: Guinea, Liberia, Nigeria, Senegal and Sierra Leone. In the present research article, the authors reviewed various studies and current research on EVD. EVD was initially restricted to West Africa when the outbreak was first identified, but later was reported in several countries around the world, including the USA. Researchers have Review Article

Vitamin B12 deficiency can be misdiagnosed as a variety of other illnesses, and if left untreated can lead to irreversible damage to the brain and nervous system. This article discusses the case of a 70-year-old female with a urostomy, well known to the stoma care department, who shortly after a routine parastomal hernia repair developed severe confusion, immobility and was unable to communicate. Subsequent investigations ruled out a cerebrovascular accident (CVA) and a diagnosis of rapidly progressing vascular dementia was made. An incidental finding of a low vitamin B12 level was identified and treatment commenced. She was transferred to a community hospital and her family were told to ‘prepare for the worst’. It was, in fact, the vitamin B12 deficiency that was causing her symptoms of vascular dementia, and once treatment was established she underwent a ‘miraculous’ improvement, returning to normal life. This article discusses vitamin B12 deficiency and why patients with a urostomy are at risk of developing it; highlights the key role of the stoma care nurse and his or her knowledge of the patient; explores the importance of testing vitamin B12 levels in this group of patients; and discusses key learning and recommendations for practice.

Because little is known about secondary stress in clergy who counsel church members, the effects of burnout and vicarious traumatization in 35 members of the clergy were examined through personal interviews, the Traumatic Stress Institute Belief Scale (1997), and the Maslach Burnout Inventory (1986). Clergy interviews and test scores indicated their experience of stress was similar to stress reported by other mental health professionals, yet they spent less time counseling. Types of problems seen in pastoral counseling, consequences of empathic listening, and advice to young clergy are reported. The following topics are discussed: (a) the need for collaboration among clergy, mental health professionals, and professors; (b) the benefits of sharing information among collaborators such as the need for secular therapists to understand their religious client's viewpoints, and the desire of clergy participants to learn more about advanced counseling skills; (c) the recognition of secondary stress and b...

Changes and trends in personality assessment documented through examination of the first issues of the Journal of Personality Assessment (JPA) for the years 1937 to 1997 revealed the following: (a) compared to the Journal of Personality and PsychologicalReview, JPA published more women first authors and coauthors in every issue except in 1987; (b) of the total 8,524 individuals whose assessment protocols comprised data sets in the 7 issues, l,6 15 (19%) were patients and 4,839 (57%) were undergraduate college students; (c) combining patients and nonpatients, the average age of children under 13 was 12.24 years, the average age of high school students was 15.28 years, and the average age of adults was 24.20 years; (d) only 6% of the participants were identified as African American, Mexican American, Asian Americans, or other; and (e) in the 74 articles examined, 98 different tests, techniques, or tasks to assess personality were discussed. We suggest that future research should include a more diverse group...