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The concentration of dissolved oxygen (DO) is an important attribute of aquatic ecosystems, influencing habitat, drinking water quality, biodiversity, nutrient biogeochemistry, and greenhouse gas emissions. While average summer DO concentrations are declining in lakes across the temperate zone, much remains unknown about seasonal factors contributing to deepwater DO losses. It is unclear whether declines are related to increasing rates of seasonal DO depletion or changes in seasonal stratification that limit re-oxygenation of deep waters. Furthermore, despite the presence of important biological and ecological DO thresholds, there has been no large-scale assessment of changes in the amount of habitat crossing these thresholds, limiting the ability to understand the consequences of observed DO losses. We used a dataset from400 widely distributed lakes to identify the drivers of DO losses and quantify the frequency and volume of lake water crossing biologically and ecologically important threshold concentrations ranging from 5 to 0.5 mg/L. Our results show that while there were no consistent changes over time in seasonal DO depletion rates, over three-quarters of lakes exhibited an increase in the duration of stratification, providing more time for seasonal deepwater DO depletion to occur. As a result, most lakes have experienced summertime increases in the amount of water below all examined thresholds in deepwater DO concentration, with increases in the proportion of the water column below thresholds ranging between 0.9% and 1.7% per decade. In the 30-day period preceding the end of stratification, increases were greater at2.2% per decade and70% of analyzed lakes experienced increases in the amount of oxygen-depleted water. These results indicate ongoing climate-induced increases in the duration of stratification have already contributed to reduction of habitat for many species, likely increased internal nutrient loading, and otherwise altered lake chemistry. Future warming is likely to exacerbate these trends.

Freshwater phytoplankton communities are currently experiencing multiple global change stressors, including increasing frequency and intensity of storms. An important mechanism by which storms affect lake and reservoir phytoplankton is by altering the water column's thermal structure (e.g., changes to thermocline depth). However, little is known about the effects of intermittent thermocline deepening on phytoplankton community vertical distribution and composition or the consistency of phytoplankton responses to varying frequency of these disturbances over multiple years. We conducted whole-ecosystem thermocline deepening manipulations in a small reservoir. We used an epilimnetic mixing system to experimentally deepen the thermocline via five short (24-72 hr) mixing events across two summers, inducing potential responses to storms. For comparison, we did not manipulate thermocline depth in two succeeding summers. We collected weekly depth profiles of water temperature, light, nutrients, and phytoplankton biomass as well as bottle samples to assess phytoplankton community composition. We then used time-series analysis and multivariate ordination to assess the effects of intermittent thermocline deepening due to both our experimental manipulations and naturally occurring storms on phytoplankton community structure. We observed inter-annual and intra-annual variability in phytoplankton community response to thermocline deepening. We found that peak phytoplankton biomass was significantly deeper in years with a higher frequency of thermocline deepening events (i.e., years with both manipulations and natural storms) due to altered thermal stratification and more variable depth distributions of soluble reactive phosphorus. Furthermore, we found that the depth of peak phytoplankton biomass was linked to phytoplankton community composition, with certain taxa being associated with deep or shallow biomass peaks, often according to functional traits such as optimal growth temperature, mixotrophy, and low-light tolerance. For example, Cryptomonas taxa, which are low-light tolerant and mixotrophic, were associated with deep peaks, while the cyanobacterial taxon Dolichospermum was associated with shallow peaks. Our results demonstrate that abrupt thermocline deepening due to water column mixing affects both phytoplankton depth distribution and community structure via alteration of physical and chemical gradients. In addition, our work supports previous research that phytoplankton depth distributions are related to phytoplankton community composition at inter-annual and intra-annual timescales. Variability in the inter-annual and intra-annual responses of phytoplankton to abrupt thermocline deepening indicates that antecedent conditions and the seasonal timing of surface water mixing may mediate these responses. Our findings emphasise that phytoplankton depth distributions are sensitive to global change stressors and effects on depth distributions should be taken into account when predicting phytoplankton responses to increased storms under global change. NSF [CNS-1737424, DEB-1753639, DGE-1651272, DBI-1933016, DBI-1933102]; Global Change Center at Virginia Tech; Virginia Tech College of Science Roundtable Make-A-Difference Scholarship; Virginia Water Resources Research Center; Western Virginia Water Authority Published version Funding was provided by NSF grants CNS--1737424, DEB--1753639, DBI-1933016, DBI-1933102, and DGE-1651272, the Western Virginia Water Authority, the Global Change Center at Virginia Tech, the Virginia Tech College of Science Roundtable Make--A--Difference Scholarship, and the Virginia Water Resources Research Center.

Globally significant quantities of carbon (C), nitrogen (N), and phosphorus (P) enter freshwater reservoirs each year. These inputs can be buried in sediments, respired, taken up by organisms, emitted to the atmosphere, or exported downstream. While much is known about reservoir-scale biogeochemical processing, less is known about spatial and temporal variability of biogeochemistry within a reservoir along the continuum from inflowing streams to the dam. To address this gap, we examined longitudinal variability in surface water biogeochemistry (C, N, and P) in two small reservoirs throughout a thermally stratified season. We sampled total and dissolved fractions of C, N, and P, as well as chlorophyll-a from each reservoir’s major inflows to the dam. We found that heterogeneity in biogeochemical concentrations was greater over time than space. However, dissolved nutrient and organic carbon concentrations had high site-to-site variability within both reservoirs, potentially as a result of shifting biological activity or environmental conditions. When considering spatially explicit processing, we found that certain locations within the reservoir, most often the stream–reservoir interface, acted as “hotspots” of change in biogeochemical concentrations. Our study suggests that spatially explicit metrics of biogeochemical processing could help constrain the role of reservoirs in C, N, and P cycles in the landscape. Ultimately, our results highlight that biogeochemical heterogeneity in small reservoirs may be more variable over time than space, and that some sites within reservoirs play critically important roles in whole-ecosystem biogeochemical processing.

Purpose: Surgery is associated with a post-operative stress response, changes in cardiopulmonary reserve, and metabolic demand. Here recovery after abdominal aortic aneurysm repair is investigated using cardiopulmonary exercise testing and patient-reported questionnaires. Materials and methods: Patients undergoing open (n = 21) or endovascular (n = 21) repair undertook cardiopulmonary exercise tests, activity, and health score questionnaires pre-operatively and, 8 and 16 weeks, post-operatively. Oxygen uptake and ventilatory parameters were measured, and routine blood tests were undertaken. Results: Recovery was characterised by falls in anaerobic threshold, peak oxygen uptake, and oxygen pulse at 8 weeks which appeared to be associated with operative severity; the fall in peak oxygen uptake was greater following open vs. endovascular repair (3.5 vs. 1.6 ml.kg−1.min−1) and anaerobic threshold showed a similar tendency (3.1 vs. 1.7 ml.kg−1.min−1). In the smaller number of patients re-tested these changes resolved by 16 weeks. Reported health and activity did not change. Conclusions: Aortic repair is associated with falls in the anaerobic threshold, peak oxygen uptake, and oxygen pulse of a magnitude that reflects operative severity and appears to resolve by 16 weeks. Thus, post-operatively patients may be at higher risk of further metabolic insult e.g. infection. This further characterises physiological recovery from aortic surgery and may assist in defining post-operative shielding time.IMPLICATIONS FOR REHABILITATION Abdominal aortic aneurysm repair is a life-saving operation, the outcome from which is influenced by pre-operative cardiopulmonary reserve; individuals with poor reserve being at greater risk of peri-operative complications and death. However, for this operation, the physiological impact of surgery has not been studied. In a relatively small sample, this study suggests that AAA repair is associated with a significant decline in cardiopulmonary reserve when measured 8 weeks post-operatively and appears to recover by 16 weeks. Moreover, the impact may be greater in endovascular vs. open repair.

Oxygen availability is decreasing in many lakes and reservoirs worldwide, raising the urgency for understanding how anoxia (low oxygen) affects coupled biogeochemical cycling, which has major implications for water quality, food webs, and ecosystem functioning. Although the increasing magnitude and prevalence of anoxia has been documented in freshwaters globally, the challenges of disentangling oxygen and temperature responses have hindered assessment of the effects of anoxia on carbon, nitrogen, and phosphorus concentrations, stoichiometry (chemical ratios), and retention in freshwaters. The consequences of anoxia are likely severe and may be irreversible, necessitating ecosystem-scale experimental investigation of decreasing freshwater oxygen availability. To address this gap, we devised and conducted REDOX (the Reservoir Ecosystem Dynamic Oxygenation eXperiment), an unprecedented, 7-year experiment in which we manipulated and modeled bottom-water (hypolimnetic) oxygen availability at the whole-ecosystem scale in a eutrophic reservoir. Seven years of data reveal that anoxia significantly increased hypolimnetic carbon, nitrogen, and phosphorus concentrations and altered elemental stoichiometry by factors of 2–5× relative to oxic periods. Importantly, prolonged summer anoxia increased nitrogen export from the reservoir by six-fold and changed the reservoir from a net sink to a net source of phosphorus and organic carbon downstream. While low oxygen in freshwaters is thought of as a response to land use and climate change, results from REDOX demonstrate that low oxygen can also be a driver of major changes to freshwater biogeochemical cycling, which may serve as an intensifying feedback that increases anoxia in downstream waterbodies. Consequently, as climate and land use change continue to increase the prevalence of anoxia in lakes and reservoirs globally, it is likely that anoxia will have major effects on freshwater carbon, nitrogen, and phosphorus budgets as well as water quality and ecosystem functioning. Fralin Life Sciences Institute Institute for Critical Technology and Applied Science National Science Foundation NSF: DGE-1651272 NSF: DBI-1933102 NSF: DBI-1933016 NSF: CNS-1737424 NSF: DEB-1753657 NSF: DEB-1753639 NSF: DEB-1753657 NSF: DEB-1753639 Virginia Tech Global Change Center Western Virginia Water Authority Published version

Near-term iterative forecasting is a powerful tool for ecological decision support and has the potential to transform our understanding of ecological predictability. However, to this point, there has been no cross-ecosystem analysis of near-term ecological forecasts, making it difficult to synthesize diverse research efforts and prioritize future developments for this emerging field. In this study, we analyzed 178 near-term (≤10-yr forecast horizon) ecological forecasting papers to understand the development and current state of near-term ecological forecasting literature and to compare forecast accuracy across scales and variables. Our results indicated that near-term ecological forecasting is widespread and growing: forecasts have been produced for sites on all seven continents and the rate of forecast publication is increasing over time. As forecast production has accelerated, some best practices have been proposed and application of these best practices is increasing. In particular, data publication, forecast archiving, and workflow automation have all increased significantly over time. However, adoption of proposed best practices remains low overall: for example, despite the fact that uncertainty is often cited as an essential component of an ecological forecast, only 45% of papers included uncertainty in their forecast outputs. As the use of these proposed best practices increases, near-term ecological forecasting has the potential to make significant contributions to our understanding of forecastability across scales and variables. In this study, we found that forecastability (defined here as realized forecast accuracy) decreased in predictable patterns over 1–7 d forecast horizons. Variables that were closely related (i.e., chlorophyll and phytoplankton) displayed very similar trends in forecastability, while more distantly related variables (i.e., pollen and evapotranspiration) exhibited significantly different patterns. Increasing use of proposed best practices in ecological forecasting will allow us to examine the forecastability of additional variables and timescales in the future, providing a robust analysis of the fundamental predictability of ecological variables. Published version

The opportunity to participate in and contribute to emerging fields is increasingly prevalent in science. However, simply thinking about stepping outside of your academic silo can leave many students reeling from the uncertainty. Here, we describe 10 simple rules to successfully train yourself in an emerging field, based on our experience as students in the emerging field of ecological forecasting. Our advice begins with setting and revisiting specific goals to achieve your academic and career objectives and includes several useful rules for engaging with and contributing to an emerging field.

The limiting nutrient for freshwater phytoplankton productivity can vary within and between geographic regions. Understanding how local (i.e., lake and catchment) and regional (i.e., multiple catchment) factors shift the relative importance of nitrogen (N) and phosphorus (P) limitation presents a key research challenge for freshwater ecosystems and may enhance our understanding of how lakes could be managed to control eutrophication. Here, we used in situ microcosm incubations with factorial N and P amendments to determine the type of limitation in 16 lakes across the northeastern United States. Study lakes had similar climate but varied in geography, trophic status, and chemistry. Limitation by both N and P was most common (colimitation n = 5 and serial limitation n = 3); however, we also observed single nutrient N (n = 3) and P limitation (n = 4). The type of limitation was related to background phytoplankton biomass, longitude, and land use. The magnitude of response to combined nutrient enrichment was negatively related to background P concentrations. This multi-lake experiment suggests that both N and P often play a role in regulating productivity and that local and regional characteristics affect nutrient limitation patterns.

Near-term, iterative ecological forecasts with quantified uncertainty have great potential for improving lake and reservoir management. For example, if managers received a forecast indicating a high likelihood of impending impairment, they could make decisions today to prevent or mitigate poor water quality in the future. Increasing the number of automated, real-time freshwater forecasts used for management requires integrating interdisciplinary expertise to develop a framework that seamlessly links data, models, and cyberinfrastructure, as well as collaborations with managers to ensure that forecasts are embedded into decision-making workflows. The goal of this study is to advance the implementation of near-term, iterative ecological forecasts for freshwater management. We first provide an overview of FLARE (Forecasting Lake And Reservoir Ecosystems), a forecasting framework we developed and applied to a drinking water reservoir to assist water quality management, as a potential open-source option for interested users. We used FLARE to develop scenario forecasts simulating different water quality interventions to inform manager decision-making. Second, we share lessons learned from our experience developing and running FLARE over 2 years to inform other forecasting projects. We specifically focus on how to develop, implement, and maintain a forecasting system used for active management. Our goal is to break down the barriers to forecasting for freshwater researchers, with the aim of improving lake and reservoir management globally. Western Virginia Water Authority; U.S. National Science FoundationNational Science Foundation (NSF) [CNS-1737424, DEB-1753639, DEB-1926050, DEB1926388, DBI-1933016, DBI-1933102] Published version This work was financially supported by the Western Virginia Water Authority and U.S. National Science Foundation grants CNS-1737424, DEB-1753639, DEB-1926050, and DEB1926388, DBI-1933016, DBI-1933102.

The strong dependence of headwater streams on allochthonous inputs of energy and nutrients from riparian plant communities predicts that the introduction of non-native tree species should significantly affect these stream systems. The response of macroinvertebrate shredders to native and non-native leaves entering the stream will affect the transfer of energy and nutrients to other components of the ecosystem, but the specifics of such a response appear to be highly variable across systems. We investigated whether a locally abundant shredder, the amphipod Gammarus pseudolimnaeus, preferred stream-conditioned native (green ash, Fraxinus pennsylvanica) or non-native (common buckthorn, Rhamnus cathartica) leaves and how an exclusive diet of conditioned leaves of each species influenced amphipod survival, body mass, behavior, and energetics in a laboratory setting. Amphipods significantly preferred leaves of common buckthorn to those of ash. However, a 24-d diet of buckthorn leaves resulted in signifi...

Oxygen dynamics in lakes and reservoirs are changing worldwide due to human activities. Changing hypolimnetic oxygen conditions will substantially alter carbon cycling in aquatic ecosystems, as oxygen dynamics near the sediment-water interface regulate whether carbon inputs will be buried, respired as carbon dioxide, or respired as methane. At the decadal scale, warming temperatures and increased nutrient loads are increasing the prevalence and duration of anoxia. Conversely, at the daily scale, mixing due to more powerful storms may periodically increase hypolimnetic oxygen availability. It remains unclear, however, how carbon quantity and quality will respond to these changes in oxygen at different time scales. Our team used unprecedented whole-ecosystem manipulations of hypolimnetic oxygen concentrations in a eutrophic reservoir to identify how changes in oxygen at different time scales (i.e., weeks to months) alter freshwater carbon processing, burial, and greenhouse gas emissions. Against the backdrop of multiple-week shifts between oxic and anoxic conditions in the bottom waters of the experimental reservoir over multiple years, we observed that the dominant scale of variability in dissolved organic matter (DOM) concentrations was predominantly at the daily scale in the summer and monthly scale in the winter. At the monthly time scale, dissolved oxygen concentrations controlled DOM; at the daily time scale, water temperature and photooxidation controlled DOM. Modeling and field results show that intermittent week-long oxic conditions mineralized “legacy” carbon that had accumulated over years of sedimentation and changed the dominant terminal electron acceptor pathways used for mineralization on the daily scale. Building off of this work, future oxygenation experiments will examine the role of alternate electron acceptors in carbon release from sediments on the daily scale, the impact of carbon quality on carbon processing under varying oxygen conditions at the daily to week scale, and the effects of future oxygen scenarios on carbon cycling in lakes and reservoirs around the world on the annual to decadal scale.

Equine obesity can cause life-threatening secondary chronic conditions, similar to those in humans and other animal species. Equine metabolic syndrome (EMS), primarily characterized by hyperinsulinemia, is often present in obese horses and ponies. Due to clinical similarities to conditions such as pituitary pars intermedia dysfunction (formerly equine Cushing's disease), conclusive diagnosis of EMS often proves challenging. Aside from changes in diet and exercise, few targeted treatments are available for EMS, emphasizing the need for early identification of at-risk individuals to enable implementation of preventative measures. A genomewide association study (GWAS) using Arabian horses with a history of severe laminitis secondary to EMS revealed significant genetic markers near a single candidate gene () that may play a role in cholesterol homeostasis. The best marker, BIEC2-263524 (chr14:69276814 T > C), was correlated with elevated insulin values and increased frequency of laminitis ( = 0.0024 and = 9.663 × 10, respectively). In a second population of Arabian horses, the BIEC2-263524 marker maintained its associations with higher modified insulin-to-glucose ratio (MIRG) values ( = 0.0056) and BCS ( = 0.0063). Screening of the predicted coding regions by sequencing identified a polymorphic guanine homopolymer and 5 haplotypes in the 3' untranslated region (UTR). An 11 guanine (11-G) allele at was correlated with elevated insulin values in the GWAS population ( = 0.0008) and, in the second population, elevated MIRG and increased BCS > 6.5 ( = 0.0055 and = 0.0162, respectively). The BIEC2-263524-C and the 3' UTR -11(G) polymorphisms were correlated at a 98% frequency, indicating strong linkage disequilibrium across this 150-kb haplotype. Assays for these markers could diagnose horses with a genetic predisposition to develop obesity. Additionally, discovery of FAM174A function may improve our understanding of the etiology of this troubling illness in the horse and warrants investigation of this locus for a role in metabolic- and obesity-related disorders of other species.

Equine obesity can cause life-threatening secondary chronic conditions, similar to those in humans and other animal species. Equine metabolic syndrome (EMS), primarily characterized by hyperinsulinemia, is often present in obese horses and ponies. Due to clinical similarities to conditions such as pituitary pars intermedia dysfunction (formerly equine Cushing's disease), conclusive diagnosis of EMS often proves challenging. Aside from changes in diet and exercise, few targeted treatments are available for EMS, emphasizing the need for early identification of at-risk individuals to enable implementation of preventative measures. A genomewide association study (GWAS) using Arabian horses with a history of severe laminitis secondary to EMS revealed significant genetic markers near a single candidate gene () that may play a role in cholesterol homeostasis. The best marker, BIEC2-263524 (chr14:69276814 TC), was correlated with elevated insulin values and increased frequency of laminitis ( = 0.0024 and = 9.663 × 10, respectively). In a second population of Arabian horses, the BIEC2-263524 marker maintained its associations with higher modified insulin-to-glucose ratio (MIRG) values ( = 0.0056) and BCS ( = 0.0063). Screening of the predicted coding regions by sequencing identified a polymorphic guanine homopolymer and 5 haplotypes in the 3' untranslated region (UTR). An 11 guanine (11-G) allele at was correlated with elevated insulin values in the GWAS population ( = 0.0008) and, in the second population, elevated MIRG and increased BCS6.5 ( = 0.0055 and = 0.0162, respectively). The BIEC2-263524-C and the 3' UTR -11(G) polymorphisms were correlated at a 98% frequency, indicating strong linkage disequilibrium across this 150-kb haplotype. Assays for these markers could diagnose horses with a genetic predisposition to develop obesity. Additionally, discovery of FAM174A function may improve our understanding of the etiology of this troubling illness in the horse and warrants investigation of this locus for a role in metabolic- and obesity-related disorders of other species.

Objective To use real-time human milk macronutrient analysis to calculate final composition following fortification. Study design Preterm HM (PHM) and pooled donor human milks (DHM) were analyzed by mid-infrared spectroscopy for protein, fat and lactose. Energy content was calculated from macronutrient results. Three lactation stages were constructed. DHM was compared to PHM. Four milk sample profiles were selected to demonstrate individualized fortification results. Results Lactose was similar in PHM and DHM. Protein in PHM showed the expected decline as lactation progressed. DHM protein was significantly lower vs. PHM. Fat was highly variable and lowest in DHM. Using standard fortification protocols, not all fortified milks met targets for protein and energy. Individualized fortification resulted in milks closer to target recommendations. Conclusions Real-time analysis of HM provides assessment of the macronutrient content of the milk and can guide fortification. Individualized protocols, based on actual milk macronutrient profiles, may need to be considered to avoid unexpected nutrient content.

The use of polymer derived ceramics (PDCs) has been slowly increasing in the aerospace and friction markets as matrix materials for ceramic composites. They have demonstrated exceptional properties as brake rotors and wear parts but their cost has severely limited large scale insertions into the market. A new family of lower cost ceramic forming, siloxane based polymers has been developed that yields ceramic materials similar in behaviour to higher cost carbosilane derived ceramics. This paper discusses the new PDC class and provides a comparison demonstrating the similarity in properties. Both polymers have been utilised as the matrix for brake rotors and the lower cost PDCs have shown slightly better friction performance in an automotive brake rotor application.

To evaluate early amino-acid (AA) administration in extremely low birth weight (ELBW) infants over three time periods, beginning with the initiation of this strategy. This was a retrospective study of ELBW infants between 2000 and 2007. Nutritional intake and laboratory results were monitored during the first 5 days of life. Growth rates and complications were followed until discharge. Infants were similar in birth weight (BW), gestational age (GA) and severity of illness. The age at initiation of AA decreased significantly over time. Age at weight nadir, return to BW and percent postnatal weight loss decreased in epoch 3. There were modest increases in blood urea nitrogen (BUN), but no significant metabolic disturbances were observed. Cholestasis was more prevalent in epoch 2. AA administration within the first hours of life appears to be safe and beneficial for ELBW infants. Absent signs of renal dysfunction, a modest rise in BUN is consistent with the neonate's utilization of AAs for energy.

Summer streamflows in the Pacific Northwest are largely derived from melting snow and groundwater discharge. As the climate warms, diminishing snowpack and earlier snowmelt will cause reductions in summer streamflow. Most assessments of the impacts of a changing climate to streamflow make use of downscaled temperature and precipitation projections from General Circulation Models (GCMs). Projected climate simulations from these GCMs are often too coarse for planning purposes, as they do not capture smaller scale topographic controls and other important watershed processes. This uncertainty is further amplified when downscaled climate predictions are coupled to macroscale hydrologic models that fail to capture streamflow contributions from deep groundwater. Deep aquifers play an important role in mediating streamflow response to climate change, and groundwater needs to be explicitly incorporated into sensitivity assessments. Here we develop and apply an analytical framework for characterizing summer streamflow sensitivity to a change in the timing and magnitude of recharge in a spatially-explicit fashion. Two patterns emerge from this analysis: first, areas with high streamflow sensitivity also have higher summer streamflows as compared to low sensitivity areas. Second, the level of sensitivity and spatial extent of highly sensitive areas diminishes over time as the summer progresses. Results of this analysis point to a robust, practical, and scalable approach that can help assess risk at the landscape scale, complement the downscaling approach, be applied to any climate scenario of interest, and provide a framework to assist land and water managers adapt to an uncertain and potentially challenging future.

A review of factors contributing to early mortality after cardiac transplantation revealed that up to 25 % of deaths were due to primary graft dysfunction unrelated to rejection or infection. In light of this finding, evaluation of a donor heart with regard to its suitability for transplantation takes on added importance. In an effort to screen the suitability of donor hearts in the region covered by the Northwest Organ Procurement Agency (USA), all donors are evaluated by two-dimensional transthoracic echocardiography as part of the initial evaluation. A total of 110 donor echocardiograms were reviewed and an attempt was made to correlate the 30-day outcome with the parameters measured. An unexpected finding was that the presence of left ventricular hypertrophy in the donor heart was associated with an increase in the incidence of donor heart dysfunction compared with donors with normal echocardiographic profiles (33 % vs 3 %, P = 0.007).

A study was conducted by surveying members of the Truss Plate Institute (TPI) on properties of steel used in the production of metal connector plates. Three out of eight truss plate manufactures (TPMs) responded with summary statistics, and one of the three provided raw data for both ASTM grade B (1993a) and grade 60 (1993b) steel coils. Statistical distributions were fit to the data and several conclusions were drawn. Ultimate strength of steel is an important attribute for modeling failure of a metal-plate-connected truss joints. A truss plate manufacturer could feasibly sample a coil of steel, and find that the ultimate and yield strengths are slightly below minimum specified standards. A truss simulation aimed at establishing minimum performance in a load test should include steel that is close to minimum specified ultimate strength. If average performance of populations of trusses is of interest, the steel properties should be modeled as random variables.

In a review of 2617 patients who were admitted with a suspected fractured neck of femur over a period of five years, 213 had normal or equivocal plain radiographs, and were subsequently investigated by bone scintigraphy. Normal scans were obtained in 127 (60%) cases. Of the remaining 86 cases, 82 (38%) were reported to show fractures of the proximal femur, three showed pubic ramus fractures, and one acetabular fracture was demonstrated. Review and follow-up has revealed eight false positive and two false negative scans. The various factors accounting for these errors are considered, and the clinical implications discussed. Careful analysis of accompanying plain radiographs is stressed when interpreting scintigrams.

Most dance injuries are of the overuse variety. Their gradual onset, coupled with the intense competition for professional positions, often results in injuries being ignored and thus seen late in their course. While treatment of the specific injury is of paramount concern, maintenance of the extremes of flexibility, strength, and conditioning necessary to dance professionally is an equally important treatment element.

The purpose of this study was to identify and prioritize research topics of importance for nephrology nursing and the American Nephrology Nurses' Association (ANNA). This was an explorative survey design using the Delphi technique. Nephrology nurses who are members of ANNA participated in the study. In Round 1 participants included 90 members of the Advanced Practice Special Interest Group. Round 2 participants were 537 nephrology nurses who attended the 28th ANNA National Symposium. Participants in Round 3 were 491 ANNA members who had at least a master's degree in nursing or another field. A three-round Delphi technique was used to solicit, identify, and prioritize problems for nephrology nursing research. In Round 1, 90 nurses identified problems in response to an open-ended question. These responses were analyzed and categorized into a 21-item research survey that was used for subsequent rounds. Round 2 participants rated each research question/topic on the survey on a 1 to 5 scale for level of importance. In addition, they were asked to identify the top-ranked research priorities from the 21 questions. In Round 3, the participants were asked to do the same as in Round 2. In addition, they indicated whether the research priority was primarily a nursing responsibility or a collaborative effort with other health care personnel. Based on 3 rounds of the Delphi study and analysis of both level of importance and rated-research priority, the five areas that were identified as research priorities are (a) nursing interventions to prevent vascular access infections, (b) nursing interventions to maintain vascular access patency, (c) educational needs of patients and families, (d) levels of nursing competence and the effect on patient outcomes, and (e) validation of nursing interventions to achieve patient outcomes. These research priorities provide direction for nephrology nursing research and the ANNA. This Delphi study represents a significant step for ANNA in its commitment to research.

The purpose of this study was to determine nephrology nurses' perceptions of barriers to research utilization and to identify effective ways to facilitate integration of research findings in nephrology nurses' practice.This was an explorative, descriptive study.Four hundred ninety-eight nephrology nurses participated in the study. The primary areas of clinical practice were hemodialysis (36%), peritoneal dialysis (29%), transplantation (15%), pediatric nephrology (3%), or various combinations (18%).Participants completed a demographic data form and the previously validated instrument, Barriers and Facilitators to Using Research in Practice. Descriptive statistics were used to analyze the data.The majority of respondents (52%) were staff nurses. The other respondents included 30% in management, 12% in advanced practice roles, and 6% in education. The barriers to research utilization most frequently identified were insufficient time on the job to implement new ideas and not enough time to read research. The most effective facilitators identified were increased administrative support and encouragement, increased time available for reviewing and implementing research findings, and improved understandability of research reports.Additional nursing and nonnursing administrative support for research activities and designated time to read research and implement research-based clinical practices may facilitate the development of research-based nephrology nursing practice.

Lung transplantation has recently offered hope for prolonged survival in patients with cystic fibrosis. Patients with cystic fibrosis have a 7% prevalence of associated liver disease and portal hypertension. These patients have been previously excluded from consideration for lung transplantation. The natural history of cystic fibrosis-associated liver disease suggests a benign and protracted course in most cases. At the University of Washington, 14 of 53 patients (26%) have undergone lung transplantation for cystic fibrosis-related respiratory failure. We report the outcome of double lung transplantation in four of these 14 patients who also had cystic fibrosis-associated liver disease and portal hypertension, all of whom were symptom free from their liver disease. All four patients are alive and well without complications 4 to 31 months after transplantation. We conclude that the presence of cystic fibrosis-associated liver disease with portal hypertension, in the setting of good synthetic function (albumin3.0 gm/L and normal prothrombin time), normal serum bilirubin, minimal varices, without ascites or encephalopathy, should not be an absolute contraindication to lung transplantation. We recommend that other transplantation centers also include this patient population in consideration for lung transplantation.

Cellular immune function in peritoneal dialysis patients has been shown to be depressed, but the mechanism of this immunosuppression has not been ascertained. Because calcium is an important mediator of lymphocyte activation, this study was designed to investigate if there was an alteration of calcium metabolism in the lymphocytes of continuous ambulatory peritoneal dialysis (CAPD) patients.Sixteen CAPD patients were studied at the initiation of CAPD and after two months of treatment. Twenty-three normal controls were also enrolled in the study. Cytoplasmic calcium changes were investigated in response to the mitogen phytohemagglutinin (PHA) in peripheral blood and peritoneal lymphocytes, using the intracellular calcium probe indo-1 and flow cytometry. Baseline cytoplasmic calcium levels and changes in cytoplasmic calcium in response to PHA were assessed at the initiation of CAPD and after two months of therapy.Peripheral lymphocytes of patients and controls had similar calcium baseline levels, but the peritoneal lymphocytes had baseline cytoplasmic calcium levels averaging 81% higher than the corresponding calcium levels of the patients' peripheral blood lymphocytes. As compared to peripheral lymphocytes, the response to PHA stimulation was significantly less in the peritoneal lymphocytes, increasing an average of only 46.8% above baseline. Peripheral blood lymphocytes of the patients responded by an average increase of 78.9% over baseline. Control cells increased an average of 66.3% over baseline. Follow-up studies done two months after the initiation of CAPD indicated there were no significant changes (as compared to month 0) that occurred in baseline or stimulated intracellular calcium concentrations.While the peripheral lymphocytes of CAPD patients respond adequately to PHA, the high baseline calcium levels of the peritoneal lymphocytes suggest that these cells may be in a state of chronic activation and may respond minimally to an antigenic challenge.

Patients with acute renal failure are at high risk for developing malnutrition. Provision of adequate nutrition support begins with an understanding of the metabolic alterations that occur due to the disease state and renal replacement therapies. Assessment of nutritional requirements and implementation of appropriate feeding modalities can lead to optimal nutritional status and positive patient outcomes. Building collaborative relationships with other health care professionals is crucial to overcoming the barriers that hinder implementation of appropriate nutritional management.

The purpose of the study was to obtain information from nephrology nurses on existing policies and protocols related to peritoneal catheter exit site care and treatment of exit site infections.This was an explorative, descriptive study.Fifty-four nurses who attended the 1995 Consensus Conference on Peritoneal Dialysis at the 26th Annual American Nephrology Nurses' Association National Symposium completed a survey questionnaire on exit site care and management of exit site infections.A survey was mailed to nephrology nurses preregistered to attend the 1995 ANNA Consensus Conference related to peritoneal dialysis at the 26th National Symposium. Surveys were also collected at the meeting.Hydrogen peroxide and povidone iodine are frequently used in the nursing care of both healing and chronic exit sites. Almost all of the dialysis units require patients to stabilize or secure the catheter. The majority of respondents had a standardized method of assessing exit sites. Risk factors for exit site infections are presented for both the immediate post-catheter insertion period and the well-healed exit site. There were many different combinations of cleansing agents used to treat inflamed and infected exit sites.Procedures for exit site care vary widely. Prospective, randomized studies of exit site care protocols and cleansing agents are necessary to determine the most effective procedures to promote healthy exit sites.

In this article, the authors examine the spectrum of HIV disease as it affects parents and their children from the initial diagnosis through the progression of the disease. The psychosocial factors affecting access to health care, family relationships, and issues of loss are focused on. Practitioner guidelines for assisting families to deal with the psychosocial challenges presented by HIV infection are provided.

The goal of this study was to examine the relationships among personality types, personal and work-related stress, coping resources, and sense of coherence (SOC) among nephrology nurses in dialysis settings. Nurses (n = 49) from 13 dialysis units in New Mexico completed a demographic data form, Perceived and Nursing Stress Scales, SOC Scale, Coping Resources Inventory, and the Myers-Briggs Type Indicator (MBTI). The results indicated that there was a positive correlation between perceived personal stress and work-related stress, especially work load. Conversely, there were negative correlations between (a) both personal and work-related stress with SOC, and (b) both coping resources and SOC with burnout. High levels of personal and work-related stress were related to inadequate coping resources. Regression analysis indicated that the main contributing factors to emotional exhaustion (a major component of burnout) were low SOC, lack of staff support, personal stress, and heavy work load. Increased utilization of coping resources may facilitate the nurses' management of personal and work-related stressors.

The overall purpose of this study was to describe the quality of life (QoL) for spouses of continuous ambulatory peritoneal dialysis (CAPD) patients and to determine what factors are the best predictors of the spouses' perceived QoL. Thirty-eight spouses of CAPD patients from 2 dialysis units completed a demographic data form, the Jalowiec Coping Scale, the Dyadic Adjustment Scale, and the Quality of Life Index. The primary CAPD nurses completed the End Stage Renal Disease Severity Index on the ill partner. The results showed that 21% of the spouses perceived their QoL as high, 55% perceived their QoL as moderate, and 24% perceived their QoL as fair to poor. The results indicated that the QoL for the spouse is similar to that of CAPD patients with the exception of the family domain. On the family domain, the spouses scored significantly lower. Marital adjustment was the best predictor of QoL for the spouse. Income was the next best predictor. These two variables combined for a predictive value of 85%. Understanding the effect that a chronic illness has on the spouse will assist nurses in providing quality care for both the patient and the spouse.