Toward Cognitive Development through Field Studie

Although field study is as ancient as the apprenticeship concept, field study programs have been recreated in recent years as innovative features of many colleges and universities. These programs are as diverse as the institutions that sponsor them. Some are part of cooperative education plans whereby students alternate between a term on campus in regular classwork and a term off-campus in paid employment. Others combine working and studying in the same term. Nearly all have as a primary objective exposing students to a world or perspective beyond the traditional classroom, usually for the purpose of advancing career planning

Non-Q Wave Myocardial Infarction

Non-Q wave myocardial infarction is a distinct and changing clinical entity characterized by lower initial mortality and a higher rate of reinfarction compared to Q wave infarction. Clinical and pathologic data suggest that the syndrome results from transient or incomplete coronary occlusion resulting in an infarct which is smaller than when Q waves are present. High-risk patients can be identified during hospitalization, allowing for aggressive therapy aimed at revascularization. Relatively few clinical trials have examined initial therapy or secondary prevention in this group of patients. These studies are reviewed and management guidelines suggested

The independent association of renal dysfunction and arrhythmias in critically ill patients

Study objectives: The purpose of this study was to quantify the impact of baseline renal dysfunction on incidence and occurrence of cardiac arrhythmias in the coronary ICU. Background: Renal dysfunction is an established predictor of all-cause mortality in the ICU setting. We set out to evaluate the independent contributory effect of renal dysfunction to arrhythmias and mortality in this population. Design and setting: We analyzed a prospective coronary care unit registry of 12, 648 admissions by 9, 557 patients over 8 years at a single, tertiary center. An admission serum creatinine level was available for 9, 544 patients. Those patients not receiving long-term dialysis were classified into quartiles of corrected creatinine clearance with cutpoints of 46.2 mL/min/72 kg (group 1), 63.1 mL/min/72 kg, and 81.5 mL/min/72 kg. Dialysis patients (n = 527) were considered as a fifth comparison group (group 5). Measurements and results: Baseline characteristics including older age, African-American race, diabetes, hypertension, history of previous coronary disease, and heart failure were incrementally more common with increasing renal dysfunction strata. There were graded, independent increased risks for accelerated idioventricular rhythm (relative risk [RR], 2.43; 95% confidence interval [CI], 1.40 to 4.20; p = 0.002), sustained ventricular tachycardia (RR, 2.07; 95% CI, 1.02 to 4.22; p = 0.04), ventricular fibrillation (RR, 2.42; 95% CI, 1.13 to 5.15; p = 0.02), and complete heart block (RR, 3.64; 95% CI, 1.77 to 7.48; p = 0.0004, group 5 vs group 1). Conclusions: We conclude that baseline renal function is a powerful, independent predictor of cardiac arrhythmias in the coronary ICU population

The influence of patient and doctor gender on diagnosing coronary heart disease

Using novel methods, this paper explores sources of uncertainty and gender bias in primary care doctors’ diagnostic decision making about coronary heart disease (CHD). Claims about gendered consultation styles and quality of care are re-examined, along with the adequacy of CHD models for women. Randomly selected doctors in the UK and the US (n=112, 56 per country, stratified by gender) were shown standardised videotaped vignettes of actors portraying patients with CHD. ‘Patients’ age, gender, ethnicity and social class were varied systematically. During interviews, doctors gave free-recall accounts of their decision making, which were analysed to determine patient and doctor gender effects. We found differences in male and female doctors’ responses to different types of patient information. Female doctors recall more patient cues overall, particularly about history presentation, and particularly amongst women. Male doctors appear less affected by patient gender but both male and especially female doctors take more account of male patients’ age and consider more age-related disease possibilities for men than women. Findings highlight the need for better integration of knowledge about female presentations within accepted CHD risk models, and do not support the contention that women receive better quality care from female doctors

Differences in isoprene and monoterpene emissions from cold-tolerant eucalypt species grown in the UK

The UK may be required to expand its bioenergy production in order to make a significant contribution towards the delivery of its ‘net zero’ greenhouse gas emissions target by 2050. However, some trees grown for bioenergy are emitters of volatile organic compounds (VOCs), including isoprene and terpenes, precursors in the formation of tropospheric ozone, an atmospheric pollutant, which require assessment to understand any consequent impacts on air quality. In this initial scoping study, VOC emission rates were quantified under UK climate conditions for the first time from four species of eucalypts suitable for growing as short-rotation forest for bioenergy. An additional previously characterised eucalypt species was included for comparison. Measurements were undertaken using a dynamic chamber sampling system on 2-3 year-old trees grown under ambient conditions. Average emission rates for isoprene, normalised to 30 °C and 1000 μmol m−2 s−1 PAR, ranged between 1.3 μg C gdw−1 h−1 to 10 μg C gdw−1 h−1. All the eucalypt species measured were categorised as ‘medium’ isoprene emitters (1–10 μg C gdw−1 h−1). Total normalised monoterpene emission rates were of similar order of magnitude to isoprene or approximately one order of magnitude lower. The composition of the monoterpene emissions differed between the species and major compounds included eucalyptol, α-pinene, limonene and β-cis-ocimene. The emission rates presented here contribute the first data for further studies to quantify the potential impact on UK atmospheric composition, if there were widespread planting of eucalypts in the UK for bioenergy purposes