Bench-to-bedside review: Oxygen as a drug

Oxygen is one of the most commonly used therapeutic agents. Injudicious use of oxygen at high partial pressures (hyperoxia) for unproven indications, its known toxic potential, and the acknowledged roles of reactive oxygen species in tissue injury led to skepticism regarding its use. A large body of data indicates that hyperoxia exerts an extensive profile of physiologic and pharmacologic effects that improve tissue oxygenation, exert anti-inflammatory and antibacterial effects, and augment tissue repair mechanisms. These data set the rationale for the use of hyperoxia in a list of clinical conditions characterized by tissue hypoxia, infection, and consequential impaired tissue repair. Data on regional hemodynamic effects of hyperoxia and recent compelling evidence on its anti-inflammatory actions incited a surge of interest in the potential therapeutic effects of hyperoxia in myocardial revascularization and protection, in traumatic and nontraumatic ischemicanoxic brain insults, and in prevention of surgical site infections and in alleviation of septic and nonseptic local and systemic inflammatory responses. Although the margin of safety between effective and potentially toxic doses of oxygen is relatively narrow, the ability to carefully control its dose, meticulous adherence to currently accepted therapeutic protocols, and individually tailored treatment regimens make it a cost-effective safe drug

Lady Landlords and the Final Defence of Landlordism on Prince Edward Island: The Case of Charlotte Sulivan

Most of the proprietors and politicians involved in the century-long struggle to end landlordism on Prince Edward Island were men. By 1875, however, when legislation compelled proprietors to sell their estates to the government, women owned some of the Island’s largest estates. One of these, Charlotte Sulivan, fought the legislation in the Colonial Office, the public press, and the newly established Supreme Court of Canada. Charlotte’s activities as an Island landlord were very much in keeping with her activities as a member of London’s elite. On Prince Edward Island, however, she was fighting a losing battle to maintain ownership of her 66,000-acre estate.La plupart des propriétaires et des politiciens mêlés à la lutte séculaire pour mettre fin au régime de la grande propriété foncière à l’Île-du-Prince-Édouard étaient des hommes. Mais en 1875, lorsque les propriétaires furent tenus par la loi de vendre leurs domaines au gouvernement, les femmes possédaient certains des plus grands domaines de l’Île. L’une d’elles, Charlotte Sulivan, combattit la loi dans le bureau des colonies, dans la presse et devant la toute nouvelle Cour suprême du Canada. Les activités de Charlotte en tant que propriétaire foncière de l’Île, étaient tout à fait conséquentes avec ses activités en tant que membre de l’élite londonienne. Mais à l’Île-du-Prince-Édouard, elle menait une lutte sans lendemain pour conserver la propriété de son domaine de 66 000 acres

Improving the Utilization of CNAs in Pressure Ulcer Prevention

An estimated 2.5 million Americans are affected by pressure ulcers annually with the largest majority impacted the geriatric population. In order to achieve prevention of facility acquired pressure ulcers, the nursing team must properly identify patients at risk to prevent the injury associated with pressure. CNAs play a key role in this effort. The purpose of this project was used to develop, implement, and evaluate a training program for CNA students to improve knowledge and promote engaged attitudes in the prevention of pressure ulcers. Results of the project showed improvement after the training, but overall was not statistically significant. Overall the training program was successful and the students did agree they would be better prepared to care for patients with pressure ulcers including identifying risk factors, identifying at risk patients, stages of ulcers, and reporting of pressure ulcers

Engagement in water governance action situations in the Lake Champlain Basin

Water quality governance encompasses multiple “wicked” interacting problems that manifest within social-ecological systems. Concerned governments, institutions, and actors concerned with addressing these issues must wrestle with complex systems that span time, space, and scale. This complexity of connected systems requires the participation of multiple actors across political boundaries, problem areas, and hydrologic domains. In Lake Champlain (US), frequent cyanobacteria blooms negatively affect property values, recreational activities, and public infrastructure, in addition to their impacts on the aquatic ecosystem. Through a survey of actors working on water quality in the Lake Champlain Basin, we analyze how actor participation in structured issue forums creates a network of connected action situations across multiple spatial scales and problem domains. We apply exponential random graph models to quantify the effects of scale, issues, and homophily on actor participation in these forums. Our findings show that actors tend to favor participating in similarly scoped forums at their spatial scale, that actors are less likely to participate in structured forums focused on agriculture, and that actors participate independently of others with whom they have pre-existing collaborative relationships. Further, we find that in the case of the Lake Champlain Basin, actor participation in issues related to water quality is misaligned with modeled sources of nutrient pollution. This study demonstrates that the design and maintenance of water quality action situations play an important role in attracting the participation of actors working collaboratively to address wicked social-ecological problems. Further, linking current and potential configurations of governance networks to social-ecological outcomes can aid in the effective and efficient achievement of management objectives

Constructing stability landscapes to identify alternative states in coupled social-ecological agent-based models

The resilience of a social-ecological system is measured by its ability to retain core functionality when subjected to perturbation. Resilience is contextually dependent on the state of system components, the complex interactions among these components, and the timing, location, and magnitude of perturbations. The stability landscape concept provides a useful framework for considering resilience within the specified context of a particular social-ecological system but has proven difficult to operationalize. This difficulty stems largely from the complex, multidimensional nature of the systems of interest and uncertainty in system response. Agent-based models are an effective methodology for understanding how cross-scale processes within and across social and ecological domains contribute to overall system resilience. We present the results of a stylized model of agricultural land use in a small watershed that is typical of the Midwestern United States. The spatially explicit model couples land use, biophysical models, and economic drivers with an agent-based model to explore the effects of perturbations and policy adaptations on system outcomes. By applying the coupled modeling approach within the resilience and stability landscape frameworks, we (1) estimate the sensitivity of the system to context- specific perturbations, (2) determine potential outcomes of those perturbations, (3) identify possible alternative states within state space, (4) evaluate the resilience of system states, and (5) characterize changes in system-scale resilience brought on by changes in individual land use decisions

The Bravest of the Brave : A Conversation with Mary Bitterman and James Narduzzi

Mary Bitterman, former President and CEO of The James Irvine Foundation, is President of The Bernard Osher Foundation and Immediate Past Chairman of the Public Broadcasting Service (PBS). James Narduzzi is Dean of the University of Richmond\u27s School of Continuing Studies. The following discussion is based on Dr. Bitterman\u27s 2008 commencement address to graduates of the University of Richmond\u27s School of Continuing Studies