Elevated CO2 reduces sap flux in mature deciduous forest trees

We enriched in CO2 the canopy of 14 broad-leaved trees in a species-rich, ca. 30-m-tall forest in NW Switzerland to test whether elevated CO2 reduces water use in mature forest trees. Measurements of sap flux density (J S) were made prior to CO2 enrichment (summer 2000) and throughout the first whole growing season of CO2 exposure (2001) using the constant heat-flow technique. The short-term responses of sap flux to brief (1.5-3h) interruptions of CO2 enrichment were also examined. There were no significant a priori differences in morphological and physiological traits between trees which were later exposed to elevated CO2 (n=14) and trees later used as controls (n=19). Over the entire growing season, CO2 enrichment resulted in an average 10.7% reduction in mean daily J S across all species compared to control trees. Responses were most pronounced in Carpinus, Acer, Prunus and Tilia, smaller in Quercus and close to zero in Fagus trees. The J S of treated trees significantly increased by 7% upon transient exposure to ambient CO2 concentrations at noon. Hence, responses of the different species were, in the short term, similar in magnitude to those observed over the whole season (though opposite because of the reversed treatment). The reductions in mean J S of CO2-enriched trees were high (22%) under conditions of low evaporative demand (vapour pressure deficit, VPD <5hPa) and small (2%) when mean daily VPD was greater than 10hPa. During a relatively dry period, the effect of elevated CO2 on J S even appeared to be reversed. These results suggest that daily water savings by CO2-enriched trees may have accumulated to a significantly improved water status by the time when control trees were short of soil moisture. Our data indicate that the magnitude of CO2 effects on stand transpiration will depend on rainfall regimes and the relative abundance of the different species, being more pronounced under humid conditions and in stands dominated by species such as Carpinus and negligible in mono-specific Fagus forest

Defining patient deterioration through acute care and intensive care nurses' perspectives

Aim: To explore variations between acute care and intensive care nurses’ understanding of patient deterioration according to their use of this term in published literature. Background: Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses’ help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains. Design: Dimensional analysis was used as a framework to analyze papers retrieved in a nursing focused database. Method: A thematic analysis of 34 papers (2002-2012) depicting acute care and intensive care unit nurses’ perspectives on patient deterioration was conducted. Findings: No explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses’ accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored. Conclusions: From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology toward critical illness. Contextual factors relating to acute care units appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modeling the concept of patient deterioration, which could be specific to acute care units. Relevance to Clinical Practice: The findings suggest it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issu

Contribution of a reflective debriefing to nursing students' clinical judgment in patient deterioration simulations : a mixed-methods study

Background While reflection is a hallmark of debriefing, there is little understanding of how it contributes to nursing students' clinical judgment. Objectives The aim of this study was to describe how nursing students perceived that the Reflective dEbriefing after a PatieNt Deterioration simulation (REsPoND) fostered learning and how it contributed to their clinical judgment in patient deterioration simulations. Design A sequential explanatory mixed-methods study. Participants Nineteen students who showed the greatest clinical judgment score variation in a randomized controlled trial of the effectiveness of REsPoND. Methods Students participated in interviews on their learning experience in REsPoND. Data were subjected to thematic analysis and themes were contrasted according to students' score variations. Results Through guided exchanges with their peers, students configured a causes–observations–interventions framework that embodied their understanding of the patient's situation. They evaluated their own simulation performance based on that framework. The contribution of REsPoND to students' clinical judgment differed depending on (1) the value placed on the review of the simulation through a systematic assessment approach; (2) their focus on anticipating the situation or on performing in the simulation; and (3) their preference for who participated more in debriefing. Conclusion Clinical judgment might be improved when a systematic assessment approach is used to structure debriefing. The relationship between reflection and self-assessment during debriefing remains to be disentangled

Testing nursing students’ clinical judgment in a patient deterioration simulation scenario : development of a situation awareness instrument

Background: Situation awareness may be used to operationalize nursing students' clinical judgment of patient deterioration simulation scenarios. Objectives: To develop and test an instrument to measure bachelor-level nursing students' situation awareness in a patient deterioration simulation scenario, using the Situation Awareness Global Assessment Technique (SAGAT). Design: Instrument development and validation. Settings: A faculty of nursing of a French-Canadian university. Participants: 15 critical care experts and 234 bachelor-level nursing students from a critical care course. Methods: The queries were developed from evidence and guidelines regarding nurses' assessment and response to patient deterioration and an inventory of nursing diagnosis. After expert content validation, the instrument was administered to three cohorts of nursing students in a high-fidelity simulation with a scenario of hypovolemic hemorrhagic shock. Difficulty, discrimination, and fidelity indices were computed. The impact of the instrument on student's performance was assessed with a post-simulation survey. Results: The instrument comprised 31 queries, which obtained high content validity indices. Most showed satisfying difficulty, discrimination, and fidelity properties. Inadequate properties of the queries may be explained by the content of the simulation scenario, the assessment practices of nursing students, and their reliance on medical assistance. Students perceived that completing the instrument helped them realize what they forgot to assess in the simulation. Conclusions: This instrument appears as a promising research tool, although it still needs to be tested with other populations and in other patient deterioration simulation scenarios

Development of a post-simulation debriefing intervention to prepare nurses and nursing students to care for deteriorating patients

To provide optimal care, nurses need to be prepared to recognize signs and symptoms of patient deterioration so they can obtain assistance from appropriate respondents and initiate rescue interventions when needed. In this paper, we describe the development of a post-simulation educational intervention aimed at improving nurses' and nursing students' recognition and response to patient deterioration. This intervention takes the form of a debriefing after a simulated patient deterioration experience. Following the Medical Research Council's guidance on complex interventions, we reviewed empirical studies of existing educational interventions for content, teaching strategies, and outcomes, as well as for frameworks, theoretical underpinnings, and rationale. Based on those results, we reviewed theoretical literature (Tanner's clinical judgment model and Dewey's theory of experiential learning) that might inform our understanding of our intervention's intended effect (learning outcomes) and of the mechanisms by which the intervention could lead to it. Integrating results from the empirical and theoretical phases helped us define the new intervention's rationale and develop its components according to relevant standards of best practices. The resulting educational intervention, REsPoND, consists in a reflective debriefing after a patient deterioration simulation. It will be tested in an upcoming mixed methods study

Debriefing approaches for high-fidelity simulations and outcomes related to clinical judgment in baccalaureate nursing students

Simulation followed by debriefing is increasingly common in clinical nursing education. Yet, limited studies have compared approaches to debriefing—the portion of simulations where participants re-examine and make sense of their experience. In this study, 120 baccalaureate nursing students in Quebec were randomized to receive one of two types of debriefing (selfassessment with Plus-Delta vs. guided reflection using a structured tool with REsPoND) after each of four simulations (a hemorrhage scenario, two sepsis scenarios, and a trauma simulation) during which their situation awareness was measured as a proxy for their clinical judgment. Unexpectedly, situation awareness scores showed little to no consistency across students or simulations and no clear improvements over time were noted, which rendered the comparison of the debriefing approaches across scenarios problematic. However, when comparing the two iterations of the sepsis scenario, students who participated in a reflective debriefing showed greater improvement in their recognition of abnormalities in patient vital signs and level of consciousness than students whose debriefing involved self-assessment

Campus Bridging: Campus Leadership Engagement in Building a Coherent Campus Cyberinfrastructure Workshop Report

This report presents the discussions at and recommendations made at “Campus Leadership Engagement in Building a Coherent Campus Cyberinfrastructure,” a workshop held in Anaheim, California from October 10-12, 2010. The main goals for this workshop focused on gathering the thoughts, ideas and perspectives of senior university administrators. The resulting report covers the topics of: - The current state of campus bridging from the perspectives of the CIO and VP for Research. - Challenges and opportunities at the campus leader level for enablement of campus bridging in the university community. - The senior campus leadership advocacy role for promoting campus bridging.This workshop and preparation of this report and related documents were supported by several sources, including: National Science Foundation through grant #OCI-1059812 (Patrick Dreher PI; Craig A. Stewart; James Pepin; Guy Almes; Michael Mundrane Co-PIs) (Co-Principal Investigator) RENCI (the Renaissance Computing Institute, http://www.renci.org/) supported this workshop and report by generously providing the time and effort of Patrick Dreher and through underwriting of this effort by RENCI Director Stanley Ahalt Indiana University Pervasive Technology Institute (http://pti.iu.edu/) for funding staff providing logistical support of the task force activities, writing and editorial staff, and layout and production of the final report document. Texas A&M University (http://www.tamu.edu) supported this workshop and report by generously providing the time and effort of Guy Almes. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the National Science Foundation, the Indiana University Pervasive Technology Institute, or Indiana University

A conceptual framework of student professionalization for health professional education and research

Objectives To present a conceptual framework of student professionalization for health professional education and research. Methods Synthesis and discussion of a program of research on competency-based education. Results Competency-based education relies on active, situation-based group learning strategies to prepare students to become health professionals who are connected to patient and population needs. Professionalization is understood as a dynamic process of imagining, becoming, and being a member of a health profession. It rests on the evolution of three interrelated dimensions: professional competencies, professional culture, and professional identity. Professionalization occurs throughout students’ encounters with meaningful learning experiences that involve three core components: the roles students experience in situations bounded within specific contexts. Educational practices conducive to professionalization include active learning, reflection, and feedback. Conclusions This conceptual framework drives a research agenda aimed at understanding how students become health professional and how learning experiences involving action, reflection, and feedback foster that process and the advancement of professional practices