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PubMed1996

The status of rural nursing in Australia: a review.

While much has been written about the practice role of remote area nurses in Australia, less is known about the role and function of the rural nurse. The majority of rural nurses practise in rural hospitals, community health settings and nursing homes. In contrast, the remote area nurse's work setting is generally involved with Aboriginal and Torres Strait Islander primary health care services. Rural nurses practice setting is usually located in a larger organisation than that of the remote area nurse. There is usually at least one medical practitioner in the town or on-call close by. Nurses who are employed in the smaller rural hospitals have what has been described as a 'specialist generalist' role. This means that they are required to be multi-skilled and competent in a wide range of nursing and non-nursing practice. In contrast, nurses who work in base/provincial hospitals, may have either a generalist or specialist role. This paper provides a summary of the literature on Australian rural nurses and develops some of the themes contained therein.

Australia↗
PubMed1995

Population cycles in northern small mammals.

I. The regular multiannual oscillations of small mammals at northern latitudes have been a subject of intensive study from the beginning of this century. The existence of a subjective bias in the research due to different schools of study together with a long series of failures and seemingly contradictory results in experiments testing a multitude of hypotheses have brought confusion to the field of study. Much of this confusion has resulted from a failure to recognize sharply the problem studied, which in turn has masked the progress made during the years. Northern mammal cycles are not a single problem but a composition of many related problems. Every problem may have a single-factor explanation, but even with a single-factor explanation, one factor is not necessarily an answer to all of the related problems. 2. At present, we can state that the cyclicity is caused by a predator-prey interaction. Both the 8-11-year and the 3-5-year cycles may be special cases of a more general cycle, most likely caused by a herbivore-resident specialist predator interaction, where the period of the cycles is determined by size-related constraints affecting the increase rate of the populations. The factors determining the amplitude of the cycles probably vary regionally and/or temporally. The operation of generalist and nomadic predators is largely responsible for the regional and geographic synchrony in cycles, although climatic factors may also contribute to the geographic synchrony. The northern distribution of animal communities; both these factors affect the density of generalist predators, which act as a stabilizing factor in the system. The age-related survival pattern seems to be mainly caused by predation, and the cyclically fluctuating reproductive output and mean body mass may be caused by changes in prey behaviour in response to fluctuating predation risk. Thus, we can already give a plausible explanation for most problems related to northern mammal cycles. 3. In all problems discussed, predation seems to be involved, and in most problems, it seems to be the factor which explains the observed patterns. Thus, as a generalization, it can be said that predation seems to be the key factor in the explanation of the northern multiannual cycles of small mammals. 4. There seems to be a linkage between diversity and cyclicity, probably because the diversity of the community (the number of prey species available) may determine the diet choice of a predator, which in turn determines whether the predators have a stabilizing or a destabilizing impact on prey populations.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗
PubMed2001

Factors influencing the choice of hysterectomy.

A retrospective review of women undergoing hysterectomy between May 1998 and April 2000 was performed. Multiple logistic regression analysis was used to identify factors influencing the choice of hysterectomy performed. Two independent factors, the surgeons' expertise and the concomitant adnexal surgery, had a strong influence on the decision-making process regarding type of hysterectomy Generalist gynaecologists tended to perform either an abdominal hysterectomy (AH) or a vaginal hysterectomy (VH) while non-generalist gynaecologists were more likely to perform laparoscopic hysterectomy (LH). Patients undergoing a hysterectomy along with adnexal surgery had a far greater chance of undergoing either an AH or a LH as opposed to a VH. In addition, patients who had bigger uterus were more likely to undergo an AH versus a VH as compared to those with a small uterus. Patients aged 50 or older had more chance of undergoing a VH than a LH.

Adnexal Diseases↗
PubMed2006

Spillover of agriculturally subsidized predators as a potential threat to native insect herbivores in fragmented landscapes.

Habitat loss and fragmentation can have strong negative impacts on populations of some native species. Spillover of generalist natural enemies from the surrounding landscape matrix is one mechanism potentially generating such effects, yet this has been rarely studied in insects. We examined the influence of habitat conversion to agriculture on the abundance and potential effects of predatory coccinellid beetles on native insect herbivores within 12 grassland remnants in central Nebraska (U.S.A.). Results of sweep sampling revealed that coccinellids were three to six times more abundant at native grassland sites embedded within cropland-dominated landscapes compared with control sites in grassland-dominated landscapes over the 3 years of the study. Exclusion experiments further demonstrated that predation intensity was strongly related to coccinellid abundances across sites and that coccinellids can dramatically reduce densities of a native aphid herbivore. In contrast to studies of specialized insect parasitoids, which have generally found reduced enemy pressure in fragmented landscapes, our results suggest that native herbivores may in some cases experience increased consumer pressure in landscapes with increasing habitat loss because of spillover of generalist predators from surrounding cropland habitats.

Agriculture↗
PubMed1992

A descriptive study of the attachment of public health nurses to family physicians' offices.

Public health nurses (PHNs) have been attached to family doctors' offices as one mode of organizing the delivery of nursing services in the community. However, different nurses function in different roles on a continuum from generalist to liaison. A descriptive study was undertaken to determine the most effective role for PHNs attached to family physicians' offices. Outcomes for both physicians and nurses were satisfaction with the role of the PHN, appropriateness of referrals, and accessibility for consultation. These outcomes were compared relative to the rating of PHNs of their role. A cohort of physicians without attachment PHNs were also surveyed to compare responses on the same criteria. The majority of nurses described their role generalist. This role was related to greater satisfaction for nurses and the physicians with whom they worked. Satisfaction with PHN service, ease of arranging consultation with PHN, and appropriateness of referrals from PHNs was greater for physicians who had the attachment than those who used the usual service.

Family Practice↗
PubMed1995

Evolution of a public health nursing program, Yukon Kuskokwim Delta, Alaska, 1893-1993.

The role of public health in a reformed health care system is currently a matter of great debate at the national and state levels. Many public health nursing leaders have expressed concern about changes in public health policy and funding sources that have led to the near demise of the generalist public health nurse. Generalist public health nurses may be an endangered species; however, the role is still in existence in rural Alaska. Will they be one more example of how "what we learn from history is that we don't learn from history?" Taking the discrete area of the Yukon Kuskokwim Delta of Alaska and studying the forces of geography, politics, economics, social factors and health issues, this article provides an historic account of the development of a unique health care delivery system and the role of the public health nursing structure within it, from earliest known records to present day. The long-standing efforts to document these data were spurred by the National Centennial of Public Health Nursing activities, celebrated in 1993.

Alaska↗
PubMed2004

An analysis of Medicare's Incentive Payment program for physicians in health professional shortage areas.

CONTEXT: Medicare's Incentive Payment (MIP) program provides a 10% bonus payment to providers who treat Medicare patients in rural and urban areas where there is a shortage of generalist physicians. PURPOSE: To examine the experience of Alaska, Idaho, North Carolina, South Carolina, and Washington with the MIP program. We determined the program's utilization and which types of physicians received payments. METHODS: Retrospective cohort design, utilizing complete 1998 Medicare Part B data. Physician specialty was determined through American Medical Association data. Rural status was determined by linking the physician business ZIP code to its Rural-Urban Commuting Area code (RUCA). FINDINGS: There were 2,220,275 patients and 39,749 providers in the cohort, including 9,769 (24.6%) generalists, 21,331 (53.7%) specialists, and 8,649 (21.8%) nonphysician providers. Over $4 million in bonus payments (median payment = $173) were made to providers in HPSAs. Specialists and urban providers received 58% and 14% of the bonus reimbursements, respectively. Two million dollars in payments were not distributed because the providers did not claim them. Over $2.8 million in bonus claims were distributed to providers who likely did not work in approved HPSA sites. CONCLUSIONS: The MIP bonus payments given to providers are small. Many providers who should have claimed the bonus did not, and many providers who likely did not qualify for the bonus claimed and received it. Consideration should be given to focusing and enlarging the bonus payments to specific providers, rather than rewarding all providers equally. Policy makers should also consider a system that prospectively determines provider eligibility.

Alaska↗
PubMed1971

A search for odour encoding in the olfactory lobe.

1. Studies were made of quality coding in the olfactory lobe of the insect by recording extracellular action potentials from single cells.2. Listing cell spectra permits to distinguish two main groups of cells, namely, ;odour specialist' which respond very specifically to biologically important substances and ;odour generalist' which respond to a large variety of odorants (thirty-two compounds) in an excitatory or inhibitory manner, or not responding at all.3. Among more than fifty cells of the ;odour generalists', very few had similar, or identical, reaction spectra to an arbitrarily chosen set of thirty-two odorants, while the ;odour specialists' are like each other in their response spectra.4. There was an indication of a regional and layer differentiation of response in the lobe to the sex attractant.5. ;On', ;on-off', and ;off' response types, as well as several variations on these response types, were found in single units during odour presentations.6. Differences in patterning of excitation for each of the thirty-two compounds can be readily detected by the comparison of the relative amounts of activity in each of the eighty-one units tested. It is therefore concluded that the mechanism of odour encoding at the olfactory lobe may involve the linear combinations of every olfactory neurone's activity result ing in a unique across-lobe pattern of discharges (;odour code pattern') for each particular odorant.7. If it follows that odour discrimination by the lobe depends on such differences of ;odour code patterns', it would be possible then to distinguish very many odorants simply by having very many neurones possessing differential odour specificity.

Acetates↗
PubMed2004

Spatiotemporal encoding of a bar's direction of motion by neural ensembles in cat primary visual cortex.

Directionally selective neurons strongly fire when presented with a preferred direction of motion of a bar and only weakly respond otherwise. Intuition suggests these "specialist" neurons would be better suited to report this stimulus feature to higher visual centers than "generalist" neurons, neurons that broadly modulate their activity to the feature. However, as stimuli are encoded not by one cell but by large neural ensembles, we have studied the role of single-cell receptive field properties in stimulus representation. Using regression error statistics, we compared the performance of direction-of-motion estimators, using ensembles of neurons selectively responding to direction of motion and estimators using ensembles not specializing to direction. We found that direction-selective ensembles were no better at representing a bar's direction of motion than nonselective ensembles. Quite the opposite, the nonselective unit ensembles provided a better estimate of the direction (standard deviation of the error of 33 degrees) than the direction-selective ensembles (standard deviation of the error of 42 degrees). The nonselective neurons provided information through a latency code that is apparent only when a neuron's activity is considered in the context of the responses of neighboring neurons. These results suggest that models utilizing both generalist and specialist neurons may better reflect the encoding mechanisms that take place in sensory pathways.

Action Potentials↗
PubMed2004

Noise emission during the first powerboat race in an Alpine lake and potential impact on fish communities.

In order to assess the effects of high-speed boating on fish communities, noise levels were measured during the first Class 1 powerboat race on the Austrian Lake Traunsee. The noise spectra were compared to natural ambient noise and hearing abilities of four native fish species. Sound pressure levels (SPLs) were significantly elevated during the training heats and the race compared with natural levels, reaching up to 128 dB re 1 microPa (instantaneous SPL) at a distance of 300 m to the powerboats. Continuous equivalent SPLs were significantly lower during training and the pole position race compared to the race itself because fewer boats were simultaneously on the lake. The hearing abilities of the native hearing specialists and generalists were investigated. While carp and roach (two cyprinids) showed enhanced auditory sensitivity typical for hearing specialists, perch and whitefish were much less sensitive to sounds. Comparisons between power boat noise spectra and audiograms showed that the cyprinids can detect the boats up to several hundred meters distance because the main noise energy is well within the most sensitive hearing range. The hearing generalists, however, probably only perceive the first harmonic of the boat noise at close distances.

Journal Article↗
PubMed2004

Functional adaptation of BabA, the H. pylori ABO blood group antigen binding adhesin.

Adherence by Helicobacter pylori increases the risk of gastric disease. Here, we report that more than 95% of strains that bind fucosylated blood group antigen bind A, B, and O antigens (generalists), whereas 60% of adherent South American Amerindian strains bind blood group O antigens best (specialists). This specialization coincides with the unique predominance of blood group O in these Amerindians. Strains differed about 1500-fold in binding affinities, and diversifying selection was evident in babA sequences. We propose that cycles of selection for increased and decreased bacterial adherence contribute to babA diversity and that these cycles have led to gradual replacement of generalist binding by specialist binding in blood group O-dominant human populations.

ABO Blood-Group System↗
PubMed2006

Diversity of fungi, bacteria, and actinomycetes on leaves decomposing in a stream.

Although fungi, bacteria, and specific bacterial taxa, such as the actinomycetes, have been studied extensively in various habitats, few studies have examined them simultaneously, especially on decomposing leaves in streams. In this study, sugar maple and white oak leaves were incubated in a stream in northeastern Ohio for 181 days during which samples were collected at regular intervals. Following DNA extraction, PCR-denaturing gradient gel electrophoresis (DGGE) was performed using fungus-, bacterium-, and actinomycete-specific primers. In addition, fungal and bacterial biomass was estimated. Fungal biomass differed on different days but not between leaves of the two species and was always greater than bacterial biomass. There were significant differences in bacterial biomass through time and between leaf types on some days. Generally, on the basis of DGGE, few differences in community structure were found for different leaf types. However, the ribotype richness of fungi was significantly greater than those of the bacteria and actinomycetes, which were similar to each other. Ribotype richness decreased toward the end of the study for each group except bacteria. Lack of differences between the two leaf types suggests that the microorganisms colonizing the leaf biofilm were primarily generalists that could exploit the resources of the leaves of either species equally well. Thus, we conclude that factors, such as the ecological role of the taxa (generalists versus specialists), stage of decay, and time of exposure, appeared to be more important determinants of microbial community structure than leaf quality.

Acer↗
PubMed1999

ACE inhibitors and heart failure in hospital: any difference between cardiologists and general physicians?

Cardiologists and generalists have been reported to diverge in terms of their self-reported use of angiotensin-converting enzyme (ACE) inhibitors, but information on their actual use of ACE inhibitors has been lacking. In order to assess ACE inhibitor use in patients with heart failure in a teaching hospital and any differences between specialties we studied all patients in the Western Infirmary of Glasgow between 1 April and 1 October 1996 with an echocardiogram showing moderate or severe left ventricular systolic dysfunction (n = 236). We found that most patients were on an ACE inhibitor (66%), 12% had been tried but found to be intolerant, 10% had not been tried because of a contraindication, but 12% had not been tried despite no contraindication. Of those on treatment, 58% were on a dose used in a major survival study (38% of all patients). Most patients were treated by a cardiologist (64%). Of these, more were on an ACE inhibitor (77% vs 53%, p < 0.01), fewer had been tried but found intolerant (11% vs 18%), and fewer had never been tried (11% vs 29%, p < 0.01), irrespective of whether they had a contraindication (5% vs 18%, p < 0.01) or not (6% vs 12%). More were on a dose used in a major survival study (48% vs 31%, p < 0.05). We conclude that, despite improvements over time, ACE inhibitors are still under-used, sometimes without good reason. There are also differences in the use of ACE inhibitors between cardiologists and generalists which may affect outcome, and could affect resource utilisation.

Aged↗
PubMed2000

Social wasp (Hymenoptera: Vespidae) foraging behavior.

Social wasps (Hymenoptera: Vespidae) forage for water, pulp, carbohydrates, and animal protein. When hunting, social wasps are opportunistic generalists and use a variety of mechanisms to locate and choose prey. Individual foragers are influenced by past foraging experience and by the presence of other foragers on resources. A forager's ability to learn odors and landmarks, which direct its return to foraging sites, and to associate cues such as odor or leaf damage with resource availability provide the behavioral foundation for facultative specialization by individual foragers. Social wasps, by virtue of their behavior and numbers, have a large impact on other organisms by consuming them directly. Indirect effects such as disruption of prey and resource depletion may also be important. Community-level impacts are particularly apparent when wasps feed upon clumped prey vulnerable to depredation by returning foragers, or when species with large, long-lived colonies are introduced into island communities. A clearer understanding of these relationships may provide insight into impacts of generalist predators on the evolution of their prey.

Animals↗
PubMed2006

Cannibalism, food limitation, intraspecific competition, and the regulation of spider populations.

Cannibalism among generalist predators has implications for the dynamics of terrestrial food webs. Spiders are common, ubiquitous arthropod generalist predators in most natural and managed terrestrial ecosystems. Thus, the relationship of spider cannibalism to food limitation, competition, and population regulation has direct bearing on basic ecological theory and applications such as biological control. This review first briefly treats the different types of spider cannibalism and then focuses in more depth on evidence relating cannibalism to population dynamics and food web interactions to address the following questions: Is cannibalism in spiders a foraging strategy that helps to overcome the effects of a limited supply of calories and/or nutrients? Does cannibalism in spiders reduce competition for prey? Is cannibalism a significant density-dependent factor in spider population dynamics? Does cannibalism dampen spider-initiated trophic cascades?

Animals↗
PubMed2005

The geriatric psychiatry workforce in 2002: analysis from the 2002 National Survey of Psychiatric Practice.

OBJECTIVE: Using the 2002 National Survey of Psychiatric Practice (NSPP), authors update demographic and professional work activities of a nationally representative sample of the psychiatric workforce who treat geriatric patients. METHODS: The sampling frame for the 2002 NSPP used the American Medical Association's Masterfile of Physicians. Professional, demographic, and patient data are compared between general and self-reported geriatric psychiatrists. Authors also present detailed analyses comparing high geriatric providers (HGPs; geriatric caseloads >20%), and board-certified geriatric psychiatrists (BCGPs). RESULTS: The proportion of HGPs in the 2002 NSPP was 26.0% of all respondents and was 28.1% among American Psychiatric Association (APA)-member respondents. Among the APA-member psychiatrists, this reflected a 55% increase from the 1996 NSPP. Of HGPs, 31.0% were certified in geriatric psychiatry. As compared with general psychiatrists, proportionally fewer men and American medical-school graduates were self-reported geriatric psychiatrists. Geriatric psychiatrists saw nearly three times as many geriatric patients and five times as many dementia patients as did their generalist counterparts. Mood-disorder patients were the largest treatment group, however. Investigators observed no significant differences in professional and practice characteristics between HGPs and BCGPs. CONCLUSIONS: About 1 in 4 psychiatrists in the 2002 survey are HGPs. Geriatric psychiatrists treat proportionally more geriatric patients than do generalists, but they do not have exclusively geriatric practices. The similarities between HGPs and BCGPs raise issues about the incentives for geriatric psychiatry certification, but not the need to train subspecialists to serve as faculty and community resources.

Adolescent↗
PubMed1999

Availability and performance of psychiatric acute care facilities in California from 1992 to 1996.

OBJECTIVE: The acute care psychiatric hospital industry has been challenged by managed care, government policies, and marketplace competition to control rising costs. This study examined changes in the availability and performance of acute care psychiatric delivery facilities in California between 1992 and 1996. METHODS: A retrospective longitudinal research design was used. Data on facilities, licensed psychiatric beds, discharged patients, days of care, occupancy, average length of stay, licensure, and type of ownership for the years 1992, 1994, and 1996 were purchased from the California Office of Statewide Health Planning and Development. Data were analyzed using numerical description and percent-change calculations. RESULTS: Between 1992 and 1996 licensed beds, days of care, and average length of stay decreased in acute psychiatric facilities and services, while psychiatric discharges and facility occupancy increased. The for-profit sector and the specialty acute care sector experienced large decreases in facilities, licensed beds, days of care, and average length of stay. The generalist sector-general psychiatric units licensed within acute general hospitals-and not-for-profit facilities experienced large increases in discharges. CONCLUSIONS: Challenges to institution-based services for the mentally ill population now extend beyond the state hospital system to include community-based acute care psychiatric hospital services. Recent declines in the for-profit, acute care psychiatric hospital specialty sector and the success of the generalist and not-for-profit sectors demonstrate the lack of uniform responses to environmental pressures. However, changes in federal Medicare reimbursement policy enacted in the Balanced Budget Act of 1997, as well as competition from alternative providers, are likely to result in further closures of all types of acute care psychiatric facilities over the next few years.

California↗
PubMed1975

A view of Danish pediatric care.

The Danish social system provides competent, accessible, continuous, and coordinated medical care to the pediatric population. The pediatrician does not deal with the routine aspects of well-infant and child care but is rather hospital based and acts on consultant to the generalists in his district. The generalist has the primary role in providing health care to the population in a program where everyone is obliged to participate and no one is excluded or ineligible for any reason. The American obsession with frequent, periodic examinations for infants, children, and young adults does not exist under the Danish pediatric health system. Hospital emergency rooms are used for truly emergent circumstances and not for episodic care.

Acute Disease↗