Long-term monitoring of Vermont's forest soils: early trends and efforts to address innate variability

Long-term monitoring of forest soils is necessary to understand the effects of continued environmental change, including climate change, atmospheric deposition of metals, and, in many regions, recovery from acidic precipitation. A monitoring program was initiated in 2002 at five protected forest sites, primarily Spodosol soils, in Vermont, northeastern USA. Every 5 years, ten soil pits were sampled from random subplots in a 50 × 50-m plot at each site. Samples were taken by genetic horizon and, to reduce variability and improve comparability, from four specific layers: the combined Oi/Oe layer, the combined Oa/A layer, the top 10 cm of the B horizon, and 60-70 cm below the soil surface (usually the C horizon). The samples were archived and a subset analyzed for carbon, nitrogen, and exchangeable cations. After four sampling campaigns, the average coefficients of variation (CVs) at each site had a broad range, 10.7% for carbon in the Oa/A horizon to 84.3% for exchangeable Ca²⁺ in the B horizon. An investigation of variability within the upper 10 cm of the B horizon across a 90-cm soil pit face showed similar CVs to the entire site, emphasizing the need for consistent and careful sampling. After 15 years, temporal trends were significant in the Oa/A and B horizons at two of the five sites, with one site showing an increase in carbon concentration in both layers along with increases in both exchangeable Ca²⁺ and Al³⁺ in the B horizon, perhaps linked to recovery from acidification. The monitoring program plans to continue at 5-year intervals for the next century.

The Osseointegration Group of Australia Accelerated Protocol (OGAAP-1) for two-stage osseointegrated reconstruction of amputated limbs

AIMS

This study describes the Osseointegration Group of Australia's Accelerated Protocol two-stage strategy (OGAAP-1) for the osseointegrated reconstruction of amputated limbs.

PATIENTS AND METHODS

We report clinical outcomes in 50 unilateral trans-femoral amputees with a mean age of 49.4 years (24 to 73), with a minimum one-year follow-up. Outcome measures included the Questionnaire for persons with a Trans-Femoral Amputation, the health assessment questionnaire Short-Form-36 Health Survey, the Amputation Mobility Predictor scores presented as K-levels, 6 Minute Walk Test and timed up and go tests. Adverse events included soft-tissue problems, infection, fractures and failure of the implant.

RESULTS

Our results demonstrated statistically significant improvements in all five outcome measures. A total of 27 patients experienced adverse events but at the conclusion of the study, all 50 were walking on osseointegrated prostheses.

CONCLUSION

These results demonstrate that osseointegrated prostheses are a suitable alternative to socket-fit devices for amputees experiencing socket-related discomfort and that our strategy offers more rapid progress to walking than other similar protocols. Cite this article: Bone Joint J 2016;98-B:952-60.

Nurses and whistleblowing: the ethical issues

Whistleblowing - the public exposure of organizational wrongdoing - presents practical and ethical dilemma for nurses, and needs to be seen as part of a spectrum of increasingly confrontative actions against miscreant organizations by their employees. The ethics of whistleblowing can only be understood in relation to its moral purpose, whether that is to achieve a good outcome (a consequentialist view) or fulfil a duty (a deontological view). The consequentialist perspective is unable on its own to resolve problems arising from the balance of good and harm resulting from the act of whistleblowing (where considerable harm might be caused) or of responsibility for that harm. A deontological approach provides an analysis of these problems but raises its own problem of conflicting duties for nurses. However, a strong argument can be made for the precedence of the nurse's duty to the patient over her duty to the employer. Although both duties are based on an implicit or an explicit promise, the promise to a person (the patient) must take precedence over the promise to an organization. It can even be argued that duty to the employer may in fact justify whistleblowing by nurses in some circumstances. However, the consequences of whistleblowing are forced upon nurses in a different way by the fact that the danger of reprisals acts as a deterrent to whistleblowers, however justified their actions may be. A more robust approach to the protection of whistleblowers is needed on the part of the government and the National Health Service (NHS) to remedy this situation.

Corporate moral responsibility in health care

The question of corporate moral responsibility--of whether it makes sense to hold an organisation corporately morally responsible for its actions, rather than holding responsible the individuals who contributed to that action--has been debated over a number of years in the business ethics literature. However, it has had little attention in the world of health care ethics. Health care in the United Kingdom (UK) is becoming an increasingly corporate responsibility, so the issue is increasingly relevant in the health care context, and it is worth considering whether the specific nature of health care raises special questions around corporate moral responsibility. For instance, corporate responsibility has usually been considered in the context of private corporations, and the organisations of health care in the UK are mainly state bodies. However, there is enough similarity in relevant respects between state organisations and private corporations, for the question of corporate responsibility to be equally applicable. Also, health care is characterised by professions with their own systems of ethical regulation. However, this feature does not seriously diminish the importance of the corporate responsibility issue, and the importance of the latter is enhanced by recent developments. But there is one major area of difference. Health care, as an activity with an intrinsically moral goal, differs importantly from commercial activities that are essentially amoral, in that it narrows the range of opportunities for corporate wrongdoing, and also makes such organisations more difficult to punish.

Nursing by agreement: a contractarian perspective on nursing ethics

Contractarianism has primarily been a political theory. A good argument can be made for its application to individual and professional ethics. A contractarian perspective on nursing ethics not only provides useful insights into the central relationship in nursing--the nurse and the patient--but also allows understanding of that relationship in the context of other relationships involving the nurse, the nursing profession, and the health care organization. While the nurse-patient contract is limited, its greater moral depth gives it moral priority.

Caring: a new framework for analysis

The increased attention given to the concept of care within the nursing literature must be considered in the light of the relatively superficial consideration given to the same concept within the educational curriculum. This article offers possible explanations for such brief consideration before discussing the development of a new framework for analysis of care.

Ethics, agency and empowerment in nurse education

The ethical demands of professional nursing practice are considered, and the concept of Agency is offered as a potentially useful part of the nurses conceptual equipment for such practice. The pressures of working in large organisations are suggested to be inimical to a sense of Agency, and it is also suggested that some of the academic disciplines involved in nurse education are offering an ambiguous view of the issue of Agency. The discipline of Ethics, while also ambiguous on this issue, is presented as offering useful ways of exploring that ambiguity. Several theories of Ethics are considered in relation to human freedom and responsibility, and the issue between determinism and free will is likewise considered. It is suggested that these offer ways of helping the individual to explore and develop their own stance on freedom and responsibility, and thereby on the issue of Agency. This discussion is related to the United Kingdom Central Council (UKCC) Code of Professional Conduct, and the paradox of choice is acknowledged.