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The effect of chemical contaminants on freshwater meiofaunal communities is poorly understood and meiofauna rarely form part of environmental impact assessments in fresh waters. The community composition and diversity of meiofauna in streams of southwest England (Cornwall) representing a gradient in trace metal contamination were investigated. Multivariate and univariate statistical techniques were used to correlate community composition, diversity and environmental variables. Meiofaunal communities were very different at sites with high compared with low metal concentrations. Copper, either singly, or in combination with other environmental variables (aluminium, zinc or dissolved organic carbon), was the most important correlate with community composition. Not all meiofaunal species were adversely affected by metals, however, and some taxa, most notably certain cyclopoid copepods, were abundant at high metal concentrations. Moreover, sites with high metal concentrations were not significantly less diverse than sites of low metal concentrations. These data suggest that metal contamination significantly alters the composition of stream meiofaunal assemblages and highlight the importance of including meiofauna in impact studies of fresh waters.

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Palliative Care Teams (PCTs) could be an answer for providing care for the hopelessly ill patient without accumulating high costs. The authors discuss their examination of the relationship between the implementation of a PCT and patient charges. Data indicated that daily charges were reduced significantly after the implementation a PCT.

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This research investigated the effect of alcohol consumption on smokers' general levels of craving for cigarettes and their reactivity to smoking-related cues. Cue reactivity was evaluated across multiple trials of exposure to both imaginal and in vivo presentations of smoking and non-smoking stimuli. On imagery trials, subjects imagined either smoking and non-smoking scenarios; during in vivo trials subjects watched an experimenter either smoke a cigarette or drink water. Measures included self-reported craving to smoke and selected somatovisceral responses. Subjects (n = 60) completed two sessions, the first examined cue reactivity in the absence of alcohol. In Session 2 subjects were told they were consuming alcohol; half received placebo and the other half were given ethanol (0.75 ml/kg). Following beverage consumption, subjects were exposed to the cue manipulation. In both sessions, exposure to smoking stimuli enhanced craving in each presentation mode and increased skin conductance levels in the in vivo mode. Alcohol intoxication produced a generalized increase in craving but did not selectively enhance craving or physiological reactivity to smoking stimuli. The results are discussed in terms of models of craving and processes through which alcohol may influence craving to smoke.

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In conclusion, redesigning the senior leadership management theory course in our undergraduate baccalaureate nursing program to incorporate new concepts of managed care, case management, critical paths, and multidisciplinary collaborations was successful. Providing students with a "real world" project developing critical paths provided an opportunity for them to make a contribution to an organization while learning verbal and written collaborative skills that may prove crucial to their future in nursing. Critical path development projects will be pursued until those specific needs of the organization have been met. Other opportunities will become obvious for class projects as new challenges are presented for organizations to address in this ever-changing health care delivery system.

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BACKGROUND: Cessation rates in smokers attending special clinics or their General Practitioners can be increased by transdermal nicotine (TNS). This study assesses the efficacy of TNS as an adjunct to advice and support in helping patients attending hospital with smoking-related diseases to stop smoking. METHODS: In a double-blind, placebo-controlled, randomized manner, 234 inpatients and outpatients with smoking-related respiratory or cardiovascular disease, aged 18-75 years, who were willing to try to stop smoking, were advised by their hospital doctor to stop smoking. This was reinforced by repeated advice and encouragement from the Smoking Cessation Counsellor initially and at 2, 4, 8 and 12 weeks, supplemented by a 24 h patch in adjusted doses over that period. Those not smoking at 12 weeks were followed up at 26 and 52 weeks. Self-reported complete abstinence from 12 to 52 weeks was validated by expired air carbon monoxide measurement at 12, 26 and 52 weeks. RESULTS: Twenty-four (21%) of 115 TNS patients were verified as non-smokers at 12, 26 and 52 weeks and claimed continued abstinence, compared with 17 (14%) of 119 in the placebo (P) group (P = 0 center dot 15) -5% confidence limits for odds ratio of abstinence on TNS compared to P: 0 center dot 83, 3 center dot 37. Cessation was related to increasing age (P = 0 center dot 02) and lower Fagerstrom score (P = 0 center dot 05). Minor skin reactions were more frequent in the TNS group (47% TNS; 34% P), as was nausea (12% TNS; 3% P). Severe skin reactions were rare (5% TNS; 4% P). CONCLUSION: The suggestion that TNS produces an increase of 50% in relative terms (7% absolute increase) in smoking cessation over placebo in this population of hospital patients is sufficiently strong to warrant a further study large enough to answer whether or not this result was due to chance.

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