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INTRODUCTION: Healthcare models for the delivery of palliative care to rural populations encounter common challenges: service gaps, the cost of the service in relation to the population, sustainability, and difficulty in demonstrating improvements in outcomes. Although it is widely agreed that a community capacity-building approach to rural palliative care is essential, how that approach can be achieved, evaluated and sustained remains in question. The purpose of this community-based research project is to test the feasibility and identify potential outcomes of implementing a rural palliative supportive service (RPaSS) for older adults living with life-limiting chronic illness and their family caregiver in the community. This paper reports on the feasibility aspects of the study. METHODS: RPaSS is being conducted in two co-located rural communities with populations of approximately 10 000 and no specialized palliative services. Participants living with life-limiting chronic illness and their family caregivers are visited bi-weekly in the home by a nurse coordinator who facilitates symptom management, teaching, referrals, psychosocial and spiritual support, advance care planning, community support for practical tasks, and telephone-based support for individuals who must commute outside of the rural community for care. Mixed-method collection strategies are used to collect data on visit patterns; healthcare utilization; family caregiver needs; and participant needs, functional performance and quality of life. RESULTS: A community-based advisory committee worked with the investigative team over a 1-year period to plan RPaSS, negotiating the best fit between research methods and the needs of the community. Recruitment took longer than anticipated with service capacity being reached at 8 months. Estimated service capacity of one nurse coordinator, based on bi-weekly visits, is 25 participants and their family caregivers. A total of 393 in-person visits and 53 telephone visits were conducted between January 2013 and May 2014. Scheduled in-person visit duration showed a mean of 67 minutes. During this same time period only 19 scheduled visits were declined, and there was no study attrition except through death, indicating a high degree of acceptability of the intervention. The primary needs that were addressed during these visits have been related to chronic disease management, and the attending physical symptoms were addressed through teaching and support. The use of structured quality of life and family caregiver needs assessments has been useful in facilitating communication, although some participants experienced the nature of the questions as too personal in the early stages of the relationship with the nurse coordinator. CONCLUSIONS: Findings from this study illustrate the feasibility of providing home-based services for rural older adults living with life-limiting chronic illness. The RPaSS model has the potential to smooth transitions and enhance quality of life along the disease trajectory and across locations of care by providing a consistent source of support and education. This type of continuity has the potential to foster the patient- and family-centered approach to care that is the ideal of a palliative approach. Further, the use of a rural community capacity-building approach may contribute to sustainability, which is a particularly important part of rural health service delivery.

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The results from the measurement of the fluorescence spectra of fluoroquinolone antibiotics including ofloxacin (OF), norfloxacin (NOR) and ciprofloxacin (CIP) complexed with cobalt (II) and ATP give information concerning the antibiotics-nucleotide interactions. From the fluorescence spectral data, it appears that the fluoroquinolone antibiotic cannot directly complex with ATP but indirectly complex with cobalt (II), which is playing an intermediary role. The interaction of fluoroquinolone antibiotic with the nucleotide occurs mainly through the phosphate group. The conclusion offers a more complete mechanism, which is important for understanding the interaction of these drugs with DNA.

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BACKGROUND: Formaldehyde levels were measured in 80 houses in the Latrobe Valley, Victoria, Australia. An association between exposure to formaldehyde and sensitization to common aeroallergens has been suggested from animal trials, but no epidemiologic studies have tested this hypothesis. METHODS: A total of 148 children 7-14 years of age were included in the study, 53 of whom were asthmatic. Formaldehyde measurements were performed on four occasions between March 1994 and February 1995 with passive samplers. A respiratory questionnaire was completed, and skin prick tests were performed. RESULTS: The median indoor formaldehyde level was 15.8 microg/ m3(12.6ppb), with a maximum of 139 microg/m3 (111 ppb). There was an association between formaldehyde exposure and atopy, and the adjusted odds ratio was 1.40 (0.98-2.00, 95% CI) with an increase in bedroom formaldehyde levels of 10 microg/m3. Furthermore, more severe allergic sensitization was demonstrated with increasing formaldehyde exposure. On the other hand, there was no significant increase in the adjusted risk of asthma or respiratory symptoms with formaldehyde exposure. However, among children suffering from respiratory symptoms, more frequent symptoms were noted in those exposed to higher formaldehyde levels. CONCLUSIONS: Low-level exposure to indoor formaldehyde may increase the risk of allergic sensitization to common aeroallergens in children.

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Indoor nitrogen dioxide exposure has been associated with respiratory symptoms in children in many studies, but in Australia, levels and sources of nitrogen dioxide in homes have not been well-characterized. Therefore, as part of a larger indoor environmental study, conducted in the Latrobe Valley, Victoria, nitrogen dioxide was monitored using passive samplers in 80 homes. Samples were collected on five occasions over one year. Mean indoor levels were higher than outdoor levels, and a seasonal variation was evident, with highest levels recorded in winter. The overall median level was 11.6 micrograms/m3 (6.0 ppb), ranging from < 0.7 to 246 micrograms/m3 (128 ppb). Major indoor nitrogen dioxide sources were: gas stoves, vented gas heaters, and smoking. Some 67% of variation in indoor nitrogen dioxide levels could be explained by presence of major sources, house age, and outdoor levels. Gas stoves were the main contributors.

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Precise laser surgery is possible with laser pulses at wavelengths that are strongly absorbed at the surface of tissue. However, pulses at these wavelengths (far UV, far infrared) are not compatible with fiber-optic transmission, making endoscopic surgical procedures inside the body difficult. We use evanescent optical waves to demonstrate an alternative for confining energy near the tissue surface. Precise, superficial tissue ablation is achieved with evanescent waves generated at a sapphire-tissue interface by a free-electron laser, where the ablation depth may be varied. A new class of precise, controlled laser surgical tools may be achieved in this novel approach for use in endoscopic procedures. Electromagnetic theory governing evanescent-wave tissue ablation is presented.

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BACKGROUND: Eighty households in the Latrobe Valley, Victoria, Australia, were sampled for house-dust-mite allergen (Der p 1). Allergen levels vary greatly between houses within climate regions. The reasons for this are not well understood. METHODS: House-dust-mite allergen samples were collected on six occasions between March 1994 and February 1995. All participating households contained at least one child between 7 and 14 years with a total of 148 subjects, 53 of whom were asthmatic. A detailed house survey was performed during every sampling visit, and a dwelling questionnaire was completed. Relative humidity was measured at the time of sample collection. RESULTS: The median bed allergen level was 30 microg/g during the first sampling period. Significantly higher allergen levels were associated with wool bedding and inner-spring mattresses (P < 0.001). As estimated from a multiple linear regression model, up to 70% reduction in bed allergen levels may be achieved by avoiding wool bedding and inner-spring mattresses. Other risk factors for high allergen levels included high indoor relative humidity, presence of substantial visible mould growth, brick cladding, and concrete slab foundation of the house. CONCLUSIONS: Avoiding wool bedding and replacing inner-spring mattresses with foam could substantially reduce bed allergen levels.

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Nitrogen dioxide levels were measured in 80 homes in the Latrobe Valley, Victoria, Australia, using passive samplers. Some 148 children between 7 and 14 yr of age were recruited as study participants, 53 of whom had asthma. Health outcomes for the children were studied using a respiratory questionnaire, skin prick tests, and peak flow measurements. Nitrogen dioxide concentrations were low, with an indoor median of 11.6 microgram/m3 (6.0 ppb), and a maximum of 246 microgram/m3 (128 ppb). Respiratory symptoms were more common in children exposed to a gas stove (odds ratio 2.3 [95% CI 1. 0-5.2], adjusted for parental allergy, parental asthma, and sex). Nitrogen dioxide exposure was a marginal risk factor for respiratory symptoms, with a dose-response association present (p = 0.09). Gas stove exposure was a significant risk factor for respiratory symptoms even after adjusting for nitrogen dioxide levels (odds ratio 2.2 [1.0-4.8]), suggesting an additional risk apart from the average nitrogen dioxide exposure associated with gas stove use. Atopic children tended to have a greater risk of respiratory symptoms compared with nonatopic children with exposure to gas stoves or nitrogen dioxide, but the difference was not significant.

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BACKGROUND: Children living in a damp house are more likely to suffer from respiratory symptoms and it has been suggested that exposure to fungi is an important contributing factor. However, more knowledge about underlying mechanisms for the association are needed. OBJECTIVE: To identify associations between measures of house dampness, levels of airborne fungal spores, housing factors and health outcomes in children. METHODS: Eighty households with 148 children between 7 and 14 years of age were recruited in the Latrobe Valley, Victoria, Australia. Some 36% of participating children were asthmatic. Six sampling visits were made to each house between March 1994 and February 1995 on a 2-monthly cycle. Samples for airborne total and viable fungal spores were collected from bedrooms, living rooms, kitchens and outdoors. A detailed dwelling characterization, using a questionnaire and inspection surveys, was carried out. Skin-prick tests were performed with extracts of common aeroallergens and a respiratory questionnaire was completed for each child. RESULTS: Large airborne fungal spore concentrations were recorded in association with: musty odour, water intrusion, high indoor humidity, limited ventilation through open windows, few extractor fans and failure to remove indoor mould growth. Visible mould growth or condensation evidence was associated with large concentrations of Cladosporium spores, but not with large total spore concentrations. Penicillium exposure was a risk factor for asthma, while Aspergillus exposure was a risk factor for atopy. Fungal allergies were more common among children exposed to Cladosporium or Penicillium in winter or to musty odour. Respiratory symptoms were marginally more common with exposure to Cladosporium or total spores in winter. CONCLUSION: Indoor exposure to certain fungal genera in winter was a risk factor for asthma, atopy and respiratory symptoms in children. On the other hand, no significant associations were seen between average viable or total spore concentrations and child health. Actual measurements of fungal spores predict health outcomes better than reported dampness.

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This single-case study explored what internal beliefs or commitments one therapist holds about the nature of reality and how those beliefs influence her delivery of occupational therapy services. Data were collected through three in-depth interviews and through observation of the therapist conducting treatment sessions. Results suggest that the therapist's view of reality can be categorized into four areas: (a) what she believes about ultimate reality; (b) what she believes about life, death, and eternity; (c) what she believes about human nature; and (d) what she believes about the nature of knowing. The findings also suggest that this core worldview informs how the therapist frames clinical practice and how she delivers occupational therapy services. Further, both the therapist's view of reality and her clinical practice are deeply rooted in her sociocultural experiences. This case study provides a rich description of the interrelatedness of sociocultural context, worldview, and clinical reasoning.

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Tunable second- and fourth-harmonic radiation was generated in a single 1-cm-long lithium niobate (LiNbO(3)) crystal with the Mark III infrared free electron laser at Duke University. The fundamental laser radiation was tuned from 2 to 2.5 µm, yielding 1-1.25-µm radiation (second harmonic) and 0.5-0.625-µm radiation (fourth harmonic). A fundamental-second-harmonic energy conversion efficiency of 66% and a fundamental-fourth-harmonic energy conversion efficiency of 3.3 × 10(-6) were measured. The maximum energy in the fourth harmonic was 3.3 nJ.

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After briefly reporting on the present status of the infrared free-electron laser now operating at the Stanford Photon Research Laboratory and powered by the linear accelerator Mark III, we discuss the results of using nonlinear optical techniques for both the characterization of its output radiation and the enhancment of its tunability range. In particular, to show the evidence of possible self-guiding effects, a new and reliable technique has been devised and successfully tested for real-time monitoring of the micropulse evolution during the buildup of radiation. Finally, we discuss the main problems connected with the damage threshold of optical materials.

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Histoplasmosis was diagnosed histopathologically in a female chinchilla. This animal had originated from a commercial chinchilla ranch in central Missouri. Seventeen of 130 animals in the colony had died within a month's period with a respiratory illness. This animal had a history of fur chewing, but this was not true of all the other animals that had died. Histoplasma capsulatum was cultured from timothy hay used for food.

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