Advanced practice nurses and physician assistants have offered small, rural hospitals an alternative to scarce primary care physicians for 30 years. This paper uses survey data from 285 small rural hospitals and case studies of 36 of these hospitals to answer questions about the extent to which advanced practice nurses and physician assistants provide primary care in small, rural hospitals, the benefits that might bring to the hospitals as well as the reactions of the public. The study used survey data collected as part of an evaluation of 285 hospitals, which received a Rural Health Care Transition grant from the Health Care Financing Administration in 1993 and 1994. Most of the hospitals used the practitioners; 70 percent used nurse practitioners; 30 percent used physician assistants; and 20 percent used both. There were some negative reactions to the use of the practitioners, but, overall, there was acceptance and benefits to the hospitals in the form of reduced recruitment costs, increased revenues and increased service offerings. These practitioners are beneficial to rural hospitals, and mechanisms to encourage their acceptance should be developed and implemented.

Gammarus minus has both cave and surface forms that differ considerably in their morphology. We experimentally compared the ability of these two forms to consume leaves and influence the activity of the microbial films associated with leaves. Both forms of G. minus were effective leaf shredders, and were equally efficient at converting leaves to small particles. We found little relationship between amphipod size and the rate at which they shredded leaves. Both forms of G. minus stimulated the respiration rate of microbes associated with leaves by 32-52%. Cave forms of G. minus had a 15% greater stimulatory effect on microbial respiration. The stimulatory effect of G. minus on microbial respiration is evident in cave streams as well as in the laboratory. It appears that G. minus plays a particularly important role in cave systems by converting leaves to fine particles and stimulating microbial films which are important foods for many cave animals.

This study appears to be the first to examine factors influencing depression detection in a mental health outreach program. Future efforts should help ensure that all older mental health outreach clients have depression detected at optimal rates.

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