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Poor farmers are particularly vulnerable to environmental stressors and often rely on traditional knowledge and grassroots creativity to help them to adapt. Such adaptation can be enhanced using other knowledge sources, but this requires greater understanding of the processes of knowledge co-production among scientists, local communities and state actors. In this study we undertook knowledge co-production on an experimental basis with two contrasting communities: smallholder farmers in Jind (Haryana) and Adi women in East Siang district (Arunachal Pradesh). We found that the Jind farmers displayed grassroots creativity in coping with salinity induced stresses to rice-wheat cropping systems, while Adi women applied their traditional knowledge of food based on namdung (Perilla ocymoides, a local plant species) to cope with climate variability that affected fermentation. Jind farmers perceived the process of knowledge co-production as moderately credible and salient , but the legitimacy of the exercise was compromised by the relatively low level of participation by state actors. The farmers rated the practical outcomes of the co-produced zero-till wheat as low to moderate for combating salinity-induce risks but as high for a community rice nursery. The knowledge co-production process was considered more credible and salient among younger Adi women than older women, and the utility of the Adi women's co-produced adaptive practices were rated as moderate to high for reducing the impacts of climate variability on namdung based foods. In both cases, an emergent property of the knowledge co-production exercise was creation of a knowledge network that has the potential to lead to ongoing enhanced adaptation to environmental change. Insights from the study could help improve knowledge co-production in similar social-ecological systems, and can be integrated with environmental change policies. [Display omitted] • Resource-poor farmers are particularly vulnerable to environmental change. • Local knowledge with science was used in knowledge co-production for environmental adaptation. • Most farmers viewed the process of knowledge co-production positively. • Knowledge co-production was salient and credible but sometimes lacked legitimacy. • Creation of knowledge networks among participants emerged as an unexpected benefit. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients undergoing chronic hemodialysis (HD) require placement of permanent vascular access with the creation of an arteriovenous fistula (AVF), an arteriovenous prosthetic graft (AVG), or a tunneled central venous catheter. AVFs provide greater long-term patency, fewer complications, and lower infection rates than do either AVGs or catheters. Despite these advantages, women continue to be underrepresented among AVF patients, possibly because of concerns about smaller vascular diameters and higher rates of early primary fistula failure in female HD patients. The numerous clinical benefits of AVF suggest that a greater effort should be made to promote AVF placement in women. OBJECTIVE: This review analyzes risk factors for AVF failure in women and describes clinical strategies to improve AVF utilization and success for female HD patients. METHODS: English-language publications were identified through a MEDLINE database search from January 1997 to March 2007, using the search terms arteriovenous fistula, vascular access, hemodialysis, female, and gender. Reference lists of identified articles were also reviewed. RESULTS: There are significant benefits to using AVFs instead of AVGs or catheters in HD patients: greater long-term fistula patency, superior flow rates, and fewer complications. Vascular anatomical differences between the sexes contribute to the underutilization of AVF in women. AVF placement rates can be improved if patients and staff are adequately educated and provided with the tools to facilitate AVF placement. Noninvasive preoperative screening is important to identify superior access sites in women. Intraoperative monitoring of blood flow is a reliable predictor of early radiocephalic AVF patency. Routine postoperative vascular monitoring may improve overall success with AVF, and exercise may improve vascular diameter and may be even more beneficial for women, who may have smaller preoperative veins. CONCLUSIONS: Concerns about smaller vascular diameters and reports of higher failure rates in women may prevent nephrologists and surgeons from considering AVF for female HD patients. The numerous advantages associated with AVF suggest that a greater effort should be made to increase its utilization in women. With appropriate motivation, care, and diligence by treating clinicians, the success of AVFs in women can approach the good results typically expected in men. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) is a promising, noninvasive imaging technique for the evaluation of inflammatory bowel disease (IBD) colitis. This article addresses the role of MRI in the diagnosis of IBD and the distinction of ulcerative colitis and Crohn's disease, including appropriate MRI sequences. The author also compares MRI findings of IBD with those of other imaging modalities, including colonoscopy, ultrasound, barium enema, and computed tomography. [ABSTRACT FROM AUTHOR]