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Background: Successful implementation can increase the availability of evidence-based treatments but continued patient access can be threatened if there is not deliberate focus on sustainment. Real-world examples are needed to elucidate contributors to sustainability. Objective: We examined sustainability of outcomes of a study which tested a 12-month external facilitation intervention. The study evaluated change in access to medications for opioid use disorder (MOUD) in Veterans Health Administration (VHA) facilities in the lowest quartile of MOUD prescribing. Design: Convergent mixed-methods design. Participants: Thirty-nine providers and leaders from eight VHA facilities. Approach: Thirty-minute post-implementation telephone interviews explored whether barriers identified pre-implementation were successfully addressed, the presence of any new challenges, helpfulness of external facilitation, and plans for sustaining MOUD access. Interviews were analyzed using a rapid turn-around approach. VHA administrative data were used to characterize the facilities and assess their ratio of patients with an OUD diagnosis receiving MOUD (MOUD/OUD ratio) at the end of a 9-month sustainability period. Key Results: Commonly reported contributors to sustained MOUD access included national attention on the opioid epidemic, accountability created by study participation, culture shift in MOUD acceptability, leadership support, and plans to build on initial progress. Frequently reported barriers included staffing issues and lack of MOUD-devoted time; the need to overhaul existing policies, practices, and/or processes; and fear and anxiety about MOUD prescribing. All facilities either maintained MOUD/OUD ratio improvement (n = 2) or further improved (n = 6) at the end of sustainability. Facilities with the highest and lowest ratio at the end of sustainability used a team-based approach to MOUD delivery; however, organizational setting differences may have impacted overall MOUD access. Conclusions: Ensuring stable and consistent staff, and sufficient time dedicated to MOUD are critical to sustaining access to evidence-based treatment in low-adopting facilities. This study highlights the importance of investing in local, system-level changes to improve and sustain access to effective treatments. [ABSTRACT FROM AUTHOR]

Food security is a key target in the UN Sustainable Development Goals (SDGs) and is also one of the biggest challenges for China, the largest developing country in population in the world. Massive attention has been directed to the future impacts of hydrometeorological extremes on crop yield. However, knowledge gaps still stand concerning the effectiveness of irrigation, as the largest water consumption sector, on agricultural production under different climate scenarios. Here we showed the drought based on the modified Palmer Drought Severity Index and analyzed the drought-induced wheat yield losses in irrigated and non-irrigated agriculture across China according to three methods including the Multiple Linear Regression method, Deep Learning algorithm, and Erosion-Productivity Impact Calculator model. We found that the droughts become more intensive in the future, and drought-induced wheat yield loss under RCP8.5 scenario was expected to reach 32–49%. Intercomparison of drought-induced wheat yield changes between irrigated and non-irrigated agriculture indicated significantly less drought-induced crop-yield losses given sufficient irrigation under the RCP2.6 and RCP6.0 scenarios. However, our results under RCP8.5 suggested that the effectiveness of irrigation in enhancing food security is minor under this high-emission future climate scenario. These findings allowed us to revisit the effectiveness of irrigation in a warming climate and highlighted the importance of climate change mitigation in food security. [ABSTRACT FROM AUTHOR]

Background: Identifying effective strategies to improve access to medication treatments for opioid use disorder (MOUD) is imperative. Within the Veterans Health Administration (VHA), provision of MOUD varies significantly, requiring development and testing of implementation strategies that target facilities with low provision of MOUD. Objective: Determine the effectiveness of external facilitation in increasing the provision of MOUD among VHA facilities with low baseline provision of MOUD compared to matched controls. Design: Pre-post, block randomized study designed to compare facility-level outcomes in a stratified sample of eligible facilities. Four blocks (two intervention facilities in each) were defined by median splits of both the ratio of patients with OUD receiving MOUD and number of patients with OUD not currently receiving MOUD (i.e., number of actionable patients). Intervention facilities participated in a 12-month implementation intervention. Participants: VHA facilities in the lowest quartile of MOUD provision (35 facilities), eight of which were randomly assigned to participate in the intervention (two per block) with twenty-seven serving as matched controls by block. Intervention: External facilitation included assessment of local barriers/facilitators, formation of a local implementation team, a site visit for action planning and training/education, cross-facility quarterly calls, monthly coaching calls, and consultation. Main Measures: Pre- to post-change in the facility-level ratio of patients with an OUD diagnosis receiving MOUD compared to control facilities. Key Results: Intervention facilities significantly increased the ratio of patients with OUD receiving MOUD from an average of 18% at baseline to 30% 1 year later, with an absolute difference of 12% (95% confidence interval [CI]: 6.6%, 17.0%). The difference in differences between intervention and control facilities was 3.0% (95% CI: − 0.2%. 6.7%). The impact of the intervention varied by block, with smaller, less complex facilities more likely to outperform matched controls. Conclusions: Intensive external facilitation improved the adoption of MOUD in most low-performing facilities and may enhance adoption beyond other interventions less tailored to individual facility contexts. [ABSTRACT FROM AUTHOR]

Neurodevelopmental impairments have been recognised as a major association of paediatric kidney disease and bladder dysfunction, presenting challenges to clinicians and families to provide reasonable adjustments in order to allow access to investigations and treatments. Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterised by impairments in social interaction/communication and repetitive sensory-motor behaviours. Mental health, learning and physical co-morbidities are common. There is emerging evidence that ASD and kidney disease have some overlaps with genetic copy number variants and environmental factors contributing to shared pathogenesis. Prevalence rates of ASD in kidney disease are currently not known. A high index of suspicion of underlying ASD is required when a young person presents with communication difficulties, anxiety or behaviour that challenges, which should then trigger referral for a neurodevelopmental and behavioural assessment. We discuss practical approaches for providing care, which include understanding methods of communication and sensory, behavioural and environmental adaptations. [ABSTRACT FROM AUTHOR]

Soil water content (θ) measurement is vital for accurate irrigation scheduling. Electromagnetic induction surveys can be used to map spatial variability of θ when other soil properties are uniform. However, depth-specific θ variations, essential for precision irrigation management, have been less investigated using this method. A quasi-2-dimensional inversion model, capable of inverting apparent soil electrical conductivity (ECa) data to calculate estimates of true electrical conductivity (σ) down the entire soil profile, was developed using ECa data collected by a multi-coil Dualem-421S sensor. The optimal relationships between σ and volumetric water content (θv) were established using all coil arrays of the Dualem-421S, a damping factor of 0.04, an initial model of 35 mSm−1, and with ten iterations (R2 = 0.70, bias = 0.00 cm3cm−3, RMSE = 0.04 cm3cm−3). These relationships were then used to derive soil profile images of these properties, and as expected, θv and σ follow similar trends down the soil profile. The derived soil profile images for θv have potential use for irrigation scheduling to two ECa-derived soil management zones under a variable rate irrigation system at this case study site. They reflect the intrinsic soil differences that occur between texture, texture transitions and drainage characteristics. The method can also be used to guide placement of soil moisture sensors for in-season monitoring of spatio-temporal variations of θv. This soil imaging method showed good potential for predicting 2D depth profiles of soil texture, moisture and drainage characteristics, and supporting soil, plant and irrigation management. [ABSTRACT FROM AUTHOR]

Introduction: Staple line leaks following laparoscopic sleeve gastrectomy (LSG) are associated with significant morbidity and mortality. Endoluminal techniques, including stent placement and endoluminal vacuum therapy (EVAC), have become viable options to treat these patients without the need for additional surgery. The purpose of this study was to define the conditions where certain endoscopic therapies are most likely to succeed compared to surgery.Methods: An IRB approved prospectively maintained database was retrospectively reviewed for all patients treated for gastrointestinal leaks from July 2013 to March 2019. All patients who were treated for gastrointestinal leaks following LSG were included. Endpoints include success of leak closure and hospital-related morbidity for the patients treated solely by endoscopic only methods (EP) compared to the additional surgery group (SP).Results: There were 39 patients (33 females; 6 males) with a median age of 45.9 years. The EP group included 23 patients (59%), whereas SP included 16 patients (31%). On average, the SP had longer days from sentinel surgery to our hospital admission (70 vs 41), a higher percentage of previous bariatric surgery prior to sentinel LSG (50% vs 17%), and a higher readmission rates following discharge (50% vs 39%). Total length of stay was also higher in the SP compared to the EP (45.4 vs 11). Using this data, a treatment algorithm was developed to optimally treat future patients who suffer from gastrointestinal leaks following LSG.Conclusions: Endoscopic therapies, such as EVAC, stent placement, internal drainage, and over-the-scope clips, have a higher chance of success if performed earlier to their sentinel surgery and if patients have had no prior bariatric surgeries. Patients who require additional surgery tend to have longer hospital stays and readmission rates. Using the treatment algorithm provided can help determine when endoscopic therapies are likely to succeed. [ABSTRACT FROM AUTHOR]

Aim: Hypertension in children with abnormal kidneys often requires multiple antihypertensive agents (complex), or could present with complications (e.g. hypertensive encephalopathy). Our objective in this report is to evaluate blood pressure control following unilateral or bilateral laparoscopic native nephrectomy in children with renal hypertension.Materials and Methods: Single-centre retrospective review of all children who underwent nephrectomy for management of hypertension over a recent study period (2008-2017) with post-operative follow-up of at least 3 years. We describe the association of age, primary kidney disease and blood pressure and its management including time to resolution following unilateral or bilateral nephrectomy.Results: During the 9-year study period, 21 of 215 (9.8%) children underwent nephrectomy for management of hypertension. We included 19 children [6 with unilateral native nephrectomy (UNN) and 13 with bilateral native nephrectomy (BNN)] in this study as they continued with their follow-up at our centre. Out of the 19 children, 15 had laparoscopic retroperitoneoscopic nephrectomies and 4 had laparoscopic transperitoneal nephrectomies. Six children had unilateral nephrectomy and 13 children had bilateral nephrectomies [7 were pre-transplant (haemodialysis-6, peritoneal dialysis-1) and 6 were post-kidney transplant]. Fifteen of 19 children (79%) had complete resolution [5 UNN and 10 BNN] and 3 (16%) partial resolution [1 UNN and 2 BNN]. One patient with BNN was observed to have no change in blood pressure control.Conclusion: Our data demonstrate improved management of hypertension in 95% of the children. Nephrectomy could offer a reasonable treatment option for selected group of complex and complicated renal hypertension. [ABSTRACT FROM AUTHOR]

Background: This study aimed to investigate the association of acute kidney injury (AKI) with change in estimated glomerular filtration rate (eGFR) in children with advanced chronic kidney disease (CKD). Methods: Single centre, retrospective longitudinal study including all prevalent children aged 1–18 years with nondialysis CKD stages 3–5. Variables associated with CKD were analysed for their potential effect on annualised eGFR change (ΔGFR/year) following multiple regression analysis. Composite end-point including 25% reduction in eGFR or progression to kidney replacement therapy was evaluated. Results: Of 147 children, 116 had at least 1-year follow-up in a dedicated CKD clinic with mean age 7.3 ± 4.9 years with 91 (78.4%) and 77 (66.4%) with 2- and 3-year follow-up respectively. Mean eGFR at baseline was 29.8 ± 11.9 ml/min/1.73 m2 with 79 (68%) boys and 82 (71%) with congenital abnormalities of kidneys and urinary tract (CAKUT). Thirty-nine (33.6%) had at least one episode of AKI. Mean ΔGFR/year for all patients was − 1.08 ± 5.64 ml/min/1.73 m2 but reduced significantly from 2.03 ± 5.82 to − 3.99 ± 5.78 ml/min/1.73 m2 from youngest to oldest age tertiles (P < 0.001). There was a significant difference in primary kidney disease (PKD) (77% versus 59%, with CAKUT, P = 0.048) but no difference in AKI incidence (37% versus 31%, P = 0.85) between age tertiles. Multiple regression analysis identified age (β = − 0.53, P < 0.001) and AKI (β = − 3.2, P = 0.001) as independent predictors of ΔGFR/year. 48.7% versus 22.1% with and without AKI reached composite end-point (P = 0.01). Conclusions: We report AKI in established CKD as a predictor of accelerated kidney disease progression and highlight this as an additional modifiable risk factor to reduce progression of kidney dysfunction. Graphical abstract [ABSTRACT FROM AUTHOR]

To evaluate an implementation intervention to increase the uptake, referred to as reach, of two evidence-based psychotherapies (EBP) for posttraumatic stress disorder (PTSD) in Veterans Health Administration (VHA) PTSD specialty clinics. The implementation intervention was external facilitation guided by a toolkit that bundled strategies associated with high EBP reach in prior research. We used a prospective quasi-experimental design. The facilitator worked with local champions at two low-reach PTSD clinics. Each intervention PTSD clinic was matched to three control clinics. We compared the change in EBP reach from 6-months pre- to post-intervention using Difference-in-Difference (DID) effect estimation. To incorporate possible clustering effects and adjust for imbalanced covariates, we used mixed effects logistic regression to model the probability of EBP receipt. Analyses were conducted separately for PTSD and other mental health clinics. 29,446 veterans diagnosed with PTSD received psychotherapy in the two intervention and six control sites in the two 6-month evaluation periods. The proportion of therapy patients with PTSD receiving an EBP increased by 16.98 percentage points in the intervention PTSD clinics compared with.45 percentage points in the control PTSD clinics (DID = 16.53%; SE = 2.26%). The adjusted odd ratio of a patient receiving an EBP from pre to post intervention was almost three times larger in the intervention than in the control PTSD clinics (RoR 2.90; 95% CI 2.22–3.80). EBP reach was largely unchanged in other (not PTSD specialty) mental health clinics within the same medical centers. Toolkit-guided external facilitation is a promising intervention to improve uptake of EBPs in VHA. Toolkits that pre-specify targets for clinic change based on prior research may enhance the efficiency and effectiveness of external facilitation. Trial registration ISRCTN registry identifier: ISRCTN65119065. Available at https://www.isrctn.com/search?q=ISRCTN65119065. [ABSTRACT FROM AUTHOR]

Head turning while walking may challenge stability by altering visual and vestibular information. Whether there are age-related changes that affect gait stability while head turning during walking remains unknown. The aim of the current study was to compare gait stability between younger and older adults immediately following a head turn while walking. Ten younger [mean (SD)] [23.4 (3.3) years] and ten older [68.8 (6.0) years] healthy adults walked on a treadmill at their preferred gait velocity and performed head turns by responding to a visual cue. The margin of stability (MoS) in the mediolateral (MoSML), anterior (MoSA) and posterior (MoSP) directions, foot placement (mean step length and width) and rotation of the head, trunk and pelvis were calculated for the four steps immediately following a cue to head turn and compared to walking only. Older adults increased their MoSML and younger adults increased their MoSP immediately following a head turn. However, older adults had a significantly greater MoSP than younger adults during this time. Older adults also had greater pelvic rotation velocity and a trend towards smaller head-on-trunk rotation compared to younger adults. Age does not compromise the stability of healthy older compared to younger adults immediately following or when completing a head turn. However, older adults may use a different motor strategy to perform a head turn to limit isolated movement of the head and the effects of a changing sensory frame of reference. [ABSTRACT FROM AUTHOR]

Background: There are limited data regarding vitamin and trace element blood concentrations and supplementation needs in children with non-dialysis stages 3–5 of chronic kidney disease (CKD). Methods: Retrospective cross-sectional review for nutritional blood concentrations measured over a recent 2-year period. In our CKD clinics, nutritional bloods including copper, zinc, selenium and vitamin A, vitamin E, active vitamin B12 and folate are monitored annually. Vitamin D status is monitored every 6–12 months. Results: We reviewed 112 children (70 boys) with median (IQ1, IQ3) age 8.97 (4.24, 13.80) years. Estimated median (IQ1, IQ3) GFR (mL/min/1.73 m2) was 28 (21, 37). Vitamin A, active vitamin B12 and vitamin E concentrations were within normal range in 19%, 23% and 67% respectively, with all others being above normal range. Vitamin D blood concentrations were within desired range for 85% (15% had low levels) and folate blood concentrations were within normal range in 92%, with the remainder above or below target. For trace elements, 60%, 85% and 87% achieved normal ranges for zinc, selenium and copper respectively. Deficiencies were seen for zinc (35%), copper (7%), folate (3%) and selenium (1%), whilst 5%, 6% and 14% had zinc, copper and selenium levels above normal ranges. Conclusions: Several vitamin and trace element blood concentrations were outside normal reference ranges. Monitoring vitamin D and zinc blood concentrations is indicated due to the percentages with low levels in this group. Targeted vitamin and trace element supplementation should be considered where indicated rather than commencing multivitamin and/or mineral supplementation. [ABSTRACT FROM AUTHOR]

Background: Magnetic sphincter augmentation (MSA) is a surgical treatment for gastroesophageal reflux disease using a ring of titanium beads to improve the function of the lower esophageal sphincter. Prior to implantation, a comprehensive preoperative esophageal workup is required to determine patient candidacy in an effort to reduce the dysphagia, dilation, and explantation rate of the device. This study was designed to assess the best predictors for these endpoints.Methods: A prospectively maintained IRB-approved database was retrospectively reviewed for patients undergoing MSA implantation. Patients were divided into 3 groups, those that needed no intervention, those that needed medical intervention with oral steroids for reported dysphagia, and surgical intervention, which included endoscopic dilation and/or surgical explantation. Primary endpoints included preoperative objective and subjective testing from a comprehensive esophageal workup including intraoperative notation of number of beads on the device.Results: There were 99 patients eligible for the study with a mean age of 52 and mean follow-up of 10.2 months. Mean BMI was 27 and 59% were female. The no-intervention group had 59 patients, medical intervention group had 25 patients, and surgical intervention group had 15 patients. Preoperative esophageal manometry findings, pH testing off medications, endoscopic and radiologic evaluation showed no difference between the 3 groups. No differences were seen in preoperative subjective evaluations based on GERD-HRQL or RSI scores. There was no difference in average number of beads on the device between the 3 groups.Conclusion: A comprehensive esophageal workup is important to confirm the presence of gastroesophageal reflux disease and rule out other esophageal pathology. However, this study shows that a preoperative comprehensive esophageal workup does not predict which patients will develop dysphagia or require either medical or surgical interventions following MSA implantation. [ABSTRACT FROM AUTHOR]

Introduction: Australia is traditionally an early adopter of vaccines, therefore comprehensive and effective post-licensure vaccine pharmacovigilance is critical to maintain confidence in immunisation, both nationally and internationally. With adverse event following immunisation (AEFI) surveillance the responsibility of Australian jurisdictions, Victoria operates an enhanced passive AEFI surveillance system integrated with clinical services, called 'SAEFVIC' (Surveillance of Adverse Events Following Vaccination In the Community).Objective: The aim of this study was to evaluate Victoria's current AEFI surveillance system 'SAEFVIC' and inform ongoing quality improvement of vaccine pharmacovigilance in Victoria and Australia.Methods: We conducted a retrospective structured desktop evaluation of AEFI reporting received by SAEFVIC from 2007 to 2014, to evaluate the system according to its stated objectives, i.e. to improve AEFI reporting; provide AEFI signal detection; and to maintain consumer confidence in vaccination.Results: AEFI reporting has tripled since SAEFVIC commenced (incidence risk ratio [IRR] 3.04, 95% confidence interval [CI] 2.35-3.93), raising Victoria to be the lead jurisdiction by AEFI reporting volume and to rank third by population reporting rate nationally. The largest increase was observed in children. Data were utilised to investigate potential signal events and inform vaccine policy. Signal detection required clinical suspicion by surveillance nurses, or prior vaccine-specific concerns. Subsequent vaccination post-AEFI was documented for 56.2% (95% CI 54.1-58.4) of reports, and the proportion of children due or overdue for vaccination was 2.3% higher for those reporting AEFI compared with the general population.Conclusion: SAEFVIC has improved AEFI surveillance, facilitates signal investigation and validation, and supports consumer confidence in immunisation. Expansion of the system nationally has the potential to improve capacity and capability of vaccine pharmacovigilance, particularly through data consistency and jurisdictional comparability in Australia. [ABSTRACT FROM AUTHOR]

Dates are economically and culturally important in the United Arab Emirates (UAE). The Emirates has a hyper-arid climate, such that rainfall (green water) is irrelevant for date production. Date farmers rely on irrigation with groundwater (blue water) that is brackish to grow the dates. However, the quantity of groundwater left in the underground reserves is diminishing. Leaching of polluted water (grey water) containing nitrogen and salts from the rootzone of the date palms is compromising the quality of the remaining groundwater reserves. Quantification of the water footprints of WFgreen, WFblue and WFgrey, in L kg−1 of dates produced can be used to assess the magnitude of the impacts of date production on the quantity and quality of the UAE's valuable groundwater resources. Our water-use experiments on dates near Dubai were used to determine these footprints. We measured the tree transpiration, ETc (m3 year−1) of three date varieties of 'Lulu' (salt-tolerant), 'Khalas' (moderately tolerant), and 'Shahlah' (salt-intolerant), irrigated with water at two rates of salinity with electrical conductivities (EC) of 5 and 15 dS m−1. The WFgreen = 0, because of the negligible rainfall. Our recommendation is for irrigation to be at 1.5 × ETc to enable the leaching of salts. So with the transpiration loss of ETc there is drainage of 0.5 × ETc back to groundwater. The WFblue is, therefore, ETc/Y, where Y is the yield of dates (kg). We found WFblue = 646.6 L kg−1. The grey water footprints were WFgrey = 523 L kg−1 for nitrogen and 970 L kg−1 for salt. The salt WFgrey had the largest magnitude. The economic benefit–cost ratio (BC) of the prior dilution of the brackish groundwater with desalinated water for irrigation was found to be 1.4. However, the externality of the environmental impact of the disposal of the rejected brine from desalination will need to be addressed. [ABSTRACT FROM AUTHOR]

In Dysfunctional voiding, failure of the external sphincter-pelvic floor complex to relax during micturition results in bladder outflow obstruction with a spectrum of presentation from more benign lower urinary tract dysfunction including recurrent urinary tract infections, to significant upper tract pathology and end-stage renal failure. There is no underlying neurological or anatomical cause and the condition is postulated to be a largely learnt behavior. Diagnosis relies on non-invasive urodynamics and in particular uroflowmetry, plus or minus EMG, which is also used in biofeedback, the mainstay of treatment. The etiology, presentation, diagnosis, and treatment with particular emphasis on non-invasive urodynamics are covered. [ABSTRACT FROM AUTHOR]

Background: Bacillus Calmette-Guérin (BCG) vaccine is used worldwide, with high efficacy against childhood Mycobacterium tuberculosis (TB) meningitis and miliary TB. BCG vaccine is considered safe, with serious systematic adverse events following immunization (AEFI) of immunocompetent recipients being rare, although adverse event rates vary between differing BCG strains. In Victoria, Australia, AEFI are reported to SAEFVIC (Surveillance of Adverse Events Following Vaccination In the Community), an enhanced passive surveillance system operational since 2007.Objective: To describe the epidemiology of reported BCG AEFI in Victoria, Australia, particularly following the 2012 recall of Connaught BCG vaccine, substitution with Denmark-SSI vaccine and subsequent programme delivery adjustments.Methods: Retrospective analysis of reported BCG AEFI in Victoria, Australia, for the 6-year period 2008-2013. Incidence rates were calculated using available doses-distributed, doses-administered and population data denominators with 95 % confidence intervals.Results: The predominant BCG AEFI reported were abscess and lymphadenopathy, with higher reports for males than for females (p = 0.039).The rates of AEFI per 10,000 doses distributed were similar for the Connaught and Denmark-SSI strains, at 11.6 and 15.4, respectively (p = 0.414). When doses administered rather than doses distributed were considered, the rate of reported Denmark-SSI AEFI was much higher, at 62.8 per 10,000 doses administered. Meaningful result interpretation was hampered by a lack of a BCG vaccination register, multiple disparate providers and absent doses-administered data prior to the recall.Conclusion: Effective AEFI surveillance is of paramount importance as countries are faced with unplanned vaccine strain changes following the 2012 BCG recall and subsequent global vaccine supply shortages. The Australian experience and lessons learned serve as a timely reminder to BCG vaccination programmes worldwide to review AEFI surveillance systems. [ABSTRACT FROM AUTHOR]

Background: Sleeve gastrectomy is a relatively new procedure that developed as a result of rapid innovation in the field of bariatric surgery. As with any newly developed operation, there is a learning curve that potentially can be associated with higher morbidity. Real-time surgical mentoring reduces the learning curve effect but can be time intensive for the mentor. The aim of this initiative was to evaluate the feasibility, effectiveness, and satisfaction of surgical telementoring for laparoscopic sleeve gastrectomy. This is the first national specialty society effort to determine if the "remote presence" of an expert surgeon (mentor) can help practicing surgeons improve skills.Methods: The experience of 15 surgical trainees (mentees) who performed laparoscopic sleeve gastrectomy under real-time telementoring by 7 mentors was reviewed. Telementoring was implemented using the Visitor1® remote presence system with two-way live audio and video communication. The receiving platform utilized a conventional laptop, iPad, or iPhone. The mentee followed a structured telementoring program including didactic learning, live case teleobservation, and telementoring of 2-3 cases. A survey on the quality of the telecommunication and effectiveness of the mentoring was performed by the mentor and mentee on a scale of "exceeded," "met," "almost met," or "failed to meet" expectations. The overall telementoring experience was rated on a scale of 1 for "poor" to 5 for "excellent."Results: Based on the mentees' survey, the overall telementoring experience was rated as 4.8. Despite the mentees having experience with laparoscopic sleeve gastrectomy, most commented that the telementoring experience was an excellent educational tool and they learned some new techniques they plan to apply it in their practice. Based on the mentors' survey, the overall telementoring experience was rated as 4.7. All mentors stated that they were satisfied with the telementoring sessions and there were no unexpected intraoperative occurrences. There were some logistical limitations including difficulties in scheduling of cases or the delay of cases.Conclusions: Surgical instruction by telementoring was shown to be feasible, practical, and successful, and was highly rated in this study by both the mentors and mentees. The currently utilized telementoring platform is thus an effective educational tool that can facilitate acquisition of surgical skills and assist with the conventional on-site surgical mentoring model. [ABSTRACT FROM AUTHOR]

Background: Current guidelines advise providers to assess smokers' readiness to quit, then offer cessation therapies to smokers planning to quit and motivational interventions to smokers not planning to quit.Objectives: We examined the relationship between baseline stage of change (SOC), treatment utilization, and smoking cessation to determine whether the effect of a proactive smoking cessation intervention was dependent on smokers' level of motivation to quit.Design: Secondary analysis of a multicenter randomized controlled trial.Participants: A total of 3006 current smokers, aged 18-80 years, at four Veterans Affairs (VA) medical centers.Interventions: Proactive care included proactive outreach (mailed invitation followed by telephone outreach), offer of smoking cessation services (telephone or face-to-face), and access to pharmacotherapy. Usual care participants had access to VA smoking cessation services and state telephone quitlines.Main Measures: Baseline SOC measured with Readiness to Quit Ladder, and 6-month prolonged abstinence self-reported at 1 year.Key Results: At baseline, 35.8 % of smokers were in preparation, 38.2 % in contemplation, and 26.0 % in precontemplation. The overall interaction between SOC and treatment arm was not statistically significant (p = 0.30). Among smokers in preparation, 21.1 % of proactive care participants achieved 6-month prolonged abstinence, compared to 13.1 % of usual care participants (OR, 1.8 [95 % CI, 1.2-2.6]). Similarly, proactive care increased abstinence among smokers in contemplation (11.0 % vs. 6.5 %; OR, 1.8 [95 % CI, 1.1-2.8]). Smokers in precontemplation quit smoking at similar rates (5.3 % vs. 5.6 %; OR, 0.9 [95 % CI, 0.5-1.9]). Within each stage, uptake of smoking cessation treatments increased with higher SOC and with proactive care as compared with usual care.Limitations: Mostly male participants limits generalizability. Randomization was not stratified by SOC.Conclusions: Proactive care increased treatment uptake compared to usual care across all SOC. Proactive care increased smoking cessation among smokers in preparation and contemplation but not in precontemplation. Proactively offering cessation therapies to smokers at all SOC will increase treatment utilization and population-level smoking cessation. [ABSTRACT FROM AUTHOR]

For veterans presenting for emergency psychiatric care, this research tested the hypothesis that patients with poor geographic accessibility to ambulatory mental health services would be more likely to be hospitalized. Logistic regression results indicated that distant patients (> 60 miles) were 4.8 times more likely (p < .05) to be admitted for acute psychiatric treatment than were proximal patients (< 60 miles), controlling for clinical and demographic case-mix factors. This finding suggests that the Department of Veterans Affairs might be less effective in its effort to substitute intensive outpatient care in place of expensive inpatient treatment for rural veterans with emergent mental health problems. [ABSTRACT FROM AUTHOR]

Aims: This study aims to (i) determine the effects of incorporating 47 Mg ha acacia green waste biochar on soil physical properties and water relations, and (ii) to explore the different mechanisms by which biochar influences soil porosity. Methods: The pore size distribution of the biochar was determined by scanning electron microscope and mercury porosimetry. Soil physical properties and water relations were determined by in situ tension infiltrometers, desorption and evaporative flux on intact cores, pressure chamber analysis at −1,500 kPa, and wet aggregate sieving. Results: Thirty months after incorporation, biochar application had no significant effect on soil moisture content, drainable porosity between -1.0 and −10 kPa, field capacity, plant available water capacity, the van Genuchten soil water retention parameters, aggregate stability, nor the permanent wilting point. However, the biochar-amended soil had significantly higher near-saturated hydraulic conductivity, soil water content at −0.1 kPa, and significantly lower bulk density than the unamended control. Differences were attributed to the formation of large macropores (>1,200 μm) resulting from greater earthworm burrowing in the biochar-amended soil. Conclusion: We found no evidence to suggest application of biochar influenced soil porosity by either direct pore contribution, creation of accommodation pores, or improved aggregate stability. [ABSTRACT FROM AUTHOR]

Nephrotic syndrome in the first year of life (NSFL) is a heterogeneous group of disorders, the management of which is supportive, as most patients do not respond to immunosuppression. Prognosis is guarded, as the syndrome tends to lead to end-stage renal failure. We describe four cases, all of which went into spontaneous remission. These patients had severe nephrosis that began postnatally at ages 15 days to 7 months and had preceding symptoms of viral infections. One infant had proven pertussis and required ventilation for respiratory failure. Renal biopsies showed varying degrees of mesangial expansion and increased cellularity. Two biopsies showed mild mesangial sclerosis and the other two only scattered globally sclerosed glomeruli. Supportive treatment was started with 20% albumin infusions, diuretics, penicillin, and thyroxine. Angiotensin-converting enzyme (ACE) inhibitors were used to reduce proteinuria in all infants, and one was also treated with indomethacin. The nephrosis gradually resolved, and protein-lowering medications were successfully weaned completely 5-30 months after presentation. The patients were protein free with normal renal function at last follow-up. Investigations including viral studies and autoimmune profiles were negative. Genetic studies for NPHS1, NPHS2, WT1, and LAM-β were negative. We therefore describe a subgroup of NSFL with good prognosis associated with infectious prodromes. This is also the first-described case of pertussis causing nephrotic syndrome. [ABSTRACT FROM AUTHOR]

Soil carbon (C) management is identified as a key element of sustainable agriculture, and an increase in nitrogen (N) mineralization rates is expected with an increase in soil C. However, any practical recommendation for using soil C management to substitute the application of synthetic N fertilizer needs to account simultaneously for other important agronomic variables and environmental conditions. For this purpose we investigated the simultaneous impact of soil C management, environmental conditions, and soil structure on N mineralization in two apple orchard systems in Havelock North, New Zealand. One system is an organic orchard using regular compost applications and the other is a neighboring integrated orchard with no external inputs of organic matter. The soil type, texture, and climate are identical in both orchards. We selected different temperatures (10°C, 15°C, and 20°C) and soil moistures (−30, −100, and −300 kPa) as the environmental conditions for N mineralization. Simultaneously, the hot-water extractable C (HWC) contents were measured and served as the indicator for the soil C management of the orchards. To analyze the impact of soil structure, the N mineralization of undisturbed cores was compared with that of disturbed samples. The net N mineralization of the soil in the organic orchard was on average six times higher than that in the integrated orchard. At the same time, in the organic orchard the HWC contents at the beginning of the N mineralization experiment were about two times higher than in the integrated orchard. In a multiple regression as a practical recommendation for the orchards of our case study, we could explain 84% of the variability of N mineralization rates using HWC and environmental conditions as the independent variables. The HWC content was the most significant variable in the multiple regression model and showed that soil C management has a more prominent role than the environmental conditions. Soil C management such as regular compost applications which increase the soil's HWC contents can also be used to manage N mineralization. The significant difference between the undisturbed and disturbed samples showed the soil structure can have an effect on N mineralization. [ABSTRACT FROM AUTHOR]

Collapsing glomerulopathy has increasingly been recognised in patients with conditions other than HIV. The non-HIV form of collapsing glomerulopathy generally shows little response to standard therapies. We describe a 12-year-old girl with a pre-existing diagnosis of systemic lupus erythematosus presenting with renal failure. A renal biopsy gave the histological diagnosis of collapsing glomerulopathy with evidence of 'full-house' immunostaining. We propose collapsing glomerulopathy in her case, as no other cause was found was secondary to systemic lupus erythematosus. The immunophenotype of her podocytes suggested a partial de-differentiation that might have been important in her partial response to immunosuppression. [ABSTRACT FROM AUTHOR]

Partial rootzone drying (PRD) is a water-saving irrigation practice which involves watering only part of the rhizosphere at each irrigation with the complement left to dry to a pre-determined level. The effect of PRD, applied at different phenological stages, on yield, fruit growth, and quality of the processing tomato cv. ‘Petopride’ was studied in this experiment. The treatments were: daily full irrigation (FI) on both sides of the root system considered as the control, and PRD treatments applied at three phenological stages. These were: during the vegetative stage until the first truss was observed (PRDVS–FT), from the first truss to fruit set (PRDFT–FS), and from fruit set to harvest (PRDFS–H). In some occasions, leaf xylem water potential was lower in each PRD period than in FI. Number of fruits, total fresh and dry weight of fruit per plant, harvest index, and fruit growth were lower in PRDFT–FS and PRDFS–H plants than in FI and PRDVS–FT plants. However, irrigation water use efficiency, on a dry weight basis, was the same among the treatments. For PRDFT–FS and PRDFS–H treatments, mean fresh weight of fruit and fruit water content were reduced and dry matter concentration of cortex and total soluble solids concentration of fruit increased compared with FI and PRDVS–FT treatments. Incidence of blossom-end rot was the same among PRDVS–FT, PRDFS–FH, and FI fruit, but it was higher in PRDFT–FS fruit. Fruit skin colour was the same among treatments. Total dry weight of fruit per plant decreased by 23% for PRDFT–FS and by 20% for PRDFS–H relative to FI. Fruit quality improvement in PRDFS–H could compensate for the reduction in total dry weight of fruit where water is expensive for tomato production. But an economical analysis would be needed to substantiate this. PRD from the first truss to fruit set is not recommended because of the high incidence of blossom-end rot. [ABSTRACT FROM AUTHOR]

We present the measurement and modelling of transpiration from squash ( Cucurbita maxima Duchesne) growing in the field under a tropical maritime climate. Measurements were carried out on Tongatapu (175°12′ W, 21°08′ S), a coral atoll located in the Pacific Ocean. Transpiration was determined from heat-pulse measurements of sap flow in the vine stem using the T-max method. Steady-state porometry was used to monitor stomatal conductance ( g S, mm s−1). The data were used to derive parameters for a functional model of conductance that includes response functions for light, air temperature and vapour pressure deficit of the air, and a novel response function for soil moisture. Leaf area development was monitored through the growing season using a point quadrant approach. The maximum leaf area was about 2.7 m2 per plant and the effective ground area was about 1 m2 for each plant. Transpiration losses were calculated using a 2-layer big-leaf model in combination with modelled stomatal response and measured leaf area. In general, the sap flow measurements were in good agreement with the calculations of plant water use. Peak water use was between 3 and 5 L per plant per day. Daily transpiration measurements from heat-pulse were used to derive a crop factor, K C, for squash in this tropical maritime climate. The derived seasonal pattern of K C was similar to the FAO recommended crop factor for squash. However, the growing season was a little shorter. Measured sap flow also revealed periods of short-term drought and leaf fungal disease that reduced the actual transpiration losses, and there was often a rapid recovery from water stress following rainfall events. [ABSTRACT FROM AUTHOR]

By using nuclear magnetic resonance imaging (NMRI) we have been able to analyse dispersion at the microscopic scale during steady-state flow through water-saturated glass beads. The flow rate through the porous medium was chosen high enough in order to neglect the influence of molecular diffusion on dispersion. Velocity statistics were measured, by NMRI, within slices of increasing thickness perpendicular to the direction of flow. It took more than two bead diameters before a representative elementary volume (REV) for the mean velocity was reached. This was in a region in the middle of the column that was not influenced by the boundary conditions. There the velocity variance decreased exponentially as a function of the slice thickness, due we consider to the formation of an interconnecting streamline network. The exponential decrease in the velocity variance reflects the transition from a local pattern of stochastic–convective flow to a convective–dispersion regime at the scale of the REV. We found that the point-like preferential influx and efflux boundary condition increased velocity variances and thus enhanced longitudinal hydrodynamic dispersion. Using the transverse correlation length of longitudinal velocity variance, we derived a mean transverse dispersivity that agreed well with Saffman’s (1959) model. So we have been able to provide for the first time a direct observation verification of a part of Saffman’s (1959) conjectures. By NMRI we observed this value to be independent of the observation scale of the slice thickness. [ABSTRACT FROM AUTHOR]

EDTA-enhanced phytoremediation of copper contaminated soil was evaluated. Up to 740 μg g-1 of Na2H2 EDTA in solution was added to repacked soil columns, and intact cores of a sandy loam of volcanic origin, that was growing Agrostis tenuis. The soil contained up to 400 μg g-1 of copper due to a history of fungicide spraying. EDTA application increased the herbage copper concentration of the grass growing in repacked soil from 30 to 300 μg g-1, but the same application to an intact core only brought about an increase from 10 to 60 μg g-1. More copper accumulated in the herbage when the EDTA was applied in numerous small doses than in just one or two larger amounts. Calculation of the concentration of copper in the water taken up by the grass revealed this to be two orders of magnitude lower than that in the soil solution. As a result of the EDTA applications, about 100 times more copper was leached than was taken up by the herbage. This means that a strategy for managing leaching losses needs to be part of any plan for EDTA-enhanced phytoremediation. [ABSTRACT FROM AUTHOR]

Primary human keratinocytes can be driven, in vitro, to differentiate, via activation of transglutaminases, by raising the culture medium calcium concentration above 1 mM. This results in transglutaminase regulated cross linking of specific amino acids with resultant cornified envelope formation. The differentiation was monitored via the incorporation of fluorescein cadaverine into the cornified envelops. This differentiation assay was combined with assessment of reductive capacity of resazurin, as a measure of cell activity/viability. One primary aim is to assess the effects of THz radiation on human skin, since medical imaging of the body through the skin is envisaged. Human keratinocytes, at passage 2 from isolation, were grown to confluence, and transported in a buffered salt solution at 22 °C. The exposure to the THz source was for 10, 20 or 30 minutes at room temperature. No donor specific inhibition or stimulation of cell activity, compared with non-exposed cells, was noted following exposure in the range 1 to 3 THz, at up to 0.45J/cm2. The differentiation also occurred in a normal way, for exposed and non-exposed cells, with the FC incorporation increasing between day 3 and day 8, as previously noted. [ABSTRACT FROM AUTHOR]

Wild-type populations of amphibians, unlike mammalians, appear to be resistant to spontaneous and chemically induced neoplasms. Few true cancers have been reported for non-isogeneic members of Xenopus laevis, despite their widespread use in laboratories around the world. Injection of even the most powerful direct mammalian oncogens e.g. N-methyl N-nitrosourea, that depleted specific populations of T lymphocytes, did not induce cancer. Phorbol diesters, e.g. PMA, are mitogens and apoptogens in both amphibian, and mammalian immunocytes. In mammalian cells, regulation of the cell cycle and of apoptosis are often intimately linked, however, a disjunction in time between early apoptosis and later cell cycling, has been observed with PMA-treated Xenopus splenocytes. Thus, a particular difference between amphibians and mammals may be the requirement to enter the cell cycle before a progression to death by apoptosis. This hypothesis was tested here using dual staining flow cytometry. Xenopus laevis splenocytes were cultured for 8, 24 and 48 hours with phorbol 12-myristate 13-acetate (PMA), previously shown to be mitogenic and apoptotic with mature Xenopus lymphocytes. The cells were stained with FITC-conjugated Annexin V or with FITC-labeled deoxyuridine triphosphates (FITC-dUTP) to assay for the apoptotic markers phosphotidylserine or DNA strand breaks respectively. Phycoerythrin (PE)-conjugated anti-human proliferating cell nuclear antigen (PE-PCNA) was used as a cell cycle marker that is present during the entire cell cycle. Propidium iodide (PI) binds DNA and was used to assay for late stage apoptosis, as well as to assess DNA content. Significantly higher levels of apoptosis develop rapidly in PMA-exposed splenocytes and are maintained at 24 hours, declining by 48 hours. Cells expressing PCNA or incorporating PI in excess of the normal genomic level were found by 48 hours following PMA exposure. The absence of any significant rise in a small (<5%) dual staining cell population indicates that the apoptotic cell population remained distinct from cells already in the cell cycle from the onset of PMA exposure. Thus, Xenopus splenocytes respond differentially to PMA. Those that undergo apoptosis rapidly were quiescent, non-cycling small lymphocytes. Moreover, the cells that eventually begin division, following PMA exposure, were unaffected by the early apoptois and do not themselves die while in the cell cycle. The rapid apoptotic response of X. laevis cells to PMA may confer a natural cancer resistance in this species, as cells that fail to enter the cell cycle after exposure to cancer promoting reagents cannot express genetic destabilization that might have led to transformation. [ABSTRACT FROM AUTHOR]

Phytoextraction describes the use of plants to remove metals and other contaminants from soils. This low-cost technology has potential for the in situ remediation of large areas of contaminated land. Despite more than 10 years of intensive research on the subject, very few commercial phytoextraction operations have been realised. Here, we investigate the viability of phytoextraction as an effective land-treatment technology. A Decision Support System (DSS) was developed to predict the effect of phytoextraction on soil metal concentration and distribution, as well as the economic feasibility of the process in comparison to either inaction or the best alternative technology. Changes in soil metal concentration are mechanistically predicted on the basis of plant water use, metal concentration in soil solution, soil density, plant root distribution and our so-called root-absorption factor. The root-absorption factor is a `lumped parameter' describing the xylem/soil solution metal concentration quotient. Phytoextraction is considered to be a viable option if it can satisfy environmental regulations and simultaneously be shown to be the most cost-effective technology, either alone, or in combination with other remediation technologies. To date, commercial phytoextraction has been constrained by the expectation that site remediation should be achieved in a time comparable to other clean-up technologies. However, if phytoextraction could be combined with a profit making operation such as forestry, then this time constraint, which has often been considered to be the Achilles heel of phytoextraction, may be less important. [ABSTRACT FROM AUTHOR]

A field experiment was conducted to investigate the influences of 0, 5, 10, 15 Mg ha-1 of wheat (Triticum aestivum) straw, composted sugarcane bagasse residue and farmyard manure on soil physical properties and yield of winter wheat. The experimental design was a split plot with four replicates. The considered physical properties, 1 year after organic matter addition, included aggregate stability, infiltration rate, water retention curve and dry bulk density. Wheat yield and chemical characteristics of wheat grains were measured. Application of organic materials significantly increased wheat yield and increased aggregate stability, infiltration rate, water retained at less than −100 kPa, and decreased soil bulk density. The effectiveness of different organic materials, farmyard manure, composted bagasse and wheat straw, on improving the soil physical properties was similar. Wheat grain and stubble yield progressively increased as the rate of the organic materials increased. The effectiveness of composted bagasse, farmyard manure and wheat straw on improving wheat grain yield was 22, 14 and 3%, and wheat stubble yield was 26, 17 and 4% over the control. [ABSTRACT FROM AUTHOR]

Determines the mechanisms prescribing the movement and uptake of chemicals in the soil of the rootzone controlled experiments that were carried out in four lysimeters growing tomatoes.

Studies the natural and induced cadmium-accumulation in poplar and willow. Effect of cadmium concentration on plant growth; Shade house experiments on the accumulation of cadmium by poplar and willow; Poplars growing in situ on contaminated soils; Effect of chelating agents on cadmium accumulation.

Spontaneous and induced cancers are rare in non-isogeneic or inbred amphibians. Neoplastic cells become immortalized through loss of a normal capacity to die by apoptosis. Mature lymphocytes of mammals require activation and entry into the cell cycle in order to become susceptible to apoptosis. Whether Xenopus lymphocytes differ from mammalian lymphocytes in this regard is examined. In vitro exposure of PMA, or its analogue, MPMA, to adult splenocytes of Xenopus laevis was used to affect apoptosis. Flow cytometric analysis of FITC-Annexin V/propidium iodide (PI) fluorescence (apoptosis) and BrdU uptake (DNA synthesis) were assayed concurrently in the same lymphocyte population over time. Significant increases in apoptotic levels were induced throughout a 72 hour period in PMA-treated cells only. Lymphocytes were also separated by size for analysis. Several sub-populations of lymphocytes were identified, the most interesting of which was small and apoptotic within 4 hours, after PMA exposure. PMA-induced DNA synthesis did not become elevated until after 24 hours. “Direct” apoptosis, i.e. without cell cycle entry, was found only in these small, mature lymphocytes. Since small lymphocytes make up the vast majority of those being analyzed, “direct” apoptosis may be a determining mechanism in the resistance to neoplasia observed in Amphibia. Cells that die more readily are less likely to transform into neoplastic cells. [ABSTRACT FROM AUTHOR]

The effects of magnetic field (H) and pressure (P) on the temperature (T) dependence of electrical resistivity (ρ) are reported for a new manganese-containing compound, Pr2/3(Ca,Pb)1/3MnO3, which was grown in single-crystal form by a flux method. The material was found to order magnetically with applied-field strength below 175 K, but have zero remanence ( M R) as H→O, i.e., there was no spontaneous magnetization ( M S), only field-induced magnetization ( M i). A zero-field “insulator” to metal transition occurred at 146 K and this transition temperature ( T 1M) was found to increase with increasing field strength. The change in resistivity with field, ρO-ρH, normalized with respect to ρH, was 900% at 146 K and H = 5T. On application of hydrostatic pressure the zero-field resistivity decreased by 200%/GPa above room temperature. The electrical transport observed was consistent with a thermally-activated process, and this process was found to be relatively independent of pressure (0–4 GPa) in the temperature region (300 K–400 K) studied. [ABSTRACT FROM AUTHOR]

The size of the free-water ponds under drippers is an important field characteristic of trickle irrigation. Here we review four existing analytical theories that purport to describe 3-D infiltration. We show how they can be used to predict the extent of the pond from basic soil parameters, and the dripper discharge rate. Via a numerical example it is shown that the different theories give significantly different free-water pond radii, especially for high drip discharge rates when the flow is dominated by gravity. We then describe field experiments that were carried out to permit a comparison of the measured and predicted values using independently-measured soil parameters. This test of the different theories was conducted on a loamy soil. Raats' (1971) solution gave the best estimates of the free-water pond radius, across the range of discharge rates. The free-water pond radius, a determinant of the lateral spread away from the dripper, was found to vary only weakly with drip discharge in the range of practical applications. Consequences for management are discussed. [ABSTRACT FROM AUTHOR]

The incubation of carrot protoplasts and cultured Xenopus cells in a protease solution has been shown to enhance their subsequent interkingdom fusion by a high pH/high Ca method. The effects of Ca concentration, pH, and temperature on the frequency of heterokaryon formation have also been studied. Potentially viable heterokaryons have been repeatedly produced at high frequencies (consistently >10%), far exceeding those so far achieved in PEG-mediated fusion. Cell aggregates are readily dispersed after this method of fusion, permitting the accurate estimation of fusion frequencies. [ABSTRACT FROM AUTHOR]

Immunofluorescence was used to demonstrate the presence and distribution of animalspecific membrane components within the plasma membranes of Xenopus/carrot heterokaryons. The inhibitor of cellulose synthesis, 2,6-dichlorobenzonitrile, was used to impair cell wall regeneration so that the plasma membranes of cultured heterokaryons would remain accessible to antibodies. Xenopus-Specific surface components were observed in heterokaryons after 14 days of culture. [ABSTRACT FROM AUTHOR]

Cultured Xenopus cells have been induced to fuse with carrot suspension cell protoplasts using PEG at high pH in the presence of high Ca. Ultrastructural observations confirm unambiguously that the fusion bodies seen by light microscopy are animal/plant cell heterokaryons. The csytoplasmic events occurring in these Xenopus/carrot fusion products during the first 48 hours of culture provide evidence for their viability. Some of the factors influencing the formation and subsequent survival in vitro of interkingdom heterokaryons are discussed. [ABSTRACT FROM AUTHOR]

Animal-plant heterokaryons were produced by electrically-induced fusion between mouse erythroleukaemic cells (Friend cells) and Petunia protoplasts. Such heterokaryons exhibited the animalspecific function of DMSO-stimulated haemoglobin synthesis, and the plant-specific function of cell wall regeneration. [ABSTRACT FROM AUTHOR]