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Participatory breeding and crop selection can satisfy the needs of underserved groups of farmers (e.g., organic producers, farmers producing specialty grain for niche markets) neglected by the modern global seed industry. Participatory research methods that value local knowledge and facilitate Interest includes re-engagement in the development of maize hybrids that perform well in a diverse range of heterogeneous growing environments and that are better suited for sustainabilityminded producers, buyers, and consumers. Systems-based breeding aimed at protecting the environment and providing food, fiber, and energy while considering equity issues, has been proposed as a way to overcome the shortcomings of privatized approaches. In this article, we consider recent projects that use collaborative methods for hybrid maize breeding, cultivar testing, and genetic research to develop, identify, and deliver traits associated with crop performance, quality, and sustainability. Three case studies consider the efforts focused on developing non-GMO varieties for organic and specialty markets. We find that, unlike many successful efforts focused on the improvement of other crops, there are few promising models for participatory breeding of hybrid maize. Even though many projects have sought to involve stakeholders with a variety of methods, all have struggled to meaningfully engage farmers in maize hybrid improvement. Still, our reflection of case studies calls for systems-based breeding and suggests a path forward. This route would seek to address the needs, perspectives, and values of a broader range of actors participating in the food system by leveraging technologies and infrastructure in service of the public. Land-grant universities are well positioned to play a crucial role in coordinating efforts, facilitating partnerships, and supporting breeding programs that satisfy societal wants that include health, equity, and care. [ABSTRACT FROM AUTHOR]

Published data suggest that the type of general anaesthesia used during surgical resection for cancer may impact on patient long-term outcome. However, robust prospective clinical evidence is essential to guide a change in clinical practice. We explored the feasibility of conducting a randomised controlled trial to investigate the impact of total intravenous anaesthesia with propofol vs. inhalational volatile anaesthesia on postoperative outcomes of patients undergoing major cancer surgery. We undertook a randomised, double-blind feasibility and pilot study of propofol total intravenous anaesthesia or volatile-based maintenance anaesthesia during cancer resection surgery at three tertiary hospitals in Australia and the USA. Patients were randomly allocated to receive propofol total intravenous anaesthesia or volatile-based maintenance anaesthesia. Primary outcomes for this study were successful recruitment to the study and successful delivery of the assigned anaesthetic treatment as per randomisation arm. Of the 217 eligible patients approached, 146 were recruited, a recruitment rate of 67.3% (95%CI 60.6-73.5%). One hundred and forty-five patients adhered to the randomised treatment arm, 99.3% (95%CI 96.2-100%). Intra-operative patient characteristics and postoperative complications were comparable between the two intervention groups. This feasibility and pilot study supports the viability of the protocol for a large, randomised controlled trial to investigate the effect of anaesthesia technique on postoperative cancer outcomes. The volatile anaesthesia and peri-operative outcomes related to cancer (VAPOR-C) study that is planned to follow this feasibility study is an international, multicentre trial with the aim of providing evidence-based guidelines for the anaesthetic management of patients undergoing major cancer surgery. [ABSTRACT FROM AUTHOR]

A proliferating literature documents cross-national variation in medical practice and seeks to explain observed differences in terms of the presence of certain kinds of healthcare systems, economic, and cultural differences between countries. Less is known about how providers themselves understand these influences and perceive them as relevant to their clinical work. Using qualitative data from a cross-national factorial experiment in the United States and United Kingdom, we analyze 244 primary care physicians’ explanations of how organizational features of their respective healthcare settings influence the treatment decisions they made for a vignette patient, including affordability of care; within-system quality deficits; and constraints due to patient behavior. While many differences are attributed to financial constraints deriving from two very differently structured healthcare systems, in other ways they are reflections of cultural and historical expectations regarding medical care, or interactions between the two. Implications, including possible challenges to the implementation of universal care in the USA, are discussed. [ABSTRACT FROM PUBLISHER]

Metals are of particular importance in relation to water quality, and concern regarding the impact of these contaminants on biodiversity is being encapsulated within the latest water-related legislation such as the Water Framework Directive in Europe and criteria revisions to the Clean Water Act in the United States. This review undertakes an evaluation of the potential of 2-stage wastewater treatment consisting of primary sedimentation and biological treatment in the form of activated sludge processes, to meet more stringent discharge consents that are likely to be introduced as a consequence. The legislation, sources of metals, and mechanisms responsible for their removal are discussed, to elucidate possible pathways by which the performance of conventional processes may be optimized or enhanced. Improvements in effluent quality, achievable by reducing concentrations of suspended solids or biochemical oxygen demand, may also reduce metal concentrations although meeting possible requirements for the removal of copper my be challenging. [ABSTRACT FROM AUTHOR]

Abstract: Annual layer analysis in two stalagmites collected from Spring Valley Caverns, southeastern Minnesota, reveals hydrological response of the cave to extreme rainfall events in the Midwest, USA. Cave-flooding events are identified within the two samples by the presence of detrital layers composed of clay sized particles. Comparison with instrumental records of precipitation demonstrates a strong correlation between these cave-flood events and extreme rainfall observed in the Upper Mississippi Valley. A simple model is developed to assess the nature of rainfall capable of flooding the cave. The model is first calibrated to the last 50-yr (1950–1998 A.D.) instrumental record of daily precipitation data for the town of Spring Valley and verified with the first 50yr of record from 1900 to 1949 A.D. Frequency analysis shows that these extreme flood events have increased from the last half of the nineteenth century. Comparison with other paleohydrological records shows increased occurrence of extreme rain events during periods of higher moisture availability. Our study implies that increased moisture availability in the Midwestern region, due to rise in temperature from global warming could lead to an increase in the occurrence of extreme rainfall events. [ABSTRACT FROM AUTHOR]

Twenty three years ago on February 23, 1987, the explosion of the SN in the L.M.C. was observed both optically and by underground detectors. The optical observations were done in Chile and Australian observatories while the neutrino burst was detected by several underground experiments in the Northern Hemisphere, running at that time: Mt. Blanc in Italy, Kamioka in Japan, and Baksan in Russia and IMB in the USA. For the first time in the history of human existence, an astrophysical phenomenon has been observed in underground detectors. In this astrophysical event, the Mt. Blanc experiment detected five pulses on-line that were not at the same time, as detected by the other three detectors around five hours later. It is still not clear to astrophysicists why two bursts at two different times have been detected and how an SN can generate two neutrino bursts. After 23 years a model has proposed an explanation for a double stage collapse at two different times, as recently suggested by V.S. Imshennik and O. Ryazhskaya. In this paper, a detailed occurrence of something strange that happened on February 23rd is presented while most of the scientific information has been exhibited in other published papers. [ABSTRACT FROM AUTHOR]

Background. The Quality and Outcomes Framework (QOF) has contributed to modest improvements in chronic illness care in the UK. US policymakers have proposed similar pay-for-performance (P4P) approaches to improve care. Since previous studies have not compared chronic illness care quality in US and UK primary care practices prior to the QOF, the relative preparedness of practices to respond to P4P incentives is unknown. [ABSTRACT FROM PUBLISHER]

The article discusses breast screening guidelines with magnetic resonance imaging (MRI) as an adjunct to mammography that were issued by the American Cancer Society. Screening MRI is advised for women with around 20-25% or greater lifetime risk of breast cancer, including women with a family history of breast or ovarian cancer. There are risk subgroups for which the available data are inadequate to recommend for or against screening, including women with personal history of breast cancer.

Ghrelin is an orexigenic hormone that may affect substrate utilization in humans. Ghrelin is influenced by macronutrients, but the effects of insoluble dietary fiber and polyphenols are unknown. We investigated the effects of a polyphenol-rich insoluble dietary fiber preparation from carob pulp (carob fiber) on postprandial ghrelin responses and substrate utilization. Dose-dependent effects of the consumption of carob fiber were investigated in a randomized, single-blind, crossover study in 20 healthy subjects, aged 22-62 y. Plasma total and acylated ghrelin, triglycerides, and serum insulin and nonesterified fatty acids (NEFA) levels were repeatedly assessed before and after ingestion of an isocaloric standardized liquid meal with 0, 5, 10, or 20 g of carob fiber over a 300-min period. The respiratory quotient (RQ) was determined after consumption of 0 or 20 g of carob fiber. Carob fiber intake lowered acylated ghrelin to 49.1%, triglycerides to 97.2%, and NEFA to 67.2% compared with the control meal (P < 0.001). Total ghrelin and insulin concentrations were not affected by consumption of a carob fiber-enriched liquid meal. Postprandial energy expenditure was increased by 42.3% and RQ was reduced by 99.9% after a liquid meal with carob fiber compared with a control meal (P < 0.001). We showed that the consumption of a carob pulp preparation, an insoluble dietary fiber rich in polyphenols, decreases postprandial responses of acylated ghrelin, triglycerides, and NEFA and alters RQ, suggesting a change toward increased fatty acid oxidation. These results indicate that carob fiber might exert beneficial effects in energy intake and body weight. [ABSTRACT FROM AUTHOR]

Groundwater recharge at Mt. Hood, Oregon, is dominated by spring snow melt which provides a natural large-amplitude and narrow-width pore-fluid pressure signal. Time delays between this seasonal groundwater recharge and seismicity triggered by groundwater recharge can thus be used to estimate large-scale hydraulic diffusivities and the state of stress in the crust. We approximate seasonal variations in groundwater recharge with discharge in runoff-dominated streams at high elevations. We interpolate the time series of number of earthquakes, N, seismic moment, Mo, and stream discharge, Q, and determine cross-correlation coefficients at equivalent frequency bands between Q and both N and Mo. We find statistically significant correlation coefficients at a mean time lag of about 151 days. This time lag and a mean earthquake depth of about 4.5 km are used in the solution to the pressure diffusion equation, under periodic (1 year) boundary conditions, to estimate a hydraulic diffusivity of κ&ap;10−1 m2/s, a hydraulic conductivity of about Kh&ap;10−7 m/s, and a permeability of about k&ap;10−15 m2. Periodic boundary conditions also allow us to determine a critical pore-fluid pressure fraction, P′/P0&ap;0.1, of the applied near-surface pore-fluid pressure perturbation, P0&ap;0.1 MPa, that has to be reached at the mean earthquake depth to cause hydroseismicity. The low magnitude of P′&ap;0.01 MPa is consistent with other studies that propose 0.01≤P′≤0.1 MPa and suggests that the state of stress in the crust near Mt. Hood could be near critical for failure. Therefore, we conclude that, while earthquakes occur throughout the year at Mt. Hood, elevated seismicity levels along pre-existing faults south of Mt. Hood during summer months are hydrologically induced by a reduction in effective stress. [Copyright &y& Elsevier]

That fixed assets should appear in the accounts on the basis of their original cost, adjusted only for depredation, has been a much revered canon of accounting, and much has been written and many considerations urged in support of this rule. Among the affirmative arguments should be mentioned the following: 1) original cost represents the value of such assets to the enterprise as a going concern; 2) writing up the value of fixed assets necessitates a corresponding credit to surplus and such credit constitutes an unrealized profit; 3) changing values of fixed assets are due in a large measure to the changing value of the monetary unit and it is both unwise and impractical to attempt to use the dollar as a unit of measure and at the same time endeavor to allow for the fluctuations in its purchasing power; 4) accounting is fundamentally a system of recording logically the historical facts of a business enterprise and this record will be most accurate and trustworthy if there be strict adherence to actual financial transactions and no attempt made to incorporate into the accounting structure the hypotheses and postulates of economic analysis or the dictates of individual judgment; 5) the practical difficulties inherent in the task of measuring current economic values are such as to invalidate the use of accounting as an effective instrument of business control.

Objective: To examine the "real-world" overactive bladder (OAB) practice patterns using national data in the United States.Materials and Methods: The Humedica EHR database was queried. This database consists of de-identified patient records from a network of organizations treating approximately over 30 million patients across states in the United States. The entire study period was from July 1, 2008, to September 30, 2013. Patients with a diagnosis of OAB between July 1, 2009, and June 30, 2012 were included and followed. Patient comorbidities, demographics, diagnostic testing, and medication usage were analyzed.Results: Of 19,309,600 subjects enrolled during the study period, 46,648 adults had a diagnosis of OAB, with follow-up of at least 6 months, and met the inclusion criteria. There were 35,315 women and 11,333 men. Compared with women, men with OAB were more likely to undergo post-void residual measurement (32% vs 22%) and diagnostic cystoscopy (10% vs 7%). Women were more likely than men to undergo urodynamics (7% vs 3%). Overall, 34% of women and 19% of men diagnosed with OAB were prescribed medication.Conclusion: Few patients with OAB underwent invasive diagnostic testing. Anticholinergic medication was prescribed to a minority of patients diagnosed with OAB, indicating possible underuse of a potentially effective therapy. Men were less likely than women to receive medical therapy, despite the fact that OAB is common in both sexes. [ABSTRACT FROM AUTHOR]

Objective: To identify factors that individuals in clinical residency training programs consider when making a choice for or against a career in academic clinical medicine., Sample: 207 veterinarians in clinical residency programs., Procedures: An online survey was distributed to 1,053 veterinarians participating in clinical residency training programs overseen by organizations recognized by the AVMA American Board of Veterinary Specialties. Results were compiled and decision factors were analyzed by means of principal component analysis to identify latent factors from the set of survey items. These factors were then used to construct a decision tree to predict respondents' choice of whether to enter academic medicine or private clinical practice., Results: 207 (20%) responses were analyzed. Ninety-three of 194 (48%) respondents reported a desire to pursue a career in academic medicine, and 101 (52%) reported a desire to pursue a career in private clinical practice. Principal component analysis identified 14 items clustered on research, clinical teaching, classroom teaching, and clinical practice. A decision tree was constructed that resulted in an overall accuracy of 82% in predicting a resident's career choice of academic medicine versus private clinical practice. The construct of professional benefits had a negative effect on desiring a career in academic medicine, whereas the construct of professional priorities and having had a positive residency training experience had a positive effect on desiring a career in academic medicine., Clinical Relevance: Understanding factors that attract and encourage residents who might have an aptitude and interest in academic medicine holds important implications for addressing the shortage of veterinarians entering academic medicine.

Introduction: Frequently, a residency program's website is the first interaction students interested in surgery have with the program. In the setting of virtual interviews for residency in 2020, the online availability of program information is of heightened importance. We sought to assess how academic versus community-based general surgery residency programs compared with respect to certain details on their websites., Methods: A total of n = 268 surgery residency programs were investigated. Our database of website characteristics included: direct link to residency website from the American Council on Graduate Medical Education (ACGME) program page, resident research requirement, listing of residents' publications, availability of residents' demographic information, program alumni information, board pass rates, attrition rate, detail of educational/academic activities, residents' evaluation methods, diversity, and mentorship. Inter-group analyses between academic and community-based programs were performed using Pearson's Chi-squared test., Results: Academic and community-based general surgery residency program websites were compared based on twelve (12) different parameters. Statistically significant differences were observed for eight of these comparisons: direct website access from ACGME (p = 0.007), research highlighted (p < 0.001), resident research requirement (p = 0.002), resident demographic information available (p=0.004), alumni information (p = 0.005), resident evaluation methods (p = 0.016), diversity (p < 0.001), and mentorship (p = 0.012). Across these domains, academic programs had more information available on their websites than the community programs did. The program websites did not differ significantly based on the frequency of mentioning resident publications, board pass rate, attrition rate, or resident education., Conclusion: Many general surgery programs are lacking detailed information on their websites. The amount of website information available on general surgery residency programs differs when comparing academic and community-based programs., Competing Interests: Conflict of interest None., (Copyright © 2021 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Aims: Overactive bladder (OAB) and benign prostatic hyperplasia (BPH) are highly prevalent conditions that place a large burden on the United States (US) health care system. We sought to analyze patterns of prescription medication usage for incident OAB in men and women, and for incident BPH in men using US health insurance claims data., Materials and Methods: This study used Truven Health MarketScan® Commercial and Medicare Supplemental Research databases. The data were pooled from diverse points of care. BPH subjects included men age 18+ with the first and last two diagnoses of BPH ≥30 days apart and no BPH diagnosis for 1 year prior. OAB subjects included men and women age 18+, who were diagnosed similarly with incident OAB. The type of medication, medication continuation (persistence), and switching to a different medication were analyzed through September 30, 2013., Results: Medication persistence was much higher overall for BPH than OAB (56% vs 34%, respectively, P < 0.0001), and was highest among men with BPH age 65+ (62%). Patients age 18-64 were less likely to continue medication than older adults (age 65+) for both BPH and OAB. A 9.4% of patients in the OAB cohort and 6.9% of men with BPH switched from one medication to another., Conclusions: Persistence was higher with BPH than OAB medications overall, whereas switching rates were higher in the OAB group. The lower persistence of OAB medication may be due to less efficacy or tolerability. The possibility of under treatment of OAB also warrants future investigations., (© 2017 Wiley Periodicals, Inc.)

Purpose: The Berlin definition for acute respiratory distress syndrome (ARDS) is a new proposal for changing the American-European consensus definition but has not been assessed prospectively as yet. In the present study, we aimed to determine (1) the prevalence and incidence of ARDS with both definitions, and (2) the initial characteristics of patients with ARDS and 28-day mortality with the Berlin definition., Methods: We performed a 6-month prospective observational study in the ten adult ICUs affiliated to the Public University Hospital in Lyon, France, from March to September 2012. Patients under invasive or noninvasive mechanical ventilation, with PaO2/FiO2 <300 mmHg regardless of the positive end-expiratory pressure (PEEP) level, and acute onset of new or increased bilateral infiltrates or opacities on chest X-ray were screened from ICU admission up to discharge. Patients with cardiogenic pulmonary edema were excluded. Patients were further classified into specific categories by using the American-European Consensus Conference and the Berlin definition criteria. The complete data set was measured at the time of inclusion. Patient outcome was measured at day 28 after inclusion., Results: During the study period 3,504 patients were admitted and 278 fulfilled the American-European Consensus Conference criteria. Among them, 18 (6.5 %) did not comply with the Berlin criterion PEEP ≥ 5 cmH2O and 20 (7.2 %) had PaO2/FiO2 ratio ≤200 while on noninvasive ventilation. By using the Berlin definition in the remaining 240 patients (n = 42 mild, n = 123 moderate, n = 75 severe), the overall prevalence was 6.85 % and it was 1.20, 3.51, and 2.14 % for mild, moderate, and severe ARDS, respectively (P > 0.05 between the three groups). The incidence of ARDS amounted to 32 per 100,000 population per year, with values for mild, moderate, and severe ARDS of 5.6, 16.3, and 10 per 100,000 population per year, respectively (P < 0.05 between the three groups). The 28-day mortality was 35.0 %. It amounted to 30.9 % in mild, 27.9 % in moderate, and 49.3 % in severe categories (P < 0.01 between mild or moderate and severe, P = 0.70 between mild and moderate). In the Cox proportional hazard regression analysis ARDS stage was not significantly associated with patient death at day 28., Conclusions: The present study did not validate the Berlin definition of ARDS. Neither the stratification by severity nor the PaO2/FiO2 at study entry was independently associated with mortality.

Background: Patients with end-stage renal disease (ESRD) have special health needs; little is known about their care experiences., Study Design: Secondary analysis of 2009-2010 Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) data, using representative random samples of Medicare beneficiaries. Description of Medicare beneficiaries with ESRD and investigation of differences in patient experiences by sociodemographic characteristics and coverage type., Setting & Participants: Data were collected from 823,564 Medicare beneficiaries (3,794 with ESRD) as part of the Medicare CAHPS survey, administered by mail with telephone follow-up of nonrespondents., Predictor: ESRD status, age, education, self-reported general and mental health status, race/ethnicity, sex, Medicare coverage type, state of residence, and other demographic measures., Outcomes: 6 composite measures of patient experience in 4 care domains (access to care, physician communication, customer service, and access to prescription drugs and drug information) and 4 ratings (overall care, personal physician, specialist physician, and prescription drug plan)., Results: Patients with ESRD reported better care experiences than non-ESRD beneficiaries for 7 of 10 measures (P < 0.05) after adjustment for patient characteristics, geography, and coverage type, although to only a small extent (adjusted mean difference, <3 points [scale, 0-100]). Black patients with ESRD and less educated patients were more likely than other patients with ESRD to report poor experiences., Limitations: Inability to distinguish patient experiences of care for different treatment modalities., Conclusions: On average, beneficiaries with ESRD report patient experiences that are at least as positive as non-ESRD beneficiaries. However, black and less educated patients with ESRD reported worse experiences than other ESRD patients. Stratified reporting of patient experience by race/ethnicity or education in patients with ESRD can be used to monitor this disparity. Physician choice and confidence and trust in physicians may be particularly important for patients with ESRD., (Copyright © 2013 National Kidney Foundation, Inc. All rights reserved.)

Picture archiving and communication systems (PACS) provide limited flexibility for the development of novel research methods. By contrast, the research model of data access is more flexible but has vulnerabilities in numerous areas. No single monolithic application can fulfill the diverse and rapidly changing needs of the clinical imaging research community. Instead, the focus should be on the interoperability of preexisting systems. To a large extent, this can be achieved by means of a unified interface for storing and retrieving data. The concept of a research PACS combines the advantages of the clinical and research models of data access while eliminating the disadvantages. A research PACS streamlines the data management process. Instead of a single software program, it consists of a confederation of independent applications brought together by the ability to store and retrieve data in a common database. A prototype research PACS has been developed that is based on the Extensible Neuroimaging Archive Toolkit (XNAT) in association with two new in-house tools: a data selection tool and a data archiving tool. By taking as an example the comparison of regions of interest in multifunctional liver data, it was demonstrated that this framework allows a number of in-house and open-source applications originally designed to work on a stand-alone basis to be integrated into a unified workflow, with minimal redevelopment effort.

Lower-limb sensory loss as a result of peripheral neuropathy or amputation results in sub-optimal movement and an increased incidence of injury. While the adoption of lower-limb prostheses and therapeutic footwear can reduce tissue injury and support movement, the fundamental problem of sensory loss continues to exist. A prototype haptic feedback system has been developed to aid in the recovery of lower-limb sensation due to these causes. Thin-film force sensors placed at the critical points for gait and balance functions collect essential force data, which is delivered to the user via pneumatically controlled balloon inflation. It is postulated that the use of this system will increase the tactile awareness of a patient's lower-limb or prosthesis, and when used in concert with modern rehabilitation techniques will create a method that will reduce the duration and improve the quality of lower-limb rehabilitation, especially in gait and balance functions.

An ultrasound imaging system is under development that features a flexible transducer that can be wrapped conformally around curved surfaces of the body. The device is intended to deliver high image quality without the need for mechanical scanning, and will benefit medical personnel with limited ultrasound training. A 2 x 8 element piezoelectric transducer prototype and 15.5 MHz imaging system have been built, and the system concept has been demonstrated by imaging a soft tissue phantom. The transducer design, imaging procedure, and preliminary image processing techniques are presented.

The French psychologist Alfred Binet is at the origin of the development of the mental test intended for diagnosing the intellectual level of children. Initially conceived as clinical tests their importation to the United States during the 1910's has considerably altered their use, significance and interpretation. Turned into political tools by eugenicists and hereditarists and used in large-scale selection operations, the tests have changed the psychologists' conception of intelligence: initially conceived as multifacted and qualitative, intelligence had become a single quantifiable entity. Within this context, the American psychologist Louis Leon Thurstone criticized the lack of exactness of the statistical tools used in the intelligence scale. Once objectivized, his method became a general law intended to account for all mental processes.

The history of the artificial eye, from antiquity to the present, is described. Around the beginning of the nineteenth century, glass eyes replaced the earlier metal ones--not always well tolerated. In 1835, cryolite glass was used instead of lead glass; to this day it remains the lightest and most desirable substance for making artificial eyes.