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Early introduction to essential communication skills is important. We sought to determine if a handoff curriculum (HC) would improve confidence, decrease anxiety, and increase participation in clinical handoffs during the surgical clerkship.A multi-center prospective cohort study was performed at two medical schools. Training in the intervention group (HC) consisted of a didactic lecture, video review, and practice session. Students completed a pre-clerkship knowledge test and confidence/anxiety/handoff experience questionnaire pre- and post-clerkship.There were no significant differences in pre-clerkship handoff experiences between institutions except having previously witnessed a verbal handoff (School A 96.4% versus School B 76.2%, P = 0.01). While there were no significant differences in post-clerkship confidence or anxiety, HC students were significantly more involved with written sign-outs (52.9% versus 18.2%, P = 0.02) and verbal handoffs (29.4% versus 4.6%, P = 0.03).Medical students exposed to handoff training shared similar confidence and anxiety scores compared to those that were not, however, they were more involved in handoff experiences during their surgical clerkship. Early introduction to handoff skills may encourage greater participation during subsequent clinical experiences.

Positive-Unlabelled (PU) learning is a growing area of machine learning that aims to learn classifiers from data consisting of labelled positive and unlabelled instances. Whilst much work has been done proposing methods for PU learning, little has been written on the subject of evaluating these methods. Many popular standard classification metrics cannot be precisely calculated due to the absence of fully labelled data, so alternative approaches must be taken. This short commentary paper critically reviews the main PU learning evaluation approaches and the choice of predictive accuracy measures in 51 articles proposing PU classifiers and provides practical recommendations for improvements in this area.

Biliary stricture is the abnormal narrowing of the biliary ductal system, leading to bile stasis and eventual ductal obstruction and dilatation. Common etiologies of biliary strictures can be broadly classified based on benign or malignant causes. The pathogenesis of benign biliary strictures (BBSs) can be a sequela of several causes, including iatrogenic, inflammatory, ischemic, infectious, and immunologic etiologies. Among the common causes of BBS, an iatrogenic biliary ductal injury sustained during hepatobiliary surgeries is the most frequently reported cause of BBS. Clinically, patients with BBS can present with obstructive biliary symptoms, and urgent biliary decompressive interventions are frequently required to prevent fatal complications. Cross-sectional imaging such as MR cholangiopancreatography enables timely evaluation of the stricture and facilitates therapeutic planning. The primary objective in managing biliary strictures (both benign and malignant) is to achieve permanent ductal patency and minimize the need for repeated interventions. A multidisciplinary team of gastroenterologists, interventional radiologists, and hepatobiliary surgeons is generally involved in caring for patients with BBS. This review provides a summary of clinically available endoscopic, percutaneous, and surgical biliary interventions for the management of patients with BBS.

The main considerations for the development of a formulation for preclinical safety assessment testing are explored. Intravenous, inhalation, oral and dermal dosing are given focus and although different dose routes do present their own individual challenges there are common themes that emerge. In each case it is necessary to maximise exposure to achieve high doses to satisfy regulatory requirements for safety assessment testing. This often involves producing formulations that are at the limits of solubility and maximum volumes possible for administration to different test species by the chosen route. It is concluded that for all routes it is important to thoroughly explore the stability of the test item in the proposed formulation matrix well ahead of dosing any animals, giving careful consideration to which excipients are used and what their underlying toxicity profile may be for the relevant preclinical species. In addition, determining the maximum achievable concentrations and weighing that against the maximum volumes that can be given by the chosen route in all the test species at an early stage will also give a read on whether it would be theoretically possible to achieve suitably high enough doses to support clinical work. Not doing so can cause delays in the development programme and may have ethical repercussions.

Objective To determine whether follicle flushing during oocyte retrieval improves live birth or secondary outcomes in assisted reproductive technology (ART). Design Systematic review and meta-analysis. Setting Not applicable. Patient(s) Women undergoing ART using autologous gametes. Intervention(s) A systematic search of PubMed, EMBASE, Cochrane Database, and Web of Science for randomized controlled trials comparing follicle flushing to direct aspiration during oocyte retrieval published in English between 1989 to 2020. Main Outcome Measure(s) Live birth as primary outcome, and clinical and ongoing pregnancy, total and mature metaphase II (MII) oocytes retrieved, and operating time as secondary outcomes. Result(s) Eleven studies were included totaling 1,178 cases. No difference in live birth was demonstrated between follicle flushing and direct aspiration. Clinical pregnancy and ongoing pregnancy were not improved with flushing. Total oocyte and MII yield were lower with flushing compared with direct aspiration. Procedure time was increased with flushing by 2 minutes in poor responders and 9 minutes in normal responders. Other sensitivity analyses did not demonstrate any changes, except the difference in MII yield was no longer statistically significant. Conclusion(s) Follicle flushing during oocyte retrieval increases procedure time and does not improve live birth or secondary ART outcomes. Randomized data do not support the use of follicle flushing as an intervention in ART.

Introduction With a deficit of effective military residency mentorships, a paucity of research on successful mentorship programs, and growing reports on innovative mentoring programs, we developed a “Speed Mentoring” event for the National Capital Consortium OBGYN Residency. Materials and Methods The development, implementation, and follow-up responses through participant surveys were designed as an institutional review board (IRB)-approved evidence-based quality improvement project at our institution. Our event coordinated mentorship opportunities between residents and faculty from a wide range of specialties, leadership roles, and research experiences. Residents were matched with faculty that aligned with self-identified goals. Surveys were distributed prior to the event and at follow-up intervals to demonstrate the lasting impact and areas for improvement. Results Prior to our first event, every resident reported by survey that they desired more mentorship opportunities. However, only 55% could identify a specific mentor, citing limited time and difficulty establishing a relationship. Immediately following the event, 90% of residents scheduled a follow-up with at least one mentor. Forty-seven percent of residents reported inspiration to initiate a new research project. Meanwhile, faculty felt valued and gained satisfaction by “giving back” to their profession. After 1 month, half of the residents and faculty had already conducted at least one meeting. At 3 months, 76% of meetings centered on research and 23% on quality improvement projects. Fifty-seven percent of participants reported future scheduled meetings. At 6 months, 75% of residents reported meaningful mentorship relationships. Conclusions After demonstrating a need for improved mentorship opportunities, we implemented an efficient way to foster mentorship while expanding resident involvement in research, QI projects, and fellowship applications. This “Speed Mentorship” program can be easily adapted to all residency programs.

Localised prostate cancer is commonly treated with external beam radiotherapy and moderate hypofractionation is non-inferior to longer schedules. Stereotactic body radiotherapy (SBRT) allows shorter treatment courses without impacting acute toxicity. We report 2-year toxicity findings from PACE-B, a randomised trial of conventionally fractionated or moderately hypofractionated radiotherapy versus SBRT.PACE is an open-label, multicohort, randomised, controlled, phase 3 trial conducted at 35 hospitals in the UK, Ireland, and Canada. In PACE-B, men aged 18 years and older with a WHO performance status 0-2 and low-risk or intermediate-risk histologically-confirmed prostate adenocarcinoma (Gleason 4 + 3 excluded) were randomly allocated (1:1) by computerised central randomisation with permuted blocks (size four and six), stratified by centre and risk group to control radiotherapy (CRT; 78 Gy in 39 fractions over 7·8 weeks or, following protocol amendment on March 24, 2016, 62 Gy in 20 fractions over 4 weeks) or SBRT (36·25 Gy in five fractions over 1-2 weeks). Androgen deprivation was not permitted. Co-primary outcomes for this toxicity analysis were Radiation Therapy Oncology Group (RTOG) grade 2 or worse gastrointestinal and genitourinary toxicity at 24 months after radiotherapy. Analysis was by treatment received and included all patients with at least one fraction of study treatment assessed for late toxicity. Recruitment is complete. Follow-up for oncological outcomes continues. The trial is registered with ClinicalTrials.gov, NCT01584258.We enrolled and randomly assigned 874 men between Aug 7, 2012, and Jan 4, 2018 (441 to CRT and 433 to SBRT). In this analysis, 430 patients were analysed in the CRT group and 414 in the SBRT group; a total of 844 (97%) of 874 randomly assigned patients. At 24 months, RTOG grade 2 or worse genitourinary toxicity was seen in eight (2%) of 381 participants assigned to CRT and 13 (3%) of 384 participants assigned to SBRT (absolute difference 1·3% [95% CI -1·3 to 4·0]; p=0·39); RTOG grade 2 or worse gastrointestinal toxicity was seen in 11 (3%) of 382 participants in the CRT group versus six (2%) of 384 participants in the SBRT group (absolute difference -1·3% [95% CI -3·9 to 1·1]; p=0·32). No serious adverse events (defined as RTOG grade 4 or worse) or treatment-related deaths were reported within the analysis timeframe.In the PACE-B trial, 2-year RTOG toxicity rates were similar for five fraction SBRT and conventional schedules of radiotherapy. Prostate SBRT was found to be safe and associated with low rates of side-effects. Biochemical outcomes are awaited.Accuray.

Introduction Evaluation of Wythenshawe Hospital’s Acute Frailty Service in January–June 2019 demonstrated slow referrals times and poor identification of frail patients due to inaccurate Clinical Frailty Scoring (CFS) at emergency department triage. This project presents the results of ongoing quality assessment of our service between June 2019–January 2021, following two quality improvement (QI) interventions. Aims: To evaluate our service’s ability to deliver early identification and intervention for complex frail patients via Complex Geriatric Assessment (CGA), as set out in National and Regional Frailty standards.(1,2). -To improve and maintain better outcomes for patients accessing our frailty service. Method Intervention1 (July’19): Specialist frailty nurses relocated to ED. Dedicated frailty clinical fellows and Consultant geriatrician input 0900–1700 weekdays. Intervention2 (Sep’20): Short-stay frailty unit opened. Junior clinical fellow cover increased (0900–1900 weekdays and 0900–1700 weekends). 299 patients seen at intervals between Jun’19-Jan’21 analysed using electronic records and completed CGA proformas. Results Pre-intervention Intervention1 Intervention2 June’19(n = 22) July’19(n = 198) Nov’19(n = 25) Sep’20(n = 26) Jan’21(n = 28) Time from triage-to-CGA (mins) (CI 95%)* 372.0 ± 178.2 56.0 83.4 ± 31.0 72.9 ± 35.7 48.4 ± 20.0 Discharge(%): Same day 22.7 39.4 21.7 36.0 25.0 Conclusion Since Intervention1, Wythenshawe frailty service has sustained a reduction in triage-to-CGA time, maintained high percentages of same-day and

We demonstrate the use of a convolutional neural network to perform neutron-gamma pulse shape discrimination, where the only inputs to the network are the raw digitised SiPM signals from a dual scintillator detector element made of 6LiF:ZnS(Ag) scintillator and PVT plastic. A realistic labelled dataset was created to train the network by exposing the detector to an AmBe source, and a data-driven method utilsing a separate PMT was used to assign labels to the recorded signals. This approach is compared to the charge integration and continuous wavelet transform methods and is found to provide superior levels of discrimination, achieving an AUC of 0.995 +/- 0.003. We find that the neural network is capable of extracting interpretable features directly from the raw data. In addition, by visualising the high-dimensional representations of the network with the t-SNE algorithm, we discover that not only is this method robust to minor mislabeling of the training dataset but that it is possible to identify an underlying substructure within the signals that goes beyond the original labelling. This technique could be utilised to explore and cluster complex, raw detector data in a novel way that may reveal more insights than standard analysis methods., 13 pages, 8 figures, submitted to Nucl. Instr. Meth. A

Introduction: Acquired adrenal insufficiency is a known risk of unilateral adrenalectomy. However, the rates of early and prolonged adrenal insufficiency following unilateral adrenalectomy are not well defined in the literature. Patients and Methods: We reviewed a case series of 184 consecutive patients to determine the likelihood of steroid supplementation at 30 days and 1 year following adrenalectomy. 109 lesions were non-functional and 75 (41%) demonstrated functionality, including 33 pheochromocytomas, 20 cortisol-producing adenomas, 19 aldosteronomas, and 3 cases of cortisol-secreting hyperplasia. No patients with a nonfunctional lesion, pheochromocytoma, or aldosteronoma required steroid supplementation following surgery. Eleven of 23 patients (48%) with primary adrenal Cushing syndrome required cortisol supplementation at 30 days, and only 1 patient (4%) necessitated supplementation one year following surgery. Discussion: Approximately 50% of patients with cortisol-producing lesions in the adrenal gland will require supplementation 30-days following surgery. Only 4% will require persistent exogenous steroids at 1-year. Conversely, less than 1% of patients with different types of functional or non-functional tumors required supplementation after surgery. Conclusion: The incidence of adrenal insufficiency following unilateral adrenalectomy is low. A large majority of patients requiring steroid supplementation 30 days following surgery are able to wean off this requirement by 1 year. With this information, we can better counsel our patients and set clearer expectations for the potential need of cortisol supplementation following adrenalectomy

The 2009 American Thyroid Association (ATA) guidelines for medullary thyroid cancer (MTC) were created to unify national practice patterns. Our aims were to (1) evaluate national adherence to ATA guidelines before and after 2009, (2) identify factors that are associated with concordance with guidelines, and (3) evaluate whether there is an association between survival and concordant treatment.Patients with MTC were identified from the 2009 to 2015 National Cancer Database. Adherence to ATA recommendations regarding extent of surgery (R61-R66) was analyzed. Logistic regression was used to determine predictors of discordance and propensity score matching was used to compare concordant treatment rates between time periods. Kaplan-Meier survival analysis was used to determine association between survival and concordant treatment.There were 3421 patients with MTC, and of these 3087 had M0 disease and 334 had M1 disease. We found that 72% of M0 cases adhered to R61-66, and 68% of M0 cases without advanced local disease were adherent to R61-63. Following propensity score matching, the adherence rate was 67% before 2009 and 74% after. Patient factors associated with discordant treatment were female gender, older age, treatment at a nonacademic facility, and living within 50 miles of the treatment facility. Adherence to guidelines was associated with improved overall survival (OS) (p 0.01).Treatment of MTC was discordant from guidelines in 26% of cases from 2009 to 2015 compared with 33% prior to 2009 in a propensity matched analysis, and was most often in cases with localized, noninvasive disease. Improved adherence to guidelines may improve overall survival.

Statement of purpose In 2018, unintentional drug overdose was the leading cause of injury-related deaths among Ohioans. In the same year, drug poisoning was the third leading mechanism of suicide deaths. This session will review the ‘who, when, where, and how’ of overdose deaths from the Ohio Violent Death Reporting System (OH-VDRS) to provide participants with an understanding of the sociodemographic characteristics and related circumstances (e.g., prior suicide attempts, prior mental health or substance use disorder treatment, co-occurring mental health conditions) surrounding overdose deaths. Methods/Approach Descriptive statistics of 2016–2018 OH-VDRS data assessed sociodemographic characteristics of and circumstances preceding deaths by unintentional and intentional (i.e., suicide) drug overdose among Ohio residents who died in Ohio. Results Regardless of intent, most drug overdose decedents were Caucasian (unintentional: 84.6% versus intentional: 95.3%) with a high school degree or less (unintentional: 77.4% versus intentional: 62.5%). While unintentional drug overdose decedents were more likely to be male (67.0%) and 25–34 years old (27.8%), most intentional drug overdose decedents were female (54.9%) and 45–54 years old (26.3%). Regarding circumstances, a larger proportion of unintentional drug overdose decedents had a substance abuse problem (86.2% versus 27.3%), while a larger proportion of intentional drug overdose decedents had a mental health condition (78.9% versus 43.3%). Toxicology differences were noted; antidepressants, anticonvulsants, antipsychotics, and benzodiazepines were identified as a cause of death in a higher proportion of intentional drug overdose deaths, while cocaine and opioids were identified in more unintentional drug overdose deaths. Conclusion Examining drug overdose trajectories by intent can better inform interventions by targeting diverse prevention strategies to the appropriate populations. Significance A better understanding of drug overdose trajectories by intent could provide evidence to guide the data-driven decision making surrounding the development and implementation of evidence-based policies, programs, and interventions.

Objective Thyroid and parathyroid surgery is performed by both general surgeons and otolaryngologists. We describe the proportion of surgeries performed by specialty, providing data to support decisions about when and to whom to direct research, education, and quality improvement interventions. Methods We tabulated case numbers for privately insured patients undergoing thyroid and parathyroid surgery in Marketscan: 2010–2016 and trainee case logs for residents and fellows in general surgery and otolaryngology. Summary statistics and tests for trends and differences were calculated. Results Marketscan data captured 114 500 thyroid surgeries. The proportion performed by each specialty was not significantly different. Otolaryngologists performed 58 098 and general surgeons performed 56 402. Otolaryngologists more commonly performed hemithyroidectomy (n = 25 148, 43.29% of all thyroid surgeries performed by otolaryngologists) compared to general surgeons (n = 20 353, 36.09% of all thyroid surgeries performed by general surgeons). Marketscan data captured 21 062 parathyroid surgeries: 6582 (31.25%) were performed by otolaryngologists, and 14 480 (68.75%) were performed by general surgeons. The case numbers of otolaryngology and general surgery trainees completing residency and fellowship varied 6- to 9-fold across different sites. The wide variation may reflect both the level of exposure a particular training program offers and trainee level of interest. Conclusion Thyroid surgical care is equally provided by general surgeons and otolaryngologists. Both specialties contribute significantly to parathyroid surgical care. Both specialties should provide input into and be targets of research, quality, and education interventions.

We sought to derive and validate a prediction model of survival and recurrence among Western patients undergoing resection of gastric cancer.Patients who underwent curative-intent surgery for gastric cancer at seven US institutions and a major Italian center from 2000 to 2020 were included. Variables included in the multivariable Cox models were identified using an automated model selection procedure based on an algorithm. Best models were selected using the Bayesian information criterion (BIC). The performance of the models was internally cross-validated via the bootstrap resampling procedure. Discrimination was evaluated using the Harrell's Concordance Index and accuracy was evaluated using calibration plots. Nomograms were made available as online tools.Overall, 895 patients met inclusion criteria. Age (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.17-1.84), presence of preoperative comorbidities (HR 1.66, 95% CI 1.14-2.41), lymph node ratio (LNR; HR 1.72, 95% CI 1.42-2.01), and lymphovascular invasion (HR 1.81, 95% CI 1.33-2.45) were associated with overall survival (OS; all p 0.01), whereas tumor location (HR 1.93, 95% CI 1.23-3.02), T category (Tis-T1 vs. T3: HR 0.31, 95% CI 0.14-0.66), LNR (HR 1.82, 95% CI 1.45-2.28), and lymphovascular invasion (HR 1.49; 95% CI 1.01-2.22) were associated with disease-free survival (DFS; all p 0.05) The models demonstrated good discrimination on internal validation relative to OS (C-index 0.70) and DFS (C-index 0.74).A web-based nomograms to predict OS and DFS among gastric cancer patients following resection demonstrated good accuracy and discrimination and good performance on internal validation.

The Hawaii–Emperor and Louisville seamounts form the two most prominent time-progressive hotspot trails on Earth. Both formed over a similar time interval on lithosphere with a similar range of ages and thickness. The Hawaii–Emperor seamounts are large and magma productivity appears to be increasing at present. The Louisville seamounts, by contrast, are smaller and the trail appears to be waning. We present new major- and trace-element data from five of the older (74–50 Ma) Louisville seamounts drilled during Integrated Ocean Drilling Program (IODP) Expedition 330 and compare these with published data from the Emperor seamounts of the same age. Despite drilling deep into the shield-forming volcanic rocks at three of the Louisville seamounts, our data confirm the results of earlier studies based on dredge samples that the Louisville seamounts are composed of remarkably uniform alkali basalt. The basalt composition can be modelled by ∼1·5–3 % partial melting of a dominantly garnet-lherzolite mantle with a composition similar to that of the Ontong Java Plateau mantle source. Rock samples recovered by dredging and drilling on the Emperor seamounts range in composition from tholeiitic to alkali basalt and require larger degrees of melting (2–10 %) and spinel- to garnet-lherzolite mantle sources. We use a simple decompression melting model to show that melting of mantle with a potential temperature of 1500 °C under lithosphere of varying thickness can account for the composition of the shield-forming tholeiitic basalts from the Emperor seamounts, whereas post-shield alkali basalt requires a lower temperature (1300–1400 °C). This is consistent with the derivation of Hawaii–Emperor shield-forming magmas from the hotter axis of a mantle plume and the post-shield magmas from the cooler plume sheath as the seamount drifts away from the plume axis. The composition of basalt from the Louisville seamounts shows no significant variation with lithosphere thickness at the time of seamount formation, contrary to the predictions of our decompression melting model. This lack of influence of lithospheric thickness is characteristic of basalt from most ocean islands. The problem can be resolved if the Louisville seamounts were formed by dehydration melting of mantle containing a small amount of water in a cooler plume. Hydrous melting in a relatively cool mantle plume (Tp = 1350–1400 °C) could produce a small amount of melt and then be inhibited by increasing viscosity from reaching the dry mantle solidus and melting further. The failure of the plume to reach the dry mantle solidus or the base of the lithosphere means that the resulting magmas would have the same composition irrespective of lithosphere thickness. A hotter mantle plume (Tp ≈ 1500 °C) beneath the Emperor seamounts and the Hawaiian Islands would have lower viscosity before the onset of melting, melt to a larger extent, and decompress to the base of the lithosphere. Thus our decompression melting model could potentially explain the composition of both the Emperor and Louisville seamounts. The absence of a significant lithospheric control on the composition of basalt from nearly all ocean islands suggests that dehydration melting is the rule and the Hawaiian islands are the exception. Alternatively, many ocean islands may not be the product of mantle plumes but may instead be formed by decompression melting of heterogeneous mantle sources composed of peridotite containing discrete bodies of carbonated and silica-oversaturated eclogite within the general upper mantle convective flow.

Advanced health assessment is a required course in advanced practice RN (APRN) education, essential to providing the foundation for differential diagnosis (DD) skills and the ability to formulate a plan of care.Feedback from clinical preceptors revealed that our doctor of nursing practice (DNP) students struggled to make a DD.This educational quality improvement project collected data from 7 cohorts of DNP students in either the Family Nurse Practitioner or Adult Gerontology Nurse Practitioner program to evaluate their readiness for clinical practicums and to inform necessary curriculum revisions.Data revealed that students' ability to identify 3 DDs correctly during the summative health assessment objective structured clinical examination was inconsistent. Qualitative data revealed students lacked understanding on how to use results from the physical assessment to formulate a DD.The findings of this project corroborate those from the literature that suggest we should teach APRN students DD skills explicitly.

Background Uterine leiomyoma are implicated in certain adverse pregnancy related outcomes such as postpartum hemorrhage. Large submucosal leiomyoma defined as greater than 5 cm, may have higher complication rates; however, high quality data is limited. Case A 44-year-old gravida 4 with history of two full-term vaginal deliveries presented at 40 and 2/7 weeks of gestation with premature rupture of membranes and delivered vaginally a viable female infant complicated by a postpartum hemorrhage due to uterine atony. During a manual uterine sweep for suspected retained products of conception, a submucosal leiomyoma was incidentally extracted. Uterine hemorrhage immediately ensued, requiring vasopressors, blood transfusion, and intensive care unit admission. Hemostasis was ultimately achieved with placement of a Bakri balloon. Conclusion This case reaffirms the association of large (greater than five centimeters) submucosal leiomyoma with severe postpartum hemorrhage. Caution should be taken with patients who have leiomyoma with these characteristics. The use of balloon tamponade in such situations may aid in hemostasis and avoidance of postpartum hysterectomy.

We report a case of histologically confirmed primary cutaneous diffuse large B-cell lymphoma, leg type (PCDLBCL-LT) that subsequently underwent spontaneous regression in the absence of systemic treatment. The case showed an atypical lymphoid infiltrate that was CD20+ and MUM-1+ and CD10–. A subsequent biopsy of the spontaneously regressed lesion showed fibrosis associated with a lymphocytic infiltrate comprising reactive T cells. PCDLBCL-LT is a cutaneous B-cell lymphoma with a poor prognosis, which is usually treated with chemotherapy. We describe a case of clinical and histologic spontaneous regression in a patient with PCDLBCL-LT who had a negative systemic workup but a recurrence over a year after his initial presentation. Key words: B cell, lymphoma, primary cutaneous diffuse large B-cell lymphoma, leg type, regression

Increasing the supply of native wildflower seed is essential for restoring burned and degraded wildlands in the Intermountain West. Limitations to wildland seed collection necessitate development of effective cultural practices to improve reliability of seed production in agricultural fields. Irrigation trials were conducted over multiple years for three perennial species in the Fabaceae family [Dalea ornata (Douglas ex Hook.) Eaton & J. Wright, Dalea searlsiae (A. Gray) Barneby, and Astragalus filipes Torr. ex A. Gray]. Each of the three species was grown at the Oregon State University Malheur Experiment Station, Ontario, OR and received 0, 100, or 200 mm·year−1 of drip irrigation in four equal biweekly increments during bud formation and flowering. Seed yield responses to irrigation were evaluated by linear and quadratic regression against 1) applied water, 2) applied water plus spring precipitation, 3) applied water plus winter and spring precipitation, and 4) applied water plus fall, winter, and spring precipitation. In general, seed yields responded quadratically to irrigation. Adding fall, winter, and spring precipitation to applied water improved the accuracy of estimated water requirements for maximum seed production of D. ornata and D. searlsiae. For D. ornata, the highest yields averaged 396 kg·ha−1 and ranged from 146 to 545 kg·ha−1. Averaged over 6 years, seed yield of D. ornata was highest with applied water plus fall, winter, and spring precipitation totaling 393 mm. For D. searlsiae, the highest yields averaged 260 kg·ha−1 and ranged from 51 to 424 kg·ha−1. Averaged over 6 years, seed yield of D. searlsiae was highest with applied water plus fall, winter, and spring precipitation totaling 412 mm. Seed yields of A. filipes ranged from 7 to 110 kg·ha−1 depending on year and averaged 40 kg·ha1 over 6 years. Seed yields of A. filipes did not respond to irrigation in any of the 5 years of testing.