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The State of California is moving towards sustainable groundwater management and carbon neutrality goals. We aim to answer questions of importance to sustainable agricultural practices, in particular how to: (1) decrease unnecessary water losses from evapotranspiration (ET), (2) increase carbon sequestration, and (3) enhance overall water use efficiency. While implementing our cooperative extension program in Biometeorology, we deployed eddy covariance systems on flux towers placed on numerous farms to directly measure net water and carbon exchange between different agricultural crops and the atmosphere. Currently, we are simultaneously running up to twenty of these flux towers on any day of the year to address the seasonality of carbon and water cycling with innovative agricultural practices. Some of the most urgent questions posed by local communities, commodity boards, state agencies, NGOs and private corporations are mainly related to water use by different agricultural landscapes, but carbon fluxes are increasingly gaining attention as well. In order to explore these questions, our network of towers spans the entire Central Valley from northern California rice fields (that are increasingly being fallowed for water transfers), to the southern part of the state where transferred water is being used for perennial crops. Although some data and measurements are reported on the ET of California crops, the ever-changing adaptation practices in agricultural management are challenging previously established parameters (e.g. crop coefficients) used in irrigation management. For better spatial resolution, we often use semi-direct ET measurements, derived from residuals of observed surface energy budgets. In addition, alternative low-cost measurements, such as the surface renewal method, are actively being evaluated and we are refining different approaches for their independent use. This talk will mostly focus on ET measurements and the simultaneous quantification of water budgets of entire agricultural fields. We are designing several of our experiments to encompass a full water budget of the targeted fields. This provides a backup estimate of ET as well as an opportunity to couple soil moisture profiles, runoff, irrigation, and precipitation dynamics to eddy covariance flux tower measurements, and eventually help with the ET partitioning. This information is increasingly being sought by modelers and remote sensing scientists to calibrate their ET estimates as we work together on addressing emerging challenges in California agriculture and could potentially be used to understand the physiological response of crops to changes in plant water status and how this response could affect crop quality and productivity. Evaluation of alternative methods and models will include cross-comparisons of existing techniques with more advanced methods under development, including ACASA. We are especially excited to broaden our extension and farm education to small growers and communities that have been historically overlooked by cooperative extension and funding agencies.

We know that both financial and nonfinancial incentives matter if we want community health workers (CHWs) who are motivated and performing. What are the practical implications for CHWs themselves and for effective management of viable CHW programs?, Key Messages We consider the types of incentives that motivate community health workers' (CHWs) performance and the implications at 2 levels of systems analysis—first, for CHWs themselves and then for appropriate management of an invaluable human resource by CHW programs.The World Health Organization recommendations on commensurability of CHW compensation with the job demands—and corresponding professionalization—represent the culmination of decades of work, advances, forgetfulness, rediscovery, collective wisdom, and available evidence.Tapping into communities' own organizing potential through volunteerism is, however, a force in both high-income and low- and middle-income countries. We offer predictions for the future direction of CHW programs: National CHW programs—whether implemented by states or non-state partners—will be a growing opportunity to viably strengthen national health systems.Partnerships between state and non-state actors will be key to sustain effective CHW programs in national PHC strategies at scale.The social-versus-institutional anchoring of CHW programs will be an enduring challenge for their performance and sustainability. Dual models (paid CHWs and volunteers), if ethically managed, will be a promising approach for efficiency and scale.

Rice (Oryza sativa L.) is an important staple crop throughout much of the world, however, it is also a significant source of agricultural methane (CH4) emissions and exposure to arsenic (As). Introduction of soil aerobic events through practices such as alternate wetting and drying or midseason drainage, in flooded rice systems can significantly decrease grain As concentration and seasonal CH4 emissions. Previous on small research plots research has shown that a single midseason drain accomplishes these goals without yield reduction, but the degree of benefit depends on soil-drying severity. A midseason drain also has the potential to fit in well within current management practices of California rice systems, however, it has not been tested across a wide range of soil types or at a scale that farmers typically manage in this region. Therefore, in this three-year study, we aimed to determine if the results from previous small plot research are similar to what can be expected on-farm. At seven on-farm trials we implemented a single midseason drain and compared the grain yields, GHG emissions, and As concentration to the traditional farmer practice (FP) practiced in an adjacent part of the field. Soil moisture parameters [perched water table, volumetric water content, gravimetric water content (GWC), and soil water potential], CH4 and nitrous oxide (N2O) emissions, grain As and cadmium concentration, and grain yield were quantified. Across site-years, midseason drainage reduced seasonal CH4 emissions by 20-77%, compared to the FP control with the magnitude of reduction related to the soil-drying severity. For every 1% reduction in soil GWC during the drainage period, CH4 emissions were reduced by approximately 3.2%, compared to 2.5% in previous on-station research using small plots. Midseason drainage increased N2O emissions (average = 0.248 kg N2O-N ha-1) compared to the control but this accounted for only 3% of the seasonal global warming potential across all drainage treatments. Drainage also decreased grain As concentration by approximately 20%, on average, but was not related to the degree of soil-drying. Importantly, midseason drainage had no significant impact on grain yields. Overall, these results confirm findings from previous on-station research, indicating that midseason drainage may be a viable on-farm management practice for GHG mitigation and for reducing grain As concentration in flooded rice fields with limited risk of yield reduction.

Dry eye disease (DED), which is a prevalent disease that still lacks successful treatment options, remains a major challenge in ophthalmology. Multiple animal models of DED have been used to decipher its pathophysiology and to develop novel treatments. These models use mice, rats, rabbits, cats, dogs and non-human primates. Each model assesses aspects of DED by focusing on elements of the lacrimal functional unit, which controls the homeostasis of the tear film. The present review outlines representative DED animal models and assesses their contribution to the study of DED. Murine models are the most extensively used, followed by rabbit models; the latter offer the advantage of larger eyes, a favorable biochemical profile for drug studies, experimental ease and relatively low cost, contrasting with non-human primates, which, although closer to humans, are not as accessible and are expensive. No comprehensive 'ideal' animal model encompassing all aspects of human DED exists nor is it feasible. Investigators often choose an animal model based on their experimental needs and the following four features of a given model: The size of the eye, its biochemical composition, the available research reagents and cost. As research efforts in DED expand, more refined animal models are needed to supplement the enormous contribution made to date by existing models.

The purpose of the study was to measure the change in intraocular pressure (IOP) after micropulse laser trabeculoplasty (MLT) and to evaluate subgroups based on initial IOP and severity of glaucoma.This was a retrospective study of 34 eyes that were treated with MLT. Follow-up measurements were obtained at 3 months. PairedIOP reduction approached significance (Patients with higher initial IOP and in the early stages of glaucoma were more likely to benefit from MLT in lowering IOP. A randomized clinical trial is necessary to confirm these preliminary findings. We recommend that clinicians should consider MLT in the management of early glaucoma and among those with IOP16 mmHg.

The Arabidopsis thaliana wall-associated kinases (WAKs) bind to pectin with an extracellular domain and also contain a cytoplasmic protein kinase domain. WAKs are required for cell elongation and modulate sugar metabolism. This work shows that in leaf protoplasts a WAK1-GFP fusion protein accumulates in a cytoplasmic compartment that contains pectin. The WAK compartment contains markers for the Golgi, the site of pectin synthesis. The migration of WAK1-GFP to the cell surface is far slower than that of a cell surface receptor not associated with the cell wall, is influenced by the presence of fucose side chains on one or more unidentified molecules that might include pectin, and is dependent upon cellulose synthesis on the plasma membrane. WAK is crosslinked into a detergent-insoluble complex within the cytoplasmic compartment before it appears on the cell surface, and this is independent of fucose modification or cellulose synthesis. Thus, the assembly and crosslinking of WAKs may begin at an early stage within a cytoplasmic compartment rather than in the cell wall itself, and is coordinated with synthesis of surface cellulose.

This paper describes the effectiveness for child health of a primary health care approach developed in Bolivia by Andean Rural Health Care and its colleagues, the census-based, impact-oriented (CBIO) approach. Here, we describe selected achievements, including child survival service coverage, mortality impact, and the level of resources required to attain these results. As a result of first identifying the entire programme population through visits at least biannually to all homes and then targeting selected high-impact services to those at highest risk of death, the mortality levels of children under five years of age in the established programme areas was one-third to one-half of mortality levels in comparison areas. Card-documented coverage for the complete series of all the standard six childhood immunizations among children 12-23 months of age was 78%, and card-documented coverage for three nutritional monitorings during the previous 12 months among the same group of children was 80%. Coverage rates in comparison areas for similar services was less than 21%. The local annual recurring cost of this approach was US $8.57 for each person (of all ages) in the programme population. This cost includes the provision of primary care services for all age groups as well as targeted child survival services. This cost is well within the affordable range for many, if not most, developing countries. Manpower costs for field staff in Bolivia are relatively high, so in countries with lower salary scales, the overall recurring cost could be substantially less. An Expert Review Panel reviewed the CBIO approach and found it to be worthy of replication, particularly if stronger community involvement and greater reliance on volunteer or minimally paid staff could be attained. The results of this approach are sufficiently promising to merit implementation and evaluation in other sites, including sites beyond Bolivia.

To survey infrastructure characteristics, personnel, equipment and procedures of surgical, obstetric and anaesthesia care in 17 hospitals in Ghana.The assessment was completed by WHO country offices using the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care, which surveyed infrastructure, human resources, types of surgical interventions and equipment in each facility.Overall, hospitals were well equipped with general patient care and surgical supplies. The majority of hospitals had a basic laboratory (100%), running water (94%) and electricity (82%). More than 75% had the basic supplies needed for general patient care and basic intra-operative care, including sterilization. Almost all hospitals were able to perform major surgical procedures such as caesarean sections (88%), herniorrhaphy (100%) and appendectomy (94%), but formal training of providers was limited: a few hospitals had a fully qualified surgeon (29%) or obstetrician (36%) available.The greatest barrier to improving surgical care at district hospitals in Ghana is the shortage of adequately trained medical personnel for emergency and essential surgical procedures. Important future steps include strengthening their number and qualifications.

Objectives. Evidence regarding the long-term impact of health and other community development programs on under-5 mortality (the risk of death from birth until the fifth birthday) is limited. We compared mortality in a population served by health and other community development programs at the Hôpital Albert Schweitzer (HAS) with national mortality rates among children younger than 5 years for Haiti between 1958 and 1999. Methods. We collected information on births and deaths in the HAS service area between 1995 and 1999 and assembled previously published under-5 mortality rates at HAS. Published national rates for Haiti served as a comparison. Results. In the early 1970s, the under-5 mortality rate at HAS declined to a level three fourths lower than that in Haiti nationwide. More recently, HAS rates have remained at one half those for Haiti nationwide. Child survival interventions in the HAS service area were substantially higher than in Haiti nationwide although socioeconomic characteristics and levels of childhood malnutrition were similar in both areas. Conclusions. HAS’s programs have been responsible for long-term sustained reduction in mortality among children aged less than 5 years. Integrated systems for health and other community development programs could be an effective strategy for achieving the United Nations Millennium Goal to reduce under-5 mortality two thirds by 2015.

Background: The degree to which local health systems contribute to reductions in under-five mortality in severely impoverished settings has not been well documented. The current study compares the under-five mortality in the Hopital Albert Schweitzer (HAS) Primary Health Care Service Area with that for Haiti in general. HAS provides an integrated system of community-based primary health care services, hospital care and community development. Methods: A sample of 10% of the women of reproductive age in the HAS service area was interviewed, and 2390 live births and 149 child deaths were documented for the period 1995-99. Under-five mortality rates were computed and compared with rates for Haiti. In addition, available data regarding inputs, processes and outputs for the HAS service area and for Haiti were assembled and compared. Results: Under-five mortality was 58% less in the HAS service area, and mortality for children 12-59 months of age was 76% less. These results were achieved with an input of fewer physicians and hospital beds per capita than is available for Haiti nationwide, but with twice as many graduate nurses and auxiliary nurses per capita than are available nationwide, and with three cadres of health workers that do not exist nationwide: Physician Extenders, Health Agents and Community Health Volunteers. The population coverage of targeted child survival services was generally 1.5-2 times higher in the HAS service area than in rural Haiti. Discussion: These findings support the conclusion that a well-developed system of primary health care, with outreach services to the household level, integrated with hospital referral care and community development programmes, can make a strong contribution to reducing infant and child mortality in severely impoverished settings.

This article describes a flexible primary health care methodology which was developed by Andean Rural Health Care and its colleagues in Bolivia, South America. This methodology, the census-based, impact-oriented (CBIO) approach to primary health care, involves determining local health priorities as defined both by locally acquired epidemiologic information and by the local people themselves. The CBIO approach to primary health care is now functioning successfully at seven program sites in Bolivia, which together serve 75,000 people in urban and rural communities in three distinct cultural and ecological regions of the country. High levels of coverage of basic health services can be achieved through a system of `epidemographic' surveillance of all families and through home delivery, when needed, of priority services to those at risk. When the services provided are based on local health priorities, when they are provided in a technically effective manner, and when the community has a strong partnership in planning, implementation and evaluation, then the CBIO approach to primary health care will lead to measurable health improvements as defined by changes in population-based rates of mortality and illness in the community. On the basis of our experience, we believe that the CBIO approach offers great potential for strengthening the effectiveness of local health programs in impoverished communities around the world in a way which fosters community ownership and, hence, long-term sustainability.

This report assesses the quality of service inputs, service processes and service outcomes (with the exception of coverage and effectiveness) for immunization services in Zone 3 of Dhaka City. The results indicate that in general, the providers of immunization services are knowledgeable, friendly and give technically appropriate immunizations. Client ratings of the quality of services are quite good. Access is 90% for childhood immunizations and 89% for tetanus toxoid (TT) immunizations for women with a child < 1 year old. Three areas were identified as needing attention: frequently missed opportunities for the promotion or provision of immunizations; uneven distribution and utilization of immunization sites, and some fundamental weaknesses of the TT immunization programme (lack of awareness among women of reproductive age about the importance of TT immunization, low access to it among women of reproductive age who do not have a child < 1 year of age, and confusion among women and service providers about the purpose of TT immunization and the dosage schedule). Efforts to monitor and strengthen the quality of EPI activities will facilitate further decline in the numbers of deaths and illnesses from vaccine-preventable diseases. The approaches used in this study and the typology for quality assessment are widely applicable elsewhere.

An 11-year-old girl with a mass arising from the caruncle and the upper eyelid was examined for spontaneous epibulbar bleeding. Excision of the lesion involved reconstruction of the proximal nasolacrimal system, lid margin, and conjunctiva. The histopathologic diagnosis was consistent with a dermoid of the caruncle. This case is notable not only for a dermoid accompanied by epibulbar bleeding but for its caruncular origin and attachment to the upper eyelid. This case suggests that the caruncle and the upper eyelid arise from similar embryologic structures.