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Relationships that involve a physician and a non-physician professional spouse face many challenges that are similar to those experienced by dual career marriages. However, there are unique demands that are associated with physicians who are married to other professionals. One such challenge is the task of navigating their multiple familial and professional roles. This present study explores how physicians who are married to other professionals confront and navigate the complex environment that is often characteristic of work-family issues in this population. Employing an exploratory qualitative design, 34 heterosexual individuals (17 couples) completed in-depth qualitative interviews. These dyadic interviews included 10 male physicians and 7 female physicians. A multisystemic approach was employed to explore themes that emerged. One major theme, contextual appreciation of the physician's work demands, and three sub-themes: familial support, non-traditional parenting and domestic roles, and paid help, emerged. These data provide important information for the medical education of physicians with specific emphasis on navigating multiple familial and professional roles when part of dual career marriages. Findings provide implications for physician vitality/health, medical education, and continuing education with a focus on physician marriages.

Background: Many women who are at increased risk of breast cancer due to a mother or sister diagnosed with breast cancer aged under 40 do not currently qualify for surveillance before 40 years of age. There are almost no available data to assess whether mammography screening aged 35–39 years would be effective in this group, in terms of detection of breast cancer at an early stage or cost effective. Methods: A cohort screening study (FH02) with annual mammography was devised for women aged 35–39 to assess the sensitivity and screening performance and potential survival of women with identified tumours. Findings: 2899 women were recruited from 12/2006–12/2015. These women underwent 12,086 annual screening mammograms and were followed for 13,365.8 years. A total of 55 breast cancers in 54 women occurred during the study period (one bilateral) with 50 cancers (49 women) (15 CIS) adherent to the screening. Eighty percent (28/35) of invasive cancers were ≤2 cm and 80% also lymph node negative. Invasive cancers diagnosed in FH02 were significantly smaller than the comparable (POSH-unscreened prospective) study group (45% (131/293) ≤ 2 cm in POSH vs 80% (28/35) in FH02 p

Abstract Background Voluntary medical male circumcision (VMMC) is a critical component of HIV prevention. VMMC policies have achieved initial targets in adult men yet continue to fall short in reaching younger men and adolescents. Setting We present the cost and scale-up implications of an education-based, VMMC intervention for adolescent street-connected males, for whom the street has become their home and/or source of livelihood. The intervention was piloted as part of the Engaging Street Youth in HIV Interventions Project in Eldoret, Kenya. Methods We used a micro-costing approach to estimate the average cost of a VMMC intervention in 116 street-connected youth. Average cost was estimated per individual and per cohort by dividing total cost per intervention by number of clients accessing the intervention over a 30-day period. Total average costs included direct and support procedure costs, educational costs, and direct research costs. Cost-effectiveness was measured in cost per DALYs averted over a 5 and 10-year period. Results The total cost of the intervention was $12,526 over the 30-day period, with an average cost per individual of $108. The direct VMMC procedure cost was approximately $9 per individual. Personnel costs contributed the greatest percentage to the total intervention cost (38.2%), with mentors and social workers representing the highest wage earners. Retreat-related and education costs contributed 51% and 13% respectively to the total average cost, with surgical equipment costs contributing less than 1%. At a cost of $108 per individual, the intervention averted 60166 DALYs in 5 years resulting in a cost per DALY averted of $267. Conclusion The VMMC intervention was highly cost-effective in Kenya, despite the additional costs incurred to reach SCY. Further scale-up may be warranted to effectively apply this intervention in comparable populations.

Background: Dietary surveys are frequently used as the basis for theorising nutritional change and diet-related non-communicable disease emergence (DR-NCD) in the Pacific islands. However, findings from historical survey data do not always align with ethnographic evidence. Aims: This paper aims to examine the extent to which the two types of evidence can lead to similar conclusions, and draw out the implications for current theories of, and interventions addressing, nutritional change. Subjects and methods: Dietary surveys carried out on Nauru between 1927 and 1979 are reviewed and compared with ethnographic evidence documented by social researchers across the colonial and post-colonial periods. Results: This comparison reveals several shortcomings of survey data. Nutritional issues considered to be relatively recent—such as high-fat, low-fibre diets and transition to imported foods—occurred a century ago in our analysis and point to a long history of nutrition policy and intervention failure. Further, there is limited evidence that caloric intake overall increased significantly over this period of time in Nauru. Conclusions: Theories of dietary change and DR-NCD emergence and resulting interventions could be improved through a more holistic approach to nutrition that integrates sociocultural and historical evidence about both the target population and the scientists doing the research.

The Nile Basin is one of the most important shared basins in Africa. Managing and developing the water resources within the basin must not only address different water uses but also the trade-off between developments upstream and water use downstream, often between different countries. Furthermore, decision-makers in the region need to evaluate and implement climate adaptation measures. Previous work has shown that the Nile flows can be highly sensitive to climate change and that there is considerable uncertainty in climate projections in the region with no clear consensus as to the direction of change. Modelling current and future changes in river runoff must address a number of challenges; including the large size of the basin, the relative scarcity of data, and the corresponding dramatic variety of climatic conditions and diversity in hydrological characteristics. In this paper, we present a methodology, to support climate adaptation on a regional scale, for assessing climate change impacts and adaptation potential for floods, droughts and water scarcity within the basin.

This study examines whether racial/ethnic differences in personal dispositions, such as self-efficacy, cultural orientation, habitual explanations for good or poor academic outcomes, and age (as an index of life experience) exist among students enrolled in a general education course at a Hispanic-serving institution (HSI). Furthermore, the study examines the extent to which such dispositions may contribute differently to the academic success of students at such an institution depending on their race/ethnicity. Although the study uncovered only minor racial/ethnic differences in student dispositions, dissimilar patterns of contributions to course-specific performance and cumulative performance (as measured by grade point average) were observed for Latino/a/x/Hispanic and White students. Taken together, these findings suggest the importance of assessing the contribution of variables to academic success above and beyond the mere measurement of group differences. Applications of our findings to students at minority-serving institutions are discussed.

The origin of chalcocite is explored through a comparison of the copper isotope values of this mineral from supergene enrichment, sedimentary copper/red bed, and high-temperature hypogene mineralization around the world. Data from the literature and the data presented here (n=361) reveal that chalcocite from high-temperature mineralization has the tightest cluster of values of δCu65=0±0.6 in comparison to sedimentary copper/red bed δCu65=-0.9±1.0 and supergene enrichment δCu65=+1.9±1.8. Although the errors of the means overlap, large portions of the data lie in different values, allowing for distinguishing ranges for δCu65 of +1 for supergene enrichment chalcocite. The copper isotope values of sedimentary copper/red bed and supergene enrichment chalcocite are caused by redox reactions associated with the dissolution and transport of copper, whereas the tighter range of copper isotope values for hypogene minerals is associated with processes active with equilibrium conditions.

Observations and models have shown that continuously degassing volcanoes have a potentially large effect on the natural background aerosol loading and the radiative state of the atmosphere. We use a global aerosol microphysics model to quantify the impact of these volcanic emissions on the cloud albedo radiative forcing under pre-industrial (PI) and present-day (PD) conditions. We find that volcanic degassing increases global annual mean cloud droplet number concentrations by 40% under PI conditions, but by only 10% under PD conditions. Consequently, volcanic degassing causes a global annual mean cloud albedo effect of −1.06 W m−2 in the PI era but only −0.56 W m−2 in the PD era. This non-equal effect is explained partly by the lower background aerosol concentrations in the PI era, but also because more aerosol particles are produced per unit of volcanic sulphur emission in the PI atmosphere. The higher sensitivity of the PI atmosphere to volcanic emissions has an important consequence for the anthropogenic cloud radiative forcing because the large uncertainty in volcanic emissions translates into an uncertainty in the PI baseline cloud radiative state. Assuming a −50/+100% uncertainty range in the volcanic sulphur flux, we estimate the annual mean anthropogenic cloud albedo forcing to lie between −1.16 W m−2 and −0.86 W m−2. Therefore, the volcanically induced uncertainty in the PI baseline cloud radiative state substantially adds to the already large uncertainty in the magnitude of the indirect radiative forcing of climate.

La extremidad distal de los dedos es la parte de la mano que más frecuentemente se lesiona. Las principales complicaciones que pueden derivar de ese tipo de lesiones traumáticas incluyen: infecciones, retracciones de la piel, deformidades óseas y amputaciones. El presente artículo tiene como objetivo presentar el tratamiento quirúrgico seguido en un pacientes de 16 años que sufrió traumatismo sobre la falange distal del segundo dedo de la mano derecha a los 2 años de edad, a consecuencia del cual se produjo deformidad ósea y falange bífida asociada a retracción de la piel en el punto de la lesión.A extremidade distal dos dedos é a parte da mão mais freqüentemente lesionada. As principais complicações que podem ocorrer como conseqüências dessas lesões traumáticas incluem: as infecções, as retrações da pele, as deformidades ósseas e as amputações. O presente trabalho tem como objetivo relatar o tratamento cirúrgico de um paciente de 16 anos que sofreu um trauma na falange distal do segundo dedo da mão direita aos dois anos de idade, resultando em deformidade óssea e falange distal bífida associada a retração de pele no local onde ocorreu a lesão.The distal extremity of the fingers of the hand is the most frequently injured. The main complications that can occur as a result of these traumatic injuries include: infections, retraction of the skin, bone deformities and amputations. This article aims to report the surgical treatment of a 16 years old patient who suffered a trauma in the distal phalanx of the second finger of right hand when he was 2 years old, resulting in bone deformity and distal phalanx bifid associated with retraction of the skin at the site where the injury occurred.

The 1783–1784 AD Laki flood lava eruption commenced on 8 June 1783 and released 122 Tg of sulphur dioxide gas over the course of 8 months into the upper troposphere and lower stratosphere above Iceland. Previous studies have examined the impact of the Laki eruption on sulphate aerosol and climate using general circulation models. Here, we study the impact on aerosol microphysical processes, including the nucleation of new particles and their growth to cloud condensation nuclei (CCN) using a comprehensive Global Model of Aerosol Processes (GLOMAP). Total particle concentrations in the free troposphere increase by a factor ~16 over large parts of the Northern Hemisphere in the 3 months following the onset of the eruption. Particle concentrations in the boundary layer increase by a factor 2 to 5 in regions as far away as North America, the Middle East and Asia due to long-range transport of nucleated particles. CCN concentrations (at 0.22% supersaturation) increase by a factor 65 in the upper troposphere with maximum changes in 3-month zonal mean concentrations of ~1400 cm−3 at high northern latitudes. 3-month zonal mean CCN concentrations in the boundary layer at the latitude of the eruption increase by up to a factor 26, and averaged over the Northern Hemisphere, the eruption caused a factor 4 increase in CCN concentrations at low-level cloud altitude. The simulations show that the Laki eruption would have completely dominated as a source of CCN in the pre-industrial atmosphere. The model also suggests an impact of the eruption in the Southern Hemisphere, where CCN concentrations are increased by up to a factor 1.4 at 20° S. Our model simulations suggest that the impact of an equivalent wintertime eruption on upper tropospheric CCN concentrations is only about one-third of that of a summertime eruption. The simulations show that the microphysical processes leading to the growth of particles to CCN sizes are fundamentally different after an eruption when compared to the unperturbed atmosphere, underlining the importance of using a fully coupled microphysics model when studying long-lasting, high-latitude eruptions.

El sistema de producción de arroz (Oryza sativa L.) en Entre Ríos ha cobrado importancia en los últimos años, siendo muy exigente respecto a los dos recursos naturales principales utilizados: el suelo y el agua. La producción de arroz tiene características diferentes al de otros sistemas productivos. Requiere de un excesivo laboreo para la preparación de la cama de siembra, tareas de construcción y nivelación de camellones, mientras que la cosecha se realiza en condiciones de saturación del perfil. En el área arrocera núcleo se utiliza para el riego agua subterránea, bicarbonatada sódica. El objetivo fue evaluar los efectos del riego y la intensificación del sistema de producción de arroz sobre la estabilidad estructural de Vertisoles. Se utilizaron los índices de Hénin y otras variables físico-químicas del suelo. El sistema de producción de arroz regado con agua bicarbonatada sódica provocó la pérdida de materia orgánica y el aumento del sodio de intercambio en el suelo, problema que se acentuó cuando la participación del arroz fue mayor en la rotación. Los índices de estabilidad estructural de Hénin constituyeron buenos indicadores que reflejaron el deterioro de la condición del suelo. Los agregados estables al benceno y agregados promedio fueron sensibles y mostraron que la participación en menos del 20% de arroz en la rotación, no produjo deterioro significativo sobre la estructura con respecto a lotes agrícolas sin arroz.

The rhizobacterial strain Serratia marcescens 90–66 mediates induced systemic resistance (ISR) to fungal, bacterial, and viral pathogens. It was determined that strain 90–166 produced salicylic acid (SA), using the salicylateresponsive reporter plasmid pUTK21. High-pressure liquid chromatography analysis of culture extracts confirmedthe production of SA in broth culture. Mini-Tn5phoA mutants, which did not produce detectable amounts of SA, retained ISR activity in cucumber against the fungal pathogen Colletotrichum orbiculare. Strain 90–166 induced disease resistance to Pseudomonas syringae pv. tabaci in wild-type Xanthi-nc and transgenic NahG-10 tobacco expressing salicylate hydroxylase. Increasing ferric iron concentrations in vitro reduced SA production below detectable limits, and increasing ferric iron concentration in planta, applied as a root drench, significantly reduced the level of ISR observed in cucumber to C. orbiculare. An ISR¯ mutant (90-166-2882) still produced SA. The results of this study indicate that SA produced by 90–166 is not the primary bacterial determinant of ISR and that this bacterial-mediated ISR system is affected by iron concentration.

Phosphate mining is a temporary land use. The jobs and economic activity associated with mining depart an area once the resource is exhausted — but the landscape created as a result of mining and reclamation will exist in perpetuity. Communities affected by mining activities need to have reclamation result in lands with high potential to provide sustainable economic opportunities while maintaining ecosystem services and ecological functions. This 8-page fact sheet provides a brief overview of the landscapes being created as a result of phosphate mining and reclamation activities in Florida. Written by M. Wilson and E.A. Hanlon, and published by the UF Department of Soil and Water Science, October 2012.

A critical nutrient for plant growth, phosphate helps sustain the world’s growing population. In 2010, seven mines in Florida produced approximately 10% of the world’s phosphate supply and more than 65% of the phosphate for the United States. But each year in Florida thousands of acres disturbed by strip-mining for phosphate rock must be reclaimed for other productive uses. This 11-page fact sheet provides a general characterization of the various soil types resulting from phosphate mine reclamation. Written by M. Wilson and E.A. Hanlon, and published by the UF Department of Soil and Water Science, October 2012.

This 8-page fact sheet contains a synopsis of findings obtained through research, contrasted with limnological studies of natural lakes in central Florida. Written by M. Wilson and E.A. Hanlon, and published by the UF Department of Soil and Water Science, May 2012.