Improve Resource Use Research Articles

National Analysis of Coronary Artery Bypass Grafting in Autoimmune Connective Tissue Disease

Autoimmune connective tissue diseases (CTDs) are associated with accelerated atherosclerosis and inflammation, while often requiring immunosuppression. Large-scale outcomes of coronary artery bypass graft (CABG) surgery in this population have not been reported thus far. This study characterized trends in use of CABG in patients with CTDs and the impact of the disease on mortality, in-hospital complications, length of stay, and costs. The 2005 to 2015 National Inpatient Sample was used to identify all adult patients undergoing isolated CABG. The CTDs cohort included rheumatoid arthritis, lupus erythematosus, and antiphospholipid syndrome (APLS), among others. Hierarchical multivariable logistic models were used to calculate the independent impact of CTDs on clinical outcomes and costs. Of an estimated 2,101,591 patients, 41,567 (1.8%) were diagnosed with CTDs (rheumatoid arthritis, 58%; systemic lupus erythematosus, 12%; APLS, 11%) Although the overall annual use of CABG decreased, the proportion of patients with CTDs receiving the operation significantly increased. After adjusting for patient and hospital characteristics, CTDs were not associated with increased mortality (adjusted odds ratio [AOR], 0.91; P= .34) but were protective against cardiovascular (AOR, 0.92; P < .003), neurologic (AOR, 0.81; P= .01), and infectious (AOR, 0.80; P= .01) complications. The diagnosis of CTDs was also predictive of reduced length of hospital stay (β-coefficient= -0.40; P < .001) and costs (β-coefficient, -$1200; P= .01). On subgroup analysis patients with APLS had significantly increased odds of mortality (AOR, 1.5) and increased renal (AOR, 1.3), infectious (AOR, 1.7), and thromboembolic (AOR, 4.3) complications (all P < .05). CABG in patients with CTDs provides acceptable outcomes and paradoxically improved resource use. However CABG in patients with APLSwarrants careful consideration given inferior outcomes.

Optimizing planting geometry for barley-Egyptian clover intercropping system in semi-arid sub-tropical climate.

Intercropping legumes with cereals has been a common cropping system in short-season rainfed environments due to its increased productivity and sustainability. Intercropping barley (Hordeum vulgare L.) with Egyptian clover (Trifolium alexandrinum L.) could increase the grain yield of barley and improve resource use efficiency of the intercropping system. However, non-optimum planting geometry has been a hurdle in the adaptation of barley-based cropping systems. This study was aimed at optimizing the planting geometry, and assess the productivity and profitability of barley-Egyptian clover intercropping system. Ten different planting geometries, differing in number of rows of barley, width and number of irrigation furrows and planting method were tested. Intercropping barley with Egyptian clover improved 56–68% grain yield of barley compared with mono-cropped barley. Barley remained dominant crop in terms of aggressiveness, relative crowding coefficient and competitive ratio. The amount of water used was linearly increased with increasing size of barley strip from 3 to 8 rows. The highest water use efficiency (4.83 kg/cf3) was recorded for 8-row barley strip system with 120 cm irrigation furrows compared to rest of the planting geometries. In conclusion, 8-rows of barley planted on beds with Egyptian clover in 120 cm irrigation furrows had the highest net income and cost benefit ratio. Therefore, it is recommended that this planting geometry can be used for better economic returns of barley-Egyptian clover intercropping system. However, barley strips with >8 rows were not included in this study, which is limitation of the current study. Therefore, future studies with >8 barley rows in strip should be conducted to infer the economic feasibility and profitability of wider barley strips.

The environmental impact of reducing food loss and waste: A critical assessment

This paper examines the rationale for pursuing environmental objectives by reducing food loss and waste (FLW). The main thrust of the literature on this issue is that FLW reduction can make a major contribution to making food systems more sustainable. Using a stylized analytical framework, we find that reducing FLW always improves resource use efficiency for land and water, and reduces the amount of greenhouse gases (GHG) emitted per unit of food consumed. However, whether the actual environmental outcome is improved will depend on where environmental damage and FLW reduction occur, and the way price transmission connects these along the food supply chain. We find that, while a food waste reduction at the consumer level always improves the environmental outcome, this is not guaranteed when reducing losses from farm to retail. We thus derive a condition linking the price transmission mechanism and the environmental impact of a loss reduction. Simulating environmental outcomes based on a range of parameter values found in the literature, we find that reducing losses at or close to the farm level can increase the aggregate amount of GHG emissions, and therefore focusing on reducing consumer waste is more effective in reducing emissions. As for reducing natural resource use, both loss and waste reductions reduce the amount of land and water use, but effectiveness is reduced by heterogeneity in environmental impact. Relative to loss reductions, effectiveness of a waste reduction is amplified if there are environmentally damaging losses upstream in the value chain, but also dampened by vertical heterogeneity of sourcing along a value chain. The paper makes the case that more targeted instruments may be better suited to address typically local water scarcity and land use and degradation issues.

Redevelopment and Upgradation of Basic Infrastructural Facilities at Nagor Village, Kutch

This work deals with study and redevelopment of Nagor village, Kutch. In this we focuses on improved resource use efficiency, local self-governance, access to assure basic amenities of village to be redeveloped for easy living of village people. We are redeveloping basic infrastructural facilities like poor road network, drainage facilities, waste disposal facilities and water storage and harvesting by taking smart decisions using various technologies and effective ideas.

Utility, Appropriateness, and Content of Electronic Consultations Across Medical Subspecialties.

Electronic consultations (e-consults) can facilitate patient access to specialists, minimize travel, and reduce unnecessary in-person visits. However, metrics to enable study of e-consults and their effect on processes and patient care are lacking. To assess novel metrics of e-consult appropriateness and utility. Retrospective cohort study. Primary and specialty care practices at 2 large academic and 2 community hospitals of an integrated health system. Patients with e-consult requests to 5 specialties-hematology, infectious disease, dermatology, rheumatology, and psychiatry-between October 2017 and November 2018. The appropriateness of e-consult inquiries was assessed by review of medical records and defined as meeting the following 4 criteria: not answerable by reviewing evidence-based summary sources ("point-of-care resource test"), not merely requesting logistic information, having appropriate clinical urgency, and having appropriate patient complexity. Interrater agreement in assessments of e-consult appropriateness was assessed by the κ statistic. Utility of e-consults was assessed by the rate of avoided visits (AVs), defined by the absence of an in-person visit to the same specialty within 120 days. Overall, 6512 eligible e-consults were made by 1096 referring providers to 121 specialist consultants. Inquiries were characterized as diagnostic, therapeutic, for provider education, or at the request of the patient. Most consultations were answered within 1 day, with variation across specialties (73.1% for psychiatry to 87.8% for infectious disease). Overall, 70.2% of e-consults met all 4 criteria for appropriateness; the frequency of unmet criteria varied among specialties. Raters agreed on the appropriateness of 94% of e-consults (κ= 0.57 [95% CI, 0.36 to 0.79]), indicating moderate agreement. The overall rate of AVs across the 5 specialties was 81.2%; the highest rate was in psychiatry (92.6%) and the lowest in dermatology (61.9%). Generalizability is unknown outside a single integrated health system, where requesting and consulting providers share a common electronic health record. Novel metrics to assess the appropriateness and utility of e-consults provide meaningful insight into practice, provide a rubric for comparison in future studies in additional settings, and suggest areas to improve resource use and patient care. None.

Antibiotic Timing in Pediatric Septic Shock.

National guidelines advocate for the administration of antibiotics within 1 hour to children with septic shock, although there is variance in the pediatric evidence-based literature supporting this benchmark. Our objective for this study was to describe the association of target time to antibiotic administration (TTAA) with outcomes of children treated for suspected septic shock in a pediatric emergency department. Septic shock is suspected when signs of perfusion and/or hypotension are present. The primary outcome was mortality. Secondary outcomes included PICU admission, hospital and PICU length of stay, and organ dysfunction resolution by hospital day 2. We conducted a retrospective study of children <18 years of age admitted from the pediatric emergency department and treated for suspected septic shock between February 1, 2007, and December 31, 2015. Associations between TTAA and outcomes were evaluated by using multivariable linear and logistic regression models obtained from stepwise selection. Of 1377 patients, 47% were boys with a median age of 4.0 (interquartile range 1.4-11.6) years, 1.5% (20) died, 90% were compliant with TTAA goals, 40% required PICU admission, 38% had ≥2 unique complex chronic conditions, 71% received antibiotics in ≤2 hours, and 30% had a culture-positive bacterial etiology. There were no significant associations between TTAA and outcomes. We found no association with TTAA and any clinical outcomes, adding to the growing body of literature questioning the timing benchmark of antibiotic administration. Although the importance of antibiotics is not in question, elucidating the target TTAA may improve resource use and decrease inappropriate or unnecessary antibiotic exposure.

Managing the water-energy-food nexus in China by adjusting critical final demands and supply chains: An input-output analysis

The rapid population growth in China has increased the demand for limited water, energy and food resources. Because the resource supply is constrained by future uncertainties such as climate change, it is necessary to examine the connections among water, energy and food resources from the perspective of the relevant final demands. Based on an input-output model and structural path analysis, this study aims to explore the hidden connections among water, energy and food resources by identifying important final demands and examine how these resources are embodied in upstream production and downstream consumption processes along the supply chain. The water-energy-food nexus approach in this research identifies where and how these resources intersect in economic sectors. By simultaneously considering the water, energy and food footprints, synergistic effects can be maximized among these resource systems. The results reveal that urban household consumption and fixed capital formation have large impacts on water-energy-food resources. Besides, agriculture, construction and service sectors have the largest water-energy-food footprints. For each resource, we rank the top-20 supply chain paths from the final demands to the upstream production sectors, and six critical supply chain paths are identified as important contributors to the consumption of all these resources. Compared with independent approach to manage water, energy and food resources, the nexus approach identifies the critical linkages of the water, energy and food systems and helps to formulate integrated policies to effectively manage these resources across sectors and actors. Synergistic strategies for conserving water, energy, and food resources can be achieved through avoiding unnecessary waste in end uses and improving resource use efficiency along critical supply chains. This research can help consumers, industries and the government make responsible consumption and production decisions to conserve water, energy and food resources.

Effects of late sowing of two season crops on annual yield and resource use efficiency in rice-wheat double cropping system

The unreasonable resource allocation and lower resource use efficiency for rice-wheat double cropping system in Jianghuai region resulted from climate change severely limit the coordinated development of annually high yield and high efficiency crops. Optimizing seasonal resource allocation through sowing date adjustment is an important way to tap the annual high-yield potential and improve resource use efficiency. To quantify the effects of sowing date of rice and wheat on annual yield and resource allocation and utilization efficiency, field experiments were conducted in 2013-2015. Results showed that compared with the conventional rice-wheat cropping system (T2), the two seasons appropriate late-cast cropping system (T3) could coordinate resource allocation in the two seasons through the sowing date adjustment, and transfer the redundant radiation and heat resources in the wheat season to the rice. The distribution rate of accumulated temperature, radiation and rainfall resources for T3 were: rice season accounted for 60.5%, 46.5% and 56.7%, wheat season accounted for 36.3%, 50.0% and 40.9%, and the ratio between two seasons was 1.67, 0.94 and 1.39, respectively. Rice yield and its proportion of annual production were significantly increased. The wheat yield was significantly decreased, with the variation range being smaller than that of rice. The total annual yield was increased by 336.3 kg·hm-2 as compared with T2. The temperature, radiation and rainfall production efficiency for rice in T3 were increased by 9.8%, 5.6% and 8.3% in compared to T2, respectively. There was no significant difference in the climate resource utilization efficiency of wheat season. The annual resource production efficiency of T3 was increased by 4.8%, 3.1% and 6.0% over the T2, respectively. Earlier (T1) or latest sowing (T4) of two seasons cropping system was not appropriate for annual yield formation and resource utilization. In summary, improving resource utilization efficiency in rice season is the key way to increase annual grain yield potential in Jianghuai region. The results provided theoretical and practical bases for the excavation of yield potential of the regional annual cropping system and the adjustment of planting structure.

Predicting successful weaning in patients treated with venovenous extracorporeal membrane oxygenation

ABSTRACT Introduction: Increasing use of extracorporeal membrane oxygenation (ECMO) for acute respiratory failure may increase resource requirements and hospital costs. Prediction of successful weaning in these patients may improve resource use and patients outcome. The Respiratory ECMO Survival Prediction (RESP) score has been proposed as an outcome prediction tool for patients undergoing venovenous (VV-ECMO). However, it was developed and validated on patients established on ECMO. This may limit its usefulness as an adjunct tool for decision-making process at the pre-ECMO stage. Aim: The aim of the work was to assess the efficacy of RESP score as a tool to predict successful weaning in patients treated with VV-ECMO before initiation of treatment. Patients and methods: The study was carried out on 23 adult patients who were admitted to the units of Critical Care Medicine Departments in Egyptian Armed Forces Hospitals within 1 year and were treated with VV-ECMO; all of them received the same treatment as recommended by ELSO guidelines for adult respiratory failure. They were classified into two groups according to ECMO weaning successfulness at the end of the study: group I (successful weaning) and group II (failed weaning). Complete physical assessment, laboratory investigations, and RESP score calculation were done before ECMO initiation. Results: Pre-ECMO RESP score, in group I it ranged from −8 to 7 (mean 1.75 ± 3.65), while in group II it ranged from −11 to 1 (mean −6.38 ± 1.88), there was statistically significant difference between the two groups (p = 0. 003). The ROC curve of RESP score showed an AUC of 0.880 (95% CI 0.658–0.981) (p < 0.001). The best cutoff value was −1, at that level the sensitivity was 69.7%, specificity was 81.5%. Calculated positive predictive value of RESP score was 88.9% while negative predictive value was 63.6%. Conclusion: RESP score may be effective tool to predict ECMO weaning successfulness before initiation of ECMO.

Farmers’ income in India: Trends and prospects for future growth

The Government of India aims to double agricultural income by 2022–23. This paper examines whether this target can be met—by analysing the trends in farmer income, sources, and factors of performance by farm class and state—and finds it unlikely. Income growth would be accelerated by improving resource use efficiency and access to agricultural extension, markets, and credit; and by diversifying towards high-value, high-growth sectors like animal husbandry and horticulture. To sustain income growth in the long term, greater resources must be allocated to agricultural research, and gainful employment opportunities must be created in the rural non-farm sector.

Cassava-legume intercrop: I. Effects of relative planting dates of legumes on cassava productivity

ABSTRACTCassava is a long duration crop which grows slowly during the early stages hence incorporation of early maturing crops may improve resource use efficiency and hence crop productivity in cassava-based cropping systems. We conducted field experiments in clay and loamy sand soils, in two consecutive seasons, to assess the response of cassava productivity to relative planting dates of 3 legume species (Bambara groundnut, chickpea and cowpea) in a cassava-legume intercrop. Root yield, determined at 10 months after planting, was greater at 4 weeks after cassava (1.7 kg plant–1) compared to when legumes were planted same time (1.2 kg plant–1) and 2 weeks after cassava (0.7 kg plant–1), and intercropping decreased cassava root yield by 40% (cowpea) and 26% (chickpea) in season I in the clay soils. Neither relative planting dates of legumes nor cropping systems affected root yield in both seasons in the loamy sand soils. Intercropping increased LER in season I by 25% to 65% in clay, and 45% to 101% in loamy sand soils. Although cassava root yield was highest with a 4 week-delay in sowing the legumes and LER greatest in cassava-cowpea intercrop, we propose further studies before making any definite recommendations.

Risk Stratification of Older Adults Who Present to the Emergency Department With Syncope: The FAINT Score

Older adults with syncope are commonly treated in the emergency department (ED). We seek to derive a novel risk-stratification tool to predict 30-day serious cardiac outcomes. We performed a prospective, observational study of older adults (≥60 years) with unexplained syncope or near syncope who presented to 11 EDs in the United States. Patients with a serious diagnosis identified in the ED were excluded. We collected clinical and laboratory data on all patients. Our primary outcome was 30-day all-cause mortality or serious cardiac outcome. We enrolled 3,177 older adults with unexplained syncope or near syncope between April 2013 and September 2016. Mean age was 73 years (SD 9.0 years). The incidence of the primary outcome was 5.7% (95% confidence interval [CI] 4.9% to 6.5%). Using Bayesian logistic regression, we derived the FAINT score: history of heart failure, history of cardiac arrhythmia, initial abnormal ECG result, elevated pro B-type natriuretic peptide, and elevated high-sensitivity troponin T. A FAINT score of 0 versus greater than or equal to 1 had sensitivity of 96.7% (95% CI 92.9% to 98.8%) and specificity 22.2% (95% CI 20.7% to 23.8%), respectively. The FAINT score tended to be more accurate than unstructured physician judgment: area under the curve 0.704 (95% CI 0.669 to 0.739) versus 0.630 (95% CI 0.589 to 0.670). Among older adults with syncope or near syncope of potential cardiac cause, a FAINT score of zero had a reasonably high sensitivity for excluding death and serious cardiac outcomes at 30 days. If externally validated, this tool could improve resource use for this common condition.

Micro-Spatial Analysis of Maize Yield Gap Variability and Production Factors on Smallholder Farms

Site-specific land management practice taking into account variability in maize yield gaps (the difference between yields in the 90th percentiles and other yields on smallholder farmers’ fields) could improve resource use efficiency and enhance yields. However, the applicability of the practice is constrained by inability to identify patterns of resource utilization to target application of resources to more responsive fields. The study focus was to map yield gaps on smallholder fields based on identified spatial arrangements differentiated by distance from the smallholder homestead and understand field-specific utilization of production factors. This was aimed at understanding field variability based on yield gap mapping patterns in order to enhance resource use efficiency on smallholder farms. The study was done in two villages, Mukuyu and Shikomoli, with high and low agroecology regarding soil fertility in Western Kenya. Identification of spatial arrangements at 40 m, 80 m, 150 m and 300 m distance from the homestead on smallholder farms for 70 households was done. The spatial arrangements were then classified into near house, mid farm and far farm basing on distance from the homestead. For each spatial arrangement, Landsat sensors acquired via satellite imagery were processed to generate yield gap maps. The focal statistics analysis method using the neighborhoods function was then applied to generate yield gap maps at the different spatial arrangements identified above. Socio-economic, management and biophysical factors were determined, and maize yields estimated at each spatial arrangement. Heterogeneous patterns of high, average and low yield gaps were found in spatial arrangements at the 40 m and 80 m distances. Nearly homogenous patterns tending towards median yield gap values were found in spatial arrangements that were located at the 150 m and 300 m. These patterns correspondingly depicted field-specific utilization of management and socio-economic factors. Field level management practices and socio-economic factors such as application of inorganic fertilizer, high frequency of weed control, early land preparation, high proportion of hired and family labor use and allocation of large land sizes were utilized in spatial arrangements at 150 and 300 m distances. High proportions of organic fertilizer and family labor use were utilized in spatial arrangements at 40 and 80 m distances. The findings thus show that smallholder farmers preferentially manage the application of socio-economic and management factors in spatial arrangements further from the homestead compared to fields closer to the homestead which could be exacerbating maize yield gaps. Delineating management zones based on yield gap patterns at the different spatial arrangements on smallholder farms could contribute to site-specific land management and enhance yields. Investigating the value smallholder farmers attach to each spatial arrangement is further needed to enhance the spatial understanding of yield gap variation on smallholder farms.

Sensitivity of Agricultural Development to Water-Related Drivers: The Case of Andalusia (Spain)

Future agricultural development will be challenged by the impacts of climate change on water, which are expected to be particularly strong in southern European regions. Thus, exploring interrelations between agriculture and water under climate change is essential to frame informed policies that ensure sustainable water management while enhancing food production. Nevertheless, studies that address future agriculture development focus on climate-induced changes in crop productivity and often disregard the water dimension. In this research, we have conducted a sensitivity analysis of agricultural development to drivers of water use in Andalusia in 2050 based on outcomes from the CAPRI-Water model. The results from the analysis show that water cost is the most determinant factor in shaping agricultural land, offsetting the impact of the driver of water availability. In contrast, irrigation water use is driven not only by water cost but also by irrigation efficiency. The magnitude of the sensitivity to these drivers differs significantly across crops. Policies aimed at improving resource use efficiency can contribute to strengthening the resilience and adaptation capacity of future agricultural systems to climate change. To achieve this goal, the policies must consider crop sensitivity to irrigation costs and the potential rebound effect.

Omeprazole Promotes Chloride Exclusion and Induces Salt Tolerance in Greenhouse Basil

The role of small bioactive molecules (&lt;500 Da) in mechanisms improving resource use efficiency in plants under stress conditions draws increasing interest. One such molecule is omeprazole (OMP), a benzimidazole derivative and inhibitor of animal proton pumps shown to improve nitrate uptake and exclusion of toxic ions, especially of chloride from the cytosol of salt-stressed leaves. Currently, OMP was applied as substrate drench at two rates (0 or 10 μM) on hydroponic basil (Ocimum basilicum L. cv. Genovese) grown under decreasing NO3−:Cl− ratio (80:20, 60:40, 40:60, or 20:80). Chloride concentration and stomatal resistance increased while transpiration, net CO2 assimilation rate and beneficial ions (NO3−, PO43−, and SO42−) decreased with reduced NO3−:Cl− ratio under the 0 μM OMP treatment. The negative effects of chloride were not only mitigated by the 10 μM OMP application in all treatments, with the exception of 20:80 NO3−:Cl−, but plant growth at 80:20, 60:40, and 40:60 NO3−:Cl− ratios receiving OMP application showed maximum fresh yield (+13%, 24%, and 22%, respectively), shoot (+10%, 25%, and 21%, respectively) and root (+32%, 76%, and 75%, respectively) biomass compared to the corresponding untreated treatments. OMP was not directly involved in ion homeostasis and compartmentalization of vacuolar or apoplastic chloride. However, it was active in limiting chloride loading into the shoot, as manifested by the lower chloride concentration in the 80:20, 60:40, and 40:60 NO3−:Cl− treatments compared to the respective controls (−41%, −37%, and −24%), favoring instead that of nitrate and potassium while also boosting photosynthetic activity. Despite its unequivocally beneficial effect on plants, the large-scale application of OMP is currently limited by the molecule’s high cost. However, further studies are warranted to unravel the molecular mechanisms of OMP-induced reduction of chloride loading to shoot and improved salt tolerance.

Nanobiotechnology approaches for engineering smart plant sensors.

Nanobiotechnology has the potential to enable smart plant sensors that communicate with and actuate electronic devices for improving plant productivity, optimize and automate water and agrochemical allocation, and enable high-throughput plant chemical phenotyping. Reducing crop loss due to environmental and pathogen-related stresses, improving resource use efficiency and selecting optimal plant traits are major challenges in plant agriculture industries worldwide. New technologies are required to accurately monitor, in real time and with high spatial and temporal resolution, plant physiological and developmental responses to their microenvironment. Nanomaterials are allowing the translation of plant chemical signals into digital information that can be monitored by standoff electronic devices. Herein, we discuss the design and interfacing of smart nanobiotechnology-based sensors that report plant signalling molecules associated with health status to agricultural and phenotyping devices via optical, wireless or electrical signals. We describe how nanomaterial-mediated delivery of genetically encoded sensors can act as tools for research and development of smart plant sensors. We assess performance parameters of smart nanobiotechnology-based sensors in plants (for example, resolution, sensitivity, accuracy and durability) including in vivo optical nanosensors and wearable nanoelectronic sensors. To conclude, we present an integrated and prospective vision on how nanotechnology could enable smart plant sensors that communicate with and actuate electronic devices for monitoring and optimizing individual plant productivity and resource use.

Ambulatory care-sensitive emergency department cases: a mixed methods approach to systemize and analyze cases in Germany.

BackgroundInternationally, emergency departments (ED) are treating increasing numbers of patients with conditions that could have been managed appropriately in ambulatory care (AC) settings. The aim of our study was to develop the first consensus-based list of AC-sensitive conditions commonly seen in German EDs and explore predictors of these visits.MethodsOur study used a Delphi survey of 30 physicians to compile a list of conditions they agreed were amenable to AC treatment. The group identified reasons why patients visit EDs instead of AC. We used the results to inform spatial regression models analysing the association of patient characteristics and attributes of AC with AC-sensitive ED visits based on 2015 district-level data.ResultsOur study provides a list of AC-sensitive conditions based on the German ED context. Results suggest that, up to the age of 70 years, the older the patients, the less likely they seek EDs for these conditions. Results of our regression analyses suggest that AC-sensitive ED rates were significantly higher in districts with lower physician density. Patients’ urgency perception and preferences were identified as main drivers of AC-sensitive ED visits.ConclusionFuture policy measures should aim to help guide patients through the healthcare system so that they receive the best care in place that is most appropriate in terms of quality, safety and continuity of care. A list of AC-sensitive ED conditions can be used as a monitoring instrument and for further analyses of routine data to inform policy makers seeking to improve resource use and allocation.

Factors contributing to maize and bean yield gaps in Central America vary with site and agroecological conditions

AbstractIn Central America, population and food demands are rising rapidly, while yields of staple crops, maize and beans, remain low. To identify the main factors limiting production, field trials were established in six maize- and bean-producing regions in Guatemala, Honduras and El Salvador, representing about three-quarters of the maize-producing area. Potential yield-limiting factors were evaluated in 2017 and included: water stress, nutrient deficiency, pest and disease pressure, and/or inter-plant competition. When considering all sites, improved fertilization and pest and disease control significantly improved yields in maize by 11 and 16%, respectively but did not have a significant effect in beans. Irrigation had no effect due to good rainfall distribution over the growing season. Optimized planting arrangement resulted in an average 18% increase in maize yield, making it the most promising factor evaluated. The treatment and site combinations that increased both crop productivity and net profit included management changes that improved resource use efficiency. However, the contribution of each limiting factor to yield gaps varied across sites and no treatment was effective at increasing yield consistently across sites. Production constraints are highly dependent on local management practices and agroecological location. Therefore, public and private development efforts that seek to increase production should conduct multi-year, participatory experiments to identify limitations pertinent to the area in question. The next step is then to evaluate sustainable and profitable practices, to address those limitations and provide sound recommendations to farmers while decreasing the environmental and economic costs.

Prospective evaluation of a primary care referral pathway for patients with non-alcoholic fatty liver disease

The development of non-invasive liver fibrosis tests may enable earlier identification of patients with non-alcoholic fatty liver disease (NAFLD) requiring referral to secondary care. We developed and evaluated a pathway for the management of patients with NAFLD, aimed at improving the detection of cases of advanced fibrosis and cirrhosis, and avoiding unnecessary referrals. This was a prospective longitudinal cohort study, with analyses performed before and after introduction of the pathway, and comparisons made to unexposed controls. We used a 2-step algorithm combining the use of Fibrosis-4 score followed by the ELF™ test if required. In total, 3,012 patients were analysed. Use of the pathway detected 5 times more cases of advanced fibrosis (Kleiner F3) and cirrhosis (odds ratio [OR]5.18;95%CI2.97-9.04; p <0.0001), while reducing unnecessary referrals from primary care to secondary care by 81% (OR0.193; 95%CI 0.111-0.337; p <0.0001). Although it was used for only 48% of referrals, significant benefits were observed in practices exposed to the pathway compared to those which were not, with unnecessary referrals falling by 77% (OR0.23; 95% CI0.658-0.082; p = 0.006) and a 4-fold improvement in detection of cases of advanced fibrosis and cirrhosis (OR4.32; 95% CI1.52-12.25; p = 0.006). Compared to referrals made before the introduction of the pathway, unnecessary referrals fell from 79/83 referrals (95.2%) to 107/152 (70.4%), representing an 88% reduction in unnecessary referrals when the pathway was followed (OR0.12; 95%CI0.042-0.349; p <0.0001). The use of non-invasive blood tests for liver fibrosis improves the detection of advanced fibrosis and cirrhosis, while reducing unnecessary referrals in patients with NAFLD. This strategy improves resource use and benefits patients. Non-alcoholic fatty liver disease effects up to 30% of the population but only a minority of cases develop liver disease. Our study has shown that established blood tests can be used in primary care to stratify patients with fatty liver disease, leading to a reduction in unnecessary referrals by 80% and greatly improving the detection of cases of advanced fibrosis and cirrhosis.

Unraveling the Role of Red:Blue LED Lights on Resource Use Efficiency and Nutritional Properties of Indoor Grown Sweet Basil.

Indoor plant cultivation can result in significantly improved resource use efficiency (surface, water, and nutrients) as compared to traditional growing systems, but illumination costs are still high. LEDs (light emitting diodes) are gaining attention for indoor cultivation because of their ability to provide light of different spectra. In the light spectrum, red and blue regions are often considered the major plants’ energy sources for photosynthetic CO2 assimilation. This study aims at identifying the role played by red:blue (R:B) ratio on the resource use efficiency of indoor basil cultivation, linking the physiological response to light to changes in yield and nutritional properties. Basil plants were cultivated in growth chambers under five LED light regimens characterized by different R:B ratios ranging from 0.5 to 4 (respectively, RB0.5, RB1, RB2, RB3, and RB4), using fluorescent lamps as control (CK1). A photosynthetic photon flux density of 215 μmol m−2 s−1 was provided for 16 h per day. The greatest biomass production was associated with LED lighting as compared with fluorescent lamp. Despite a reduction in both stomatal conductance and PSII quantum efficiency, adoption of RB3 resulted in higher yield and chlorophyll content, leading to improved use efficiency for water and energy. Antioxidant activity followed a spectral-response function, with optimum associated with RB3. A low RB ratio (0.5) reduced the relative content of several volatiles, as compared to CK1 and RB ≥ 2. Moreover, mineral leaf concentration (g g−1 DW) and total content in plant (g plant−1) were influences by light quality, resulting in greater N, P, K, Ca, Mg, and Fe accumulation in plants cultivated with RB3. Contrarily, nutrient use efficiency was increased in RB ≤ 1. From this study it can be concluded that a RB ratio of 3 provides optimal growing conditions for indoor cultivation of basil, fostering improved performances in terms of growth, physiological and metabolic functions, and resources use efficiency.