Archaeogenomic distinctiveness of the Isthmo-Colombian area.

The recently enriched genomic history of Indigenous groups in the Americas is still meager concerning continental Central America. Here, we report ten pre-Hispanic (plus two early colonial) genomes and 84 genome-wide profiles from seven groups presently living in Panama. Our analyses reveal that pre-Hispanic demographic events contributed to the extensive genetic structure currently seen in the area, which is also characterized by a distinctive Isthmo-Colombian Indigenous component. This component drives these populations on a specific variability axis and derives from the local admixture of different ancestries of northern North American origin(s). Two of these ancestries were differentially associated to Pleistocene Indigenous groups that also moved into South America, leaving heterogenous genetic footprints. An additional Pleistocene ancestry was brought by a still unsampled population of the Isthmus (UPopI) that remained restricted to the Isthmian area, expanded locally during the early Holocene, and left genomic traces up to the present day.

Evidence for ARGONAUTE4-DNA interactions in RNA-directed DNA methylation in plants.

RNA polymerase V (Pol V) long noncoding RNAs (lncRNAs) have been proposed to guide ARGONAUTE4 (AGO4) to chromatin in RNA-directed DNA methylation (RdDM) in plants. Here, we provide evidence, based on laser UV-assisted zero-length cross-linking, for functionally relevant AGO4-DNA interaction at RdDM targets. We further demonstrate that Pol V lncRNAs or the act of their transcription are required to lock Pol V holoenzyme into a stable DNA-bound state that allows AGO4 recruitment via redundant glycine-tryptophan/tryptophan-glycine AGO hook motifs present on both Pol V and its associated factor, SPT5L. We propose a model in which AGO4-DNA interaction could be responsible for the unique specificities of RdDM.

Catch-Up Growth in Infants and Young Children With Faltering Growth: Expert Opinion to Guide General Clinicians.

Faltering growth (FG) is a problem regularly seen by clinicians in infants and young children (<2 years of age). It can occur due to non-disease-related and disease-related causes and is associated with a wide range of adverse outcomes, including shorter-term effects such as impaired immune responses and increased length of hospital stay, and longer-term consequences, including an impact on schooling and cognitive achievements, short stature, and socioeconomic outcomes. It is essential to detect FG, address underlying causes and support catch-up growth where this is indicated. However, anecdotal reports suggest misplaced fear of promoting accelerated (too rapid) growth may deter some clinicians from adequately addressing FG. An invited international group of experts in pediatric nutrition and growth reviewed the available evidence and guidelines on FG resulting from disease-related and non-disease-related effects on nutritional status in healthy term and small for gestational age infants and children up to the age of 2 years in low-, middle-, and high-income countries. Using a modified Delphi process, we developed practical consensus recommendations to provide clarity and practical recommendations for general clinicians on how FG should be defined in different young child populations at risk, how FG should be assessed and managed, and the role of catch-up growth after a period of FG. We also suggested areas where further research is needed to answer remaining questions on this important issue.

Understandings and practices: Towards socially responsive curricula for the health professions.

Global health inequities have created an urgency for health professions education to transition towards responsive and contextually relevant curricula. Such transformation and renewal processes hold significant implications for those educators responsible for implementing the curriculum. Currently little is known about how health professions educators across disciplines understand a responsive curriculum and how this understanding might influence their practice. We looked at curricula that aim to deliver future health care professionals who are not only clinically competent but also critically conscious of the contexts in which they serve and the health care systems within which they practice. We conducted a qualitative study across six institutions in South Africa, using focus group discussions and in-depth individual interviews to explore (i) how do health professions educators understand the principles that underpin their health professions education curriculum; and (ii) how do these understandings of health professions educators shape their teaching practices? The transcripts were analysed thematically following multiple iterations of critical engagement to identify patterns of meaning across the entire dataset. The results reflected a range of understandings related to knowing, doing, and being and becoming; and a range of teaching practices that are explicit, intentionally designed, take learning to the community, embrace a holistic approach, encourage safe dialogic encounters, and foster reflective practice through a complex manner of interacting. This study contributes to the literature on health professions education as a force for social justice. It highlights the implications of transformative curriculum renewal and offers insights on how health professions educators embrace notions of social responsiveness and health equity to engage with these underlying principles within their teaching.

"We just don't have the resources": Supervisor perspectives on introducing workplace-based assessments into medical specialist training in South Africa.

BACKGROUND: South Africa (SA) is on the brink of implementing workplace-based assessments (WBA) in all medical specialist training programmes in the country. Despite the fact that competency-based medical education (CBME) has been in place for about two decades, WBA offers new and interesting challenges. The literature indicates that WBA has resource, regulatory, educational and social complexities. Implementing WBA would therefore require a careful approach to this complex challenge. To date, insufficient exploration of WBA practices, experiences, perceptions, and aspirations in healthcare have been undertaken in South Africa or Africa. The aim of this study was to identify factors that could impact WBA implementation from the perspectives of medical specialist educators. The outcomes being reported are themes derived from reported potential barriers and enablers to WBA implementation in the SA context. METHODS: This paper reports on the qualitative data generated from a mixed methods study that employed a parallel convergent design, utilising a self-administered online questionnaire to collect data from participants. Data was analysed thematically and inductively. RESULTS: The themes that emerged were: Structural readiness for WBA; staff capacity to implement WBA; quality assurance; and the social dynamics of WBA. CONCLUSIONS: Participants demonstrated impressive levels of insight into their respective working environments, producing an extensive list of barriers and enablers. Despite significant structural and social barriers, this cohort perceives the impending implementation of WBA to be a positive development in registrar training in South Africa. We make recommendations for future research, and to the medical specialist educational leaders in SA.

Paired denitrifying bioreactors with wide orientation for increased drainage flow capacity.

Denitrifying bioreactors are a conservation drainage practice for reducing nitrate loads in subsurface agricultural drainage. Bioreactor hydraulic capacity is limited by cross-sectional area perpendicular to flow through the woodchip bed, with excess bypass flow untreated. Paired bioreactors with wide orientations were built in 2017 in Illinois, USA, to treat drainage from a relatively large 29 ha field. The paired design consisted of: a larger, Main bioreactor (LWD: 6.1 × 18.3 × 0.9 m) for treating base flow, and 2) a smaller, Booster bioreactor (7.8 × 13.1 × 0.9 m) receiving bypass flow from the Main bioreactor during periods of high flow. Over three years of monitoring, the paired bioreactor captured 84-92% of the annual drainage discharge which demonstrated an expanded cross-sectional area could improve bioreactor flow capture, even for a large drainage area. However, the paired bioreactors removed 6-28% of the annual N load leaving the field (1.8-5.6 kg N ha-1 removed; 52-161 kg N), which was not a notable improvement compared to bioreactors treating smaller drainage areas. The design operated as intended at low annual flow-weighted hydraulic retention times (HRTs) of usually ≤2 h, but these short HRTs ultimately limited bioreactor nitrate removal efficiency. Daily HRTs of <2 h often resulted in nitrate flushing. The Main bioreactor had higher hydraulic loading as intended and was responsible for the majority of flow captured in each year although not always the most nitrate mass removal. The Booster bioreactor provided better nitrate removal than the Main at HRTs of 3.0-11.9 h, possibly due to its drying cycles which may have liberated more available carbon. This new design approach tested at the field-scale illustrated tradeoffs between greater flow capacity (via increased bioreactor width) and longer HRT (via increased length), given a consistent bioreactor surface footprint.

Effect of Canagliflozin Compared With Sitagliptin on Serum Lipids in Patients with Type 2 Diabetes Mellitus and Heart Failure with Reduced Ejection Fraction: A Post-Hoc Analysis of the CANA-HF Study.

ABSTRACT: The sodium glucose co-transporter 2 inhibitors have demonstrated favorable effects on cardiovascular and renal disease; however, they may also increase low-density lipoprotein cholesterol (LDL-C). There are limited data directly comparing the effects of sodium glucose co-transporter 2inhibitors on serum lipids to other antihyperglycemic therapies. In this post-hoc analysis of the CANA-HF trial, we sought to compare the effects of canagliflozin to sitagliptin in patients with type 2 diabetes mellitus (T2DM) and heart failure and reduced ejection fraction (HFrEF). The CANA-HF trial was a prospective, randomized controlled study that compared the effects of canagliflozin 100 mg daily to sitagliptin 100 mg daily on cardiorespiratory fitness in patients with HFrEF and T2DM. Of the 36 patients enrolled in CANA-HF, 35 patients had both baseline and 12-weeks serum lipids obtained via venipuncture. The change in LDL-C from baseline to 12 weeks was 5 (-12.5 to 19.5) mg/dL versus -8 (-19 to -1) mg/dL (P = 0.82) and triglyceride levels was -4 (-26 to 9) mg/dL and -10.5 (-50 to 29.3) mg/dL (P = 0.52) for canagliflozin and sitagliptin, respectively. No significant differences were found between canagliflozin and sitagliptin for total cholesterol, high-density lipoprotein cholesterol or non-HDL-C (P > 0.5 for all). These data suggest that compared with sitagliptin, canagliflozin may not increase LDL-C in patients with T2DM and HFrEF.

Iron Balance and Iron Nutritional Status in Preterm Infants During the First Four Months of Life.

OBJECTIVES: To determine whether iron absorption occurs in a dose-dependent fashion and/or is a function of iron nutritional status (INS) in preterm infants during the first 4 months of life. METHODS: Preterm very-low-birth-weight infants (VLBWI) were fed an iron-fortified (0.7 mg/dL) infant formula. Three 48 h balance studies were performed on each infant. INS was determined by serially measuring hemoglobin, mean corpuscular volume (MCV), hematocrit, ferritin, transferrin and transferrin saturation levels. The data were analyzed using ANOVA and stepwise regression. RESULTS: Fifty-four balance studies were performed in 18 infants (birth weight, 1347 ± 201 g; gestation, 30 ±â€Š1.3 weeks; mean ±â€Šstandard deviation) at 33 ±â€Š1.3, 34 ±â€Š1.2, and 48 ±â€Š0.5 weeks corrected age and weights of 1768 ±â€Š260, 2298 ±â€Š314, 5127 ±â€Š939 g. No relationship was detected between iron intake and absorption. Intake decreased during the study (1.17 ±â€Š.08, 1.24 ±â€Š0.11 > 1.1 ±â€Š0.15 mg ·â€Škg-1 ·â€Šday-1) but net (0.32 ±â€Š0.26, 0.36 ±â€Š31 < 0.49 ±â€Š.23 mg ·â€Škg-1 ·â€Šday-1) and % (27 ±â€Š22, 29 ±â€Š23 < 46 ±â€Š21) absorption increased (P < 0.01). Serum ferritin, transferrin saturation and MCV fell, while hematocrit and hemoglobin remained stable. No relationship was noted between serum ferritin and iron absorption but transferrin saturation (54%), MCV (7%), and hematocrit (6%) accounted for 67% of the variation in iron absorption (P < 0.001). CONCLUSIONS: At intakes of 0.8-1.4  mg ·â€Škg-1 ·â€Šday-1, iron absorption is not dose-dependent nor affected by iron stores. Only when iron delivery to the tissues decreases does absorption increase to meet needs in these otherwise normal and rapidly growing infants.

Identification of Behavior Change Techniques From Successful Web-Based Interventions Targeting Alcohol Consumption, Binge Eating, and Gambling: Systematic Review.

BACKGROUND: Web-based interventions are thought to overcome barriers to treatment, such as accessibility and geographical location, which can undermine the effectiveness of traditional face-to-face interventions. Owing to these features, researchers are increasingly testing the efficacy of web-based interventions as ways to reduce alcohol misuse, binge eating, and gambling. However, many web-based interventions have poorly defined mechanisms of action; therefore, it is often uncertain how they propose to bring about behavior change. OBJECTIVE: This systematic review aims to identify effective behavior change techniques (BCTs) present in web-based interventions aimed at reducing alcohol consumption, binge eating, or gambling. METHODS: This systematic review covered research conducted in the last 20 years. Inclusion criteria for interventions were web-based administration; targeting alcohol use, binge eating, and/or gambling; and reporting on baseline and postintervention measures of behavior. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. We coded intervention effectiveness, study quality, and BCTs present in the interventions. RESULTS: Following removal of 4152 ineligible articles, 45 were included in the review: 32 (71%) targeted alcohol misuse, 6 (13%) targeted binge eating, and 7 (16%) targeted gambling. In total, 5 frequency counts were performed to identify the most commonly used BCTs: all studies, effective interventions, high-quality studies at 2 thresholds, and both high quality and effective studies. The results obtained from this were integrated to identify 7 BCTs. These 7 BCTs were problem solving, feedback on behavior, self-monitoring of behavior, self-monitoring of outcomes, instruction on how to perform a behavior, information about social and health consequences, and social comparison. A total of 4 BCTs were found in all frequency counts: feedback on behavior, self-monitoring of behavior, instruction on how to perform a behavior, and social comparison. Self-monitoring of outcomes of behavior was found in 3 of the 5 frequency counts, problem solving was found in 2 frequency counts, and information about social and health consequences was found in 1 frequency count. CONCLUSIONS: This systematic review identified 7 of the most frequently used BCTs used in web-based interventions focused on alcohol misuse, binge eating, and gambling. These results can inform the development of evidence-based eHealth interventions that have the potential to lead to effective, positive behavior changes in all 3 areas.

Climate change and extreme events on drainage systems: numerical simulation of soil water in corn crops in Illinois (USA).

The influence of climate conditions in the agricultural environment is important in evapotranspiration, water availability for plants and roots, and other processes. This research focuses on two aspects: (1) the effects of climate change on the occurrence of extreme events that may affect agricultural processes in a region in Illinois (USA), and (2) the effects of climate change on the soil water dynamics in a corn crop. Different climate scenarios developed by the Institut Pierre Simon Laplace, using a climate model with medium resolution-IPSL(CM5MR), provided input to simulate soil water dynamics in two fields with different drainage system layouts. The Hydrus model simulated surface flux and runoff. Results indicate that the variation of precipitation and temperature in the future may increase extreme events, representing a risk for agriculture. Hydrus simulations indicate different results accordingly to the drainage layout, suggesting that it may be necessary to make adjustments in drainage systems in the future. In general, surface flux and runoff will increase over time, and these changes are more related to extreme events than average values. Extreme event indices show vulnerability in agriculture and will be reflected in changes in the soil water dynamics, and may increase the climatic risk of corn production.

Where and What You Drink Is Linked to How Much You Drink: An Exploratory Survey of Alcohol Use in 17 Countries.

BACKGROUND: This paper aimed to explore the differences in subjective experiences of intoxication depending on drinking location and drink type. Methods: Data came from 32,194 respondents to The Global Drug Survey (GDS) 2015, an annual, cross-sectional, online survey. Respondents selected their usual drinking location (home alone: home with partner/family: house parties: pubs/bars or clubs) and usual drink (wine; beer/cider/lager; spirits or alcopops/coolers). They indicated how many drinks they required to reach three stages of intoxication (feeling the effects; an ideal stage of intoxication; and the tipping point) and how frequently they reached each stage. Results: Drink type affected grams of alcohol reported to reach the tipping point: 109 gm wine, 127 gm alcopops, 133 gm of beer, and 134 gm of spirts. Respondents who drank at home alone, or in clubs reached their tipping point more frequently compared to other locations. Conclusions: Where people drink, and the type of alcohol they drink, affected the amount of alcohol reported to reach different stages of intoxication. Understanding why different drinking locations, and drink types lead to a need for greater consumption to reach an ideal state of drunkenness, such as social cues from other people who drink, may enable people to reduce their drinking.

The effects of canagliflozin compared to sitagliptin on cardiorespiratory fitness in type 2 diabetes mellitus and heart failure with reduced ejection fraction: The CANA-HF study.

BACKGROUND: Canagliflozin reduces hospitalizations for heart failure (HF) in type 2 diabetes mellitus (T2DM). Its effect on cardiorespiratory fitness and cardiac function in patients with established HF with reduced ejection fraction (HFrEF) is unknown. METHODS: We conducted a double-blind randomized controlled trial of canagliflozin 100 mg or sitagliptin 100 mg daily for 12 weeks in 88 patients, and measured peak oxygen consumption (VO2 ) and minute ventilation/carbon dioxide production (VE/VCO2 ) slope (co-primary endpoints for repeated measure ANOVA time_x_group interaction), lean peak VO2 , ventilatory anaerobic threshold (VAT), cardiac function and quality of life (ie, Minnesota Living with Heart Failure Questionnaire [MLHFQ]), at baseline and 12-week follow-up. RESULTS: The study was terminated early due to the new guidelines recommending canagliflozin over sitagliptin in HF: 17 patients were assigned to canagliflozin and 19 to sitagliptin, total of 36 patients. There were no significant changes in peak VO2 and VE/VCO2 slope between the two groups (P = .083 and P = .98, respectively). Canagliflozin improved lean peak VO2 (+2.4 mL kgLM-1 min-1 , P = .036), VAT (+1.5 mL kg-1 min-1 , P = .012) and VO2 matched for respiratory exchange ratio (+2.4 mL Kg-1 min-1 , P = .002) compared to sitagliptin. Canagliflozin also reduced MLHFQ score (-12.1, P = .018). CONCLUSIONS: In this small and short-term study of patients with T2DM and HFrEF, interrupted early after only 36 patients, canagliflozin did not improve the primary endpoints of peak VO2 or VE/VCO2 slope compared to sitagliptin, while showing favourable trends observed on several additional surrogate endpoints such as lean peak VO2 , VAT and quality of life.

NERD, a plant-specific GW protein, defines an additional RNAi-dependent chromatin-based pathway in Arabidopsis.

In Arabidopsis, transcriptional gene silencing (TGS) can be triggered by 24 nt small-interfering RNAs (siRNAs) through the RNA-directed DNA methylation (RdDM) pathway. By functional analysis of NERD, a GW repeat- and PHD finger-containing protein, we demonstrate that Arabidopsis harbors a second siRNA-dependent DNA methylation pathway targeting a subset of nonconserved genomic loci. The activity of the NERD-dependent pathway differs from RdDM by the fact that it relies both on silencing-related factors previously implicated only in posttranscriptional gene silencing (PTGS), including RNA-DEPENDENT RNA POLYMERASE1/6 and ARGONAUTE2, and most likely on 21 nt siRNAs. A central role for NERD in integrating RNA silencing and chromatin signals in transcriptional silencing is supported by data showing that it binds both to histone H3 and AGO2 proteins and contributes to siRNA accumulation at a NERD-targeted locus. Our results unravel the existence of a conserved chromatin-based RNA silencing pathway encompassing both PTGS and TGS components in plants.

Investigating the mediating effect of working memory on intentional forgetting in dysphoria.

Our aim was to determine if deficits in intentional forgetting that are associated with depression and dysphoria (subclinical depression) could be explained, at least in part, by variations in working memory function. Sixty dysphoric and 61 non-dysphoric participants completed a modified version of the think/no-think (TNT) task and a measure of complex working memory (the operation span task). The TNT task involved participants learning a series of emotional cue-target word pairs, before being presented with a subset of the cues and asked to either recall the associated target (think) or to prevent it from coming to mind (no think) by thinking about a substitute target word. Participants were subsequently asked to recall the targets to all cues (regardless of previous recall instructions). As expected, after controlling for anxiety, we found that dysphoric individuals exhibited impaired forgetting relative to the non-dysphoric participants. Also as expected, we found that superior working memory function was associated with more successful forgetting. Critically, in the dysphoric group, we found that working memory mediated the effect of depression on intentional forgetting. That is, depression influenced forgetting indirectly via its effect on working memory. However, under conditions of repeated suppression, there was also a direct effect of depression on forgetting. These findings represent an important development in the understanding of impaired forgetting in depression and also suggest that working memory training might be a viable intervention for improving the ability of depressed individuals to prevent unwanted memories from coming to mind.

Regret Me Not: Examining the Relationship between Alcohol Consumption and Regrettable Experiences.

BACKGROUND: Alcohol use is a considerable public health concern, leading to negative health and adverse social consequences. Despite widespread knowledge and acceptance of these consequences many individuals continue to drink excessively. Lack of regret for these consequences may partially explain this. Objectives: To examine the prevalence of regrettable experiences and their role in future intentions to drink. Methods: In two studies (Study 1: cross-sectional; Study 2: longitudinal) participants reported on 18 regrettable experiences; from common regrets (e.g. hangover), to risky behaviors (e.g. drug taking), and serious regrets (e.g. driving under the influence), over a two-week period. Results: Prevalence of regrettable experiences was high (e.g. 79.0% of individuals in study 1 and 66.9% of individuals in study 2 experienced a hangover). Prevalence was greater for common regrets compared to risky behaviors and serious regrets. In study one, alcohol consumed over the previous fortnight predicted the number of different regrettable experiences over the same period. In study two, units consumed on a day-to-day basis predicted the number of regrets on that same basis. Neither study demonstrated evidence for the predictive utility of regrets for intentions to consume alcohol in the future. Conclusions: These findings suggest high prevalence of regrettable experiences, that are predicted by increased alcohol consumption. However, there was little evidence that increased number of experiences predicted future drinking intentions. Regrettable experiences are prevalent following consumption, however a focus on these regrets to deter future alcohol consumption may not be an effective psychological intervention.

Cold-water diving in the tropics? External auditory exostoses among the pre-Columbian inhabitants of Panama.

OBJECTIVES: The appearance of external auditory exostoses archaeologically has been attributed to aquatic activities in middle latitudes. However, recent clinical research implicates low sea surface temperatures, especially below a threshold of 19°C, as a stronger predictor of ear exostosis development than latitude. Here, we examine the frequency of external auditory exostoses in human remains from nine pre-Columbian archaeological sites in Panama, representing individuals from a warm, tropical region. MATERIALS AND METHODS: External auditory exostoses were recorded as present when an abnormal bony growth was observed macroscopically within the ear canal. The presence of exostoses was compared by right and left side, geographical region, sex, and degree of stenosis. RESULTS: A total of 125 adult individuals made up the observable sample analyzed in this study. Exostoses were observed in seven males and one female. All individuals affected by this pathology were excavated from mortuary contexts along the Gulf of Panama-a region characterized by intense cold water upwelling in the dry season. DISCUSSION: This study suggests that external auditory exostoses in pre-Columbian Panama affected individuals involved in habitual aquatic activities in the cold, upwelled waters of the Gulf of Panama. These activities appear to be almost exclusively dominated by male individuals. Ethnohistorical and archaeological records point to marine shell resource acquisition by deep-water diving as the activity driving exostosis development in pre-Columbian Panama.

Patterns of alcohol consumption and alcohol-related harm among European university students.

BACKGROUND: To compare patterns of alcohol consumption and alcohol-related harm from a survey of university students sampled from universities in Denmark, England, Germany, Italy, Portugal and Switzerland. METHODS: A total of 2191 university students (70% female, 90% white ethnic group, age range 18-25) completed the survey. Participants completed measures of demographic variables (age, age of onset, ethnic group and sex) and the Alcohol Use Disorders Identification Test (AUDIT), which was the primary outcome. RESULTS: Sixty-three percent of the sample scored negative for harmful drinking on the AUDIT (<8), with 30% categorized as hazardous drinkers, 4% harmful drinkers and 3% with probable dependence. Analysis of variance, including demographic factors as covariates, identified a main effect of country on AUDIT scores F(5, 2086) = 70.97, P < 0.001, partial eta square = 0.15. AUDIT scores were highest in England (M = 9.99; SD = 6.17) and Denmark (M = 9.52; SD = 4.86) and lowest in Portugal (M = 4.90; ° = 4.60). Post hoc tests indicated large effect size differences between scores in Denmark and England and scores in all other countries (0.79 < d < 0.94; all P's < 0.001). CONCLUSIONS: European university students in our sample mainly reported low risk patterns of alcohol consumption and alcohol-related harm. However, students from Northern European countries had significantly higher AUDIT scores compared with students from Central and Southern European countries. Research is needed to replicate the present study using nationally representative samples to estimate the prevalence of alcohol use disorders among university students in different European countries.

Understanding conversations about alcohol between parents and their 15-17 year olds: a qualitative study.

BACKGROUND: There is an increasing awareness that parents can play an important role in shaping their children's attitudes towards alcohol and use of alcohol. However, there has been little research exploring the conversations parents have with their children about alcohol. The present study aims to address this gap by exploring conversations between parents and their 15-17 year old children. METHODS: Using a cross-sectional qualitative design, recruitment took place over two phases to allow a purposive maximum variation sample of parents and young people. Sixty-four participants (n = 48 parents; n = 16 young people aged 15-17 years) took part in semi-structured interviews. The sample was diverse and included participants from throughout the United Kingdom. Thematic analysis was used to analyse the data separately for all parents and 16 matched parent-child pairs. RESULTS: The parents' findings were summarised within the following thematic areas: 1) style of conversation; 2) triggers to conversations; 3) topics conveyed during conversations; and 4) supervision of child's alcohol consumption. Most parents were comfortable talking to their children about alcohol. It was considered that open and honest conversations helped demystify alcohol for young people. Most conversations that parents had with their children were brief and informal and a wide range of triggers to these conversations were reported. There was some indication that as children got older conversations became more frequent and more focused on safety. Overall, the matched parent-child interviews were very consistent regarding levels of child drinking, conversation starters, and topics discussed. However, in some cases parents underestimated their child's need and desire for further conversations about alcohol. CONCLUSIONS: Most parents felt comfortable having conversations with their older children about alcohol. However, parents also wanted more support with having these conversations, particularly about how to start a conversation and what to talk about. This study provides several recommendations to help parents have an open conversation about alcohol with their children. For example, brief, informal chats seem to be the most appropriate way of speaking to children about alcohol compared to a more formal, "sit-down" style of conversation.

Evaluation of fly ash pellets for phosphorus removal in a laboratory scale denitrifying bioreactor.

Nitrate and orthophosphate from agricultural activities contribute significantly to nutrient loading in surface water bodies around the world. This study evaluated the efficacy of woodchips and fly ash pellets in tandem to remove nitrate and orthophosphate from simulated agricultural runoff in flow-through tests. The fly ash pellets had previously been developed specifically for orthophosphate removal for this type of application, and the sorption bench testing showed a good promise for flow-through testing. The lab-scale horizontal-flow bioreactor used in this study consisted of an upstream column filled with woodchips followed by a downstream column filled with fly ash pellets (3 and 1 m lengths, respectively; both 0.15 m diameter). Using influent concentrations of 12 mg/L nitrate and 5 mg/L orthophosphate, the woodchip bioreactor section was able to remove 49-85% of the nitrate concentration at three hydraulic retention times ranging from 0.67 to 4.0 h. The nitrate removal rate for woodchips ranged from 40 to 49 g N/m3/d. Higher hydraulic retention times (i.e., smaller flow rates) corresponded with greater nitrate load reduction. The fly ash pellets showed relatively stable removal efficiency of 68-75% across all retention times. Total orthophosphate adsorption by the pellets was 0.059-0.114 mg P/g which was far less than the saturated capacity (1.69 mg/g; based on previous work). The fly ash pellets also removed some nitrate and the woodchips also removed some orthophosphate, but these reductions were not significant. Overall, woodchip denitrification followed by fly ash pellet P-sorption can be an effective treatment technology for nitrate and phosphate removal in subsurface drainage.

Transformation of medical education through Decentralised Training Platforms: a scoping review.

INTRODUCTION: Medical education in South Africa is facing a major paradigm shift. The urgency to increase the number of suitable, qualified and socially accountable health sciences graduates has brought to the fore the need to identify alternative training platforms and learning environments, often in rural areas. Subsequently, the focus has now shifted towards strengthening primary health care and community based health services. This scoping review presents a synopsis of the existing literature on decentralized training platform (DTP) strategies for medical education internationally, outlining existing models within it and its impact. METHODS: This scoping review followed Arksey and O'Malley's framework outlining five stages: (i) identification of a research question, (ii) identification of relevant studies, (iii) study selection criteria, (iv) data charting, and (v) collating, summarizing and reporting results. The literature for the scoping review was found using online databases, reference lists and hand searched journals. Data were charted and sorted inductively according to key themes. RESULTS: A final review included 59 articles ranging over the years 1987-2015 with the largest group of studies falling in the period 2011-2015 (47.5%). Studies mostly employed quantitative (32.2%), qualitative (20.3%), systematic/literature review (18.6%) and mixed methods research approaches (11.9%). The scoping review highlighted a range of DTP strategies for transforming medical education. These include training for rural workforce, addressing context specific competencies to promote social accountability, promoting community engagement, and medical education partnerships. Viable models of DTP include community based education, distributed community engaged learning, discipline based clinical rotations, longitudinal clerkships and dedicated tracks focusing on rural issues. Shorter rural placements and supplemental rural tracks are also described. CONCLUSIONS: This scoping review showed a considerable amount of literature on decentralized training platforms that highlight the necessary adaptations needed for transforming medical education. The rural context is critical for many of these. Further studies are required to address the impact of DTPs on health service outcomes and human resource outcomes.