2020-2021 field seasons of Maize GxE project within the Genomes to Fields Initiative.

OBJECTIVES: This release note describes the Maize GxE project datasets within the Genomes to Fields (G2F) Initiative. The Maize GxE project aims to understand genotype by environment (GxE) interactions and use the information collected to improve resource allocation efficiency and increase genotype predictability and stability, particularly in scenarios of variable environmental patterns. Hybrids and inbreds are evaluated across multiple environments and phenotypic, genotypic, environmental, and metadata information are made publicly available. DATA DESCRIPTION: The datasets include phenotypic data of the hybrids and inbreds evaluated in 30 locations across the US and one location in Germany in 2020 and 2021, soil and climatic measurements and metadata information for all environments (combination of year and location), ReadMe, and description files for each data type. A set of common hybrids is present in each environment to connect with previous evaluations. Each environment had a collaborator responsible for collecting and submitting the data, the GxE coordination team combined all the collected information and removed obvious erroneous data. Collaborators received the combined data to use, verify and declare that the data generated in their own environments was accurate. Combined data is released to the public with minimal filtering to maintain fidelity to the original data.

Is there an association between socioeconomic status of General Practice population and postgraduate training practice accreditation? A cross-sectional analysis of Scottish General Practices.

BACKGROUND: Practice population socioeconomic status is associated with practice postgraduate training accreditation. General Practitioner recruitment to socioeconomically deprived areas is challenging, exposure during training may encourage recruitment. OBJECTIVES: To determine the association of practice population socioeconomic deprivation score and training status, and if this has changed over time. METHODS: Cross-sectional study looking at socioeconomic deprivation and training status for all General Practices in Scotland (n = 982). Data from Information Services Division, from 2015, were combined with the Scottish Index of Multiple Deprivation to calculate weighted socioeconomic deprivation scores for every practice in Scotland. Scottish training body database identified training practices (n = 330). Mean deprivation score for training and non-training practices was calculated. Logistic regression was used to quantify the odds ratio of training status based on deprivation score, adjusted for practice list size, and compared with a similar 2009 analysis. RESULTS: Socioeconomic deprivation score is associated with training status, but is not significant when adjusted for practice list size [OR (adjusted) 0.87, 95% CI: 0.74-1.04]. In contrast, in 2009, adjusted deprivation score remained significant. Mean deprivation score in training and non-training practices remained similar at both time points [2015: 2.98 (SD 0.88) versus 3.17 (SD 0.81); 2009: 2.95 versus 3.19), with a more deprived mean score in non-training practices. CONCLUSIONS: General practices in affluent areas remain more likely to train, although this association appears to be related to larger practice list sizes rather than socioeconomic factors. To ensure a variety of training environments training bodies should target, and support, smaller practices working in more socioeconomically deprived areas.

Deployment of Lidar from a Ground Platform: Customizing a Low-Cost, Information-Rich and User-Friendly Application for Field Phenomics Research.

Using sensors and electronic systems for characterization of plant traits provides valuable digital inputs to support complex analytical modeling in genetics research. In field applications, frequent sensor deployment enables the study of the dynamics of these traits and their interaction with the environment. This study focused on implementing lidar (light detection and ranging) technology to generate 2D displacement data at high spatial resolution and extract plant architectural parameters, namely canopy height and cover, in a diverse population of 252 maize (Zea mays L.) genotypes. A prime objective was to develop the mechanical and electrical subcomponents for field deployment from a ground vehicle. Data reduction approaches were implemented for efficient same-day post-processing to generate by-plot statistics. The lidar system was successfully deployed six times in a span of 42 days. Lidar data accuracy was validated through independent measurements in a subset of 75 experimental units. Manual and lidar-derived canopy height measurements were compared resulting in root mean square error (RMSE) = 0.068 m and r2 = 0.81. Subsequent genome-wide association study (GWAS) analyses for quantitative trait locus (QTL) identification and comparisons of genetic correlations and heritabilities for manual and lidar-based traits showed statistically significant associations. Low-cost, field-ready lidar of computational simplicity make possible timely phenotyping of diverse populations in multiple environments.

GP speciality training in areas of deprivation: factors influencing engagement. A qualitative study.

BACKGROUND: GP training practices are less likely to be situated in areas of deprivation; little is known about GP views of postgraduate training in such areas. AIM: To explore the views of GPs working in deprived areas about GP speciality training (GPST). DESIGN & SETTING: Qualitative in-depth interviews with GPs working in practices in deprived areas in Scotland. METHOD: Ten in-depth interviews were conducted with GPs in training and non-training practices, to explore views on training. Interviews were audiotaped and transcribed verbatim, and inductive thematic analysis was undertaken. RESULTS: The importance of producing 'well-rounded' GPs who are able to work in a variety of environments was highlighted. Trainees need exposure to the specific challenges of deprived contexts (such as early multimorbidity, child protection, and addiction) and the benefit of this for trainees was thought to be invaluable. GPs identified many perceived barriers and benefits to training, some generic but some - such as inspiring the next generation (benefit) or overwhelming workload (barrier) - may be more relevant in areas of high deprivation. Overwhelming workload was the main reason for not becoming a training practice, though some would consider it if supported to develop a training culture. All the GPs, including non-trainers, were involved in optional activities which were felt to be important for resilience. CONCLUSION: GPs in areas of deprivation highlighted specific skills that could be gained by undertaking at least a part placement in deprived areas, with different skills likely to be gained from affluent areas. National education bodies should consider GP training rotations ensure a variety of training environments.

Genetic Costs of Domestication and Improvement.

The "cost of domestication" hypothesis posits that the process of domesticating wild species can result in an increase in the number, frequency, and/or proportion of deleterious genetic variants that are fixed or segregating in the genomes of domesticated species. This cost may limit the efficacy of selection and thus reduce genetic gains in breeding programs for these species. Understanding when and how deleterious mutations accumulate can also provide insight into fundamental questions about the interplay of demography and selection. Here we describe the evolutionary processes that may contribute to deleterious variation accrued during domestication and improvement, and review the available evidence for "the cost of domestication" in animal and plant genomes. We identify gaps and explore opportunities in this emerging field, and finally offer suggestions for researchers and breeders interested in understanding or avoiding the consequences of an increased number or frequency of deleterious variants in domesticated species.

Quality improvement and person-centredness: a participatory mixed methods study to develop the 'always event' concept for primary care.

OBJECTIVES: (1) To ascertain from patients what really matters to them on a personal level of such high importance that it should 'always happen' when they interact with healthcare professionals and staff groups. (2) To critically review existing criteria for selecting 'always events' (AEs) and generate a candidate list of AE examples based on the patient feedback data. DESIGN: Mixed methods study informed by participatory design principles. SUBJECTS AND SETTING: Convenience samples of patients with a long-term clinical condition in Scottish general practices. RESULTS: 195 patients from 13 general practices were interviewed (n=65) or completed questionnaires (n=130). 4 themes of high importance to patients were identified from which examples of potential 'AEs' (n=8) were generated: (1) emotional support, respect and kindness (eg, "I want all practice team members to show genuine concern for me at all times"); (2) clinical care management (eg, "I want the correct treatment for my problem"); (3) communication and information (eg, "I want the clinician who sees me to know my medical history") and (4) access to, and continuity of, healthcare (eg, "I want to arrange appointments around my family and work commitments"). Each 'AE' was linked to a system process or professional behaviour that could be measured to facilitate improvements in the quality of patient care. CONCLUSIONS: This study is the first known attempt to develop the AE concept as a person-centred approach to quality improvement in primary care. Practice managers were able to collect data from patients on what they 'always want' in terms of expectations related to care quality from which a list of AE examples was generated that could potentially be used as patient-driven quality improvement (QI) measures. There is strong implementation potential in the Scottish health service. However, further evaluation of the utility of the method is also necessary.

Combining QOF data with the care bundle approach may provide a more meaningful measure of quality in general practice.

BACKGROUND: A significant minority of patients do not receive all the evidence-based care recommended for their conditions. Health care quality may be improved by reducing this observed variation. Composite measures offer a different patient-centred perspective on quality and are utilized in acute hospitals via the 'care bundle' concept as indicators of the reliability of specific (evidence-based) care delivery tasks and improved outcomes. A care bundle consists of a number of time-specific interventions that should be delivered to every patient every time. We aimed to apply the care bundle concept to selected QOF data to measure the quality of evidence-based care provision. METHODS: Care bundles and components were selected from QOF indicators according to defined criteria. Five clinical conditions were suitable for care bundles: Secondary Prevention of Coronary Heart Disease (CHD), Stroke & Transient Ischaemic Attack (TIA), Chronic Kidney Disease (CKD), Chronic Obstructive Pulmonary Disease (COPD) and Diabetes Mellitus (DM). Each bundle has 3-8 components. A retrospective audit was undertaken in a convenience sample of nine general medical practices in the West of Scotland. Collected data included delivery (or not) of individual bundle components to all patients included on specific disease registers. Practice level and overall compliance with bundles and components were calculated in SPSS and expressed as a percentage. RESULTS: Nine practices (64.3%) with a combined patient population of 56,948 were able to provide data in the format requested. Overall compliance with developed QOF-based care bundles (composite measures) was as follows: CHD 64.0%, range 35.0-71.9%; Stroke/TIA 74.1%, range 51.6-82.8%; CKD 69.0%, range 64.0-81.4%; and COPD 82.0%, range 47.9-95.8%; and DM 58.4%, range 50.3-65.2%. CONCLUSIONS: In this small study compliance with individual QOF-based care bundle components was high, but overall ('all or nothing') compliance was substantially lower. Care bundles may provide a more informed measure of care quality than existing methods. However, the acceptability, feasibility and potential impact on clinical outcomes are unknown.

Do we know what foundation year doctors think about patient safety incident reporting? Development of a Web based tool to assess attitude and knowledge.

BACKGROUND: Making healthcare safer is an international priority. Patient safety modules are now taught in medical schools, and methods to assess related student knowledge and attitudes have been developed. However, little is known about the attitudes and knowledge which foundation doctors are developing to patient safety and incident reporting in the healthcare workplace, since a specific assessment tool appears to be lacking. AIMS: To develop, content validate and pilot test an online questionnaire survey to elicit foundation doctors' knowledge and experience of patient safety and incident reporting, and assess related attitudes and behaviours. METHODS: Questionnaire content validity was facilitated through: a steering group; literature review; feedback from foundation year doctors and consultant staff; a modified Delphi group; and completion of a content validity index by experts. In 2010 a cross-sectional online survey of 110 foundation year 1 and 2 doctors was then undertaken in three Scottish NHS board areas, utilising the developed 25 item questionnaire. RESULTS: The questionnaire was validated, and piloted among 69 foundation year doctors who responded to the questionnaire. The pilot has provided valuable insights into trainee attitudes and experience. For example, 32 (48%) believed that most safety incidents were due to things that they could not do anything about; and 31 (43%) admitted to being involved in medication errors which were not formally reported. CONCLUSIONS: The pilot study was successful in taking the first steps to developing a validated survey questionnaire for a key staff group, foundation year doctors, in a priority area. However, the findings raise concerns about trainee experience of and attitudes to reporting, and the frequency with which incidents go unreported.

Food and health considerations in Asia-Pacific regional security.

Recent dramatic increases in food prices in much of the world have caused much concern, and have even resulted in some public protests and riots. This is easy to understand given the large percentages of incomes that the poor devote to food purchases. Many commentators have predicted that food supplies in the Asia-Pacific region will become much more limited in the future as the result of population growth, the rapid growth of cities, new food demands by a growing middle class, the impacts of climate change, and the growth of a global food industry. But will these possible shortages of food result in pressures that will destabilise the security situation in the region? Recent work of the whole concept of security has resulted in some redefinition of the term to include issues of human security, but it could also be argued that severe strains on the human security situation could even result in increased instability in the more traditional kind of security regime. The extreme case of North Korea is used as an example of how this might happen. But we really do not know if such dangers are real ones for the region as a whole, and it is suggested that much more research is needed in this area. The whole concept of resilience has been used in some studies elsewhere and this may be useful starting point for new work in this area.

A Food in Health Security (FIHS) platform in the Asia-Pacific Region: the way forward.

The advent of multiple global crises, especially those of climate change, economics, energy, water, food and health evident in 2008, is of considerable moment to those who are suffering their consequences and for those with responsibility and interest in the systems affected. A coalition of parties in the Asia Pacific Region who work in the food and health systems met in August, 2009 in Taiwan and instigated a Food in Health Security (FIHS) Network which might join with other like-minded networks in and beyond the region. Sustainable health has many dimensions, among which food and nutrition is often neglected; there is a wide spectrum of nutritionally-related disorders. Malnutrition remains the global concern for agricultural research and development scientists and linkage with the health sector is key to progress. The disconnect between agricultural and health sectors negatively impacts consumer nutrition and health. Ethical and equity affect food and health systems. Food and health security is attainable only when the underlying social inequities are addressed; it is an ethical issue as reflected in the UN Universal declaration of Human Rights which includes the right to food for health and well-being. Food and health security are part of the larger security agenda and merit corresponding attention. Policy recommendations with immediacy are greater investment in combined food and health research; an Asia Pacific security agenda which emphasizes planetary, human, health and food security as relevant to traditional defence security; and community and household security measures which include maternal literacy, communication technology and entrepreneurial opportunity.

The assessment of criterion audit cycles by external peer review - when is an audit not an audit?

INTRODUCTION: Clinical audit has failed to fully deliver the rewards initially envisaged. Contributory factors include: an ill-defined approach to audit; the assumption that health care professionals can intuitively apply audit methods; and the lack of a system to 'quality assure' the process. A method of criterion audit was defined and developed in conjunction with an instrument to facilitate trained General Practitioner (GP) assessors in the review of colleagues' audit projects. Given the potential for improving audit practice, this study aimed to define the methodological factors that contributed to 'unsatisfactory' audits as judged by peer assessors. METHODS: West of Scotland GPs voluntarily submitted a criterion audit in a standard format for review by two trained colleagues using an assessment instrument. Audits judged unsatisfactory and associated educational feedback were subjected to content analysis. RESULTS: Between 1999 and 2004, 336 audits were submitted, of which 132 (39%) were judged to be unsatisfactory. Of these, 118 audits (89%) had a methodological issue identified in the initial project design (e.g. defining criteria) that effectively invalidated the audit. 119 projects (90%) were also judged to have at least one deficiency in the data analysis or change management stages of the audit (e.g. implementing inadequate change). CONCLUSION: A range of audit method issues was found. The proportion of unsatisfactory audits may point to a larger problem beyond this sample, which may have implications for health care quality. If audit practise is to be consistent and rigorous, consideration should be given to assessing the standard of this activity.

Food industry and economic development in the Asia Pacific.

The food industry in the Asia Pacific region is gigantic in size, and is therefore a key element in the economic development prospects for the region. It is estimated that in 2000, for example, total expenditure on food and beverages in China was worth $US 188.5 billion, second only to that in Japan at $322 billion. Yet it is clear that given the expansion of both populations and incomes in the region this market will expand rapidly over the next few years. Particularly important will be the continued growth of cities and of the share of employment in industrial and service activities. Much of this growth in food purchases will be supplied from local sources, but this will demand some fundamental changes in domestic food production systems. There will also be a substantial growth in the food trade, with ever increasing levels of national and regional specialisation. These developments will put increasing pressures on quality standards at all levels, with a growing emphasis on food safety, integrity, quality, and nutritional and health impacts. This paper reviews the current status of the food industry and the food trade in the region, and presents some projections for future developments. Particular emphasis is given to policy choices that must be made to ensure that the food system in the region develops in ways that are sustainable and most beneficial to the population as a whole.

Variations in the ability of general medical practitioners to apply two methods of clinical audit: A five-year study of assessment by peer review.

INTRODUCTION: Clinical audit has a central role in the NHS clinical governance agenda and the professional appraisal of medical practitioners in the UK. However, concerns have been raised about the poor design and impact of clinical audit studies and the ability of practitioners to apply audit methods. One method of making informed judgements on audit performance is by peer review. In the west of Scotland a voluntary peer review model has been open to general practitioners since 1999, while general practice trainees are compelled to participate as part of summative assessment. The study aimed to compare the outcomes of peer review for two methods of audit undertaken by different professional and academic groups of doctors. METHODS: Participants submitted a criterion audit or significant event analysis in standard formats for review by two informed general practitioners (GPs) using appropriate instruments. Peer review outcome data and the professional status of doctors participating were generated by computer search. Differences in proportions of those gaining a satisfactory peer review for each group were calculated. RESULTS: Of 1002 criterion audit submissions, 552 (55%) were judged to be satisfactory. GP registrars were significantly more likely than GP trainers (P < 0.001) and other established GP groups (P < 0.001) to gain a satisfactory peer review. GPs in non-training practices were less likely to achieve a satisfactory review than registrars (P < 0.001) and colleagues in training practices (P < 0.001). Of 883 SEA submissions, 541 (65%) were judged as satisfactory, with all groups gaining a similar proportion of satisfactory assessments, although GP registrars may have outperformed non-training practice GPs (P = 0.05). CONCLUSION: A significant proportion of GPs may be unable to adequately apply audit methods, potentially raising serious questions about the effectiveness of clinical audit as a health care improvement policy in general medical practice.

Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism.

BACKGROUND: The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001-2002. METHODS: A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. The number and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspected PE during an eight month period prior to the clinical trial (January 2002-August 2002) were compared with the number and type of diagnostic tests in 745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were used as unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. RESULTS: The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. CONCLUSION: Extrapolating the observed cost-savings of $59.30 per patient to the whole of Australia could potentially result in annual savings between $3.1 million to $3.7 million.

Reducing the use of diagnostic imaging in patients with suspected pulmonary embolism: validation of a risk assessment strategy.

OBJECTIVES: The aims of this study were to measure the: (i) effects of implementation of a new risk assessment strategy for patients with suspected pulmonary embolism (PE) on the use of imaging and D-dimer assay; (ii) negative predictive value for PE of a combination of low risk and negative D-dimer assay; and (iii) compliance of ED clinicians with the strategy. METHODS: A non-randomized clinical trial was conducted in the ED of a 720-bed teaching hospital between November 2002 and August 2003. Study subjects with suspected PE were compared with 191 randomly selected historical controls. The risk assessment strategy of Kline et al. was disseminated and implemented. RESULTS: The negative predictive value for PE was 99% (95% confidence interval [CI] = 97-100%) in 114 patients with low risk and negative D-dimer. There was a 21% absolute reduction in the rate of imaging following the implementation of the risk assessment strategy (56% vs 77%, P < 0.001). CONCLUSION: Low risk combined with a negative D-dimer result may allow exclusion of PE without imaging.

Economic development and its influences and risks for nutrition, cuisine and health.

This paper reviews the evidence on some of the major trends in economic development at a global level and assess their influence on food, nutrition and health. Food and nutrition are themselves broad topics, and each is influenced by a myriad of local and international forces, making them both interesting and important, but also challenging in their complexity. It is especially difficult to deal with such a vast and complicated terrain in such a short paper, and one must inevitably deal only superficially with a number of complex areas. This paper will review a number of key forces for change in the global system, with a focus on the implications of each for food and nutrition. Each area is central to the experience of economic, social and political development, particularly in the period since 1945, and each is tied in various ways with that complex and interrelated set of changes that we call globalisation. Seven key factors will be explored: global population growth, leading to strong pressures on world availability of arable land and food; increasing integration in the global economy, as measured through such things as trade, financial flows and information exchanges, and with specific implications for the food industry and for trade in food products; growing gaps between rich and poor countries; similar increases in disparities between rich and poor segments within individual countries; the rapid growth of cities in the developing world, resulting in massive challenges for the food supply systems of many nations; the growth within some countries, for example in a number of Asian countries, of a "new middle class" with distinctive patterns of consumption; and, high levels of population movements between countries resulting in the creation of significant communities of immigrants in a number of nations. Examples will be drawn from the two regions familiar to the author, Asia and Sub-Saharan Africa, but with a particular emphasis on East Asia.