Promoting advance care planning (ACP) in community health clinics in Israel: Perceptions of older adults with pro-ACP attitudes and their family physicians.

OBJECTIVE: We examined barriers and facilitators to patient-family physician discussions in Israel about advance care planning, including preparation of an advance directive by adults over age 65, as part of a program in two community health clinics which afforded family physicians the opportunity to dedicate time to such discussions with patients. To the best of our knowledge, the program is the first of its kind in Israel. METHOD: We used thematic analyses of qualitative data collected through 22 interviews with patients with pro-advanced care planning attitudes and three focus groups with eleven family physicians. RESULTS: Overall, three themes in the interviews with patients and two themes in the focus groups with physicians emerged. The program gave people with pro-advanced care planning attitudes the opportunity to follow through with their ideas. We found that patients viewed their family physicians as facilitators and that the use of an information leaflet was an effective way to promote advance directives. Family physicians expressed positive attitudes toward assisting patients in the preparation of advance directives and welcomed an allotment of time for this endeavor as part of their schedule but expressed hesitation about assisting patients concerning legal and moral issues. SIGNIFICANCE OF RESULTS: A pro-advanced care planning attitude is not enough for patients to complete the process of creating an advance directive; patients need active encouragement and intervention in order to turn their ideas into action. More patient and physician education are necessary to enable patients to protect their right to self-determination in end-of-life medical decision-making and to support physicians as facilitators of the process.

Genome-Wide Association Study in Bread Wheat Identifies Genomic Regions Associated with Grain Yield and Quality under Contrasting Water Availability.

The objectives of this study were to identify genetic loci in the bread wheat genome that would influence yield stability and quality under water stress, and to identify accessions that can be recommended for cultivation in dry and hot regions. We performed a genome-wide association study (GWAS) using a panel of 232 wheat accessions spanning diverse ecogeographic regions. Plants were evaluated in the Israeli Northern Negev, under two environments: water-limited (D; 250 mm) and well-watered (W; 450 mm) conditions; they were genotyped with ~71,500 SNPs derived from exome capture sequencing. Of the 14 phenotypic traits evaluated, 12 had significantly lower values under D compared to W conditions, while the values for two traits were higher under D. High heritability (H2 = 0.5-0.9) was observed for grain yield, spike weight, number of grains per spike, peduncle length, and plant height. Days to heading and grain yield could be partitioned based on accession origins. GWAS identified 154 marker-trait associations (MTAs) for yield and quality-related traits, 82 under D and 72 under W, and identified potential candidate genes. We identified 24 accessions showing high and/or stable yields under D conditions that can be recommended for cultivation in regions under the threat of global climate change.

The Framing Effect of Digital Textual Messages on Uptake Rates of Medical Checkups: Field Study.

BACKGROUND: Health care authorities often use text messages to enhance compliance with medical recommendations. The effectiveness of different message framings has been studied extensively over the past 3 decades. Recently, health care providers have begun using digital media platforms to disseminate health-related messages. OBJECTIVE: This study aimed to examine the effectiveness of some of the most widely used message framings on the uptake rates of medical checkups. METHODS: This study used a large-scale digital outreach campaign conducted by Maccabi Healthcare Services (MHS) during 2020-2021, involving a total of 113,048 participants. MHS members aged 50-74 years were invited to take their recommended medical actions from the following list: human papillomavirus (HPV), mammography, abdominal aortic aneurysm, fecal occult blood test (FOBT), and pneumococcal vaccination. Each member was randomly assigned to receive 1 of 6 message framings: control (neutrally framed; n=20,959, 18.5%), gains (benefits of compliance; n=20,393, 18%), losses (negative consequences of noncompliance; n=15,165, 13.4%), recommendation (a recommendation by an authoritative figure, in this context by a physician; n=20,584, 18.2%), implementation intentions (linking potential outcomes to future reactions; n=20,701, 18.3%), and empowerment (emphasizing personal responsibility for maintaining good health; n=15,246, 13.5%). The time frames for measuring a successful intervention were 14 days for scheduling screenings (ie, HPV, mammography, or abdominal aortic aneurysm), 30 days for performing the FOBT, and 60 days for receiving pneumococcal vaccination. We also examined the effectiveness of media channels (text message or email) on uptake rates and whether the subject-line length is correlated with message-opening rates. RESULTS: No significant effect of message framing on uptake rates of medical checkups was observed. The rates of appointments for screening ranged from 12.9% to 14.1% across treatments. Based on a chi-square test, there was no evidence to reject the null hypothesis that these compliance rates are independent of the treatments (P=.35). The uptake rates for the FOBT and pneumococcal vaccination ranged from 23.3% to 23.8% across treatments, and we could not reject the hypothesis that they are independent of the treatments (P=.88). We also found that emails are more effective than text messages (P<.001) and that the subject-line length is negatively correlated with message-opening rates. CONCLUSIONS: No evidence was found for an effect of the 5 message framings on uptake rates of medical checkups. To enhance compliance rates, public health officials may consider alternative framings. Furthermore, media channels and the subject-line length should be given careful consideration in the planning stages of health care campaigns. TRIAL REGISTRATION: AEA RCT Registry AEARCTR-0006317; https://www.socialscienceregistry.org/trials/6317/history/201365.

The potential of remote sensing of cover crops to benefit sustainable and precision fertilization.

Cover crops and precision fertilization are two core strategies to advance sustainable agriculture. Based on a review of proven achievements in remote sensing of vegetation, a novel approach is proposed to use remote-sensing of cover crops to map soil nutrient availability and to produce prescription maps for precision basal fertilization prior to sowing the following cash crop. The first goal of this manuscript is to introduce the concept of using remote-sensing of cover crops as 'reflectors' or 'bio-indicators' of soil nutrient availability. This concept has two components: 1. mapping nitrogen availability using remote-sensing of cover crops; 2. using remotely-detected visual symptoms of cover crops' nutrient deficiencies to guide sampling schemes. The second goal was to describe two case studies that initially evaluated the feasibility of this concept in a 20 ha field. In the first case study, cover crops mixtures containing legumes and cereals were sown during two seasons in soils with different nitrogen levels. Cereals dominated the mixture when soil nitrogen levels were low, while legumes dominated when levels were high. Plant height and texture analysis derived from UAV-RGB-images were used to measure differences between the dominant species as an indicator of soil nitrogen availability. In the second case study, in an oat cover crop, three different appearances of visual symptoms (phenotypes) were observed throughout the field, and laboratory analysis showed they significantly differed in their nutrient levels. Spectral vegetation indices and plant height derived from UAV-RGB-images were analyzed by a multi-stage classification procedure to differentiate between the phenotypes. The classified product was interpreted and interpolated to generate a high-resolution map showing nutrient uptake for the whole field. The suggested concept essentially elevates the services cover crops can provide to benefit sustainable agriculture if incorporated with remote-sensing. The potentials, limitations and open questions concerning the suggested concept are discussed.

Rootstock-Dependent Response of Hass Avocado to Salt Stress.

Salt stress is a major limiting factor in avocado (Persea americana) cultivation, exacerbated by global trends towards scarcity of high-quality water for irrigation. Israeli avocado orchards have been irrigated with relatively high-salinity recycled municipal wastewater for over three decades, over which time rootstocks were selected for salt-tolerance. This study's objective was to evaluate the physiological salt response of avocado as a function of the rootstock. We irrigated fruit-bearing 'Hass' trees grafted on 20 different local and introduced rootstocks with water high in salts (electrical conductivity of 1.4-1.5 dS/m). The selected rootstocks represent a wide range of genetic backgrounds, propagation methods, and horticultural characteristics. We investigated tree physiology and development during two years of salt exposure by measuring Cl and Na leaf concentrations, leaf osmolality, visible damages, trunk circumference, LAI, CO2 assimilation, stomatal conductance, spectral reflectance, stem water potential, trichomes density, and yield. We found a significant effect of the rootstocks on stress indicators, vegetative and reproductive development, leaf morphogenesis and photosynthesis rates. The most salt-sensitive rootstocks were VC 840, Dusa, and VC 802, while the least sensitive were VC 159, VC 140, and VC 152. We conclude that the rootstock strongly influences avocado tree response to salinity exposure in terms of physiology, anatomy, and development.

Use of multiple indicators to compare sustainability performance of organic vs conventional vineyard management.

The wine sector is paying more attention to sustainable wine production practices, but this topic is highly debated because organic viticulture aims to a reduction of environmental impacts, while conventional viticulture ensures an increase of yield. This work provides an economic and environmental comparison using different indicators whereas no previous studies on viticulture have faced on both aspects of sustainability. Two distinct vineyards within the same case study farm were considered, where conventional and organic viticulture practices were applied for 5 years. For each type of production, we calculated the economic benefit and environmental indicators such as the Water Footprint, Carbon Footprint, and an indicator of environmental performance associated with the vineyard phase ("Vineyard Management" or "Vigneto" indicator part of the Italian VIVA certification framework). This latter considers six sub-indicators investigating pesticides management, fertilizers management, organic matter content, soil compaction, soil erosion, and landscape quality. The multi criteria approach is a novel framework assessing sustainability on vineyard management using environmental indicators from VIVA calculator and the economic aspect. Main results showed that organic management in viticulture can be applied without having economic losses and with the benefit of better preserving the natural capital.

Water Productivity Mapping (WPM) Using Landsat ETM+ Data for the Irrigated Croplands of the Syrdarya River Basin in Central Asia.

The overarching goal of this paper was to espouse methods and protocols for water productivity mapping (WPM) using high spatial resolution Landsat remote sensing data. In a world where land and water for agriculture are becoming increasingly scarce, growing "more crop per drop" (increasing water productivity) becomes crucial for food security of future generations. The study used time-series Landsat ETM+ data to produce WPMs of irrigated crops, with emphasis on cotton in the Galaba study area in the Syrdarya river basin of Central Asia. The WPM methods and protocols using remote sensing data consisted of: (1) crop productivity (ton/ha) maps (CPMs) involvingcrop type classification, crop yield and biophysical modeling, and extrapolating yield models to larger areas using remotely sensed data; (2) crop water use (m³/ha) maps (WUMs) (or actual seasonal evapotranspiration or actual ET) developed through Simplified Surface Energy Balance (SSEB) model; and (3) water productivity (kg/m³) maps (WPMs) produced by dividing raster layers of CPMs by WUMs. The SSEB model calculated WUMs (actual ET) by multiplying the ET fractionby reference ET. The ETfraction was determined using Landsat thermal imagery by selecting the "hot" pixels (zero ET) and "cold" pixels (maximum ET). The grass reference ET was calculated by FAO Penman-Monteith method using meteorological data. The WPMs for the Galaba study area demonstrated a wide variations (0-0.54 kg/m³) in water productivity of cotton fields with overwhelming proportion (87%) of the area having WP less than 0.30 kg/m³, 11% of the area having WP in range of 0.30-0.36 kg/m³, and only 2% of the area with WP greater than 0.36 kg/m³. These results clearly imply that there are opportunities for significant WP increases in overwhelming proportion of the existing croplands. The areas of low WP are spatially pin-pointed and can be used as focus for WP improvements through better land and water management practices.

Spatial Spread of the Root Parasitic Weed Phelipanche aegyptiaca in Processing Tomatoes by Using Ecoinformatics and Spatial Analysis.

Egyptian broomrape (Phelipanche aegyptiaca) is one of the main threats to tomato production in Israel. The seed bank of P. aegyptiaca rapidly develops and spreads in the field. Knowledge about the spatio-temporal distribution of such weeds is required in advance of emergence, as they emerge late in their life cycle when they have already caused major crop damage. The aim of this study is to reveal the effects of two major internal infestation sources: crop rotation and infestation history; and one external source: proximity to infested tomato fields; on infestation of P. aegyptiaca in processing tomatoes. Ecoinformatics, spatial analysis and geostatistics were used to examine these effects. A regional survey was conducted to collect data on field history from 238 tomato fields between 2000 and 2012, in a major tomato-growing region in Israel. Multivariate logistic regression in the framework of generalized linear models (GLM) has demonstrated the importance of all three variables in predicting infestation in tomato fields. The parameters of the overall model indicated a high specificity between tomatoes and P. aegyptiaca, which is potentially responsible for aggravating infestation. In addition, P. aegyptiaca infestation levels were intensively mapped in 43 of the 238 tomato fields in the years 2010-2012. Geostatistical measures showed that 40% of the fields had clustered infestation spatial patterns with infestation clusters located along the fields' borders. Strong linear and negative relationships were found between infestation level and distance from a neighboring infested field, strengthening the role of infested tomato fields in P. aegyptiaca spread. An experiment specifically designed for this study showed that during harvest, P. aegyptiaca seeds are blown from an infested field to a distance of at least 90 m, and may initiate infestation in neighboring fields. Integrating current knowledge about the role of agricultural practices on the spread of P. aegyptiaca with the results of this study enabled us to propose a mechanism for the spread of P. aegyptiaca. Given the major effect of agricultural practices on infestation levels, it is assumed that the spread of this weed can be suppressed by implementing sanitation and using decision support tools for herbicide application.