New but for whom? Discourses of innovation in precision agriculture.

We describe how the set of tools, practices, and social relations known as "precision agriculture" is defined, promoted, and debated. To do so, we perform a critical discourse analysis of popular and trade press websites. Promoters of precision agriculture champion how big data analytics, automated equipment, and decision-support software will optimize yields in the face of narrow margins and public concern about farming's environmental impacts. At its core, however, the idea of farmers leveraging digital infrastructure in their operations is not new, as agronomic research in this vein has existed for over 30 years. Contemporary discourse in precision ag tends to favour emerging digital technologies themselves over their embeddedness in longstanding precision management approaches. Following several strands of science and technology studies (STS) research, we explore what rhetorical emphasis on technical innovation achieves, and argue that this discourse of novelty is a reinvention of precision agriculture in the context of the growing "smart" agricultural economy. We overview six tensions that remain unresolved in this promotional rhetoric, concerning the definitions, history, goals, adoption, uses, and impacts of precision agriculture. We then synthesize these in a discussion of the extent to which digital tools are believed to displace farmer decision-making and whether digital agriculture addresses the biophysical heterogeneity of farm landscapes or land itself has become an "experimental technology"-a way to advance the general development of artificial intelligence. This discussion ultimately helps us name a larger dilemma: that the smart agricultural economy is perhaps less about supporting land and its stewards than promising future tech and profits.

Self-care training using the Tablo hemodialysis system.

INTRODUCTION: Recently published results of the investigational device exemption (IDE) trial using the Tablo hemodialysis system confirmed its safety and efficacy for home dialysis. This manuscript reports additional data from the Tablo IDE study on the training time required to be competent in self-care, the degree of dependence on health care workers and caregivers after training was complete, and participants' assessment of the ease-of-use of Tablo. METHODS: We collected data on the time required to set up concentrates and the Tablo cartridge prior to treatment initiation. We asked participants to rate system setup, treatment, and takedown on a Likert scale from 1 (very difficult) to 5 (very simple) and if they had required any assistance with any aspect of treatment over the prior 7 days. In a subgroup of 15 participants, we recorded the number of training sessions required to be deemed competent to do self-care dialysis. FINDINGS: Eighteen men and 10 women with a mean age of 52.6 years completed the study. Thirteen had previous self-care experience using a different dialysis system. Mean set up times for the concentrates and cartridge were 1.1 and 10.0 minutes, respectively. Participants with or without previous self-care experience had similar set-up times. The mean ease-of-use score was 4.5 or higher on a scale from 1 to 5 during the in-home phase. Sixty-five percent required no assistance at home and on average required fewer than four training sessions to be competent in managing their treatments. Results were similar for participants with or without previous self-care experience. CONCLUSIONS: Participants in the Tablo IDE trial were able to quickly learn and manage hemodialysis treatments in the home, found Tablo easy to use, and were generally independent in performing hemodialysis.

Safety and efficacy of the Tablo hemodialysis system for in-center and home hemodialysis.

INTRODUCTION: Home hemodialysis remains underutilized despite observational data indicating more favorable outcomes with home compared with in-center hemodialysis. The Tablo Hemodialysis system is designed to be easy to learn and use and to facilitate adoption of home hemodialysis. The objective of the current investigational device exemption (IDE) study was to evaluate the safety and efficacy of Tablo managed in-center by health care professionals and in-home by patients and/or caregivers. METHODS: A prospective, multicenter, open-label, crossover trial comparing in-center and in-home hemodialysis using Tablo. There were 4 treatment periods during which hemodialysis was prescribed 4 times per week: 1-week Run-In, 8-week In-Center, 4-week Transition, and 8-week In-Home. The primary efficacy endpoint was weekly standard Kt/Vurea ≥ 2.1. The secondary efficacy endpoint was delivery of ultrafiltration (UF) within 10% of prescribed UF. We collected safety and usability data. FINDINGS: Thirty participants enrolled and 28 completed all trial periods. Adherence to the protocol requirement of 4 treatments per week was 96% in-center and 99% in-home. The average prescribed and delivered session lengths were 3.4 hours for both the In-Center and the In-Home periods. The primary efficacy endpoint for the intention-to-treat cohort was achieved in 199/200 (99.5%) of measurements during the In-Center period and 168/171 (98.3%) In-Home. The average weekly standard Kt/Vurea was 2.8 in both periods. The secondary efficacy UF endpoint was achieved in the ITT cohort in 94% in both in-center and in-home. Two prespecified adverse events (AEs) occurred during the In-Center period and 6 in the In-Home period. None of the AEs were deemed by investigators as related to Tablo. The median resolution time of alarms was 8 seconds in-center and 5 seconds in-home. CONCLUSION: Primary and secondary efficacy and safety endpoints were achieved during both In-Center and In-Home trial periods. This study confirms that Tablo is safe and effective for home hemodialysis use.

Optimization of bioenergy crop selection and placement based on a stream health indicator using an evolutionary algorithm.

The emission of greenhouse gases continues to amplify the impacts of global climate change. This has led to the increased focus on using renewable energy sources, such as biofuels, due to their lower impact on the environment. However, the production of biofuels can still have negative impacts on water resources. This study introduces a new strategy to optimize bioenergy landscapes while improving stream health for the region. To accomplish this, several hydrological models including the Soil and Water Assessment Tool, Hydrologic Integrity Tool, and Adaptive Neruro Fuzzy Inference System, were linked to develop stream health predictor models. These models are capable of estimating stream health scores based on the Index of Biological Integrity. The coupling of the aforementioned models was used to guide a genetic algorithm to design watershed-scale bioenergy landscapes. Thirteen bioenergy managements were considered based on the high probability of adaptation by farmers in the study area. Results from two thousand runs identified an optimum bioenergy crops placement that maximized the stream health for the Flint River Watershed in Michigan. The final overall stream health score was 50.93, which was improved from the current stream health score of 48.19. This was shown to be a significant improvement at the 1% significant level. For this final bioenergy landscape the most often used management was miscanthus (27.07%), followed by corn-soybean-rye (19.00%), corn stover-soybean (18.09%), and corn-soybean (16.43%). The technique introduced in this study can be successfully modified for use in different regions and can be used by stakeholders and decision makers to develop bioenergy landscapes that maximize stream health in the area of interest.

Ecohydrological model parameter selection for stream health evaluation.

Variable selection is a critical step in development of empirical stream health prediction models. This study develops a framework for selecting important in-stream variables to predict four measures of biological integrity: total number of Ephemeroptera, Plecoptera, and Trichoptera (EPT) taxa, family index of biotic integrity (FIBI), Hilsenhoff biotic integrity (HBI), and fish index of biotic integrity (IBI). Over 200 flow regime and water quality variables were calculated using the Hydrologic Index Tool (HIT) and Soil and Water Assessment Tool (SWAT). Streams of the River Raisin watershed in Michigan were grouped using the Strahler stream classification system (orders 1-3 and orders 4-6), k-means clustering technique (two clusters: C1 and C2), and all streams (one grouping). For each grouping, variable selection was performed using Bayesian variable selection, principal component analysis, and Spearman's rank correlation. Following selection of best variable sets, models were developed to predict the measures of biological integrity using adaptive-neuro fuzzy inference systems (ANFIS), a technique well-suited to complex, nonlinear ecological problems. Multiple unique variable sets were identified, all which differed by selection method and stream grouping. Final best models were mostly built using the Bayesian variable selection method. The most effective stream grouping method varied by health measure, although k-means clustering and grouping by stream order were always superior to models built without grouping. Commonly selected variables were related to streamflow magnitude, rate of change, and seasonal nitrate concentration. Each best model was effective in simulating stream health observations, with EPT taxa validation R2 ranging from 0.67 to 0.92, FIBI ranging from 0.49 to 0.85, HBI from 0.56 to 0.75, and fish IBI at 0.99 for all best models. The comprehensive variable selection and modeling process proposed here is a robust method that extends our understanding of watershed scale stream health beyond sparse monitoring points.

Ferric carboxymaltose in patients with iron-deficiency anemia and impaired renal function: the REPAIR-IDA trial.

BACKGROUND: Iron-deficiency anemia in non-dialysis-dependent chronic kidney disease (NDD-CKD) frequently requires parenteral iron replacement, but existing therapies often require multiple administrations. We evaluated the efficacy and cardiovascular safety of ferric carboxymaltose (FCM), a non-dextran parenteral iron permitting large single-dose infusions, versus iron sucrose in patients with iron-deficiency anemia and NDD-CKD. METHODS: A total of 2584 participants were randomized to two doses of FCM 750 mg in one week, or iron sucrose 200 mg administered in up to five infusions in 14 days. The primary efficacy endpoint was the mean change to highest hemoglobin from baseline to Day 56. The primary composite safety endpoint included all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, unstable angina, congestive heart failure, arrhythmias and hyper- and hypotensive events. RESULTS: The mean hemoglobin increase was 1.13 g/dL in the FCM group and 0.92 g/dL in the iron sucrose group (95% CI, 0.13-0.28). Similar results were observed across all subgroups, except Stage 2 CKD. More subjects in the FCM group achieved a hemoglobin increase of ≥ 1.0 g/dL between baseline and Day 56 (48.6 versus 41.0%; 95% CI, 3.6-11.6%). There was no significant difference between FCM and iron sucrose recipients with respect to the primary composite safety endpoint, including the major adverse cardiac events of death, myocardial infarction, or stroke. A significant difference in the number of protocol-defined, predominantly transient hypertensive episodes was observed in the FCM group. CONCLUSIONS: Two 750-mg infusions of FCM are a safe and effective alternative to multiple lower dose iron sucrose infusions in NDD-CKD patients with iron-deficiency anemia.

Histological characteristics of singleton placentas delivered before the 28th week of gestation.

AIMS: The placenta is a record of the fetal environment and its examination may provide information about the baby's subsequent growth and development. We describe the histological characteristics of 947 singleton placentas from infants born between 23 and 27 weeks gestation. METHODS: Consent was obtained from mothers who delivered before 28 weeks (clinical estimate). We evaluated the gross and histopathological features of the placenta and assessed pair-wise correlations between variables. RESULTS: Lesions of uteroplacental circulation (abruption, extensive infarction or thrombosis, marked basal or perivillous fibrin deposition, increased syncytial knots) were inversely related to those associated with inflammation of the membranes and cord. Earlier age favoured inflammatory variables, while older age favoured characteristics attributed to impaired blood flow. We observed inflammation of the chorionic plate in 43%, the cord in 19%, and of chorionic plate vessels in 30%. Of the placentas with umbilical cord inflammation, 8% had no inflammation of the chorionic plate. CONCLUSIONS: This study population is unique in its size and recruitment by gestational age rather than birth weight. Inflammation occurred frequently, but not in placentas that had characteristics of vasculopathy. The prevalence of inflammation decreased with increasing gestational age, while vasculopathy increased. Funisitis need not be accompanied by chorionic inflammation.

Validation of p53 immunohistochemistry as a prognostic factor in breast cancer in clinical practice.

CONTEXT: Abnormal p53 tumor suppressor gene expression as detected by immunohistochemistry is a possible prognostic factor in breast cancer. The difference in techniques used to evaluate the expression of mutated p53 protein is under intense scrutiny, as well as its uses either independently or in conjunction with other prognostic factors in breast cancer. OBJECTIVE: To determine whether p53 immunohistochemistry can be used as a reliable indicator of the presence of mutated nuclear p53 protein, and whether this method can be performed reliably in a community hospital's clinical practice. DESIGN: ne hundred twenty-two cases of breast carcinoma were stained and analyzed for the presence of p53 protein using DO-7 (Dako Corporation, Carpinteria, Calif) p53 antibody. RESULTS: Of the 122 cases of invasive carcinoma studied, 23 (18.7%) were positive for p53, and 16 (16.3%) of 98 cases with coexisting ductal carcinoma in situ were positive for p53. This finding is in agreement with comparable published studies. CONCLUSIONS: Based on the results of this study, we conclude that p53 immunohistochemistry qualifies as a diagnostic technique suitable for clinical practice in a community hospital. Its detection may be particularly promising in clinical trials of new molecular therapies directed at the p53 tumor suppressor gene.