Inorganic fertilizer use and its association with rice yield gaps in sub-Saharan Africa.

Where and which countries should receive higher priority for improving inorganic fertilizer use in rice fields in sub-Saharan Africa (SSA)? This study addressed this question by assessing the spatial variation in fertilizer use and its association with rice yield and yield gap in 24 SSA countries through a systematic literature review of peer-reviewed papers, theses, and grey literature published between 1995 and 2021. The results showed a large variation in N, P, and K fertilizer application rates and rice yield and an opportunity for narrowing the yield gap by increasing N and P rates, especially in irrigated rice systems. We identified clusters of sites/countries based on nutrient input and yield and suggested research and development strategies for improving yields and optimizing nutrient use efficiencies. Further research is essential to identify the factors causing low fertilizer use and the poor association between its use and yield in rainfed systems.

Estimating nutrient concentrations and uptake in rice grain in sub-Saharan Africa using linear mixed-effects regression.

Context or problem: Quantification of nutrient concentrations in rice grain is essential for evaluating nutrient uptake, use efficiency, and balance to develop fertilizer recommendation guidelines. Accurate estimation of nutrient concentrations without relying on plant laboratory analysis is needed in sub-Saharan Africa (SSA), where farmers do not generally have access to laboratories. Objective or research question: The objectives are to 1) examine if the concentrations of macro- (N, P, K, Ca, Mg, S) and micronutrients (Fe, Mn, B, Cu) in rice grain can be estimated using agro-ecological zones (AEZ), production systems, soil properties, and mineral fertilizer application (N, P, and K) rates as predictor variables, and 2) to identify if nutrient uptakes estimated by best-fitted models with above variables provide improved prediction of actual nutrient uptakes (predicted nutrient concentrations x grain yield) compared to average-based uptakes (average nutrient concentrations in SSA x grain yield). Methods: Cross-sectional data from 998 farmers' fields across 20 countries across 4 AEZs (arid/semi-arid, humid, sub-humid, and highlands) in SSA and 3 different production systems: irrigated lowland, rainfed lowland, and rainfed upland were used to test hypotheses of nutrient concentration being estimable with a set of predictor variables among above-cited factors using linear mixed-effects regression models. Results: All 10 nutrients were reasonably predicted [Nakagawa's R2 ranging from 0.27 (Ca) to 0.79 (B), and modeling efficiency ranging from 0.178 (Ca) to 0.584 (B)]. However, only the estimation of K and B concentrations was satisfactory with a modeling efficiency superior to 0.5. The country variable contributed more to the variation of concentrations of these nutrients than AEZ and production systems in our best predictive models. There were greater positive relationships (up to 0.18 of difference in correlation coefficient R) between actual nutrient uptakes and model estimation-based uptakes than those between actual nutrient uptakes and average-based uptakes. Nevertheless, only the estimation of B uptake had significant improvement among all nutrients investigated. Conclusions: Our findings suggest that with the exception of B associated with high model EF and an improved uptake over the average-based uptake, estimates of the macronutrient and micronutrient uptakes in rice grain can be obtained simply by using average concentrations of each nutrient at the regional scale for SSA. Implications: Further investigation of other factors such as the timing of fertilizer applications, rice variety, occurrence of drought periods, and atmospheric CO2 concentration is warranted for improved prediction accuracy of nutrient concentrations.

Risk of endometrial cancer in patients with polycystic ovarian syndrome: A meta­analysis.

While existing literature suggests an association between polycystic ovarian syndrome (PCOS) and endometrial cancer, the sparsity and inconsistency of current evidence indicates a lack of clarity regarding the exact strength of this association. It also remains uncertain whether the degree of risk of disease is affected by confounding factors, such as age and body mass index (BMI). The present meta-analysis is aimed to quantify the risk of endometrial cancer in female subjects with PCOS compared to those without PCOS. PubMed, MEDLINE, EMBASE, Scopus and Cochrane were searched from inception to October 31, 2022, to identify peer-reviewed case-control, cohort and cross-sectional studies that assessed the association between endometrial cancer and PCOS and contained original data. Two researchers independently extracted data and performed quality assessment using the Newcastle-Ottawa criteria. Pooled odds ratios (ORs) were calculated using the random-effect model and inverse variance. The degree of heterogeneity was assessed using I2 statistics. A total of 10 relevant studies were identified and included in the meta-analysis (comprising 12,248 female patients with PCOS and 54,120 controls). Females with PCOS had a significantly increased odds of developing endometrial cancer as compared to those without PCOS [OR, 4.07; 95% confidence interval (CI), 2.13-7.78; P<0.0001]. When postmenopausal subjects (age, >54 years) were excluded from the meta-analysis, the odds increased further (OR, 5.14; 95% CI, 3.22-8.21; P<0.00001). Patients with PCOS are up to 5 times more likely to develop endometrial cancer compared to those without PCOS. Larger, prospective studies that are well-controlled for confounding factors, such as BMI, are required.

A rare case of postmenopausal hyperandrogenism due to ovarian hyperthecosis and hilus cell hyperplasia.

Postmenopausal hyperandrogenism is rare, and without consensus on specific investigative indices, diagnosis is challenging. A 77-year-old woman had a three-year history of hirsutism, male-pattern baldness and increased libido alongside elevated androstenedione, total testosterone and free androgen index levels. A magnetic resonance imaging (MRI) scan showed bilateral ovarian lesions, suggesting ovarian hyperthecosis. Histopathology obtained after a laparoscopic bilateral salpingo-oophorectomy confirmed ovarian hyperthecosis and hilus cell hyperplasia. We believe it's the first time they have been reported to occur in combination. The symptoms resolved within a month of surgery. This case highlights the difficulties of diagnosis alongside demonstrating the importance of management by a multidisciplinary team.

Emerging Conceptual Frameworks for Co-Serving Veterans of Color Across the State-Federal Vocational Rehabilitation Program: SVRAs, AIVRPs, and VA-VR&E.

Existing models of interagency collaborations serving the United States (U.S.) Armed Forces veterans of color, i.e., African Americans, Latinx, Native Americans/Alaskan Natives and Asian Americans and/or Pacific islanders are sparse, and few co-service partnership models are available. This article proposes two different emerging conceptual frameworks, i.e., state vocational rehabilitation agency (SVRA) and the U.S. Department of Veterans Affairs Veterans Readiness and Employment Program (VA-VR&E) co-service model, and American Indian Vocational Rehabilitation Program (AIVRP) and VA-VR&E co-service model designed to enhance successful employment outcomes for these veterans. Diffusions of innovations Theory was used to develop the Co-Service Models. A set of recommended approaches that these agencies and researchers can consider are presented.

African soil properties and nutrients mapped at 30 m spatial resolution using two-scale ensemble machine learning.

Soil property and class maps for the continent of Africa were so far only available at very generalised scales, with many countries not mapped at all. Thanks to an increasing quantity and availability of soil samples collected at field point locations by various government and/or NGO funded projects, it is now possible to produce detailed pan-African maps of soil nutrients, including micro-nutrients at fine spatial resolutions. In this paper we describe production of a 30 m resolution Soil Information System of the African continent using, to date, the most comprehensive compilation of soil samples ([Formula: see text]) and Earth Observation data. We produced predictions for soil pH, organic carbon (C) and total nitrogen (N), total carbon, effective Cation Exchange Capacity (eCEC), extractable-phosphorus (P), potassium (K), calcium (Ca), magnesium (Mg), sulfur (S), sodium (Na), iron (Fe), zinc (Zn)-silt, clay and sand, stone content, bulk density and depth to bedrock, at three depths (0, 20 and 50 cm) and using 2-scale 3D Ensemble Machine Learning framework implemented in the mlr (Machine Learning in R) package. As covariate layers we used 250 m resolution (MODIS, PROBA-V and SM2RAIN products), and 30 m resolution (Sentinel-2, Landsat and DTM derivatives) images. Our fivefold spatial Cross-Validation results showed varying accuracy levels ranging from the best performing soil pH (CCC = 0.900) to more poorly predictable extractable phosphorus (CCC = 0.654) and sulphur (CCC = 0.708) and depth to bedrock. Sentinel-2 bands SWIR (B11, B12), NIR (B09, B8A), Landsat SWIR bands, and vertical depth derived from 30 m resolution DTM, were the overall most important 30 m resolution covariates. Climatic data images-SM2RAIN, bioclimatic variables and MODIS Land Surface Temperature-however, remained as the overall most important variables for predicting soil chemical variables at continental scale. This publicly available 30-m Soil Information System of Africa aims at supporting numerous applications, including soil and fertilizer policies and investments, agronomic advice to close yield gaps, environmental programs, or targeting of nutrition interventions.

An aortic wall to vertebral body fistula presenting as a lytic lesion.

There have been multiple reported cases of aortic fistulas but few cases of aorta to vertebral body fistulas and no aortic wall to vertebral body fistulas have been reported. Here we present a case of a patient who is status post thoracic aortic aneurysm (TAA) repair and found to have a lytic vertebral body lesion. Biopsy of the mass revealed blood products without evidence of malignancy and further investigation revealed a fistulous tract between the aortic wall and the vertebral body causing a vertebral body hematoma.

Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise.

BACKGROUND: More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions. METHODS: The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings. RESULTS: The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care - all within LMICs. CONCLUSIONS: Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities.

National Organization of Nurse Practitioner Faculties: A 40-year history of preparing nurse practitioners for practice.

This article provides a historic view of the development and accomplishments of the National Organization of Nurse Practitioner Faculties (NONPF). The authors explore the history leading up to the formalization of NONPF, noting the major factors leading to the creation of NONPF. Since its inception in 1980, NONPF has led efforts to provide resources to nurse practitioner program faculty, create standards and guidelines for quality programs, and most recently work to develop measurable competencies. This article tracks the achievement of the organization by decade and provides an education, practice, and policy context that informed and inspired the activities of NONPF.

Cancer incidence and mortality associated with non-occupational and low dose exposure to Libby vermiculite in Minnesota.

BACKGROUND: A vermiculite processing plant in a Minneapolis, Minnesota neighborhood utilized asbestos-containing ore from Libby, Montana from the late 1930's until 1989. Multiple pathways of exposure to Libby asbestos were characterized in a cohort of over 6000 plant workers and residents living near the plant. OBJECTIVE: We conducted a cohort linkage study to assess the impact of cumulative low dose exposure and the role of occupational history on asbestos-related mortality and cancer morbidity among cohort members residing near a vermiculite plant. METHODS: Cohort members alive in 1988 (n = 5848) were linked to the Minnesota Cancer Surveillance System to identify incident cases of mesothelioma, lung cancer, and all-cancer diagnosed from 1988 to 2010. Proportional incidence ratios (PIRs) were calculated for mesothelioma and lung cancer. Vital status and cause of death were ascertained from Minnesota vital records and the National Death Index (1988-2011). Mortality rates of the cohort (2001-2011) for asbestos-related outcomes were compared to the Minnesota population to estimate standardized mortality ratios (SMRs) and stratified by gender, exposure, and occupational history categories. RESULTS: We identified seven cases of mesothelioma, with elevated incidence only in females (PIR = 11.76, 95% CI: 3.17, 30.12). Lung cancer was elevated in both genders: PIR = 1.54 (95% CI: 1.19, 2.0) in males and 1.62 (95% CI: 1.21, 2.12) in females. We found elevated mortality from COPD, lung cancer, and mesothelioma among females (SMR for mesothelioma in females = 18.97, CI: 3.91, 55.45), among the 546 deaths identified. All four deaths from mesothelioma occurred in the >75th percentile of exposure (>0.0156 fiber/cc x months). The SMR for lung cancer and all respiratory cancer was elevated even after controlling for occupation. CONCLUSIONS: Community exposure to Libby amphibole asbestos from a vermiculite processing plant is associated with increased risk of COPD, lung cancer and mesothelioma incidence and mortality, most notably among females, and is likely to remain a public health issue for years to come.

Elevated blood pressure and illness beliefs: a cross-sectional study of emergency department patients in Jamaica.

BACKGROUND: Elevated blood pressure (BP) is common among emergency department (ED) patients. While some data exist on the association between ED BP and hypertension (HTN) in the USA, little is known about this relationship in Afro-Caribbean nations. The aim of the study was to evaluate the relationship between elevated systolic BP in the ED and a previous diagnosis of HTN, accounting for potential factors that could contribute to poor HTN control among those with a previous diagnosis: socioeconomic status, health-seeking behavior, underlying HTN illness beliefs, medication adherence, and perceived adherence self-efficacy. METHODS: This was a cross-sectional survey over 6 weeks, from November 19 through December 30, 2014. Those surveyed were non-critically ill or injured adult ED patients (≥ 18 years) presenting to an Afro-Caribbean hospital. Descriptive statistics were derived for study patients as a whole, by HTN history and by presenting BP subgroup (with systolic BP ≥ 140 mmHg considered elevated). Data between groups were compared using chi-square and t tests, where appropriate. RESULTS: A total of 307 patients were included: 145 (47.2%) had a prior history of HTN, 126 (41.4%) had elevated BP, and 89 (61.4%) of those presenting with elevated blood pressure had a previous diagnosis of HTN. Those with less formal education were significantly more likely to present with elevated BP (52.1 vs. 28.8% for those with some high school and 19.2% for those with a college education; p = 0.001). Among those with a history of HTN, only 56 (30.9%) had a normal presenting BP. Those with a history of HTN and normal ED presenting BP were no different from patients with elevated BP when comparing the in duration of HTN, medication compliance, location of usual follow-up care, and HTN-specific illness beliefs. CONCLUSIONS: In this single-center study, two out of every five Jamaican ED patients had elevated presenting BP, the majority of whom had a previous diagnosis of HTN. Among those with a history of HTN, 60% had an elevated presenting BP. The ED can be an important location to identify patients with chronic disease in need of greater disease-specific education. Further studies should evaluate if brief interventions provided by ED medical staff improve HTN control in this patient population.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia diagnosed by tranbronchoscopic cryoprobe biopsy technique.

Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH) remains a poorly understood clinical entity. It is currently classified as a premalignant condition by the World Health Organization (WHO). Symptoms are similar to those associated with obstructive lung disease, including breathlessness and cough. The presentation is often initially ascribed to other diseases such as asthma or chronic obstructive pulmonary disease. Here, we present what we believe is the first described case of DIPNECH diagnosed by transbronchoscopic cryoprobe biopsy. The patient presented with chronic cough, dyspnoea, pulmonary function tests consistent with obstruction, and a computed tomography (CT) scan of chest with multiple nodules. The patient went on to have transbronchoscopic cryoprobe biopsies of the lung, which confirmed the diagnosis of DIPNECH.

Estimating the Public Health Impact of Air Pollution for Informing Policy in the Twin Cities: A Minnesota Tracking Collaboration.

OBJECTIVE: The Minnesota Department of Health and the Minnesota Pollution Control Agency used local air pollution and public health data to estimate the impacts of particulate matter and ozone on population health, to identify disparities, and to inform decisions that will improve health. SETTING: While air quality in Minnesota currently meets federal standards, urban communities are concerned about the impact of air pollution on their health. The Twin Cities (Minneapolis-St Paul) metropolitan area includes 7 counties where fine particulate levels and rates of asthma exacerbations are elevated in some communities. DESIGN: We used the Environmental Protection Agency's BenMAP (Environmental Benefits Mapping and Analysis Program) software, along with local PM2.5 (fine particulate) and ozone ambient concentrations, census and population health data, to calculate impacts for 2008 at the zip code level. The impacts were summed across all zip codes for area-wide estimates. American Community Survey data were used to stratify zip codes by poverty and race for assessment of disparities. MAIN OUTCOME MEASURES: Attributable fraction, attributable rate and counts for all-cause mortality, asthma and chronic obstructive pulmonary disease hospitalizations, asthma emergency department (ED) visits, and cardiovascular disease hospitalizations. RESULTS: In the Twin Cities (2008), air pollution was a contributing cause for an estimated 2% to 5% of respiratory and cardiovascular hospitalizations and ED visits and between 6% and 13% of premature deaths. The elderly (aged 65+ years) experienced the highest air pollution-attributable rates of death and respiratory hospitalizations; children experienced the highest asthma ED visit rates. Geographical and demographic differences in air pollution-attributable health impacts across the region reflected the differences in the underlying morbidity and mortality rates. CONCLUSIONS: Method was effective in demonstrating that changes in air quality can have quantifiable health impacts across the Twin Cities. Key messages and implications from this work were shared with the media, community groups, legislators and the public. The results are being used to inform initiatives aimed at reducing sources of air pollution and to address health disparities in urban communities.

Does the Regulatory Environment Affect Nurse Practitioners' Patterns of Practice or Quality of Care in Health Centers?

OBJECTIVE: To examine the impact of state-granted nurse practitioner (NP) independence on patient-level quality, service utilization, and referrals. DATA SOURCES/STUDY SETTING: The National Ambulatory Medical Care Survey's community health center (HC) subsample (2006-2011). Primary analyses included approximately 6,500 patient visits to 350 NPs in 220 HCs. STUDY DESIGN: Propensity score matching and multivariate regression analysis were used to estimate the impact of state-granted NP independence on each outcome, separately. Estimates were adjusted for sampling weights and NAMCS's complex design. DATA COLLECTION/EXTRACTION METHODS: Every "NP-patient visit unit" was isolated using practitioner and patient visit codes and, using geographic identifiers, assigned to its state-year and that state-year's level of NP independence based on scope of practice policies. Nine outcomes were specified using ICD-9 codes, standardized drug classification codes, and NAMCS survey items. PRINCIPAL FINDINGS: After matching, no statistically significant differences in quality were detected by states' independence status, although NP visits in states with prescriptive independence received more educational services (aIRR 1.66; 95 percent CI 1.09-2.53; p = .02) and medications (aIRR 1.26; 95 percent CI 1.04-1.53; p = .02), and NP visits in states with practice independence had a higher odds of receiving physician referrals (AOR 1.88; 95 percent CI 1.10-3.22; p = .02) than those in restricted states. CONCLUSIONS: Findings do not support a quality-scope of practice relationship.

Intraocular inflammatory mass associated with lens-induced uveitis.

Intraocular inflammatory tumefactions large enough to simulate neoplasms are uncommon. We report a patient with a large intraocular inflammatory mass composed of cells with features of histiocytes and myofibroblasts that was associated with lens-induced uveitis. The spindle cell mass appears to have arisen as an exaggerated response to exposed lens fibers. Although information from immunohistochemistry and cytogenetics has advanced the classification of inflammatory tumefactions, this case highlights the challenges in establishing the nature of these lesions.

Clinical residency training: Is it essential to the Doctor of Nursing Practice for nurse practitioner preparation?

BACKGROUND: The Doctor of Nursing Practice (DNP) degree positions nurse practitioners (NPs) and other advanced practice registered nurses, with clinical competencies similar to other disciplines requiring doctoral education (medicine, physical therapy, psychology, and pharmacy). In addition, all these disciplines also offer residencies. However, nursing is the only discipline that does not require a doctoral degree and/or have a systematic approach to residency training for advanced practice roles. The authors posit that there are critical policy issues to resolve within the nursing profession to clarify the role that clinical residencies should play in transition to DNP practice specifically related to NPs. PURPOSE: The purpose of this article was to (a) describe the context of NP residency models within NP curricula that strengthen the DNP Essentials with an emphasis on Essential VIII and a focus on distinctive clinical specialization, (b) describe the history and policy implications of NP residency programs as well as existing programs that assist transition to practice, and (c) recommend policies for consideration related to DNP NP residencies. METHODS: Literature on nurse practitioner residencies was reviewed. DISCUSSION: While nurse practitioner residencies continue to grow, research is needed regarding outcomes of job satisfaction, clinical competencies, and patient satisfaction. CONCLUSION: The first year of practice for nurse practitioners is a critical period of professional development. It is important to further clarify the need, direction, and program standards. Academically affiliated residencies will facilitate the development and standardization of curricula and competencies to enhance clinical rigor. The partnership between academic units and clinical agencies will pool resources and strengthen nursing in both settings.

Asthma exacerbations and traffic: examining relationships using link-based traffic metrics and a comprehensive patient database.

BACKGROUND: The Rochester Epidemiology Project (REP) is a unique community-based medical record data linkage system that provides individual patient address, diagnosis and visit information for all hospitalizations, as well as emergency department, urgent care and outpatient clinic visits for asthma. Proximity to traffic is known to be associated with asthma exacerbations and severity. Our null hypothesis was that there is no association between residential proximity to traffic and asthma exacerbations over eleven years of REP data. METHODS: Spatial coordinates of the homes of 19,915 individuals diagnosed with asthma were extracted from the REP database. Three metrics of traffic exposure at residences were calculated from link-based traffic count data. We used exploratory statistics as well as logistic and Poisson regression to examine associations between three traffic metrics at the home address and asthma exacerbations. RESULTS: Asthma exacerbations increased as traffic levels near the home increased. Proximity to traffic was a significant predictor of asthma exacerbations in logistic and Poisson regressions controlling for age, gender and block group poverty. CONCLUSIONS: Over eleven years in a comprehensive county-wide data set of asthma patients, and after controlling for demographic effects, we found evidence that living in proximity to traffic increased the risk of asthma exacerbations.

Assessing a New Method for Measuring Fetal Exposure to Mercury: Newborn Bloodspots.

BACKGROUND: Measuring mercury in newborn bloodspots to determine fetal exposures is a novel methodology with many advantages. Questions remain, however, about its reliability as an estimate of newborn exposure to mercury. METHODS: We studied mercury concentrations in paired bloodspots and cord blood from a convenience sample of 48 Minnesota women and infants. RESULTS: The limit of detection for bloodspots was higher than for cord blood (0.7 and 0.3 µg/L in bloodspots and cord blood, respectively) with the result that mercury was detected in only 38% of newborn bloodspots compared to 62% of cord blood samples. The geometric mean mercury concentration in cord blood was 0.6 µg/L. Mercury concentrations were almost uniformly lower in bloodspots than in cord blood (mean ratio (±SD) = 0.85 ± 0.4), their mean value was significantly less than that for the cord blood (p = 0.02), and the two methods were highly correlated (r = 0.82). CONCLUSION: These preliminary findings indicate that newborn bloodspot mercury measurements have utility; however, until bloodspot analyses are more sensitive, they are likely to underestimate in utero exposure.