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Patient-reported outcome measures (PROMs), increasingly used for research and quality measurement, are lauded for their potential to improve patient-centered care, both through aggregate reporting and when integrated into clinical practice. However, there are few published studies of the resultant use of PROMs in clinical practice. This case study describes the implementation and use of PROMS in a Midwestern multispecialty medical group orthopedic practice among patients undergoing total knee and hip surgery. Specifically, rates of PROMs use by care teams are tracked over time once made available in the electronic health record. During this time, the orthopedics department achieved a patient PROMS survey response rate of 68% at baseline, 58% 3 months post-surgery, and 55% 12 months post-surgery. However, these data were only accessed by the care teams for fewer than 1% of associated clinical encounters. This suggests that making PROMs available for care team review in the electronic health record, even when coupled with relatively high response rates from patients and departmental leadership support is not enough to encourage integration of PROMs into clinical care for patients. Additional effort is required to identify barriers to PROMs use in clinical care and to test methods to enhance use.
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Ortopedia , Medidas de Resultados Relatados pelo Paciente , Humanos , Inquéritos e Questionários , Assistência Centrada no Paciente , Projetos de PesquisaRESUMO
The rate-limiting step for diagnostics development is the discovery and validation of biomarker analytes. We describe a new analyte-agnostic and label-free approach based on colorimetric reactions involving type I polymerization photoinitiators. We demonstrate that a chemically diverse array of hydrogels embedded with cleaved type I photoinitiators could act as microreactors, undergoing colorimetric reactions with bound analytes. The colorimetric signatures produced were visually distinctive and readable with a flatbed document scanner. Signatures of a broad range of sample types were accurately differentiated by unsupervised clustering without knowledge of any analytes bound to the array. The principles described have the potential to enable scalable and cost-effective analysis of complex samples.
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Colorimetria , Língua , Polimerização , HidrogéisRESUMO
Reversing ecological degradation through restoration activities is a key societal challenge of the upcoming decade. However, lack of evidence on the effectiveness of restoration interventions leads to inconsistent, delayed, or poorly informed statements of success, hindering the wise allocation of resources, representing a missed opportunity to learn from previous experiences. This study contributes to a better understanding of spatial and temporal dynamics of ecosystem services at ecological restoration sites. We developed a method using Landsat satellite images combined with a Before-After-Control-Impact (BACI) design, and applied this to an arid rural landscape, the Baviaanskloof in South Africa. Since 1990, various restoration projects have been implemented to halt and reverse degradation. We applied the BACI approach at pixel-level comparing the conditions of each intervened pixel (impact) with 20 similar control pixels. By evaluating the conditions before and after the restoration intervention, we assessed the effectiveness of long-term restoration interventions distinguishing their impact from environmental temporal changes. The BACI approach was implemented with Landsat images that cover a 30-year period at a spatial resolution of 30 meter. We evaluated the impact of three interventions (revegetation, livestock exclusion, and the combination of both) on three ecosystem services; forage provision, erosion prevention, and presence of iconic vegetation. We also evaluated whether terrain characteristics could partially explain the variation in impact of interventions. The resulting maps showed spatial patterns of positive and negative effects of interventions on ecosystem services. Intervention effectiveness differed across vegetation conditions, terrain aspect, and soil parent material. Our method allows for spatially explicit quantification of the long-term restoration impact on ecosystem service supply, and for the detailed visualization of impact across an area. This pixel-level analysis is specifically suited for heterogeneous landscapes, where restoration impact not only varies between but also within restoration sites.
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Monitoramento Ambiental/métodos , Recuperação e Remediação Ambiental/métodos , Recuperação e Remediação Ambiental/tendências , Conservação dos Recursos Naturais/métodos , Ecossistema , Meio Ambiente , Humanos , Processamento de Imagem Assistida por Computador/métodos , Imagens de Satélites , Solo , África do SulRESUMO
Good access to resources and opportunities is essential for sustainable development. Improving access, especially in rural areas, requires useful measures of current access to the locations where these resources and opportunities are found. Recent work has developed a global map of travel times to cities with more than 50,000 people in the year 2015. However, the provision of resources and opportunities will differ across the broad spectrum of settlements that range from small towns to megacities, and access to this spectrum of settlement sizes should also be measured. Here we present a suite of nine global travel-time accessibility indicators for the year 2015, at approximately one-kilometre spatial resolution, for a range of settlement size classes. We validated the travel-time estimates against journey times from a Google driving directions application across 1,511 2° × 2° tiles representing 47,812 journeys. We observed very good agreement, though our estimates were more frequently shorter than those from the Google application with a median difference of -13.7 minutes and a median percentage difference of -16.9%.
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Crop pathogens and pests reduce the yield and quality of agricultural production. They cause substantial economic losses and reduce food security at household, national and global levels. Quantitative, standardized information on crop losses is difficult to compile and compare across crops, agroecosystems and regions. Here, we report on an expert-based assessment of crop health, and provide numerical estimates of yield losses on an individual pathogen and pest basis for five major crops globally and in food security hotspots. Our results document losses associated with 137 pathogens and pests associated with wheat, rice, maize, potato and soybean worldwide. Our yield loss (range) estimates at a global level and per hotspot for wheat (21.5% (10.1-28.1%)), rice (30.0% (24.6-40.9%)), maize (22.5% (19.5-41.1%)), potato (17.2% (8.1-21.0%)) and soybean (21.4% (11.0-32.4%)) suggest that the highest losses are associated with food-deficit regions with fast-growing populations, and frequently with emerging or re-emerging pests and diseases. Our assessment highlights differences in impacts among crop pathogens and pests and among food security hotspots. This analysis contributes critical information to prioritize crop health management to improve the sustainability of agroecosystems in delivering services to societies.
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Mudança Climática , Produtos Agrícolas/fisiologia , Abastecimento de Alimentos , Insetos/fisiologia , Ácaros/fisiologia , Plantas Daninhas/fisiologia , Agricultura , Animais , Produtos Agrícolas/microbiologia , Interações Hospedeiro-PatógenoRESUMO
More than two billion people are micronutrient deficient. Polished grains of popular rice varieties have concentration of approximately 2 µg g(-1) iron (Fe) and 16 µg g(-1) zinc (Zn). The HarvestPlus breeding programs for biofortified rice target 13 µg g(-1) Fe and 28 µg g(-1) Zn to reach approximately 30% of the estimated average requirement (EAR). Reports on engineering Fe content in rice have shown an increase up to 18 µg g(-1) in glasshouse settings; in contrast, under field conditions, 4 µg g(-1) was the highest reported concentration. Here, we report on selected transgenic events, field evaluated in two countries, showing 15 µg g(-1) Fe and 45.7 µg g(-1) Zn in polished grain. Rigorous selection was applied to 1,689 IR64 transgenic events for insert cleanliness and, trait and agronomic performances. Event NASFer-274 containing rice nicotianamine synthase (OsNAS2) and soybean ferritin (SferH-1) genes showed a single locus insertion without a yield penalty or altered grain quality. Endosperm Fe and Zn enrichment was visualized by X-ray fluorescence imaging. The Caco-2 cell assay indicated that Fe is bioavailable. No harmful heavy metals were detected in the grain. The trait remained stable in different genotype backgrounds.