Nesting nitrogen budgets through spatial and system scales in the Spanish agro-food system over 26 years.

Along its route through the agro-food system nitrogen (N) can be wasted, heightening diverse environmental problems. Geopolitical instabilities affect prices of N fertilisers and livestock feed, challenging production systems and increasing their need to reduce N waste. The analysis of N flows is essential to understanding the agroenvironmental performance of agro-food systems to detect leakages and to design strategies for reducing N pollution while producing feed and food. Sectorial analyses can mislead conclusions, prompting the need for integrated approaches. We present a multiscale analysis of N flows for the 1990-2015 period to identify both the strengths and weaknesses of the Spanish agro-food system. We constructed N budgets at three system scales, namely crop, livestock and the agro-food system, and at two spatial scales: national and regional (50 provinces). The big picture shows a country with increasing crop (575 to 634 GgN/yr) and livestock (138 to 202 GgN/yr, edible) production and nitrogen use efficiency improvements, especially for certain crop and livestock categories. Nevertheless, this falls short of reducing agricultural surpluses (812 GgN/yr) and external dependency, which is closely related to the externalisation of certain environmental impacts (system NUE, from 31 % to 19 % considering externalisation). The regional picture shows the contrasted operation between provinces, assigned to three agro-food system categories: fuelled by synthetic fertiliser (29 provinces), grassland inputs to livestock (5 provinces) or the net import of feed (16 provinces). Regional specialisation on crop or livestock production was reinforced, hampering good recirculation of N through livestock feed from regional cropland and their N fertilisation by regional livestock excretion. We conclude that pollution and external dependency need to be further reduced in Spain. To do so, the big picture of the full system is paramount but must be adapted to the regional particularities.

Simulation of winter wheat response to variable sowing dates and densities in a high-yielding environment.

Crop multi-model ensembles (MME) have proven to be effective in increasing the accuracy of simulations in modelling experiments. However, the ability of MME to capture crop responses to changes in sowing dates and densities has not yet been investigated. These management interventions are some of the main levers for adapting cropping systems to climate change. Here, we explore the performance of a MME of 29 wheat crop models to predict the effect of changing sowing dates and rates on yield and yield components, on two sites located in a high-yielding environment in New Zealand. The experiment was conducted for 6 years and provided 50 combinations of sowing date, sowing density and growing season. We show that the MME simulates seasonal growth of wheat well under standard sowing conditions, but fails under early sowing and high sowing rates. The comparison between observed and simulated in-season fraction of intercepted photosynthetically active radiation (FIPAR) for early sown wheat shows that the MME does not capture the decrease of crop above ground biomass during winter months due to senescence. Models need to better account for tiller competition for light, nutrients, and water during vegetative growth, and early tiller senescence and tiller mortality, which are exacerbated by early sowing, high sowing densities, and warmer winter temperatures.

[Study of workers with vulnerability to COVID-19 in teaching staff of Palma de Mallorca.] / Estudio de la vulnerabilidad a COVID-19 en personal docente de Palma de Mallorca.

OBJECTIVE: During this year, in relation to the health crisis triggered by COVID-19, a total of 532 people have been evaluated by the Teaching Staff Prevention Service of the Ministry of Education and Vocational Training of the Balearic Islands, most of them which were women, as is usually the case in the teaching community. After some time of reflection, there are some questions that we would like to answer, such as knowing the most frequent pathologies with vulnerability to COVID-19 in our service and the work adaptations made. To answer these questions, we carried out this descriptive study. METHODS: This study was made with sample of 508 people from Prevention Service of teachers during the course 2020-2021. We studied differences between sex, age, job, developed actuation, pathology. Statistical calculations were performed with Libreoffice's numerical calculation processor. RESULTS: From the several pathologies included among the vulnerable groups to COVID-19 according to the Health Ministry, the one with more prevalence is chronic pulmonar disease (25.39%). CONCLUSIONS: The pulmonar disease is the most frequent in our study, but due to the presence of many workers with pluripathology, this datum should be keepen in mind with some caution.

OBJETIVO: Durante este año, en relación a la crisis sanitaria desencadenada por la COVID-19, desde el Servicio de Prevención del Personal Docente de la Conselleria de Educación y Formación Profesional de las Islas Baleares se han evaluado un total de 532 personas, la mayoría de las cuales eran mujeres, como suele ser en el colectivo de la docencia. Existen ciertas cuestiones a las que intentamos dar respuesta, como es saber las patologías más frecuentes que han hecho reconocer una vulnerabilidad a COVID-19 en nuestro servicio y las consecuencias que han tenido en cuanto a las adaptaciones laborales establecidas. Para dar respuesta a estas cuestiones, realizamos este estudio descriptivo. METODOS: El estudio se desarrolló con una muestra de 508 personas del Servicio de Prevención del Personal Docente de Palma durante el curso 2020-2021. Para lo cual evaluamos las diferencias según sexo, edad, puesto de trabajo, actuación llevada a cabo y patología. Los cálculos estadísticos se realizaron con el procesador de cálculo numérico de Libreoffice. RESULTADOS: Del desglose de las patologías incluidas dentro de los grupos vulnerables frente a COVID-19 según el Ministerio de Sanidad, la más prevalente fue la enfermedad pulmonar crónica (25,39%). CONCLUSIONES: La patología pulmonar fue la más frecuente de nuestro estudio, pero debido a la presencia de muchos trabajadores con pluripatología, este dato debe ser tenido en cuenta con cierta cautela.

Complications With Time-to-Ambulation Following Skin Grafting for Burn Patients: A Meta-Analysis and Systematic Review.

Accurate models are fundamental tools for risk-stratification, therapy guidance, resource-allocation, and comparative-effectiveness research. Enhanced recovery after surgery (ERAS) protocols increase early post-operative recovery rates in surgical patients. The uniqueness of burn injuries and their post-operative care requires developing a specialized protocol, enhanced recovery after burn surgery (ERABS). To develop such a protocol, we need to examine post-operative practices, like time-to-ambulation, and their effect on post-operative complications. We evaluated evidence supporting complications such as graft loss, thrombolytic events, and pain, relating to the timing of post-surgical ambulation. A literature search on early-ambulation and skin-grafting was performed by two independent researchers. No time limit was set for publication dates. Relevant studies relating to ambulation of adult burn patients (>18 years of age) and their post-surgical outcomes were captured using search terms. Of the 888 studies retrieved from the query, 11 were used for review and meta-analysis. Our review revealed minimal evidence exists relating to thromboembolic events and time-to-ambulation in post-operative burn patients. The evidence that does exist found no significant difference in the number of events between early- and late-ambulation groups. Increased pain during rest and ambulation was shown in patients with delayed ambulation after five or more days. One study found an increased infection rate in late-ambulatory patients. The primary conclusion from this review is that further studies must be performed examining the correlation of thromboembolic events and infection rates with post-operative time-to-ambulation. Based on current literature, early ambulation should be included as part of a future model of ERABS.

Generalized Structure Functions and Multifractal Detrended Fluctuation Analysis Applied to Vegetation Index Time Series: An Arid Rangeland Study.

Estimates suggest that more than 70% of the world's rangelands are degraded. The Normalized Difference Vegetation Index (NDVI) is commonly used by ecologists and agriculturalists to monitor vegetation and contribute to more sustainable rangeland management. This paper aims to explore the scaling character of NDVI and NDVI anomaly (NDVIa) time series by applying three fractal analyses: generalized structure function (GSF), multifractal detrended fluctuation analysis (MF-DFA), and Hurst index (HI). The study was conducted in four study areas in Southeastern Spain. Results suggest a multifractal character influenced by different land uses and spatial diversity. MF-DFA indicated an antipersistent character in study areas, while GSF and HI results indicated a persistent character. Different behaviors of generalized Hurst and scaling exponents were found between herbaceous and tree dominated areas. MF-DFA and surrogate and shuffle series allow us to study multifractal sources, reflecting the importance of long-range correlations in these areas. Two types of long-range correlation appear to be in place due to short-term memory reflecting seasonality and longer-term memory based on a time scale of a year or longer. The comparison of these series also provides us with a differentiating profile to distinguish among our four study areas that can improve land use and risk management in arid rangelands.

The First Reported Case of Metoprolol-Induced Pemphigus Foliaceus in the United States: A Critical Report and Review of Literature.

Pemphigus is a rare family of autoimmune disorders characterized by epithelial and mucosal blisters. Pemphigus foliaceus (PF) commonly affects the scalp, face, and trunk. Lesions often arise as superficial blisters and develop into scaly, crusted erosions. Management includes corticosteroids with immunosuppressants. Novel therapies include immunoadsorption and active clinical trials. We present the only reported case of metoprolol-induced PF in the United States (US), with an extremely complicated hospital course.  A 66-year-old male patient with a history of hypertension, diabetes, and hyperlipidemia presented to his doctor with a blistering, pruritic rash that started after switching to metoprolol for hypertension treatment.  PF is very rare in North America. Given its solely superficial penetration, it creates no direct fatal complication. However, the developing blisters and subsequent wounds are susceptible to a wide array of secondary infections, which can be life-threatening.

Two False Negative Test Results in a Symptomatic Patient with a Confirmed Case of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and Suspected Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN).

The recent outbreak of COVID-19 has put significant strain on the current health system and has exposed dangers previously overlooked. The pathogen known as severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), is notable for attacking the pulmonary system causing acute respiratory distress, but it can also severely affect other systems in at-risk individuals including cardiovascular compromise, gastrointestinal distress, acute kidney injury, coagulopathies, cutaneous manifestations, and ultimately death from multi-organ failure. Unfortunately, the reliability of negative test results is questionable and the high infectious burden of the virus calls for extended safety precautions, especially in symptomatic patients. We present a confirmed COVID-19 case that was transferred to our burn center for concern of Steven Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) overlap syndrome after having two negative confirmatory COVID-19 tests at an outside hospital. A 58-year-old female with a history of morbid obesity, HTN, gout, CML managed with imatinib, and chronic kidney disease presented as a transfer from a community hospital to our burn center. The patient was admitted to her community hospital with febrile, acute respiratory distress. Imaging and clinical presentation was consistent with COVID-19 and lab tests for the pathogen were ordered. During observation, while waiting for results, she was placed under patient under investigation (PUI) protocol. Once negative results were obtained, the PUI protocol was abandoned despite ongoing symptoms. Subsequently, dermatological symptoms developed and transfer to our burn center was initiated. After a second negative test result, the symptomatic patient was transferred to our burn center for expert wound management. Given the lack of resolve of respiratory symptoms and concern for the burn patient population, the patient was placed in PUI protocol and an internal COVID-19 was ordered. The patient's initial exam under standard COVID-19 airborne precautions revealed 5% total body surface area of loss of epidermis affecting bilateral thighs, bilateral arms, and face. A dermatopathological biopsy suggested a bullous drug reaction with an erythema multiform-like reaction pattern versus SJS/TEN. Moreover, the internal COVID-19 test returned positive. The delayed positive test results and complicated hospital course with our patient required us to scale back and notify every patient and staff member whom they came in contact with, across multiple institutions. We suggest that whenever a suspected COVID-19 patient is transferred to a specialized center, they should be isolated and re-checked before joining the new patient population for treatment of the unique condition.

Magnetic Resonance Imaging to Differentiate the Histology of Testicular Masses: A Systematic Review of Studies With Pathologic Confirmation.

Ultrasound is the imaging modality of choice to evaluate scrotal pathology. However, differentiating malignant and benign testicular tumors is not always possible, and there is interest in evaluating magnetic resonance imaging (MRI) as a potential adjunct for diagnosis. We conducted a systematic review and found 9 studies related to MRI diagnosis of testicular masses. A total of 220 testicular masses (217 patients) undergoing MRI were identified. Notable findings include malignant masses having a lower apparent diffusion coefficient compared to benign masses (3 of 4 studies) and that quantitative enhancement patterns could differentiate Leydig cell tumors from germ cell tumors in 2 studies. While there were some distinct qualitative characterizations of testicular masses on MRI, further research is needed to identify appropriate clinical contexts for use.

Improving the Yields and Reaction Rate in the Ethanolysis of Soybean Oil by Using Mixtures of Lipase CLEAs.

Due to the heterogeneity of oils, the use of mixtures of lipases with different activity for a large number of glycerol-linked carboxylic acids that compose the substrate has been proposed as a better alternative than the use of one specific lipase preparation in the enzymatic synthesis of biodiesel. In this work, mixtures of lipases from different sources were evaluated in their soluble form in the ethanolysis of soybean oil. A mixture of lipases (50% of each lipase, in activity basis) from porcine pancreas (PPL) and Thermomyces lanuginosus lipase (TLL) gave the highest fatty acid ethyl ester (FAEE) yield (around 20 wt.%), while the individual lipases gave FAEE yields 100 and 5 times lower, respectively. These lipases were immobilized individually by the cross-linked enzyme aggregates (CLEAs) technique, yielding biocatalysts with 89 and 119% of expressed activity, respectively. A mixture of these CLEAs (also 50% of each lipase, in activity basis) gave 90.4 wt.% FAEE yield, while using separately CLEAs of PPL and TLL, the FAEE yields were 84.7 and 75.6 wt.%, respectively, under the same reaction conditions. The mixture of CLEAs could be reused (five cycles of 6 h) in the ethanolysis of soybean oil in a vortex flow-type reactor yielding an FAEE yield higher than 80% of that of the first batch.

A School-Based Intervention Using Health Mentors to Address Childhood Obesity by Strengthening School Wellness Policy.

PURPOSE AND OBJECTIVES: The objective of our study was to strengthen wellness policy in Title 1 schools by implementing a mentored behavior-change model that extends the continuum of care from academic to community settings and mobilizes existing public resources in accordance with US Preventive Services Task Force screening guidelines for childhood obesity management. INTERVENTION APPROACH: Team Kid POWER! (KiPOW!) health mentors (students and trainees in medical and health-related fields) in 2 geographically and demographically distinct school districts, the District of Columbia and Orange County, California, delivered standardized health curricular modules to fifth grade classrooms, modeled healthy eating behaviors during school lunchtime, and engaged in active play at recess. EVALUATION METHODS: Initial interventions in the the District of Columbia and Orange County delivered 10 sessions in which all participants received the intervention. Two subsequent interventions in Orange County, for 5 weeks (Lite) and 10 weeks (Full), included controls. Pre-post measurements of body mass index (BMI) and blood pressure were documented in all participants. A mixed linear regression model, which included a random effect for each school, estimated differences between Full and Lite interventions compared with controls, adjusting for site, sex, and baseline status of the dependent variable. RESULTS: KiPOW! Full, but not KiPOW! Lite, was associated with a modest reduction in BMI percentile compared with control (KiPOW! Full, P = .04; KiPOW! Lite, P = .41), especially in Orange County (P < .001). Systolic blood pressure improved in Full (P < .046) more than in Lite interventions (P = .11), and diastolic blood pressure improved in both Full (P = .02) and Lite (P = .03) interventions. Annual renewal of the school and volunteer commitment needed to maintain KiPOW! was found to be sustainable. IMPLICATIONS FOR PUBLIC HEALTH: KiPOW! is a generalizable academic-community partnership promoting face-to-face contact between students and trusted health mentors to reinforce school wellness policies and foster youth confidence in decision-making about nutrition- and activity-related behaviors to achieve reduced BMI percentile and lowered blood pressure.

Mitigation efforts will not fully alleviate the increase in water scarcity occurrence probability in wheat-producing areas.

Global warming is expected to increase the frequency and intensity of severe water scarcity (SWS) events, which negatively affect rain-fed crops such as wheat, a key source of calories and protein for humans. Here, we develop a method to simultaneously quantify SWS over the world's entire wheat-growing area and calculate the probabilities of multiple/sequential SWS events for baseline and future climates. Our projections show that, without climate change mitigation (representative concentration pathway 8.5), up to 60% of the current wheat-growing area will face simultaneous SWS events by the end of this century, compared to 15% today. Climate change stabilization in line with the Paris Agreement would substantially reduce the negative effects, but they would still double between 2041 and 2070 compared to current conditions. Future assessments of production shocks in food security should explicitly include the risk of severe, prolonged, and near-simultaneous droughts across key world wheat-producing areas.

Decline in climate resilience of European wheat.

Food security relies on the resilience of staple food crops to climatic variability and extremes, but the climate resilience of European wheat is unknown. A diversity of responses to disturbance is considered a key determinant of resilience. The capacity of a sole crop genotype to perform well under climatic variability is limited; therefore, a set of cultivars with diverse responses to weather conditions critical to crop yield is required. Here, we show a decline in the response diversity of wheat in farmers' fields in most European countries after 2002-2009 based on 101,000 cultivar yield observations. Similar responses to weather were identified in cultivar trials among central European countries and southern European countries. A response diversity hotspot appeared in the trials in Slovakia, while response diversity "deserts" were identified in Czechia and Germany and for durum wheat in southern Europe. Positive responses to abundant precipitation were lacking. This assessment suggests that current breeding programs and cultivar selection practices do not sufficiently prepare for climatic uncertainty and variability. Consequently, the demand for climate resilience of staple food crops such as wheat must be better articulated. Assessments and communication of response diversity enable collective learning across supply chains. Increased awareness could foster governance of resilience through research and breeding programs, incentives, and regulation.

Diverging importance of drought stress for maize and winter wheat in Europe.

Understanding the drivers of yield levels under climate change is required to support adaptation planning and respond to changing production risks. This study uses an ensemble of crop models applied on a spatial grid to quantify the contributions of various climatic drivers to past yield variability in grain maize and winter wheat of European cropping systems (1984-2009) and drivers of climate change impacts to 2050. Results reveal that for the current genotypes and mix of irrigated and rainfed production, climate change would lead to yield losses for grain maize and gains for winter wheat. Across Europe, on average heat stress does not increase for either crop in rainfed systems, while drought stress intensifies for maize only. In low-yielding years, drought stress persists as the main driver of losses for both crops, with elevated CO2 offering no yield benefit in these years.

1,3-Regiospecific ethanolysis of soybean oil catalyzed by crosslinked porcine pancreas lipase aggregates.

The preparation of crosslinked aggregates of pancreatic porcine lipase (PPL-CLEA) was systematically studied, evaluating the influence of three precipitants and two crosslinking agents, as well as the use of soy protein as an alternative feeder protein on the catalytic properties and stability of the immobilized PPL. Standard CLEAs showed a global yield (CLEA' observed activity/offered total activity) of less than 4%, whereas with the addition of soy protein (PPL:soy protein mass ratio of 1:3) the global yield was approximately fivefold higher. The CLEA of PPL prepared with soy protein as feeder (PPL:soy protein mass ratio of 1:3) and glutaraldehyde as crosslinking reagent (10 µmol of aldehyde groups/mg of total protein) was more active mainly because of the reduced enzyme leaching in the washing step. This CLEA, named PPL-SOY-CLEA, had an immobilization yield around 60% and an expressed activity around 40%. In the ethanolysis of soybean oil, the PPL-SOY-CLEA yielded maximum fatty acid ethyl ester (FAEE) concentration around 12-fold higher than that achieved using soluble PPL (34 h reaction at 30°C, 300 rpm stirring, soybean oil/ethanol molar ratio of 1:5) with an enzyme load around 2-fold lower (very likely due to free enzyme inactivation). The operational stability of the PPL-SOY-CLEA in the ethanolysis of soybean oil in a vortex flow type reactor showed that FAEE yield was higher than 50% during ten reaction cycles of 24 h. This reactor configuration may be an attractive alternative to the conventional stirred reactors for biotransformations in industrial plants using carrier-free biocatalysts. © 2018 American Institute of Chemical Engineers Biotechnol. Prog., 34:910-920, 2018.

Assessing cover crop management under actual and climate change conditions.

The termination date is recognized as a key management factor to enhance cover crops for multiple benefits and to avoid competition with the following cash crop. However, the optimum date depends on annual meteorological conditions, and climate variability induces uncertainty in a decision that needs to be taken every year. One of the most important cover crop benefits is reducing nitrate leaching, a major concern for irrigated agricultural systems and highly affected by the termination date. This study aimed to determine the effects of cover crops and their termination date on the water and N balances of an irrigated Mediterranean agroecosystem under present and future climate conditions. For that purpose, two field experiments were used for inverse calibration and validation of the WAVE model (Water and Agrochemicals in the soil and Vadose Environment), based on continuous soil water content data, soil nitrogen content and crop measurements. The calibrated and validated model was subsequently used in advanced scenario analysis under present and climate change conditions. Under present conditions, a late termination date increased cover crop biomass and subsequently soil water and N depletion. Hence, preemptive competition risk with the main crop was enhanced, but a reduction of nitrate leaching also occurred. The hypothetical planting date of the following cash crop was also an important tool to reduce preemptive competition. Under climate change conditions, the simulations showed that the termination date will be even more important to reduce preemptive competition and nitrate leaching.

Contribution of crop model structure, parameters and climate projections to uncertainty in climate change impact assessments.

Climate change impact assessments are plagued with uncertainties from many sources, such as climate projections or the inadequacies in structure and parameters of the impact model. Previous studies tried to account for the uncertainty from one or two of these. Here, we developed a triple-ensemble probabilistic assessment using seven crop models, multiple sets of model parameters and eight contrasting climate projections together to comprehensively account for uncertainties from these three important sources. We demonstrated the approach in assessing climate change impact on barley growth and yield at Jokioinen, Finland in the Boreal climatic zone and Lleida, Spain in the Mediterranean climatic zone, for the 2050s. We further quantified and compared the contribution of crop model structure, crop model parameters and climate projections to the total variance of ensemble output using Analysis of Variance (ANOVA). Based on the triple-ensemble probabilistic assessment, the median of simulated yield change was -4% and +16%, and the probability of decreasing yield was 63% and 31% in the 2050s, at Jokioinen and Lleida, respectively, relative to 1981-2010. The contribution of crop model structure to the total variance of ensemble output was larger than that from downscaled climate projections and model parameters. The relative contribution of crop model parameters and downscaled climate projections to the total variance of ensemble output varied greatly among the seven crop models and between the two sites. The contribution of downscaled climate projections was on average larger than that of crop model parameters. This information on the uncertainty from different sources can be quite useful for model users to decide where to put the most effort when preparing or choosing models or parameters for impact analyses. We concluded that the triple-ensemble probabilistic approach that accounts for the uncertainties from multiple important sources provide more comprehensive information for quantifying uncertainties in climate change impact assessments as compared to the conventional approaches that are deterministic or only account for the uncertainties from one or two of the uncertainty sources.

Inequalities in Specialist Hand Surgeon Distribution across the United States.

BACKGROUND: Unequal access to hospital specialists for emergency care is an issue in the United States. The authors sought to describe the geographic distribution of specialist hand surgeons and associated factors in the United States. METHODS: Geographic distributions of surgeons holding a Subspecialty Certificate in Surgery of the Hand and hand surgery fellowship positions were identified from the American Board of Medical Specialties Database and the literature (2013), respectively. State-level population and per capita income were ascertained using U.S. Census data. Variations in hand trauma admissions were determined using Healthcare Cost and Utilization Project national/state inpatient databases. Risk-adjusted generalized linear models were used to assess independent association between hand surgeon density and hand trauma admission density, fellowship position density, and per capita income. RESULTS: Among 2019 specialist hand surgeons identified, 72.1 percent were orthopedic surgeons, 18.3 percent were plastic surgeons, and 9.6 percent were general surgeons. There were 157 hand surgery fellowship positions nationwide. There were 149,295 annual hand trauma admissions. The national density of specialist hand surgeons and density of trauma admission were 0.6 and 47.6, respectively. The density of specialist hand surgeons varied significantly between states. State-level variations in density of surgeons were independent and significantly associated with median per capita income (p < 0.001) and with density of fellowships (p = 0.014). CONCLUSIONS: Specialist hand surgeons are distributed unevenly across the United States. State-level analyses suggest that states with lower per capita incomes may be particularly underserved, which may contribute to regional disparities in access to emergency hand trauma care.