Integrated Agricultural Practices and Engineering Technologies Enhance Synergies of Food-Energy-Water Systems in Corn Belt Watersheds.

Interconnected food, energy, water systems (FEWS) require systems level understanding to design efficient and effective management strategies and policies that address potentially competing challenges of production and environmental quality. Adoption of agricultural best management practices (BMPs) can reduce nonpoint source phosphorus (P) loads, but there are also opportunities to recover P from point sources, which could also reduce demand for mineral P fertilizer derived from declining geologic reserves. Here, we apply the Integrated Technology-Environment-Economics Model to investigate the consequences of watershed-scale portfolios of agricultural BMPs and environmental and biological technologies (EBTs) for co-benefits of FEWS in Corn Belt watersheds. Via a pilot study with a representative agro-industrial watershed with high P and nitrogen discharge, we show achieving the nutrient reduction goals in the watershed; BMP-only portfolios require extensive and costly land-use change (19% of agricultural land) to perennial energy grasses, while portfolios combining BMPs and EBTs can improve water quality while recovering P from corn biorefineries and wastewater streams with only 4% agricultural land-use change. The potential amount of P recovered from EBTs is estimated as 2 times as much as the agronomic P requirement in the watershed, showing the promise of the P circular economy. These findings inform solution development based on the combination of agricultural BMPs and EBTs for the cobenefits of FEWS in Corn Belt watersheds.

Proteomic characterization of GSK3ß knockout shows altered cell adhesion and metabolic pathway utilisation in colorectal cancer cells.

Glycogen-specific kinase (GSK3ß) is an integral regulator of the Wnt signalling pathway as well as many other diverse signalling pathways and processes. Dys-regulation of GSK3ß is implicated in many different pathologies, including neurodegenerative disorders as well as many different tumour types. In the context of tumour development, GSK3ß has been shown to play both oncogenic and tumour suppressor roles, depending upon tissue, signalling environment or disease progression. Although multiple substrates of the GSK3ß kinase have been identified, the wider protein networks within which GSK3ß participates are not well known, and the consequences of these interactions not well understood. In this study, LC-MS/MS expression analysis was performed using knockout GSK3ß colorectal cancer cells and isogenic controls in colorectal cancer cell lines carrying dominant stabilizing mutations of ß-catenin. Consistent with the role of GSK3ß, we found that ß-catenin levels and canonical Wnt activity are unaffected by knockout of GSK3ß and therefore used this knockout cell model to identify other processes in which GSK3ß is implicated. Quantitative proteomic analysis revealed perturbation of proteins involved in cell-cell adhesion, and we characterized the phenotype and altered proteomic profiles associated with this. We also characterized the perturbation of metabolic pathways resulting from GSK3ß knockout and identified defects in glycogen metabolism. In summary, using a precision colorectal cancer cell-line knockout model with constitutively activated ß-catenin we identified several of the diverse pathways and processes associated with GSK3ß function.

Effect of a geriatric curriculum on emergency medicine resident attitudes, knowledge, and decision-making.

OBJECTIVES: Despite an increasing number of elderly emergency department (ED) patients, emergency medicine (EM) residency training lacks geriatric-specific curricula. The objective was to determine if a 1-year geriatric curriculum, designed for residents, would affect residents' attitudes, knowledge, and decision-making for older patients seen in the ED. METHODS: The authors created a geriatric curriculum for EM residents composed of six lectures on the following topics: trauma, abdominal pain, transitions of care, medication management, iatrogenic injuries, and confusional states. A second component of the curriculum included seven high-fidelity simulation skills training sessions on aortic aneurysm, salicylate toxicity, drugs of abuse, infection from a posterior pressure ulcer, medication-induced elevated prothrombin time resulting in gastrointestinal bleeding, mesenteric ischemia, and myocardial infarction. Before and after completion of the curriculum, residents were assessed on attitudes toward caring for geriatric patients using a validated survey and knowledge of geriatric principals of care using a 35-question multiple choice test. To determine differences before and after the new curriculum was implemented, the paired t-test was performed on knowledge and attitude scores. ED records were also reviewed for frequency of chemical sedation and urinary catheter placement in patients aged 65 and over, both before and after the educational intervention, as a measure of appropriate decision-making. Appropriateness of urinary catheter placement was determined by two physician reviewers using criteria adapted from the Centers for Disease Control and Prevention indications for appropriate urinary catheter use. Reviewers met to adjudicate any disagreements about appropriateness. Fisher's exact test was used to examine differences in frequency of chemical sedation and urinary catheter placement. RESULTS: Twenty-nine EM residents underwent the training. There was no measured change in attitudes. Knowledge improved from the pre- to posttest with average scores of 58.5 and 68.0%, respectively (p < 0.0001), among the 25 residents who completed both tests. There was no change in the percentage of elderly patients receiving chemical sedation and urinary catheters before and after the curriculum (5.4% vs. 4.5%, p = 0.47; and 7.4% vs. 5.9%, p = 0.3, respectively). The number of inappropriate urinary catheters placed significantly decreased after the curriculum, from 8 of 49 to 1 of 47 (16.3% vs. 2.1%, p = 0.03). CONCLUSIONS: Geriatric educational curricula for EM residents may positively affect knowledge base and appropriate decision-making when working with older adults in the ED. These educational enhancements may place elderly patients at less risk of adverse outcomes.

¿Cómo abordar a un paciente con apnea del sueño? / How to treat sleep apnea patient?

El Síndrome de Apnea Hipoapnea Obstructiva del Sueño (SAHOS) es un trastorno frecuente, crónico y de evolución progresiva. Se asocia a mayor morbilidad cardiovascular, neurocognitiva y metabólica, riesgo de accidentes, mala calidad de vida y mortalidad aumentada (1). Por su alta prevalencia e identificación de factores de riesgo, se puede lograr un enfoque multidisciplinario encaminado a realizar una historia clínica completa, que incluya tanto una revisión exhaustiva de los antecedentes como un examen físico completo, los cuales lograrían garantizar un manejo y tratamiento adecuados. Este trastorno ha generado un gran impacto en salud pública, debido a los altos costos que genera y también por las múltiples patologías asociadas que lo acompañan. Recientes estudios lo consideran como parte de una enfermedad crónica, y por esto se ha despertado gran interés en el diagnóstico y tratamiento adecuado por parte de los profesionales de la salud, en este caso cardiólogos, neumólogos, neurólogos, otorrinolaringólogos y psiquiatras (3). El propósito de este artículo es realizar un enfoque práctico de cómo abordar a un paciente con apnea del sueño en nuestra consulta médica diaria, como especialistas basados en la evidencia actual de la medicina...

Obstructive Sleep Apnea Syndrome (OSAS) is a common chronic and progressive disorder. It has cardiovascular, neurocognitive and metabolic consequences. Also has increased risk of accident, poor quality of life and higher mortality. Because of its high prevalence and identification of risk factors it is possible to achieve a multidisciplinary approach aimed at performing a complete medical history that includes both an exhaustive review as a full physical examination, which would achieve a proper management and treatment. This condition has generated a large impact on public health due to the high costs it generates, as well as the many associated pathologies that accompany it. Recent studies considered it as part of a chronic disease, this has aroused great interest in the diagnosis and treatment by health professionals, in this case cardiologists, neumologists, neurologists, psychiatrists and otolaryngologists (3). The purpose of this article is to make a practical approach of how to approach a patient with sleep apnea in our daily medical practice as specialists based on current medical evidence...