Impact of climate change on greenhouse gas emissions and water balance in a dryland-cropping region with variable precipitation.

Wheat covers a significant fraction of the US Pacific Northwest (PNW) dryland agriculture. Past studies have suggested that management practices can differentially affect productivity and emission of greenhouse gases (GHGs) across the different agro-ecological Zones (AEZs) in PNW. In this study we used CropSyst, a biophysically-based cropping systems model that simulates crop processes and water and nitrogen cycles, with the purpose of evaluating relevant scenarios and contributing analyses to inform adaptation and mitigation strategies aimed at reducing and managing the risks of climate change. We compared the baseline historical period of 1980-2010 with three future periods: 2015-2045 (2030s), 2035-2065 (2050s), and 2055-2085 (2070s). The uncertainty of the future climate was captured using 12 general circulation models (GCMs) forced with two representative carbon dioxide concentration pathways (RCP 4.5 and 8.5). The study region was divided into three AEZs: crop-fallow (CF), continuous cropping to fallow transition (CCF), and continuous cropping (CC). The results indicated that areas with higher precipitation, N fertilization, and mineralization produced more N2O emissions during both baseline and future periods. The average annual N2O emission during the baseline period was between 1.8 and 4.1 kg ha-1 depending on AEZ. The overall N2O emission showed decreasing future trends from 2030s to 2070s which resulted from a higher proportion of N used by crops. From 2015 to 2085 under RCP 4.5, the average N2O emission was between 1.8 and 4.4 kg ha-1 year-1. They are slightly higher under RCP 8.5 since it is a warmer scenario. The soil organic carbon (SOC) content decreased during the baseline period while SOC did not reach equilibrium with the cropping systems considered in the study. SOC decreased during the future periods as well, with rate of change ranging from -146 to -352 kg ha-1year-1 depending on AEZ and RCP. Warming increased SOC oxidation in future scenarios, but after an initial increase of SOC losses during the 2030s period, the rate of SOC losses decreased in the 2050s, and more so in the 2070s as SOC and carbon input reached equilibrium with losses. Higher carbon input resulted from higher biomass production under elevated CO2 scenarios. The total GHG emissions were 1.95, 3.16 and 4.84 Mg CO2-equivalent ha-1year-1 under RCP 4.5, and 1.99, 3.43 and 5.49 Mg CO2-equivalent ha-1year-1 under RCP 8.5 during 2070s in CF, CCF and CC respectively, with N2O accounting for about 81% of total GHG emissions.

Supply chains for processed potato and tomato products in the United States will have enhanced resilience with planting adaptation strategies.

Food systems are increasingly challenged to meet growing demand for specialty crops due to the effects of climate change and increased competition for resources. Here, we apply an integrated methodology that includes climate, crop, economic and life cycle assessment models to US potato and tomato supply chains. We find that supply chains for two popular processed products in the United States, French fries and pasta sauce, will be remarkably resilient, through planting adaptation strategies that avoid higher temperatures. Land and water footprints will decline over time due to higher yields, and greenhouse gas emissions can be mitigated by waste reduction and process modification. Our integrated methodology can be applied to other crops, health-based consumer scenarios (fresh versus processed) and geographies, thereby informing decision-making throughout supply chains. Employing such methods will be essential as food systems are forced to adapt and transform to become carbon neutral due to the imperatives of climate change.

Novel multimodel ensemble approach to evaluate the sole effect of elevated CO2 on winter wheat productivity.

Elevated carbon-dioxide concentration [eCO2] is a key climate change factor affecting plant growth and yield. Conventionally, crop modeling work has evaluated the effect of climatic parameters on crop growth, without considering CO2. It is conjectured that a novel multimodal ensemble approach may improve the accuracy of modelled responses to eCO2. To demonstrate the applicability of a multimodel ensemble of crop models to simulation of eCO2, APSIM, CropSyst, DSSAT, EPIC and STICS were calibrated to observed data for crop phenology, biomass and yield. Significant variability in simulated biomass production was shown among the models particularly at dryland sites (44%) compared to the irrigated site (22%). Increased yield was observed for all models with the highest average yield at dryland site by EPIC (49%) and lowest under irrigated conditions (17%) by APSIM and CropSyst. For the ensemble, maximum yield was 45% for the dryland site and a minimum 22% at the irrigated site. We concluded from our study that process-based crop models have variability in the simulation of crop response to [eCO2] with greater difference under water-stressed conditions. We recommend the use of ensembles to improve accuracy in modeled responses to [eCO2].

Weighting the Parameters, a Response to Bancel׳s "Searching for Global Consciousness: A Seventeen Year Exploration".

This brief report is a response to the article by Peter Bancel entitled "Searching for Global Consciousness: A Seventeen Year Exploration" in which he compares a goal orientation (GO) model with a field-like model he refers to as global consciousness (GC). He first attempts to exclude the latter, and then presents selected tests that compare the models. While the article appears to provide support for Bancel׳s conclusion that GC cannot explain the data and must be supplanted by GO, there are good reasons to believe this conclusion is premature at best. I address the vulnerable assumptions underlying Bancel׳s rejection of GC, and then provide multiple examples of parametric structure in the data, which cannot be attributed to GO, but are amenable to explanation by field-like models.

Stress induction in the bacteria Shewanella oneidensis and Deinococcus radiodurans in response to below-background ionizing radiation.

PURPOSE: The 'Linear no-threshold' (LNT) model predicts that any amount of radiation increases the risk of organisms to accumulate negative effects. Several studies at below background radiation levels (4.5-11.4 nGy h(-1)) show decreased growth rates and an increased susceptibility to oxidative stress. The purpose of our study is to obtain molecular evidence of a stress response in Shewanella oneidensis and Deinococcus radiodurans grown at a gamma dose rate of 0.16 nGy h(-1), about 400 times less than normal background radiation. MATERIALS AND METHODS: Bacteria cultures were grown at a dose rate of 0.16 or 71.3 nGy h(-1) gamma irradiation. Total RNA was extracted from samples at early-exponential and stationary phases for the rt-PCR relative quantification (radiation-deprived treatment/background radiation control) of the stress-related genes katB (catalase), recA (recombinase), oxyR (oxidative stress transcriptional regulator), lexA (SOS regulon transcriptional repressor), dnaK (heat shock protein 70) and SOA0154 (putative heavy metal efflux pump). RESULTS: Deprivation of normal levels of radiation caused a reduction in growth of both bacterial species, accompanied by the upregulation of katB, recA, SOA0154 genes in S. oneidensis and the upregulation of dnaK in D. radiodurans. When cells were returned to background radiation levels, growth rates recovered and the stress response dissipated. CONCLUSIONS: Our results indicate that below-background levels of radiation inhibited growth and elicited a stress response in two species of bacteria, contrary to the LNT model prediction.

Measurement properties of the Brazilian Portuguese version of the MedRisk instrument for measuring patient satisfaction with physical therapy care.

STUDY DESIGN: Clinical measurement study. OBJECTIVES: To translate and cross-culturally adapt the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS) into Brazilian Portuguese and to test its measurement properties. BACKGROUND: To date, there is no standardized instrument for measuring patient satisfaction with physical therapy care in Brazil. METHODS: The MRPS was translated and cross-culturally adapted into Brazilian Portuguese. Patients completed the MRPS and a global change measure after 5 or more treatment visits. A subset of patients also completed the instrument a second time, 24 to 48 hours after the first assessment. We evaluated factorial validity, internal consistency, reproducibility, construct validity, and ceiling and floor effects. RESULTS: Three hundred three patients with different musculoskeletal conditions receiving physical therapy care in Brazil participated in this study. A 3-factor solution labeled as interpersonal, convenience and efficiency, and patient education provided the best factor loadings. Cronbach alpha coefficients ranged from .63 to .77, intraclass correlation coefficients ranged from 0.64 to 0.79, and standard errors of measurement ranged from 0.86 to 1.75 points. Thirteen items of the MRPS were moderately correlated with the global measure of change. A large ceiling effect was detected. CONCLUSION: Although we did not fully achieve the measurement properties suggested by the guidelines, we believe that the MRPS can be used among Brazilian Portuguese-speaking patients. Some differences with regard to factor structure of the Brazilian Portuguese MPRS compared with the English version were observed. The reason for this is likely a combination of cultural aspects, differences in clinical settings, and patient expectation.

Differences among health care settings in utilization and type of physical rehabilitation administered to patients receiving workers' compensation for musculoskeletal disorders.

INTRODUCTION: There is a paucity of data describing the relationship between practice setting and the delivery of physical rehabilitation to injured workers. PURPOSE: To determine differences in the number of visits, the number of treatment units, and the proportion of billing for physical agents over an episode of care between different practice settings' providing physical rehabilitation to patients receiving workers' compensation for a musculoskeletal problem. METHODS: A large administrative database was evaluated retrospectively. Practice settings were classified as physician office, corporate physical therapy clinic, occupational medicine clinic, hospital-based outpatient clinic, or private physical therapy practice. RESULTS: 70,306 subjects (72.7 % male; mean age = 44.6, SD = 11.8 years) were included in this study. Corporate physical therapy clinics had the highest mean values for total visits (13.1, SD = 12.7) and for total units (66.8, SD = 85.5), and the lowest mean values for proportion of physical agents during the episode of care (.22, SD = .18). Occupational medicine clinics had the lowest mean values for total visits (6.8, SD = 7.9) and for total units (30.4, SD = 36.5), and the highest mean value for proportion of physical agents during the episode of care (.41, SD = .22). When controlling for ICD-9-CM codes, body-part treated, surgical status, and geographical region there were small changes in effect size; however, the significance and directionality of differences between practice settings were not changed. CONCLUSIONS: There were significant differences in billing for physical rehabilitation services between practice settings for patients receiving workers' compensation. Corporate physical therapy clinics billed for more total visits and total units over an episode of care than did other practice settings; however they also billed for a lower proportion of physical agents indicating a greater use of those interventions supported by evidence-based guidelines (exercise and manual therapy) compared to other practice settings.

Intercultural comparison of patient satisfaction with physiotherapy care in Australia and Korea: an exploratory factor analysis.

OBJECTIVES: The aim of this study was to conduct a cross-cultural comparison of the factors that influence patient satisfaction with musculoskeletal physiotherapy care in Australia and Korea. METHODS: Prospective studies were conducted in Australia and Korea. Patient satisfaction data were collected using the MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) from a total of 1666 patients who were attending clinics for physiotherapy treatment of a musculoskeletal condition. Exploratory factor analysis was conducted to identify factors determining patient satisfaction in each cohort. RESULTS: A four-factor solution for the MRPS was found for the Australian and Korean data sets, explaining 61 and 55% of the variance respectively. Communication and respect, convenience and quality time and person-focused care were factors common to both countries. One factor unique to Korea was courtesy and propriety. For both cultures, global patient satisfaction was significantly but weakly correlated with the outcome of treatment. CONCLUSIONS: The interpersonal aspect of care, namely effective communication and respect from the therapist, appears to be the predominant and universal factor that influences patient satisfaction with physiotherapy care, although other culturally specific factors were identified. Physiotherapists can maximize patient satisfaction with care by addressing those features that uniquely contribute to patient satisfaction in the cultural context in which they are working.

Patient satisfaction with musculoskeletal physiotherapy care in Australia: an international comparison.

OBJECTIVES: (1) To attain a quantitative estimate of patient satisfaction with physiotherapy care for musculoskeletal conditions in Australia; (2) to compare the observed level of patient satisfaction with care in Australia with those from other countries; and (3) to compare factors contributing to patient satisfaction between Australia and the United States (US). METHODS: We conducted a prospective study of 274 patients presenting for physiotherapy treatment of a musculoskeletal disorder in Australian clinics. Patient satisfaction was measured using the 20-item MedRisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MRPS) and satisfaction scores were compared with those from Northern Europe, North America, the United Kingdom, and Ireland. To investigate factors contributing to patient satisfaction between Australia and the US, we compared 20-item MRPS data from Australian and Spanish-speaking US cohorts. RESULTS: Mean Australian MRPS satisfaction score was 4.55 (95% confidence interval: 4.51-4.59) on a scale of 1 to 5, where 1 indicates high dissatisfaction and 5 indicates high satisfaction. This high level of patient satisfaction is consistent with international data. Australian respondents specifically valued interpersonal aspects of care, including advice and information about their condition and an explanation about self-management. The correlation between treatment outcomes and global patient satisfaction was low (r = -0.22). A comparison of data collected from Australia and the US showed that MRPS items regarding interpersonal aspects of care, such as the therapists' communication skills, correlated strongly with global satisfaction in both countries. However, there were other questionnaire items for which the correlation with global satisfaction was significantly different between Australia and the US. CONCLUSIONS: Patient satisfaction with musculoskeletal physiotherapy care in Australia is high and comparable with Northern Europe, North America, the United Kingdom and Ireland. Comparison of data between Australia and the US indicates that while some determinants of patient satisfaction are common, country-specific differences also exist.

Effects of mass consciousness: changes in random data during global events.

A long-term, continuing experiment is designed to assess the possibility that correlations may occur in synchronized random data streams generated during major world events. The project is motivated by numerous experiments that suggest that the behavior of random systems can be altered by directed mental intention, and related experiments showing subtle changes associated with group coherence. Since 1998, the Global Consciousness Project (GCP) has maintained a global network of random number generators (RNGs), recording parallel sequences of random data at 65 sites around the world. A rigorous experiment tests the hypothesis that data from the RNG network will deviate from expectation during times of "global events," defined as transitory episodes of widespread mental and emotional reaction to major world events. An ongoing replication experiment measures correlations across the network during the designated events, and the result from over 345 formal hypothesis tests departs substantially from expectation. A composite statistic for the replication series rejects the null hypothesis by more than six standard deviations. Secondary analyses reveal evidence of a second, independent correlation, as well as temporal and spatial structure in the data associated with the events. Controls exclude conventional physical explanations or experimental error as the source of the measured deviations. The experimental design constrains interpretation of the results: they suggest that some aspect of human consciousness is involved as a source of the effects.

Development and preliminary validation of the MedRisk instrument to measure patient satisfaction with chiropractic care.

OBJECTIVE: The purpose of this study is to provide preliminary information regarding the factor-structure, group- and individual-level reliability, and criterion-referenced validity of measures obtained from the MedRisk Instrument for Measuring Patient Satisfaction with Chiropractic Care. METHOD: Three hundred twenty-three subjects who had completed a course of chiropractic care responded to questionnaire in which they rated their degree of satisfaction from 1 to 5 (1 = very unsatisfied to 5 = very satisfied) for each of 20 items. Factor structure was assessed using item-correlation and exploratory factor analysis. Group-level reliability for single test administration was assessed by calculating Cronbach α, and individual-level reliability was determined using the standard error of measure. Criterion-referenced validity was investigated by comparing the item scores and mean scores of individual factors to global measures of satisfaction. RESULTS: Individual item scores ranged from 3.98 for "Office location was convenient" to 4.77 for "My chiropractor treats me respectfully." The items that were most highly correlated with overall patient satisfaction were "My chiropractor thoroughly explained the treatment I received" (r = 0.77) and "My chiropractor answered all of my questions" (r = 0.71). Exploratory factor analysis suggested a 2-factor solution: a 5-item "internal" factor and a 6-item "external" factor. The mean scores from these factors were correlated with the 2 global measures ranging from r = 0.68 to r = 0.80. The standard error of measure was 0.20 for the internal factor and 0.17 for the external factor. CONCLUSIONS: Preliminary assessment suggests that a 13-item version of the MedRisk instrument provides psychometrically sound measures to assess patient satisfaction with chiropractic care; however, additional confirmatory validation should be performed.

The relationship between patient satisfaction with physical therapy care and global rating of change reported by patients receiving worker's compensation.

This study examined relationships between patient satisfaction with physical therapy care and global rating of change; 1,944 respondents completed the Medrisk Instrument for Measuring Patient Satisfaction with Physical Therapy Care (MR-12) and a nine-point Global Rating of Change Scale (GROC) following a course of physical therapy for a work-related musculoskeletal problem. Ninety percent of all respondents reported being satisfied or very satisfied with their overall care, whereas 70.1% of all respondents indicated they improved following treatment. Respondents who reported improvement had significantly higher scores for all measures of satisfaction (p<0.01) than did those who reported failure to improve; however, both of these groups had mean scores of greater than 4.0 on the MR-12, indicating that respondents were likely to be satisfied or very satisfied with care regardless of perceived change following treatment. Scores>4.0 from the MR-12 had high sensitivity to detect those respondents classified as "improved" (0.87-0.95), but low specificity to differentiate between those who were classified as "improved" and those who were classified as "did not improve" (0.22-0.30). Our findings support the hypothesis that patient satisfaction with care is primarily independent of perceived clinical change.

A systems approach for implementing practice-based learning and improvement and systems-based practice in graduate medical education.

The Accreditation Council for Graduate Medical Education (ACGME) initiated its Outcome Project to better prepare physicians-in-training to practice in the rapidly changing medical environment and mandated assessment of competency in six outcomes, including Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP). Before the initiation of the Outcome Project, these competencies were not an explicit element of most graduate medical education training programs. Since 1999, directors of ACGME-accredited programs nationwide have been challenged to teach and assess these competencies. The authors describe an institution-wide curriculum intended to facilitate the teaching and assessment of PBLI and SBP competencies in the 115 ACGME-accredited residency and fellowship programs (serving 1,327 trainees) sponsored by Mayo School of Graduate Medical Education. Strategies to establish the curriculum in 2005 included development of a Quality Improvement (QI) curriculum Web site, one-on-one consultations with program directors, a three-hour program director workshop, and didactic sessions for residents and fellows on core topics. An interim program director self-assessment survey revealed a 13% increase in perceived ability to measure competency in SBP, no change in their perceived ability to measure competence in PBLI, a 15% increase in their ability to provide written documentation of competence in PBLI, and a 35% increase in their ability to provide written documentation of competence in SBP between 2005 and 2007. Nearly 70% of the programs had trainees participating in QI projects. Further research is needed to evaluate the cost-effectiveness of such a program and to measure its impact on learner knowledge, skills, and attitudes and, ultimately, on patient outcomes.

Discovery of abundant cellulose microfibers encased in 250 Ma Permian halite: a macromolecular target in the search for life on other planets.

In this study, we utilized transmission electron microscopy to examine the contents of fluid inclusions in halite (NaCl) and solid halite crystals collected 650 m below the surface from the Late Permian Salado Formation in southeastern New Mexico (USA). The halite has been isolated from contaminating groundwater since deposition approximately 250 Ma ago. We show that abundant cellulose microfibers are present in the halite and appear remarkably intact. The cellulose is in the form of 5 nm microfibers as well as composite ropes and mats, and was identified by resistance to 0.5 N NaOH treatment and susceptibility to cellulase enzyme treatment. These cellulose microfibers represent the oldest native biological macromolecules to have been directly isolated, examined biochemically, and visualized (without growth or replication) to date. This discovery points to cellulose as an ideal macromolecular target in the search for life on other planets in our Solar System.

Outcomes after a prone lumbar traction protocol for patients with activity-limiting low back pain: a prospective case series study.

OBJECTIVE: To determine outcomes after administration of a prone lumbar traction protocol. DESIGN: Prospective, longitudinal, case series. SETTING: Suburban, chiropractic practice. PARTICIPANTS: A total of 296 subjects with low back pain (LBP) and evidence of a degenerative and/or herniated intervertebral disk at 1 or more levels of the lumbar spine. We excluded patients involved in litigation and those receiving workers' compensation. INTERVENTION: An 8-week course of prone lumbar traction, using the vertebral axial decompression (VAX-D) system, consisting of five 30-minute sessions a week for 4 weeks, followed by one 30-minute session a week for 4 additional weeks. MAIN OUTCOME MEASURES: The numeric pain rating scale and the Roland-Morris Disability Questionnaire (RMDQ) were completed at preintervention, discharge (within 2 weeks of the last visit), and at 30 days and 180 days after discharge. Intention-to-treat strategies were used to account for those subjects lost to follow-up. RESULTS: A total of 250 (84.4%) subjects completed the treatment protocol. On the 30-day follow-up, 247 (83.4%) subjects were available; on the 180-day follow-up, data were available for 241 (81.4%) subjects. We noted significant improvements for all postintervention outcome scores when compared with preintervention scores (P<.01). CONCLUSIONS: Traction applied in the prone position using the VAX-D for 8 weeks was associated with improvements in pain intensity and RMDQ scores at discharge, and at 30 and 180 days after discharge in a sample of patients with activity-limiting LBP. Causal relationships between these outcomes and the intervention should not be made until further study is performed using randomized comparison groups.

Evaluating research studies that address prognosis for patients receiving physical therapy care: a clinical update.

A prognosis is a broad statement that predicts a patient's likely status, or degree of change, at some time in the future. Clinicians are likely to improve the accuracy of their judgments of prognosis by incorporating relevant research findings. In recent years, there has been substantial growth in the number of primary studies and systematic reviews addressing prognosis for people likely to receive physical therapy care. The purpose of this clinical update is to provide a framework for identifying, appraising, and utilizing these research findings to help make prognostic judgments.

Spanish-language version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS): preliminary validation.

BACKGROUND AND PURPOSE: An instrument that provides valid measurements of satisfaction with physical therapy care for Spanish-speaking patients will enhance communication and ensure their representation in quality assurance analyses and research on health care disparities. The purpose of this investigation was to provide preliminary information on the factor structure, group- and individual-level reliability, and criterion-referenced validity of measurements obtained from a Spanish-language version of the MedRisk Instrument for Measuring Patient Satisfaction With Physical Therapy Care (MRPS). SUBJECTS: A total of 203 Spanish-speaking patients in the New York City area participated in this study. METHODS: Consenting subjects completed a 20-item MRPS after discharge from outpatient physical therapy care. Several translators performed "forward" and "backward" translation of the MRPS, followed by consensus agreement on item structure. Factor structure was investigated using item-correlation and exploratory factor analysis. Group-level reliability for single test administration was assessed using the Cronbach alpha, and individual-level reliability was assessed by calculating the standard error of the measure (SEM). Concurrent validity was tested by comparing the item scores and mean scores of factors to global measures of satisfaction. RESULTS: The means of individual item scores (1-5) ranged from 3.22 for "I did not wait too long" to 4.80 for "My therapist treated me respectfully." There were no sex-based differences in item scores. Exploratory factor analysis suggested a 2-factor solution: a 7-item "external" factor and a 3-item "internal" factor. The correlations (r) of the mean scores from these factors with the 2 global measures ranged from .59 to .82. The SEM was 0.16 for the internal factor and 0.25 for the external factor. DISCUSSION AND CONCLUSION: The underlying factor structure of the Spanish-language version of the MRPS was identical to the English-language version. Our findings provide preliminary support for the reliability and validity of measurements obtained from the Spanish-language version of the MRPS. Further study is needed to assess the stability of these findings in other samples. As with English-speaking patients, Spanish-speaking patient's satisfaction with physical therapy care is most strongly linked to the professional behavior of the clinician.