CO2 and N2 O emissions and microbial community structure from fields that include salt-affected soils.

Although salinity and sodicity are worldwide problems, information on greenhouse gas (GHG) emissions from agricultural salt-affected soils is scarce. The CO2 -C and N2 O-N emissions were quantified from three zones intertwined within a single U.S. northern Great Plains field: a highly productive zone (electrical conductivity with 1:1 soil/water mass ratio [EC1:1 ] = 0.4 dS m-1 ; sodium adsorption ratio [SAR] = 1.8), a transition zone (moderately salt-affected; EC1:1  = 1.6 dS m-1 ; SAR = 4.99), and a saline/sodic zone (EC1:1  = 3.9 dS m-1 ; SAR = 22). In each zone, emissions were measured every 4 h for 7 d in four randomly placed chambers that were treated with two N rates (0 and 224 kg N ha-1 ). The experiment was conducted in 2018 and 2019 during similar seasonal periods. Soil samples taken from treatments after GHG measurement were analyzed for soil inorganic N, and microbial biomass from different communities was quantified using phospholipid fatty acid analysis. Real-time polymerase chain reaction was used to quantify the number of copies of some specific denitrification functional genes. The productive zone had the highest CO2 -C, the lowest N2 O-N emissions, and the greatest microbial biomass, whereas the saline/sodic zone had the lowest CO2 -C, the highest N2 O-N emissions, and the lowest microbial biomass. Within a zone, urea application did not influence CO2 -C emissions; however, N2 O-N emissions from the urea-treated saline/sodic zone were 84 and 57% higher than from the urea-treated productive zone in 2018 and 2019, respectively. The copy number of the nitrite reductase gene, nirS, was 42-fold higher in the saline/sodic zone than in the productive soil, suggesting that the saline/sodic soil had a high potential for denitrification. These findings suggest N2 O-N emissions could be reduced by not applying N to saline/sodic zones.

Alcohol Withdrawal Syndrome: Improving Recognition and Treatment in the Emergency Department.

Alcoholism continues to be a persistent health problem in the United States, accounting for up to 62% of emergency department (ED) visits. This quality improvement (QI) project examined whether identifying the benefit for early use of Alcohol Use Disorders Identification Test (AUDIT C) and Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIW-ar) in the ED would avoid escalation of care and offset poor outcomes of alcohol withdrawal syndrome (AWS). A preimplementation chart review (N = 99) showed an average of 12%-15% of patients requiring escalation of care at the project site. The QI project utilized a single-group, pre-/posttest design. The setting was a Southwest Veterans Affair tertiary care referral center. Thirty-five ED staff members were surveyed for baseline knowledge and attended education sessions, led by an advanced practice nurse, on the use of AUDIT-C and CIWA-ar. Posteducation, patients admitted to the hospital were screened with AUDIT-C and treated with CIWA-ar. Postimplementation, charts were reviewed for admitted patients (N = 42) on the use of AUDIT-C, CIWA-ar, length of stay (LOS), and area patient treated. Although the test scores after didactic education were statistically significant (p ≤ 0.050), there was no significant difference in the use of AUDIT-C or CIWA-ar in the ED, nor a significant decrease in LOS for those patients with CIWA-ar ordered. However, the potential for clinical benefit could not be disavowed. Barriers to implementation included survey fatigue, inability to embed AUDIT-C in the electronic medical record, inconsistency in completing AUDIT-C, interrater reliability, and patient fear of stigmatization. Advanced practice nurses provide an integral role to augment early identification and treatment of AWS in the ED.