Italian Ryegrass, Perennial Ryegrass, and Meadow Fescue as Undersown Cover Crops in Spring Wheat and Barley: Results from a Mixed Methods Study in Norway

Cover crops could provide environmental benefits in spring-grain systems through diversification, reduced nitrate leaching, and carbon sequestration. However, few farmers apply the technique, partly as they believe the cover crops will compete with the main crop and cause yield losses. Cover crops can either be sown together with the grain (undersown) or in autumn and establish after grain harvest. The current study uses a mixed-method approach combining field trials, interviews, and literature synthesis. The field trials focused on perennial ryegrass (Lolium perenne L.), Italian ryegrass (Lolium multiflorum Lam.), and meadow fescue (Festuca pratensis L.) that were undersown with 15 kg ha−1 but with different seeding dates in spring wheat and barley. The interviews focused on gathering practical experiences from farmers in Norway and the literature synthesis gathered results from other studies. For carbon sequestration, nine studies were judged relevant for our target climate and included in our synthesis. They showed a median value at 264 kg C ha−1 year−1 . In our field trials, 300–900 kg DM ha−1 year−1 was produced, with Italian ryegrass sown at the same date as the grain on top. Our trials showed no significant grain yield reduction due to the use of cover crops. However, our synthesis of the literature showed a 5–10% yield reduction with Italian ryegrass that was sown at the same time as the grain. One- or two-weeks delay in the sowing of Italian ryegrass, or reduced seeding rates, could reduce the problem. The interviews showed that farmers do not prefer undersown species, especially not perennial species, as they have experienced that such species may come up again in the following years and cause a weed problem. We recommend farmers to use cover crops and for undersowing, we recommend Italian ryegrass that is sown one or two weeks after the grain. Perennial ryegrass can also be recommended, as long as the growth is properly terminated.publishedVersio

Towards Adaptive Technology in Routine Mental Healthcare

This paper summarizes the information technology-related research findings after 5 years with the INTROducing Mental health through Adaptive Technology project. The aim was to improve mental healthcare by introducing new technologies for adaptive interventions in mental healthcare through interdisciplinary research and development. We focus on the challenges related to internet-delivered psychological treatments, emphasising artificial intelligence, human-computer interaction, and software engineering. We present the main research findings, the developed artefacts, and lessons learned from the project before outlining directions for future research. The main findings from this project are encapsulated in a reference architecture that is used for establishing an infrastructure for adaptive internet-delivered psychological treatment systems in clinical contexts. The infrastructure is developed by introducing an interdisciplinary design and development process inspired by domain-driven design, user-centred design, and the person based approach for intervention design. The process aligns the software development with the intervention design and illustrates their mutual dependencies. Finally, we present software artefacts produced within the project and discuss how they are related to the proposed reference architecture. Our results indicate that the proposed development process, the reference architecture and the produced software can be practical means of designing adaptive mental health care treatments in correspondence with the patients’ needs and preferences. In summary, we have created the initial version of an information technology infrastructure to support the development and deployment of Internet-delivered mental health interventions with inherent support for data sharing, data analysis, reusability of treatment content, and adaptation of intervention based on user needs and preferences.publishedVersio

Bowel Perfusion Measured with Dynamic Contrast-enhanced Ultrasound Predicts Treatment Outcome in Patients with Crohn’s Disease

Background: To improve management of patients with Crohn's disease (CD), objective measurements of the degree of local inflammation in the gastrointestinal wall are needed. Increased microvessel density and perfusion are typical features of acute inflammation and can be estimated with contrast-enhanced ultrasound (CEUS). The aim of the study was to investigate whether CEUS can provide prognostic information about patients treated medically for an acute exacerbation of CD. Methods: Fourteen patients with CD who received medical treatment for acute exacerbation with systemic steroids or tumor necrosis factor–α inhibitors were prospectively recruited. The patients were examined with clinical scoring, blood tests, and CEUS at time 0, 1, 3, and 12 months after initiation of the treatment. Outcome was treatment efficacy or treatment failure defined as change in medical treatment after 1 month or later. The perfusion analysis was performed with a commercially available software program that analyzes the contrast intensity in a selected area, fits the data to a standardized time-intensity curve, and derives several relative perfusion parameters. Results: Six of the 14 patients had treatment failure during the study period. There was a significant difference between the groups for peak contrast enhancement (P = 0.013), rate of wash-in (P = 0.020) and wash-out (P = 0.008), and the area under the time-intensity curve in the wash-in phase (0.013) at the examination 1 month after the start of treatment. Conclusions: Perfusion analysis of the intestinal wall with CEUS 1 month after starting treatment in patients with CD can provide prognostic information regarding treatment efficacy

Combined endorectal ultrasonography and strain elastography for the staging of early rectal cancer

Aim: Strain elastography is a novel approach to rectal tumour evaluation. The primary aim of this study was to correlate elastography to pT stages of rectal tumours and to assess the ability of the method to differentiate rectal adenomas (pT0) from early rectal cancer (pT1–2). Secondary aims were to compare elastography with endorectal ultrasonography (ERUS) and to propose a combined strain elastography and ERUS staging algorithm. Method: In all, 120 consecutive patients with a suspected rectal tumour were examined in this staging study. Patients receiving surgery without neoadjuvant radiotherapy were included (n = 59). All patients were examined with ERUS and elastography. Treatment decisions were made by multidisciplinary team (MDT) assessment, without considering the strain elastography examination. Results: Histopathology identified 21 adenomas, 13 pT1, 9 pT2, 15 pT3 and one pT4. Mean elastography strain ratios were predictive of T stage (P = 0.01). Differentiation of adenomas from early rectal cancer (pT1–2) had sensitivity, specificity and accuracy of 0.82, 0.86 and 0.84 for elastography and 0.82, 0.62 and 0.72 for ERUS. A combined staging algorithm was developed to identify tumours eligible for local resection. Based on MDT evaluation 32% of tumours later identified as pT0 or pT1 were treated with total mesorectal excision, even though a local excision might have sufficed. Combined ERUS and elastography evaluation would have significantly reduced this number to 9% (P = 0.008). Conclusion: Elastography may improve the staging of adenomas and early rectal cancer compared with ERUS alone. Combined ERUS and elastography assessment is likely to further improve the selection of patients for local resection

Endorectal ultrasonography, strain elastography and MRI differentiation of rectal adenomas and adenocarcinomas.

Aim Strain elastography is a method for recording tissue hardness. Strain in different areas may be compared using strain ratio (SR). The aims of this study were to validate a previously proposed SR cut-off value of 1.25 for differentiating adenocarcinomas from adenomas and to compare the performance of endorectal ultrasonography (ERUS), strain elastography and MRI in the same patients. Method A prospective evaluation of 120 consecutive patients with rectal neoplasia, using a predetermined elastography strain ratio cut-off value, was performed to differentiate adenomas from adenocarcinomas. ERUS and MRI were performed according to standard routine at Haukeland University Hospital, defining T0 as adenomas and T1–T4 as adenocarcinomas. Subsequent histopathology was used as the reference standard. Results Histopathological evaluation revealed 21 adenomas and 99 adenocarcinomas. Sensitivity, specificity and accuracy (with 95% CI) were as follows: ERUS: 0.96 (0.90–0.99), 0.62 (0.40–0.80) and 0.90 (0.83–0.94); elastography SR: 0.96 (0.90–0.99), 0.86 (0.66–0.96) and 0.94 (0.88–0.97); and MRI: 0.99 (0.94–1.00), 0.07 (0.00–0.31) and 0.87 (0.80–0.93). Conclusion This study confirms that the elastography SR assessment accurately differentiates sessile adenomas from adenocarcinomas. SR assessment has a superior ability to differentiate adenomas and adenocarcinomas when compared with ERUS and MRI. MRI examination seems unable to recognize adenomas and should be interpreted with care when early-stage rectal neoplasia is suspected

Advanced imaging and visualization in gastrointestinal disorders

Advanced medical imaging and visualization has a strong impact on research and clinical decision making in gastroenterology. The aim of this paper is to show how imaging and visualization can disclose structural and functional abnormalities of the gastrointestinal (GI) tract. Imaging methods such as ultrasonography, magnetic resonance imaging (MRI), endoscopy, endosonography, and elastography will be outlined and visualization with Virtual Reality and haptic methods. Ultrasonography is a versatile method that can be used to evaluate antral contractility, gastric emptying, transpyloric fl ow, gastric confi guration, intragastric distribution of meals, gastric accommodation and strain measurement of the gastric wall. Advanced methods for endoscopic ultrasound