Leaf habit of tree species does not strongly predict leaf litter decomposition but alters climate-decomposition relationships

Leaf habit of tree species (evergreen versus deciduous) is proposed to be an important determinant of leaf litter decomposition, but it remains largely understudied as to how climatic regulation of litter decomposition differs between leaf habits. We isolated the relative role of climate and leaf habit in leaf litter decomposition by investigating the latitudinal pattern of leaf litter decomposition for Chinese broad-leaved tree species. Litter decomposition rate decreased with latitude, which was largely driven by mean annual temperature (MAT). Evergreen and deciduous broad-leaved tree species shared similar decomposition rate where they coexisted. Leaf litter decomposition of evergreen broad-leaved tree species was more sensitive to MAT than that of the deciduous species, whereas leaf litter decomposition of the deciduous trees was more sensitive than that of the evergreen to mean annual precipitation. Climatic variables explained more variation in leaf litter decomposition than did leaf habit alone. Our findings support the conventional paradigm that climate is a dominant regulator of leaf litter decomposition over broad geographical scales, notwithstanding recent studies calling into question this paradigm. While leaf habit alone does not predict leaf litter decomposition very well where both evergreen and deciduous species coexisted, the direction and strength of shift in leaf litter decomposition diverged between leaf habits across the climatic gradient. These findings underscore the urgent need to consider the impacts of changes in leaf habits when predicting leaf litter decomposition in response to climate change.Peer reviewe

A Method for Balancing Provider Schedules in Outpatient Specialty Clinics

Background. Variability in outpatient specialty clinic schedules contributes to numerous adverse effects including chaotic clinic settings, provider burnout, increased patient waiting times, and inefficient use of resources. This research measures the benefit of balancing provider schedules in an outpatient specialty clinic. Design. We developed a constrained optimization model to minimize the variability in provider schedules in an outpatient specialty clinic. Schedule variability was defined as the variance in the number of providers scheduled for clinic during each hour the clinic is open. We compared the variance in the number of providers scheduled per hour resulting from the constrained optimization schedule with the actual schedule for three reference scenarios used in practice at M Health Fairview’s Clinics and Surgery Center as a case study. Results. Compared to the actual schedules, use of constrained optimization modeling reduced the variance in the number of providers scheduled per hour by 92% (1.70–0.14), 88% (1.98–0.24), and 94% (1.98–0.12). When compared with the reference scenarios, the total, and per provider, assigned clinic hours remained the same. Use of constrained optimization modeling also reduced the maximum number of providers scheduled during each of the actual schedules for each of the reference scenarios. The constrained optimization schedules utilized 100% of the available clinic time compared to the reference scenario schedules where providers were scheduled during 87%, 92%, and 82% of the open clinic time, respectively. Limitations. The scheduling model’s use requires a centralized provider scheduling process in the clinic. Conclusions. Constrained optimization can help balance provider schedules in outpatient specialty clinics, thereby reducing the risk of negative effects associated with highly variable clinic settings

Subtotal Adrenalectomy in Multiple Endocrine Neoplasia Type 2

We report two patients in whom pheochromocytoma was treated by subtotal adrenalectomy leaving a rim of vascularized cortical tissue in situ. Both patients are doing well without cortisol supplementation although they have subnormal cortisol responses to ACTH stimulation

Formation of forest gaps accelerates C, N and P release from foliar litter during 4 years of decomposition in an alpine forest

Relative to areas under canopy, the soils in forest gaps receive more irradiance and rainfall (snowfall); this change in microclimate induced by forest gaps may influence the release of carbon (C) and nutrients during litter decomposition. However, great uncertainty remains about the effects of forest gaps on litter decomposition. In this study, we incubated foliar litters from six tree and shrub species in forest gaps and canopy plots and measured the release of C, nitrogen (N) and phosphorus (P) in different snow cover periods in an alpine forest from 2012 to 2016. We found that N was retained by 24-46% but that P was immediately released during an early stage of decomposition. However, forest gaps decreased litter N retention, resulting in more N and P being released from decomposing litters for certain species (i.e., larch, birch and willow litters). Moreover, the release of C and nutrients during litter decomposition stimulated by forest gaps was primarily driven by warmer soil temperature in this high-altitude forest. We conclude that gap formation during forest regeneration may accelerate C turnover and nutrient cycling and that this stimulation might be regulated by the litter species in this seasonally snow-covered forest.Peer reviewe

Defining antimicrobial prescribing quality indicators: what is a new prescription?

Contains fulltext : 95791.pdf (publisher's version ) (Open Access): Since guidelines on antibiotic drug treatment often focus on appropriate first choice drugs, assessment of guideline adherence should only concentrate on the first drug prescribed, and not on subsequent antibiotics prescribed after failure of the first one. PURPOSE: To determine a valid cut-off point for a definition of "first" or "new" prescription in indicators for the assessment of the quality of antibiotic drug treatment on the basis of pharmaceutical data. METHODS: Three possible definitions for the term "new prescription" were compared, based on three different periods of time, viz. more than 35, 28, or 21 days after starting a previous antibiotic. In an observational study, 1,225 antimicrobial prescriptions from the medical files of five family practices were audited ("clinical classification") and compared with a classification based on the three definitions ("technical classification"). Agreement between these clinical and technical classifications was determined by calculating Cohen's kappa. The technical classification was analyzed as a diagnostic test, using the clinical classification as the gold standard, and sensitivity, specificity, likelihood ratios, and post-test probabilities were calculated. RESULTS: Defining "new prescription" as "more than 35 days after a previous prescription was issued" resulted in a Cohen's kappa of 0.93 (95% CI 0.92-0.98). The diagnostic value of this definition was extremely high, with a sensitivity of 0.976, specificity of 0.987, positive likelihood ratio of 77.7, and negative likelihood ratio of 0.02. CONCLUSION: We recommend using a cut-off value of 35 days since the last antimicrobial prescription as the definition of a "new prescription" when no diagnostic information is available, i.e., when using pharmaceutical data to assess the quality of antibiotic prescribing behavior.01 januari 201

INDCOR White Paper 5: Addressing Societal Issues in Interactive Digital Narratives

This white paper introduces Interactive Digital Narratives (IDN) as a powerful tool for tackling the complex challenges we face in today's society. In the scope of the COST Action 18230 - Interactive Narrative Design for Complexity Representation, a group of researchers dedicated to studying media, systematically selected six case studies of IDNs, including educational games, news media, and social media content, that confront and challenge the existing traditional media landscape. These case studies cover a wide range of important societal issues, such as racism, coloniality, feminist social movements, cultural heritage, war, and disinformation. By exploring this broad range of examples, we aim to demonstrate how IDN can effectively address social complexity in an interactive, participatory, and engaging manner. We encourage you to examine these case studies and discover for yourself how IDN can be used as a creative tool to address complex societal issues. This white paper might be inspiring for journalists, digital content creators, game designers, developers, educators using information and communication technologies in the classroom, or anyone interested in learning how to use IDN tools to tackle complex societal issues. In this sense, along with key scientific references, we offer key takeaways at the end of this paper that might be helpful for media practitioners at large, in two main ways: 1) Designing IDNs to address complex societal issues and 2) Using IDNs to engage audiences with complex societal issues

Estimating the Cost of No-Shows and Evaluating the Effects of Mitigation Strategies

To measure the cost of non-attendance (“no-shows”) and benefit of overbooking and interventions to reduce no-shows for an outpatient endoscopy suite

Metabolic network reconstruction of Chlamydomonas offers insight into light-driven algal metabolism

A comprehensive genome-scale metabolic network of Chlamydomonas reinhardtii, including a detailed account of light-driven metabolism, is reconstructed and validated. The model provides a new resource for research of C. reinhardtii metabolism and in algal biotechnology

Policies to Enhance Prescribing Efficiency in Europe: Findings and Future Implications

Introduction: European countries need to learn from each other to address unsustainable increases in pharmaceutical expenditures. Objective: To assess the influence of the many supply and demand-side initiatives introduced across Europe to enhance prescribing efficiency in ambulatory care. As a result provide future guidance to countries. Methods: Cross national retrospective observational study of utilization (DDDs – defined daily doses) and expenditure (Euros and local currency) of proton pump inhibitors (PPIs) and statins among 19 European countries and regions principally from 2001 to 2007. Demand-side measures categorized under the “4Es” – education engineering, economics, and enforcement. Results: Instigating supply side initiatives to lower the price of generics combined with demand-side measures to enhance their prescribing is important to maximize prescribing efficiency. Just addressing one component will limit potential efficiency gains. The influence of demand-side reforms appears additive, with multiple initiatives typically having a greater influence on increasing prescribing efficiency than single measures apart from potentially “enforcement.” There are also appreciable differences in expenditure (€/1000 inhabitants/year) between countries. Countries that have not introduced multiple demand side measures to counteract commercial pressures to enhance the prescribing of generics have seen considerably higher expenditures than those that have instigated a range of measures. Conclusions: There are considerable opportunities for European countries to enhance their prescribing efficiency, with countries already learning from each other. The 4E methodology allows European countries to concisely capture the range of current demand-side measures and plan for the future knowing that initiatives can be additive to further enhance their prescribing efficiency