Weber Basin Water Conservancy District: An Economic Appraisal

Information on Water Conservancy Districts in Utah was collected by mail and personal visits to district offices. There are a total of 12 districts in Utah, but only five were selling water in 1965. The water development projects of the remaining seven were not finished. Some of the districts are small and consolidation would bring them many advantages of large scale operation. The success of the Weber Basin Water Conservancy District was evaluated from the point of view of economic efficiency . Insistence on long term contract, adherence to water duty requirements set by the Bureau of Reclamation, inability to sell water on land acreages larger than 160 acres, pricing based on costs of producing and distributing water, and disallowing resale or transfer of water rights were hindrances to the efficient allocation of water. High projections of demand, high prices, and salt content in the water were impediments to the District in sel ling all water available

International Supervisees’ Experiences with Discrimination: A Critical Events Model

Although there is burgeoning literature highlighting international trainees\u27 experiences in clinical supervision, limited attention has been given to trainees\u27 challenges related to discriminatory instances in counseling and supervision. Research suggests that international supervisees experience both overt and covert instances of discrimination during counseling and supervision interaction. Supervisors\u27 intervention is critical in discussing such events during supervision, as it can either promote or hinder supervisee competencies and growth. Yet, little is known about how supervisors handle such critical situations and its relation to supervisee outcomes. Therefore, using the Critical Events Model in supervision (CEM) and a mixed-method design, the current study examined supervisory interventions in addressing international supervisees\u27 perspectives on their experiences with discrimination and its influence on predicting supervisee outcomes (supervisee competencies: knowledge, awareness, skills; supervisee self-efficacy, supervisory working alliance, and supervisee perception of supervisor\u27s multicultural competence). Consensual Qualitative Research-Modified (CQR-M) was utilized to explore the discriminatory events experienced by international supervisees and their reactions following these events. Results revealed seven categories of discriminatory events including, negative attitude toward supervisee\u27s language ability, witnessing prejudiced/racist comment, assumption about supervisee\u27s culture or knowledge of culture, supervisor invalidated/ignored supervisee\u27s cross-cultural experience, supervisee not seen as competent, questioned supervisee\u27s interpersonal style, and lack of supervisory support/encouragement. Supervisee reported their reactions to the discriminatory events through endorsing various feelings (sadness, anger, frustration, confusion, helplessness), thoughts (self-doubt, reflection on supervisory relationship, rationalization, worry about professional issues), and behaviors (avoiding topic or contact with supervisor, impact on clinical work, seeking support from outside networks, processing with supervisor, masking their feelings or advocating for own needs). An exploration of the kinds of supervisor interventions revealed that supervisees perceived their supervisors to predominantly use four interventions, namely, focus on self-efficacy (71%), skills (66%), evaluation (64%), and exploration of supervisee feelings (60%). Additionally, supervisees perceived focus on countertransference (56%), therapeutic process (51%), multicultural awareness (50%), normalizing experience (44%), focusing on reactions in an indirect manner (40%), focus on self-disclosure (40%), focus on supervisory working alliance (39%), becoming angry/dismissive (36%), focusing on supervision process (36%), changing topic of discussion (36%), and discussion of parallel process (20%) as interventions used by their supervisors. Quantitative analyses using multivariate multiple linear regressions revealed that only focus on supervisee feelings was a significant predictor of supervisory working alliance, and supervisee perception of supervisee\u27s multicultural competence. Implications and limitations of these findings are discussed

Person-Context Influences on Educational Involvement in Rural Cambodian Schools

Based on Bronfenbrenner’s Process-Person-Context-Time model, this study explored the attitudes and potential factors affecting children’s educational participation in two non-governmental organization-sponsored rural schools in Siem Reap, Cambodia. Focus groups and individual interviews were conducted with students (female and male), teachers, principals, and parents. A discovery-oriented qualitative analytical approach revealed that at the individual level, truancy and student respect for school regulations impacted school participation. At the family level, parental support and family difficulties influenced school participation. At the school level, teacher ability, teacher-parent interactions, and adequate resources either facilitated or hindered student success. At the socio-cultural level, socioeconomic conditions, communal supports, and traditional gendered expectations created gender disparities in school involvement. Policy implications include a nation-wide comprehensive professional development program targeting teacher training (structural level), a strong teacher-counselor partnership to facilitate the development of literacy campaigns (community level), and increasing female mentors and counselors to increase gender parity (cultural level)

Clinical and pathological report of an unusual anterior chamber lesion: A case report

To describe an unusual anterior chamber lesion found on routine eye examination of a 71 year-old Hispanic gentleman who presented for cataract evaluation. The lesion was biopsied at the time of cataract surgery and its pathology presented

Further evidence for the involvement of EFL1 in a Shwachman-Diamond-like syndrome and expansion of the phenotypic features.

Recent evidence has implicated EFL1 in a phenotype overlapping Shwachman-Diamond syndrome (SDS), with the functional interplay between EFL1 and the previously known causative gene SBDS accounting for the similarity in clinical features. Relatively little is known about the phenotypes associated with pathogenic variants in the EFL1 gene, but the initial indication was that phenotypes may be more severe, when compared with SDS. We report a pediatric patient who presented with a metaphyseal dysplasia and was found to have biallelic variants in EFL1 on reanalysis of trio whole-exome sequencing data. The variant had not been initially reported because of the research laboratory's focus on de novo variants. Subsequent phenotyping revealed variability in her manifestations. Although her metaphyseal abnormalities were more severe than in the original reported cohort with EFL1 variants, the bone marrow abnormalities were generally mild, and there was equivocal evidence for pancreatic insufficiency. Despite the limited number of reported patients, variants in EFL1 appear to cause a broader spectrum of symptoms that overlap with those seen in SDS. Our report adds to the evidence of EFL1 being associated with an SDS-like phenotype and provides information adding to our understanding of the phenotypic variability of this disorder. Our report also highlights the value of exome data reanalysis when a diagnosis is not initially apparent

Factors affecting clinical decision-making in inflammatory bowel disease and the role of point-of-care calprotectin

Objectives: Patient-reported symptoms correlate poorly with mucosal inflammation. Clinical decision-making may, therefore, not be based on objective evidence of disease activity. We conducted a study to determine factors associated with clinical decision-making in a secondary care inflammatory bowel disease (IBD) population, using a cross-sectional design. Methods: Decisions to request investigations or escalate medical therapy were recorded from outpatient clinic encounters in a cohort of 276 patients with ulcerative colitis (UC) or Crohn’s disease (CD). Disease activity was assessed using clinical indices, self-reported flare and faecal calprotectin ≥ 250 µg/g. Demographic, disease-related and psychological factors were assessed using validated questionnaires. Logistic regression was performed to determine the association between clinical decision-making and symptoms, mucosal inflammation and psychological comorbidity. Results: Self-reported flare was associated with requesting investigations in CD [odds ratio (OR) 5.57; 95% confidence interval (CI) 1.84-17.0] and UC (OR 10.8; 95% CI 1.8-64.3), but mucosal inflammation was not (OR 1.62; 95% CI 0.49-5.39; and OR 0.21; 95% CI 0.21-1.05, respectively). Self-reported flare (OR 7.96; 95% CI 1.84-34.4), but not mucosal inflammation (OR 1.67; 95% CI 0.46-6.13) in CD, and clinical disease activity (OR 10.36; 95% CI 2.47-43.5) and mucosal inflammation (OR 4.26; 95% CI 1.28-14.2) in UC were associated with escalation of medical therapy. Almost 60% of patients referred for investigation had no evidence of mucosal inflammation. Conclusions: Apart from escalation of medical therapy in UC, clinical decision-making was not associated with mucosal inflammation in IBD. The use of point-of-care calprotectin testing may aid clinical decision-making, improve resource allocation and reduce costs in IBD

Pro- and Antiatherogenic Effects of a Dominant-Negative P465L Mutation of Peroxisome Proliferator-Activated Receptor- in Apolipoprotein E-Null Mic

The dominant-negative mutation, P467L, in Peroxisome Proliferator Activated Receptor gamma (PPARγ) affects adipose tissue distribution, insulin sensitivity and blood pressure in heterozygous humans. We hypothesized that the equivalent mutation, PPARγ-P465L, in mice will worsen atherosclerosis

A semi-automated software program to assess the impact of second reads in prostate MRI for equivocal lesions: results from a UK tertiary referral centre

Purpose: To investigate the utility of a prostate magnetic resonance imaging (MRI) second read using a semi-automated software program in the one-stop clinic, where patients undergo multiparametric MRI, review and biopsy planning in one visit. We looked at concordance between readers for patients with equivocal scans and the possibility for biopsy deferral in this group. Methods: We present data from 664 consecutive patients. Scans were reported by seven different expert genitourinary radiologists using dedicated software (MIM®) and a Likert scale. All scans were rescored by another expert genitourinary radiologist using a customised workflow for second reads that includes annotated biopsy contours for accurate visual targeting. The number of scans in which a biopsy could have been deferred using biopsy results and prostate specific antigen density was assessed. Gleason score ≥ 3 + 4 was considered clinically significant disease. Concordance between first and second reads for equivocal scans (Likert 3) was evaluated. Results: A total of 209/664 (31%) patients scored Likert 3 on first read, 128 of which (61%) were concordant after second read. 103/209 (49%) of patients with Likert 3 scans were biopsied, with clinically significant disease in 31 (30%) cases. Considering Likert 3 scans that were both downgraded and biopsied using the workflow-generated biopsy contours, 25/103 (24%) biopsies could have been deferred. Conclusions: Implementing a semi-automated workflow for accurate lesion contouring and targeting biopsies is helpful during the one-stop clinic. We observed a reduction of indeterminate scans after second reading and almost a quarter of biopsies could have been deferred, reducing the potential biopsy-related side effects

A National Referral Service for Paediatric Brachytherapy: An Evolving Practice and Outcomes Over 13 Years

AIMS: Most children requiring radiotherapy receive external beam treatment and few have tumours suitable for brachytherapy. No paediatric radiotherapy centre will treat enough patients from its own normal catchment population for expertise in brachytherapy to be developed and sustained. Following discussion and agreement in the national paediatric radiotherapy group, a service for paediatric brachytherapy in the UK has been developed. We report the process that has evolved over more than 10 years, with survival and functional outcome results. MATERIALS AND METHODS: Since 2009, potential patients have been referred to the central paediatric oncology multidisciplinary team meeting, where imaging, pathology and treatment options are discussed. Since 2013, the National Soft Tissue Sarcoma Advisory Panel has also reviewed most patients, with the principal aim of advising on the most suitable primary tumour management for complex patients. Clinical assessment and examination under anaesthetic with biopsies may be undertaken to confirm the appropriateness of brachytherapy, either alone or following conservative surgery. Fractionated high dose rate brachytherapy was delivered to a computed tomography planned volume after implantation of catheters under ultrasound imaging guidance. Since 2019, follow-up has been in a dedicated multidisciplinary clinic. RESULTS: From 2009 to 2021 inclusive, 35 patients (16 female, 19 male, aged 8 months to 17 years 6 months) have been treated. Histology was soft-tissue sarcoma in 33 patients and carcinoma in two. The treated site was pelvic in 31 patients and head and neck in four. With a median follow-up of 5 years, the local control and overall survival rates are 100%. Complications have been few, and functional outcome is good. CONCLUSION: Brachytherapy is effective for selected paediatric patients, resulting in excellent tumour control and good functional results. It is feasible to deliver paediatric brachytherapy at a single centre within a national referral service

Robust Reproducible Resting State Networks in the Awake Rodent Brain

Resting state networks (RSNs) have been studied extensively with functional MRI in humans in health and disease to reflect brain function in the un-stimulated state as well as reveal how the brain is altered with disease. Rodent models of disease have been used comprehensively to understand the biology of the disease as well as in the development of new therapies. RSN reported studies in rodents, however, are few, and most studies are performed with anesthetized rodents that might alter networks and differ from their non-anesthetized state. Acquiring RSN data in the awake rodent avoids the issues of anesthesia effects on brain function. Using high field fMRI we determined RSNs in awake rats using an independent component analysis (ICA) approach, however, ICA analysis can produce a large number of components, some with biological relevance (networks). We further have applied a novel method to determine networks that are robust and reproducible among all the components found with ICA. This analysis indicates that 7 networks are robust and reproducible in the rat and their putative role is discussed