The Behavior of Soluble Salt in Sharkey Clay

Soluble salt problems do exist and are significant in Arkansas. Studies have been conducted on Crowley silt loam (Typic Albaqualfs) which have established the behavior of soluble salt in that soil. The major objective of this study was to quantify the behavior of soluble salt in a second important Mississippi River Delta soil - the Sharkey (Vertic Haplaquepts). To this end, estimation of the downward redistribution of salt and the estimation of various components of the water balance for this soil served as specific objectives. Field studies were designed to monitor the movement of salt in the Sharkey soil and to characterize selected components of the water balance. In total, three tentative conclusions may be drawn from the data. First, the infiltration for the Sharkey soil was approximately three times that of the Crowley silt loam. The average value was 29 cm for the rice season. Second, levee seepage, while significant for small plots, was shown to be small for production-sized fields. Levee seepage remained relatively constant throughout the season and averaged 0.025 nvfym/d. And third, downward redistribution of salt was large and appeared to follow a pattern where a peak occurred at the surface and, possibly, at the lower soil depths

A Survey of Soils Irrigated with Arkansas River Water

Interest in the use of Arkansas River water for irrigation has increased recently as land adjacent to the river is converted to crop production and river water is considered as an alternative to depleted underground supplies. Since the Arkansas River can contain elevated concentrations of sodium chloride, this study was designed to determine if soil conditions adverse to crop growth were developing where river water has been used. The impact of river water on sites where river water was used as either the sole source for up to 3 years or as a supplement to another surface source for up to 20 years was evaluated. The mean surface and profile ESPs were both 3.7%, while parallel ECs for 1:2 soil:, water extract were 183 and 163 umhos/cm, respectively. Mean surface and profile chloride concentrations were 32 and 50 ug/g, respectively. Mean saturated hydraulic conductivities were 0.015 cm/hr for the surface soil. No data were obtained which suggested that the use of the Arkansas River under the conditions described above was detrimental to soil physical or chemical properties. Periodic reevaluation of this conclusion is suggested at sites where direct use of Arkansas River water continues for an extended period of time

The Behavior of Soluble Salt in Sharkey Clay- II

Soluble salts have been shown to accumulate in Arkansas soils in sufficient quantities to impair crop plant growth. The major objective of this study was to describe the behavior of soluble chloride salt over long time periods in Sharkey clay - a major Mississippi Delta soil. Prior to flooding rice, leaching of chloride in response to rainfall was observed. The inclusion of a sandy subsoil layer reduced this effect presumably by limiting downward movement of water under unsaturated conditions. No lateral movement of the chloride salt was found during the period prior to flooding. Removal of soluble chloride salts from the top 100 cm of Sharkey soil was complete in a 1-2 year period depending on weather conditions. In a year where the rice cropping season was followed by a wet winter, losses were smaller than in a year where the rice cropping season was followed by a drier winter. These results suggested that removal of soluble salts via leaching in this soil was more efficient under less saturated soil conditions

Medicare Payments for Common Inpatient Procedures: Implications for Episode-Based Payment Bundling

Aiming to align provider incentives toward improving quality and efficiency, the Center for Medicare and Medicaid Services is considering broader bundling of hospital and physician payments around episodes of inpatient surgery. Decisions about bundled payments would benefit from better information about how payments are currently distributed among providers of different perioperative services and how payments vary across hospitals.Using the national Medicare database, we identified patients undergoing one of four inpatient procedures in 2005 (coronary artery bypass [CABG], hip fracture repair, back surgery, and colectomy). For each procedure, price-standardized Medicare payments from the date of admission for the index procedure to 30 days postdischarge were assessed and categorized by payment type (hospital, physician, and postacute care) and subtype.Average total payments for inpatient surgery episodes varied from U.S.$26,515 for back surgery to U.S.$45,358 for CABG. Hospital payments accounted for the largest share of total payments (60–80 percent, depending on procedure), followed by physician payments (13–19 percent) and postacute care (7–27 percent). Overall episode payments for hospitals in the lowest and highest payment quartiles differed by U.S.$16,668 for CABG, U.S.$18,762 for back surgery, U.S.$10,615 for hip fracture repair, and U.S.$12,988 for colectomy. Payments to hospitals accounted for the largest share of variation in payments. Among specific types of payments, those associated with 30-day readmissions and postacute care varied most substantially across hospitals.Fully bundled payments for inpatient surgical episodes would need to be dispersed among many different types of providers. Hospital payments—both overall and for specific services—vary considerably and might be reduced by incentives for hospitals and physicians to improve quality and efficiency.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79298/1/j.1475-6773.2010.01150.x.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/79298/2/HESR_1150_sm_authormatrix.pd

Differences in Healthcare Utilization and Associated Costs Between Patients Prescribed vs. Nonprescribed Opioids During an Inpatient or Emergency Department Visit

Objectives Compare healthcare resource utilization ( HCRU ) and costs between patients prescribed opioids ( R x OP ) and those who were not ( N o R x OP ) during an emergency department ( ED ) or inpatient visit. Methods Retrospective cohort analysis was performed ( J anuary 2006 to S eptember 2010). Continuously eligible R x OP patients in ED /inpatient settings ( J anuary 2007 to S eptember 2009) were included if age was ≥ 12 years by initial prescription date (or random date between first ED /inpatient admission and S eptember 30, 2009 [ N oRx OP patients]). Healthcare resource utilization and costs for 12 months after initial prescription were compared. Univariate descriptive analyses were performed for baseline and outcome variables and compared using appropriate tests. Risk adjustment compared HCRU between R x OP and N o R x OP cohorts for the postindex period. Results Of 27,599 eligible patients, R x OP patients ( n  = 18,819) were younger, less likely to be male, more likely to reside in southern U nited S tates and to have Preferred Provider Organization health plans, and had lower comorbidity index scores, compared with N o R x OP patients ( n  = 8,780). R x OP patients were less likely to have nonpain‐related comorbidities and more frequently diagnosed with pain‐related comorbidities. Unmatched and propensity‐matched R x OP patients experienced higher HCRU and costs in all subcategories (total, inpatient, outpatient ED , physician, pharmacy, other outpatient settings). Opioid abuse frequency was low in patients with common diagnoses/procedures within 3 months before initial prescription (0.48%). Average time to abuse was < 1 year (201 days). Conclusion Most patients were prescribed opioids initially during ED /inpatient visits and incurred higher HCRU than those not prescribed opioids. Among those with diagnosed opioid abuse after initiating opioids, time to diagnosis was rapid (range: 14 to 260 days) for patients with common diseases and procedures.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/107375/1/papr12098.pd

Different Methods of Balancing Covariates Leading to Different Effect Estimates in the Presence of Effect Modification

A number of covariate-balancing methods, based on the propensity score, are widely used to estimate treatment effects in observational studies. If the treatment effect varies with the propensity score, however, different methods can give very different answers. The authors illustrate this effect by using data from a United Kingdom–based registry of subjects treated with anti–tumor necrosis factor drugs for rheumatoid arthritis. Estimates of the effect of these drugs on mortality varied from a relative risk of 0.4 (95% confidence interval: 0.16, 0.91) to a relative risk of 1.3 (95% confidence interval: 0.8, 2.25), depending on the balancing method chosen. The authors show that these differences were due to a combination of an interaction between propensity score and treatment effect and to differences in weighting subjects with different propensity scores. Thus, the methods are being used to calculate average treatment effects in populations with very different distributions of effect-modifying variables, resulting in different overall estimates. This phenomenon highlights the importance of careful selection of the covariate-balancing method so that the overall estimate has a meaningful interpretation

Prospective assessment of white matter integrity in adult stem cell transplant recipients

Hematopoietic stem cell transplantation (HSCT) is often used in the treatment of hematologic disorders. Although it can be curative, the pre-transplant conditioning regimen can be associated with neurotoxicity. In this prospective study, we examined white matter (WM) integrity with diffusion tensor imaging (DTI) and neuropsychological functioning before and one year after HSCT in twenty-two patients with hematologic disorders and ten healthy controls evaluated at similar intervals. Eighteen patients received conditioning treatment with high-dose (HD) chemotherapy, and four had full dose total body irradiation (fTBI) and HD chemotherapy prior to undergoing an allogeneic or autologous HSCT. The results showed a significant decrease in mean diffusivity (MD) and axial diffusivity (AD) in diffuse WM regions one year after HSCT (p-corrected <0.05) in the patient group compared to healthy controls. At baseline, patients treated with allogeneic HSCT had higher MD and AD in the left hemisphere WM than autologous HSCT patients (p-corrected <0.05). One year post-transplant, patients treated with allogeneic HSCT had lower fractional anisotropy (FA) and higher radial diffusivity (RD) in the right hemisphere and left frontal WM compared to patients treated with autologous HSCT (p-corrected <0.05). There were modest but significant correlations between MD values and cognitive test scores, and these were greatest for timed tests and in projection tracts. Patients showed a trend toward a decline in working memory, and had lower cognitive test scores than healthy controls at the one-year assessment. The findings suggest a relatively diffuse pattern of alterations in WM integrity in adult survivors of HSCT

The pharmaceutical use of permethrin: Sources and behavior during municipal sewage treatment

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2010 Springer Science+Business Media, LLC.Permethrin entered use in the 1970s as an insecticide in a wide range of applications, including agriculture, horticultural, and forestry, and has since been restricted. In the 21st century, the presence of permethrin in the aquatic environment has been attributed to its use as a human and veterinary pharmaceutical, in particular as a pedeculicide, in addition to other uses, such as a moth-proofing agent. However, as a consequence of its toxicity to fish, sources of permethrin and its fate and behavior during wastewater treatment are topics of concern. This study has established that high overall removal of permethrin (approximately 90%) was achieved during wastewater treatment and that this was strongly dependent on the extent of biological degradation in secondary treatment, with more limited subsequent removal in tertiary treatment processes. Sources of permethrin in the catchment matched well with measured values in crude sewage and indicated that domestic use accounted for more than half of the load to the treatment works. However, removal may not be consistent enough to achieve the environmental quality standards now being derived in many countries even where tertiary treatment processes are applied.United Utilities PL