Farmers’ attitudes about farming and the environment: A survey of conventional and organic farmers

Farmers have been characterized as people whose ties to the land have given them a deep awareness of natural cycles, appreciation for natural beauty and sense of responsibility as stewards. At the same time, their relationship to the land has been characterized as more utilitarian than that of others who are less directly dependent on its bounty. This paper explores this tension by comparing the attitudes and beliefs of a group of conventional farmers to those of a group of organic farmers. It was found that while both groups reject the idea that a farmer’s role is to conquer nature, organic farmers were significantly more supportive of the notion that humans should live in harmony with nature. Organic farmers also reported a greater awareness of and appreciation for nature in their relationship with the land. Both groups view independence as a main benefit of farming and a lack of financial reward as its main drawback. Overall, conventional farmers report more stress in their lives although they also view themselves in a caretaker role for the land more than do the organic farmers. In contrast, organic farmers report more satisfaction with their lives, a greater concern for living ethically, and a stronger perception of community. Finally, both groups are willing to have their rights limited (organic farmers somewhat more so) but they do not trust the government to do so.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/83671/1/Sullivan,_S.,_E._McCann,_R._De_Young_&_D._Erickson_(1996)._Farmers_attitudes_about_farming_and_the_environment,_JAEE,_9,_123-143.pd

Anterior cruciate ligament reconstruction is associated with greater tibial tunnel widening when using a bioabsorbable screw compared to an all-inside technique with suspensory fixation

Purpose: To compare clinical outcomes and tunnel widening following anterior cruciate ligament reconstruction (ACLR) performed with an all-inside technique (Group A) or with a bioabsorbable tibial screw and suspensory femoral fixation (Group B). Methods: Tunnel widening was assessed using computed tomography (CT) and a previously validated analytical best fit cylinder technique at approximately 1-year following ACLR. Clinical follow-up comprised evaluation with IKDC, KSS, Tegner, Lysholm scores, and knee laxity assessment. Results: The study population comprised 22 patients in each group with a median clinical follow-up of 24 months (range 21–27 months). The median duration between ACLR and CT was 13 months (range 12–14 months). There were no significant differences in clinical outcome measures between groups. There were no differences between groups with respect to femoral tunnel widening. However, there was a significantly larger increase in tibial tunnel widening, at the middle portion, in Group B (2.4 ± 1.5 mm) compared to Group A (0.8 ± 0.4 mm) (p = 0.027), and also at the articular portion in Group B (1.5 ± 0.8 mm) compared to Group A (0.8 ± 0.8 mm) (p = 0.027). Conclusion: Tibial tunnel widening after ACLR using hamstring tendon autograft is significantly greater with suspensory femoral fixation and a bioabsorbable tibial interference screw when compared to an all-inside technique at a median follow-up of 2 years. The clinical relevance of this work lies in the rebuttal of concerns arising from biomechanical studies regarding the possibility of increased tunnel widening with an all-inside technique. Level of evidence: III

Resistant Hypertension : consequences and treatment options

Resistant hypertension, uncontrolled blood pressure despite use of ≥3 antihypertensives including a diuretic or use of ≥4 antihypertensives regardless of blood pressure (BP), was studied. In this thesis, 1/3 of patients with chronic kidney disease, including kidney transplant patients, is shown to have resistant hypertension. Even intensive guidance by nurse practitioners, aimed at both optimization of antihypertensive drug use and life style adjustments, does not decrease the prevalence during follow-up. Risks of resistant hypertension are very high in this population, with an 1.5-fold increased risk for a composite cardiovascular endpoint and a 2.3-fold increased risk for reaching end stage renal disease. In patients with hypertension and a history of cardiovascular disease, 9% has resistant hypertension. A strong relationship with higher age, and with an adverse cardiovascular risk profile of increased BMI, presence of diabetes mellitus and burden of vascular disease was found. Also, resistant hypertension was significantly more frequent in patients with microalbuminuria or an eGFR below 60 ml/min/1.73m2. Risk for a composite of cardiovascular endpoint was 25% higher in this population, and cardiovascular death 1.5-fold more likely. These risks were similar in resistant hypertensive patients with controlled BP. The role of sympathetic hyperactivity in the pathophysiology of hypertension in chronic kidney disease is reviewed. Experimental studies show that renal denervation can abolish hypertension and have kidney protective effects. Sympathetic activity increases with decrease in kidney function in humans. Therefore, patients with chronic kidney disease are expected to have greater benefit from a new antihypertensive treatment aimed at decreasing sympathetic activity. Antihypertensive drugs have a variable effect on sympathetic activity, with diuretics and calcium channel blockers having a stimulating effect, whereas RAAS inhibitors, beta blockers and central acting drugs have an inhibitory effect. The SYMPATHY trial compared renal denervation (RDN) added to usual care with usual care in patients with resistant hypertension or uncontrolled BP due to intolerance for ≥2 of the major antihypertensive drug classes. The intervention was not found to be effective in decreasing BP, as the daytime systolic blood pressure (primary endpoint) decreased with 6.0 mmHg (95%CI -10.7 to -1.2) in the intervention group as compared with a 7.9 mmHg (95%CI -14.7 to -1.3) decrease in the controls. An interaction term did not show a differential effect with lower eGFR. As a secondary analysis, adherence to antihypertensive drugs, assessed by direct measurement of the compounds, was shown to be strikingly low in these patients. A post-hoc analysis showed that dietary sodium intake cannot be used to select patients with greater effectiveness of RDN. Decrease in salt sensitivity after RDN could not be demonstrated. In the last part of the thesis, a beneficial effect of RDN is found on kidney related pain in patients with polycystic kidney disease and loin pain hematuria syndrome. Overall conclusion is that resistant hypertension is an important issue and both an effective RDN procedure and effective measures to increase adherence to antihypertensive drugs are still to be found. RDN studies should be designed in ways minimizing nonadherence as an important source of bias

Catheter-based renal denervation as a novel treatment for loin pain haematuria syndrome

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Peripartum cardiomyopathy: a condition intensivists should be aware of

Peripartum cardiomyopathy: a condition intensivists should be aware of. de Beus E, van Mook WN, Ramsay G, Stappers JL, van der Putten HW. Department of Intensive Care Medicine, University Hospital Maastricht, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. We use an illustrative case of severe peripartum cardiomyopathy with congestive heart failure to introduce this topic and proceed to cover its pathophysiology, incidence, management and outcome

Professionalization of community engagement in flood risk management: Insights from four European countries

Flood management has long been dominated by scientific expertise, centralized decision-making, and top-down professional management. However, changing patterns of risk probabilities instigate shifts in the ways floods are managed, bringing forward the necessity for flood mitigation, preparedness and resilience. Community engagement is recognized as paramount in the attainment of these goals. This provokes risk management authorities to facilitate professionalization of community members in becoming risk management stakeholders. Professionalization of community engagement is becoming the esteemed norm, as it ensures better alignment between all stakeholders and increases capacity and efficiency of authority-community collaboration. At the same time, community engagement in flood management in general, and its professionalization, in particular, has its paradoxes. This paper examines the micro-level facets of professionalization of community engagement in Italy, Germany, England, and the Netherlands based on five-months fieldwork conducted in 2020 and discusses the ambivalent implications of professionalization for community engagement in flood risk management. We conclude that professionalization largely contributes to better coordination of the group members’ activities, their alignment with risk management needs and priorities, and enhances community members sense of belonging in the professional field of flood risk management. At the same time, professionalization entails the burden of increasing explicit and implicit state requirements for communities. It reinforces participatory limits and reproduces flood risk management unattainability for the broader public