Twelve tips for teaching brief motivational interviewing to medical students

Background: Shifting from paternalistic to patient-centred doctor-patient relationships has seen a growing number of medical programs incorporate brief motivational interviewing training in their curriculum. Some medical educators, however, are unsure of precisely what, when, and how to incorporate such training. Aims: This article provides educators with 12 tips for teaching brief motivational interviewing to medical students, premised on evidence-based pedagogy. Methods: Tips were drawn from the literature and authors’ own experiences. Results: The 12 tips are: (1) Set clear learning objectives, (2) Select experienced educators, (3) Provide theoretical perspectives, (4) Share the evidence base, (5) Outline the “spirit”, principles, and sequence, (6) Show students what it looks like, (7) Give students a scaffold to follow, (8) Provide opportunities for skill practice, (9) Involve clinical students in teaching, (10) Use varied formative and summative assessments, (11) Integrate and maintain, and (12) Reflect and evaluate. Conclusions: We describe what to include and why, and outline when and how to teach the essential components of brief motivational interviewing knowledge and skills in a medical curriculum

Mathematical modelling long-term effects of replacing Prevnar7 with Prevnar13 on invasive pneumococcal diseases in England and Wales

England and Wales recently replaced the 7-valent pneumococcal conjugate vaccine (PCV7) with its 13-valent equivalent (PCV13), partly based on projections from mathematical models of the long-term impact of such a switch compared to ceasing pneumococcal conjugate vaccination altogether. A compartmental deterministic model was used to estimate parameters governing transmission of infection and competition between different groups of pneumococcal serotypes prior to the introduction of PCV13. The best-fitting parameters were used in an individual based model to describe pneumococcal transmission dynamics and effects of various options for the vaccination programme change in England and Wales. A number of scenarios were conducted using (i) different assumptions about the number of invasive pneumococcal disease cases adjusted for the increasing trend in disease incidence prior to PCV7 introduction in England and Wales, and (ii) a range of values representing serotype replacement induced by vaccination of the additional six serotypes in PCV13. Most of the scenarios considered suggest that ceasing pneumococcal conjugate vaccine use would cause an increase in invasive pneumococcal disease incidence, while replacing PCV7 with PCV13 would cause an overall decrease. However, the size of this reduction largely depends on the level of competition induced by the additional serotypes in PCV13. The model estimates that over 20 years of PCV13 vaccination, around 5000–62000 IPD cases could be prevented compared to stopping pneumococcal conjugate vaccination altogether. Despite inevitable uncertainty around serotype replacement effects following introduction of PCV13, the model suggests a reduction in overall invasive pneumococcal disease incidence in all cases. Our results provide useful evidence on the benefits of PCV13 to countries replacing or considering replacing PCV7 with PCV13, as well as data that can be used to evaluate the cost-effectiveness of such a switch

Web-based Media Literacy to Prevent Tobacco Use among High School Students

Facilitator-led smoking media literacy (SML) programs have improved media literacy and reduced intention to smoke. However, these programs face limitations including high costs and barriers to standardization. We examined the efficacy of a Web-based media literacy program in improving smoking media literacy skills among adolescents. Sixty-six 9th grade students participated in a Web-based SML tobacco education program based on health behavior theory. Pre- and post-test assessments demonstrated statistically significant changes in the primary outcome of total SML as well as each of the individual SML items. However, there were inconsistent changes in other theory-based outcomes including attitudes and normative beliefs

Chapter 4- Human Dimensions of Water for Food Production

Feeding 9 Billion and Maintaining the Planet: Meeting the Challenge of 2050 Environmental concerns, which fall outside normal market powers, require special incentives and consideration in water resource decisions, Marty Matlock said. Given that the world’s population now consumes past the point of sustainability, should sustainability be a market choice for consumers? “This should be pre-competitive,” Matlock said. “The consumers should have confidence that everything they buy complies with a certain threshold of humanity, of behavior, of ethics and sustainability.” The market has the power to move materials, goods and services from areas of plenty to those of scarcity. The problem is that the market is not responding to water scarcity, in part because crops are grown where there is no water. For example, in Brazil, areas that once were rainforest now grow 2.4 crops annually for export to China. “They’re exporting de facto water to China,” Matlock said. Another example stems from the 1 billion people who lack access to water and the 2.4 billion who don’t have basic sanitation. Every day, waterborne diseases kill 5,400 children. “That’s the cost of this failure of technology – failure of civilizations,” Matlock said. “It’s a pretty dramatic cost.” Global climate change will increase water scarcity in already water-stressed areas. Although agriculture no longer accounts for 90 percent of global water use, as it did in 1900, agricultural water use has increased fivefold since then. Competing with other sectors for limited water affects the many other uses that are not monetized, such as biodiversity. The Colorado and Ganges rivers offer examples of dramatic decreases in water discharge due to overallocation. Peak flows have not changed, but critical base flows have dropped considerably over time. “It’s hard to have a functional, viable aquatic ecosystem without the aquatic,” Matlock said. Rice, which accounts for 15 percent of human water use, presents another problem. But improvement is possible, Matlock said. Human Dimensions of Water for Food Production Anheuser-Busch InBev, for example, achieved 4.7 percent per-unit reductions in rice culture, saving 3.5 billion liters of water in five years. Water intake is only one issue; equally important is water effluent. From an ecological standpoint, given grossly limited incentive funding, Matlock believes profitable production practices should not be incentivized. “If you already have an incentive for conserving water − reducing soil erosion − then we don’t need to give you more money to do that which you ought to be doing anyway, because the marketplace will weed you out if you don’t perform,” he said. “It’s the things that we don’t incentivize, like preservation of riparian zones, that we should perhaps be incentivizing with our limited resources.” The Mesoamerican Barrier Reef System offers an example of the interconnectedness of agriculture effluent and environmental harm. Pollutants, particularly sediment and nutrients carried downstream from plantations to the Caribbean Sea, have the equivalent effect of a 10-degree temperature change, bleaching the coral reefs. Impacts that are acceptable with 6.7 billion people will not be with 9 billion, Matlock concluded. If management happens only to things that are measured, and not everything can be measured, which metrics are important and how can they be incentivized? “We have to shift our thinking from maximizing any one variable or metric to optimizing several key ones.

Chapter 6- A View from Agricultural Producers

Rainfed and Irrigated Production in Argentina Martin Pasman, an Argentine agronomist with a master’s degree in business administration, began his career as a consultant to farmers and has experience in Argentina, Uruguay, Paraguay and Brazil, where he was instrumental in helping to develop 80,000 hectares in the western part of the Cerrado area. His farming experience stems from his family’s farms, located in five areas of Argentina. Most are rainfed, but one area receives less than 500 millimeters of rain annually. Pasman also runs an irrigation business serving 80 percent of the Argentine market, giving him vast experience in developing irrigated land. Argentina is the second-largest South American country after Brazil and is one-third the size of the U.S. One-third of Argentina receives more than 800 millimeters of rain and depends upon rainfed agriculture, while the majority receives less than 800 millimeters. Argentina cultivates 30 million hectares per year, of which 2.2 million are irrigated. Total production output is 90 million metric tons, and about 70 percent of farmers in Argentina practice no-till agriculture. Pasman’s family came to Argentina from the U.S. around 1825, when it was primarily cattle country. His family brought the first Aberdeen Angus bull to Argentina and also helped develop agriculture. In the 1970s, the family farmed 6,000 hectares, of which only 500 were used for crops, yielding 3.5 tons of corn per hectare and 1.5 tons of wheat per hectare. They plowed the land and used few herbicides and no fertilizers. The majority of the land was used to raise 3,000 head of cattle, which were finished in natural pastures. Today, the family’s farm operation has expanded to 20,000 hectares, 15,000 of them used for agriculture. In the low-productivity land, they also manage 9,000 head of cattle in cow-calf operations, finishing the animals in American style feedlots. In rainfed fields, the Pasmans produce 8 tons of corn per hectare and 3 tons of wheat; under irrigation, they get 12 tons of corn and 6 tons of wheat. The most important crop, however, is soybeans. They also grow potatoes, corn and sunflower seeds for Monsanto Company. The farm uses 42 pivots to irrigate 4,000 hectares, and about 80 percent of the farm is double-cropped: wheat plus soybeans, seed corn plus soybeans, potato plus corn. Argentina uses a huge amount of herbicides and genetically modified crops, Pasman said, adding that his farm was one of the first to produce Roundup Ready® soybean seeds in 1994. A View from Agricultural Producers “The cornerstone of our production technology is no-till,” Pasman said, a technique used on the entire farm except the potato fields, which follow a rotation of one year of potatoes followed by three years of no-till. A corn crop follows the potato harvest in the same year. No-till improves water infiltration and water retention and reduces evaporation because the previous crops’ residue minimizes runoff and allows the soil to retain more water. No-till also reduces erosion risk and increases organic matter, improving oxidation and carbon circulation in the soil. It improves soil fertility, increases productivity and sustainability, and allows farming in difficult soils, particularly shallow soils of 3 inches. No-till uses less than half the water and less labor compared to conventional tillage, reducing production costs by 30 percent, Pasman concluded. “It is very important, the mix of no tillage with center pivot (irrigation) against traditional management.

Appendix- Water for Food conference proceedings

Poster Competition, Conference Participants, and Photos Technologies and Advances in Water Management Human Dimensions of Water for Food Production Genetics and Physiology of Crop Water Other Conference Participants (148-153) Photos (154-160

The growing and vital role of botanical gardens in climate change research.

Botanical gardens make unique contributions to climate change research, conservation, and public engagement. They host unique resources, including diverse collections of plant species growing in natural conditions, historical records, and expert staff, and attract large numbers of visitors and volunteers. Networks of botanical gardens spanning biomes and continents can expand the value of these resources. Over the past decade, research at botanical gardens has advanced our understanding of climate change impacts on plant phenology, physiology, anatomy, and conservation. For example, researchers have utilized botanical garden networks to assess anatomical and functional traits associated with phenological responses to climate change. New methods have enhanced the pace and impact of this research, including phylogenetic and comparative methods, and online databases of herbarium specimens and photographs that allow studies to expand geographically, temporally, and taxonomically in scope. Botanical gardens have grown their community and citizen science programs, informing the public about climate change and monitoring plants more intensively than is possible with garden staff alone. Despite these advances, botanical gardens are still underutilized in climate change research. To address this, we review recent progress and describe promising future directions for research and public engagement at botanical gardens.Publisher versio

Chapter 4- Human Dimensions of Water for Food Production

Feeding 9 Billion and Maintaining the Planet: Meeting the Challenge of 2050 Environmental concerns, which fall outside normal market powers, require special incentives and consideration in water resource decisions, Marty Matlock said. Given that the world’s population now consumes past the point of sustainability, should sustainability be a market choice for consumers? “This should be pre-competitive,” Matlock said. “The consumers should have confidence that everything they buy complies with a certain threshold of humanity, of behavior, of ethics and sustainability.” The market has the power to move materials, goods and services from areas of plenty to those of scarcity. The problem is that the market is not responding to water scarcity, in part because crops are grown where there is no water. For example, in Brazil, areas that once were rainforest now grow 2.4 crops annually for export to China. “They’re exporting de facto water to China,” Matlock said. Another example stems from the 1 billion people who lack access to water and the 2.4 billion who don’t have basic sanitation. Every day, waterborne diseases kill 5,400 children. “That’s the cost of this failure of technology – failure of civilizations,” Matlock said. “It’s a pretty dramatic cost.” Global climate change will increase water scarcity in already water-stressed areas. Although agriculture no longer accounts for 90 percent of global water use, as it did in 1900, agricultural water use has increased fivefold since then. Competing with other sectors for limited water affects the many other uses that are not monetized, such as biodiversity. The Colorado and Ganges rivers offer examples of dramatic decreases in water discharge due to overallocation. Peak flows have not changed, but critical base flows have dropped considerably over time. “It’s hard to have a functional, viable aquatic ecosystem without the aquatic,” Matlock said. Rice, which accounts for 15 percent of human water use, presents another problem. But improvement is possible, Matlock said. Human Dimensions of Water for Food Production Anheuser-Busch InBev, for example, achieved 4.7 percent per-unit reductions in rice culture, saving 3.5 billion liters of water in five years. Water intake is only one issue; equally important is water effluent. From an ecological standpoint, given grossly limited incentive funding, Matlock believes profitable production practices should not be incentivized. “If you already have an incentive for conserving water − reducing soil erosion − then we don’t need to give you more money to do that which you ought to be doing anyway, because the marketplace will weed you out if you don’t perform,” he said. “It’s the things that we don’t incentivize, like preservation of riparian zones, that we should perhaps be incentivizing with our limited resources.” The Mesoamerican Barrier Reef System offers an example of the interconnectedness of agriculture effluent and environmental harm. Pollutants, particularly sediment and nutrients carried downstream from plantations to the Caribbean Sea, have the equivalent effect of a 10-degree temperature change, bleaching the coral reefs. Impacts that are acceptable with 6.7 billion people will not be with 9 billion, Matlock concluded. If management happens only to things that are measured, and not everything can be measured, which metrics are important and how can they be incentivized? “We have to shift our thinking from maximizing any one variable or metric to optimizing several key ones.

Chapter 6- A View from Agricultural Producers

Rainfed and Irrigated Production in Argentina Martin Pasman, an Argentine agronomist with a master’s degree in business administration, began his career as a consultant to farmers and has experience in Argentina, Uruguay, Paraguay and Brazil, where he was instrumental in helping to develop 80,000 hectares in the western part of the Cerrado area. His farming experience stems from his family’s farms, located in five areas of Argentina. Most are rainfed, but one area receives less than 500 millimeters of rain annually. Pasman also runs an irrigation business serving 80 percent of the Argentine market, giving him vast experience in developing irrigated land. Argentina is the second-largest South American country after Brazil and is one-third the size of the U.S. One-third of Argentina receives more than 800 millimeters of rain and depends upon rainfed agriculture, while the majority receives less than 800 millimeters. Argentina cultivates 30 million hectares per year, of which 2.2 million are irrigated. Total production output is 90 million metric tons, and about 70 percent of farmers in Argentina practice no-till agriculture. Pasman’s family came to Argentina from the U.S. around 1825, when it was primarily cattle country. His family brought the first Aberdeen Angus bull to Argentina and also helped develop agriculture. In the 1970s, the family farmed 6,000 hectares, of which only 500 were used for crops, yielding 3.5 tons of corn per hectare and 1.5 tons of wheat per hectare. They plowed the land and used few herbicides and no fertilizers. The majority of the land was used to raise 3,000 head of cattle, which were finished in natural pastures. Today, the family’s farm operation has expanded to 20,000 hectares, 15,000 of them used for agriculture. In the low-productivity land, they also manage 9,000 head of cattle in cow-calf operations, finishing the animals in American style feedlots. In rainfed fields, the Pasmans produce 8 tons of corn per hectare and 3 tons of wheat; under irrigation, they get 12 tons of corn and 6 tons of wheat. The most important crop, however, is soybeans. They also grow potatoes, corn and sunflower seeds for Monsanto Company. The farm uses 42 pivots to irrigate 4,000 hectares, and about 80 percent of the farm is double-cropped: wheat plus soybeans, seed corn plus soybeans, potato plus corn. Argentina uses a huge amount of herbicides and genetically modified crops, Pasman said, adding that his farm was one of the first to produce Roundup Ready® soybean seeds in 1994. A View from Agricultural Producers “The cornerstone of our production technology is no-till,” Pasman said, a technique used on the entire farm except the potato fields, which follow a rotation of one year of potatoes followed by three years of no-till. A corn crop follows the potato harvest in the same year. No-till improves water infiltration and water retention and reduces evaporation because the previous crops’ residue minimizes runoff and allows the soil to retain more water. No-till also reduces erosion risk and increases organic matter, improving oxidation and carbon circulation in the soil. It improves soil fertility, increases productivity and sustainability, and allows farming in difficult soils, particularly shallow soils of 3 inches. No-till uses less than half the water and less labor compared to conventional tillage, reducing production costs by 30 percent, Pasman concluded. “It is very important, the mix of no tillage with center pivot (irrigation) against traditional management.

Regulation of Chromatin Remodeling by Inositol Polyphosphates

Chromatin remodeling is required for efficient transcription of eukaryotic genes. In a genetic selection for budding yeast mutants that were defective in induction of the phosphate-responsive PHO5 gene, we identified mutations inARG82/IPK2, which encodes a nuclear inositol polyphosphate kinase. In arg82 mutant strains, remodeling ofPHO5 promoter chromatin is impaired, and the adenosine triphosphate–dependent chromatin-remodeling complexes SWI/SNF and INO80 are not efficiently recruited to phosphate-responsive promoters. These results suggest a role for the small molecule inositol polyphosphate in the regulation of chromatin remodeling and transcription