Implementation of duty of candour within neurosurgery: a national survey and framework for improved application in clinical practice

INTRODUCTION: Statutory duty of candour was introduced in November 2014 for NHS bodies in England. Contained within the regulation were definitions regarding the threshold for what constitutes a notifiable patient safety incident. However, it can be difficult to determine when the process should be implemented. The aim of this survey was to evaluate the interpretation of these definitions by British neurosurgeons. MATERIALS AND METHODS: All full (consultant) members of the Society of British Neurological Surgeons were electronically invited to participate in an online survey. Surgeons were presented with 15 cases and asked to decide in the case of each one whether they would trigger the process of duty of candour. Cases were stratified according to their likelihood and severity. RESULTS: In all, 106/357 (29.7%) members participated in the survey. Responses varied widely, with almost no members triggering the process of duty of candour in cases where adverse events were common (greater than 10% likelihood) and required only outpatient follow-up (7/106; 6.6%), and almost all members doing so in cases where adverse events were rare (less than 0.1% likelihood) and resulted in death (102/106; 96.2%). However, there was clear equipoise in triggering the process of duty of candour in cases where adverse events were uncommon (0.1-10% likelihood) and resulted in moderate harm (38/106; 35.8%), severe harm (57/106; 53.8%) or death (49/106; 46.2%). CONCLUSION: There is considerable nationwide variation in the interpretation of definitions regarding the threshold for duty of candour. To this end, we propose a framework for the improved application of duty of candour in clinical practice

Early corn stand count of different cropping systems using UAV-imagery and deep learning

Optimum plant stand density and uniformity is vital in order to maximize corn (Zea mays L.) yield potential. Assessment of stand density can occur shortly after seedlings begin to emerge, allowing for timely replant decisions. The conventional methods for evaluating an early plant stand rely on manual measurement and visual observation, which are time consuming, subjective because of the small sampling areas used, and unable to capture field-scale spatial variability. This study aimed to evaluate the feasibility of an unmanned aerial vehicle (UAV)-based imaging system for estimating early corn stand count in three cropping systems (CS) with different tillage and crop rotation practices. A UAV equipped with an on-board RGB camera was used to collect imagery of corn seedlings (~14 days after planting) of CS, i.e., minimum-till corn-soybean rotation (MTCS), no-till corn-soybean rotation (NTCS), and no-till corn-corn rotation with cover crop implementation (NTCC). An image processing workflow based on a deep learning (DL) model, U-Net, was developed for plant segmentation and stand count estimation. Results showed that the DL model performed best in segmenting seedlings in MTCS, followed by NTCS and NTCC. Similarly, accuracy for stand count estimation was highest in MTCS (R2 = 0.95), followed by NTCS (0.94) and NTCC (0.92). Differences by CS were related to amount and distribution of soil surface residue cover, with increasing residue generally reducing the performance of the proposed method in stand count estimation. Thus, the feasibility of using UAV imagery and DL modeling for estimating early corn stand count is qualified influenced by soil and crop management practices

Role of inherent soil characteristics in assessing soil health across Missouri

Soil health indicator values vary based on parent material, native vegetation, and other soil forming factors; therefore, useful interpretations require consideration of inherent soil characteristics. Our objective was to evaluate the distribution of soil health indicators across soil and climate gradients throughout the state of Missouri through a statewide cover crop cost-share program. Soil samples (0–7 cm) were collected from 5,300 agricultural fields and analyzed for several soil health indicators. Comparisons were made among six regions in the state based on Major Land Resource Area and county boundaries. Results varied for soil organic carbon (C), active C, potentially mineralizable nitrogen, water stable aggregates, and cation exchange capacity by region and corresponded with soil forming factors. Interpretation of soil health indicators must account for regional factors, recognizing that areas with different inherent values have a different potential for soil health

A long‑term precision agriculture system sustains grain profitability

After two decades of availability of grain yield-mapping technology, long-term trends in field-scale profitability for precision agriculture (PA) systems and conservation practices can now be assessed. Field-scale profitability of a conventional or ‘business-as-usual’ system with an annual corn (Zea mays L.)-soybean (Glycine max [L.]) rotation and annual tillage was assessed for 11 years on a 36 ha field in central Missouri during 1993 to 2003. Following this, a ‘precision agriculture system’ (PAS) with conservation practices was implemented for the next 11 years to address production, profit and environmental concerns. The PAS was multifaceted and temporally dynamic. It included no-till, cover crops, crop rotation changes, site-specific N and variable-rate or zonal P, K and lime. Following a recent evaluation of differences in yield and yield variability, this research compared profitability of the two systems. Results indicated that PAS sustained profits in the majority (97%) of the field without subsidies for cover crops or payments for enhanced environmental protection. Profit was only lower with PAS in a drainage channel where no-till sometimes hindered soybean stands and wet soils caused wheat (Triticum aestivum L.) disease. Although profit gains were not realized after 11 years of PA and conservation practices, this system sustained profits. These results should help growers gain confidence that PA and conservation practices will be successful

An uncharged amine in the transition state of the ribosornal peptidyl transfer reaction.

The ribosome has an active site comprised of RNA that catalyzes peptide bond formation. To understand how RNA promotes this reaction requires a detailed understanding of the chemical transition state. Here, we report the Bronsted coefficient of the a-amino nucleophile with a series of puromycin derivatives. Both 50S subunit- and 70S ribosome-catalyzed reactions displayed linear free-energy relationships with slopes close to zero under conditions where chemistry is rate limiting. These results indicate that, at the transition state, the nucleophile is neutral in the ribosome-catalyzed reaction, in contrast to the substantial positive charge reported for typical uncatalyzed aminolysis reactions. This suggests that the ribosomal transition state involves deprotonation to a degree commensurate with nitrogen-carbon bond formation. Such a transition state is significantly different from that of uncatalyzed aminolysis reactions in solution

Effects of combined conservation practices on soil and water quality in the Central Mississippi River Basin

Conventional cultivation of claypan soils leads to soil and water quality degradation because of high runoff and associated soil erosion. The Goodwater Creek Experimental Watershed, which is part of the USDA Agricultural Research Service Benchmark Conservation Effects Assessment Project, Watershed Assessment Studies, was established to address these issues. Plot studies have highlighted trade-offs between erosion control and herbicide or nutrient runoff. There is a need for long-term field-scale evaluation of combined practices that reduce sediment, nutrient, and herbicide losses by runoff. A 36 ha field located in Missouri was under a conventional corn (Zea mays L.)-soybean (Glycine max L.) system from 1993 to 2003 with fertilizer application and tillage prior to planting in the spring. A precision agriculture system defined by two main management zones was implemented from 2004 to 2014: Wheat (Triticum aestivum L.) and soybean in 60% of the field, and corn and soybean in the remaining 40%. The system included no-till, cover crops, atrazine split-applications based on weed pressure, variable rates of nitrogen (N), and variable rates of fall-applied phosphorus (P). The objective of this study was to compare runoff water quality from the two management systems, based on flow and load duration curves, cumulative distribution functions, and conclusions from replicated plot studies. The precision agriculture system did not affect annual runoff, but it did increase the frequency of low flows. Sediment losses were reduced by 87% as a result of no-till and cover crops. Atrazine and P losses were lower than expected, despite the lack of incorporation into the soil. Atrazine losses were possibly lower because of the wheat area acting as a buffer, greater atrazine adsorption and retention in the field, and faster decay. Dissolved P losses as a fraction of applied remained the same, likely because of greater adsorption and lower runoff risk when applying P. Finally, nitrate-N (NO3-N) losses decreased and resulted in an overall decrease of N losses despite a slight increase of ammonium-N (NH4-N) losses. Explanations includeincluded a greater soil water content, a different timing of N applications, and N uptake by cover crops. Building on these successes, an aspirational management system is proposed to further improve on the performance and practicality of the precision agriculture system

A new perspective when examining maize fertilizer nitrogen use efficiency, incrementally

For maize (Zea mays L.), nitrogen (N) fertilizer use is often summarized from field to global scales using average N use efficiency (NUE). But expressing NUE as averages is misleading because grain increase to added N diminishes near optimal yield. Thus, environmental risks increase as economic benefits decrease. Here, we use empirical datasets obtained in North America of maize grain yield response to N fertilizer (n = 189) to create and interpret incremental NUE (iNUE), or the change in NUE with change in N fertilization. We show for those last units of N applied to reach economic optimal N rate (EONR) iNUE for N removed with the grain is only about 6%. Conversely stated, for those last units of N applied over 90% is either lost to the environment during the growing season, remains as inorganic soil N that too may be lost after the growing season, or has been captured within maize stover and roots or soil organic matter pools. Results also showed iNUE decrease averaged 0.63% for medium-textured soils and 0.37% for fine-textured soils, attributable to fine-textured soils being more predisposed to denitrification and/or lower mineralization. Further analysis demonstrated the critical nature growing season water amount and distribution has on iNUE. Conditions with too much rainfall and/or uneven rainfall produced low iNUE. Producers realize this from experience, and it is uncertain weather that largely drives insurance fertilizer additions. Nitrogen fertilization creating low iNUE is environmentally problematic. Our results show that with modest sub-EONR fertilization and minor forgone profit, average NUE improvements of ~10% can be realized. Further, examining iNUE creates unique perspective and ideas for how to improve N fertilizer management tools, educational programs, and public policies and regulations

Cropping system and landscape characteristics influence long-term grain crop profitability

Converting from standard tillage or no-tillage cropping systems to more conservation-based cropping systems that include no-tillage, cover crops, and reduced agrichemical inputs must be profitable for large-scale adoption. Therefore, research was conducted at the central Mississippi River Basin site of the USDA Long-Term Agroecosystem Research Network from 1996 to 2009 to determine how cropping systems, landscape position, and depth to claypan affected net economic return. Treatments consisted of three cropping systems {mulch-till corn (Zea mays L.)–soybean [Glycine max (L.) Merr.], MTCS; no-till corn–soybean, NTCS; no-till corn–soybean–wheat (Triticum aestivum L.) (NTCSW)–cover crop} and three landscape positions (summit, backslope, and footslope). Within each cropping system, landscape position influenced the depth to claypan and net returns, which were greatest in the summit and footslope positions. Across landscape positions, net return for NTCS was US$252 and$119 ha−1 yr−1 greater than MTCS and NTCSW, respectively. Net return of corn in MTCS and NTCSW was negative, whereas corn in NTCS averaged $97 ha−1 yr−1. Only NTCS corn exhibited a positive linear response in net return to depth to claypan. Soybean was much more profitable than corn, and both NTCS and NTCSW soybean were less influenced by landscape position and had at least$252 ha−1 yr−1 greater return than did MTCS soybean across landscape position. Results suggest that converting from MTCS to NTCS would have large positive impacts on reducing within-field variability and increasing profitability in the region, and modifications to the NTCSW system are needed to improve profitability

Dynamics of direct inter-pack encounters in endangered African wild dogs

Aggressive encounters may have important life history consequences due to the potential for injury and death, disease transmission, dispersal opportunities or exclusion from key areas of the home range. Despite this, little is known of their detailed dynamics, mainly due to the difficulties of directly observing encounters in detail. Here, we describe detailed spatial dynamics of inter-pack encounters in African wild dogs (Lycaon pictus), using data from custom-built high-resolution GPS collars in 11 free-ranging packs. On average, each pack encountered another pack approximately every 7 weeks and met each neighbour twice each year. Surprisingly, intruders were more likely to win encounters (winning 78.6% of encounters by remaining closer to the site in the short term). However, intruders did tend to move farther than residents toward their own range core in the short-term (1 h) post-encounter, and if this were used to indicate losing an encounter, then the majority (73.3%) of encounters were won by residents. Surprisingly, relative pack size had little effect on encounter outcome, and injuries were rare (<15% of encounters). These results highlight the difficulty of remotely scoring encounters involving mobile participants away from static defendable food resources. Although inter-pack range overlap was reduced following an encounter, encounter outcome did not seem to drive this, as both packs shifted their ranges post-encounter. Our results indicate that inter-pack encounters may be lower risk than previously suggested and do not appear to influence long-term movement and ranging

Emotional Impairment and Persistent Upregulation of mGlu5 Receptor following Morphine Abstinence: Implications of an mGlu5-MOPr Interaction.

BACKGROUND: A difficult problem in treating opioid addicts is the maintenance of a drug-free state because of the negative emotional symptoms associated with withdrawal, which may trigger relapse. Several lines of evidence suggest a role for the metabotropic glutamate receptor 5 in opioid addiction; however, its involvement during opioid withdrawal is not clear. METHODS: Mice were treated with a 7-day escalating-dose morphine administration paradigm. Following withdrawal, the development of affective behaviors was assessed using the 3-chambered box, open-field, elevated plus-maze and forced-swim tests. Metabotropic glutamate receptor 5 autoradiographic binding was performed in mouse brains undergoing chronic morphine treatment and 7 days withdrawal. Moreover, since there is evidence showing direct effects of opioid drugs on the metabotropic glutamate receptor 5 system, the presence of an metabotropic glutamate receptor 5/μ-opioid receptor interaction was assessed by performing metabotropic glutamate receptor 5 autoradiographic binding in brains of mice lacking the μ-opioid receptor gene. RESULTS: Withdrawal from chronic morphine administration induced anxiety-like, depressive-like, and impaired sociability behaviors concomitant with a marked upregulation of metabotropic glutamate receptor 5 binding. Administration of the metabotropic glutamate receptor 5 antagonist, 3-((2-Methyl-4-thiazolyl)ethynyl)pyridine, reversed morphine abstinence-induced depressive-like behaviors. A brain region-specific increase in metabotropic glutamate receptor 5 binding was observed in the nucleus accumbens shell, thalamus, hypothalamus, and amygdala of μ-opioid receptor knockout mice compared with controls. CONCLUSIONS: These results suggest an association between metabotropic glutamate receptor 5 alterations and the emergence of opioid withdrawal-related affective behaviors. This study supports metabotropic glutamate receptor 5 system as a target for the development of pharmacotherapies for the treatment of opioid addiction. Moreover, our data show direct effects of μ-opioid receptor system manipulation on metabotropic glutamate receptor 5 binding in the brain