The EVERT (effective verruca treatments) trial protocol: a randomised controlled trial to evaluate cryotherapy versus salicylic acid for the treatment of verrucae

<p>Abstract</p> <p>Background</p> <p>Verrucae are a common, infectious and sometimes painful problem. The optimal treatment for verrucae is unclear due to a lack of high quality randomised controlled trials. The primary objective of this study is to compare the clinical effectiveness of two common treatments for verrucae: cryotherapy using liquid nitrogen versus salicylic acid. Secondary objectives include a comparison of the cost-effectiveness of the treatments, and an investigation of time to clearance of verrucae, recurrence/clearance of verrucae at six months, patient satisfaction with treatment, pain associated with treatment, and use of painkillers for the treatments.</p> <p>Methods/Design</p> <p>This is an open, pragmatic, multicentre, randomised controlled trial with two parallel groups: cryotherapy using liquid nitrogen delivered by a healthcare professional for a maximum of 4 treatments (treatments 2-3 weeks apart) or daily self-treatment with 50% salicylic acid for a maximum of 8 weeks. Two hundred and sixty-six patients aged 12 years and over with a verruca are being enrolled into the study. The primary outcome is complete clearance of all verrucae as observed on digital photographs taken at 12 weeks compared with baseline and assessed by an independent healthcare professional. Secondary outcomes include self-reported time to clearance of verrucae, self-reported clearance of verrucae at 6 months, cost-effectiveness of the treatments compared to one another, and patient acceptability of both treatments including possible side effects such as pain. The primary analysis will be intention to treat. It is planned that recruitment will be completed by December 2009 and results will be available by June 2010.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN18994246.</p

Water Banking Can Help Great Salt Lake

Utah’s Great Salt Lake is a treasured resource, yet dedicated flows have not been established to preserve the economic, ecological, and cultural values that the lake provides. Utah’s prior appropriation law allocates water rights based on time of first use, meaning agricultural water uses typically have senior rights. Utah’s Water Banking Act, which was adopted in 2020, presents an opportunity to reallocate some water to the environment within existing appropriative rights water law.Under the act, water users can create local water banks to temporarily lease water. Leased water can be used for various purposes, including environmental or agricultural uses. Water banking under the act allows right holders to lease some or all of their water and, crucially, protects banked water rights from forfeiture. Additionally, the water and money from leases remain in the local watershed. Water banking presents an opportunity to flexibly manage water and help preserve the dwindling Great Salt Lake. This analysis estimates the volume of water that could be delivered to Great Salt Lake and the lake’s water level based on wet-year water banking in Utah’s Cache Valley

Water Development, Consumptive Water Uses, and the Great Salt Lake

Great Salt Lake (GSL) covers 5500 km2 (2100 mi2) at its unimpacted elevation and is the eighth largest saline lake in the world. Its highly productive food web supports millions of migratory birds and the economic value of the lake is estimated at $1.5 billion US dollars in 2019. Droughts and wet cycles have caused huge fluctuations in lake level, area, and salinities, and this variation has masked anthropogenic impacts. Recent work, however, has determined that consumptive water uses in the watershed have depleted inflows by approximately 39$14–96 million ($5–32 per person). Water conservation paired with water markets reduce costs further, costing between$2 and $16 per person. Descriptions of potential solutions to reduce consumptive water uses and stabilize GSL level are a starting point to encourage discussion. Strategies have yet to be prioritized or thoroughly evaluated. Quantifying water diversions from rivers that feed GSL and consumptive water uses will allow Utahns to make defensible decisions to manage water resources and the lake’s biology for long-term ecological, recreational, and economic benefit

The Data Information Literacy Toolkit

The Data Information Literacy Toolkit was the interview instrument developed and used by the Data Information Literacy project to better understand the educational needs of graduate students in managing, working with and curating their data sets. Results from the interviews conducted at Purdue University, Cornell University, the University of Minnesota and the University of Oregon were used to inform the educational programs offered by librarians at each institution in 2012 or 2013. The interview is based in part on the 12 data information literacy competencies as defined by Carlson, Fosmire, Miller and Sapp Nelson in an article that appeared in the April 2011 edition of portal: Libraries and the academy (doi: 10.1353/pla.2011.0022)

Exploring Utah\u27s Water

This factsheet is intended to help Utah citizens better understand where our water comes from, the different ways we use water, and the challenges of meeting our multiple, and often competing needs. A better understanding of Utah’s water will help as we work together to plan for the future

Storing Water for the Environment: Technical Appendix B: An Experimental Reservoir Model for Storage and Allocation of an Ecosystem Water Budget

Dams alter flow regimes, fragment rivers, and harm freshwater ecosystems (Munsch et al. 2022; Barbarossa et al. 2020). Yet, freshwater ecosystems are increasingly dependent on surface reservoirs for environmental flows and suitable water temperatures as rivers have become irrevocably altered by water development, consumptive water uses, land use change, and climate change (Grantham et al. 2020; Yarnell et al. 2020). This creates a paradox where dams have contributed to freshwater ecosystem decline, but are now instrumental for managing environmental water and enhancing downstream ecosystems

Associations between quality indicators of internal medicine residency training programs

<p>Abstract</p> <p>Background</p> <p>Several residency program characteristics have been suggested as measures of program quality, but associations between these measures are unknown. We set out to determine associations between these potential measures of program quality.</p> <p>Methods</p> <p>Survey of internal medicine residency programs that shared an online ambulatory curriculum on hospital type, faculty size, number of trainees, proportion of international medical graduate (IMG) trainees, Internal Medicine In-Training Examination (IM-ITE) scores, three-year American Board of Internal Medicine Certifying Examination (ABIM-CE) first-try pass rates, Residency Review Committee-Internal Medicine (RRC-IM) certification length, program director clinical duties, and use of pharmaceutical funding to support education. Associations assessed using Chi-square, Spearman rank correlation, univariate and multivariable linear regression.</p> <p>Results</p> <p>Fifty one of 67 programs responded (response rate 76.1%), including 29 (56.9%) community teaching and 17 (33.3%) university hospitals, with a mean of 68 trainees and 101 faculty. Forty four percent of trainees were IMGs. The average post-graduate year (PGY)-2 IM-ITE raw score was 63.1, which was 66.8 for PGY3s. Average 3-year ABIM-CE pass rate was 95.8%; average RRC-IM certification was 4.3 years. ABIM-CE results, IM-ITE results, and length of RRC-IM certification were strongly associated with each other (p < 0.05). PGY3 IM-ITE scores were higher in programs with more IMGs and in programs that accepted pharmaceutical support (p < 0.05). RRC-IM certification was shorter in programs with higher numbers of IMGs. In multivariable analysis, a higher proportion of IMGs was associated with 1.17 years shorter RRC accreditation.</p> <p>Conclusions</p> <p>Associations between quality indicators are complex, but suggest that the presence of IMGs is associated with better performance on standardized tests but decreased duration of RRC-IM certification.</p