Building a functional, integrated GIS/remote sensing resource analysis and planning system

To be an effective tool for resource analysis and planning, a geographic information system (GIS) needs to be integrated with a digital remote sensing capability. To be truly functional, the paired system must be driven by grass roots local needs. A case study couched in a Soil Conservation District in northern Utah is presented. Agency representatives determined that the most fundamental data sets to be entered into the GIS system analysis system in the first round were: land use/land cover; geomorphic/soil unit data; hydrologic unit data; and digital terrain. The least expensive and best ways to obtain these data were determined. Data were acquired and formatted to enter the state's PRIME/ARC-INFO GIS, and are being interrogated for resource management decisions related to such issues as agricultural preservation, urban expansion, soil erosion control, and dam siting

Irrigated acreage in the Bear River Basin as of the 1975 growing season

The irrigated cropland in the Bear River Basin as of the 1975 growing season was inventoried from satellite imagery. LANDSAT color infrared images (scale 1:125,000) were examined for early, mid, and late summer dates, and acreage was estimated by use of township/section overlays. The total basin acreage was estimated to be 573,435 acres, with individual state totals as follows: Idaho 234,370 acres; Utah 265,505 acres; and Wyoming 73,560 acres. As anticipated, wetland areas intermingled among cropland appears to have produced an over-estimation of irrigated acreage. According to a 2% random sample of test sites evaluated by personnel from the Soil Conservation Service such basin-wide over-estimation is 7.5%; individual counties deviate significantly from the basin-wide figure, depending on the relative amount of wetland areas intermingled with cropland

Complex consultations in primary care: a tool for assessing the range of health problems and issues addressed in general practice consultations

Background: There is an increasing recognition that many consultations in general practice involve several problems covering multiple disease domains. However there is a paucity of reliable tools and techniques to understand and quantify this phenomenon. The objective was to develop a tool that can be used to measure the number and type of problems discussed in primary care consultations. Methods: Thirteen consultations between general practitioners and patients were initially videoed and reviewed to identify the problems and issues discussed. An iterative process involving a panel of clinicians and researchers and repeated cycles of testing and development was used to develop a measurement proforma and coding manual for assessment of video recorded consultations. The inter-rater reliability of this tool was assessed in 60 consultations. Results: The problems requiring action were usually readily identified. However the different dimensions of the problem and how they were addressed required the identification and definition of ‘issues’. A coding proforma was developed that allowed quantification of the numbers and types of health problems and issues discussed. Ten categories of issues were identified and defined. At the consultation level, inter-rater agreements for the number of problems discussed (within ±1), types of problems and issues were 98.3%, 96.5% and 90% respectively. The tool has subsequently been used to analyse 229 consultations. Conclusion: The iterative approach to development of the tool reflected the complexity of doctor-patient interactions. A reliable tool has been developed that can be used to analyse the number and range of problems managed in primary care consultations

The role of intratidal oscillations in sediment resuspension in a diurnal, partially mixed estuary

Using detailed observations of the mean and turbulent properties of flow, salinity and turbidity that spanned 2001/02, we examined the physical mechanisms underpinning sediment resuspension in the low-energy Swan River estuary, Western Australia. In this diurnal tidally-dominated estuary, the presence of intratidal oscillations, a tidal inequality lasting 2 to 3 hours on the flood tide, generated by interactions of the four main diurnal and semidiurnal astronomical constituents, K₁, O₁, M₂, and S₂, played a major role in modifying vertical stratification and mixing. These intratidal oscillations are controlled by phase differences between the tropic and synodic months rather than being temporally-fixed by bed friction, as occurs in semidiurnal estuaries. Intratidal oscillations are largest, at around 0.1 m, near to the Austral solstice when the lunar and solar declination are in-phase. Despite the seemingly small change in water level, shear-induced interfacial mixing caused destratification of the water column with the top-to-bottom salinity (ΔS) difference of 3.5 present early in the flood tide eroded to less than 0.3 by the end of the intratidal oscillation. High turbidity peaks, of 250 nephelometric turbidity units, coincided with these intratidal oscillations and could not be explained by bed friction since shear stress from mean flow did not exceed threshold criteria. High Reynolds stresses of ∼1 Nm⁻² did, however, exceed τcr and together with negative Reynolds fluxes indicate a net downward transport of material. Destratification of the water column induced by shear instabilities resulted in large overturns capable of moving in situ material towards the bed during intratidal oscillations and these turbidities were ∼10 times greater than those from bed-generated resuspension observed later during the flood tide

Report from the fourth international consensus meeting to harmonize core outcome measures for atopic eczema/dermatitis clinical trials (HOME initiative)

This article is a report of the fourth meeting of the Harmonising Outcome Measures for Eczema (HOME) initiative held in Malmö, Sweden on 23–24 April 2015 (HOME IV). The aim of the meeting was to achieve consensus over the preferred outcome instruments for measuring patient-reported symptoms and quality of life for the HOME core outcome set for atopic eczema (AE). Following presentations, which included data from systematic reviews, consensus discussions were held in a mixture of whole group and small group discussions. Small groups were allocated a priori to ensure representation of different stakeholders and countries. Decisions were voted on using electronic keypads. For the patient-reported symptoms, the group agreed by vote that itch, sleep loss, dryness, redness/inflamed skin and irritated skin were all considered essential aspects of AE symptoms. Many instruments for capturing patient-reported symptoms were discussed [including the Patient-Oriented SCOring Atopic Dermatitis index, Patient-Oriented Eczema Measure (POEM), Self-Administered Eczema Area and Severity Index, Itch Severity Scale, Atopic Dermatitis Quickscore and the Nottingham Eczema Severity Score] and, by consensus, POEM was selected as the preferred instrument to measure patient-reported symptoms. Further work is needed to determine the reliability and measurement error of POEM. Further work is also required to establish the importance of pain/soreness and the importance of collecting information regarding the intensity of symptoms in addition to their frequency. Much of the discussion on quality of life concerned the Dermatology Life Quality Index and Quality of Life Index for Atopic Dermatitis; however, consensus on a preferred instrument for measuring this domain could not be reached. In summary, POEM is recommended as the HOME core outcome instrument for measuring AE symptoms

Phosphorus dynamics in a tropical forest soil restored after strip mining

Background and aims We hypothesized that successful early ecosystem and soil development in these P-deficient soil materials will initially depend on effective re-establishment of P storage and cycling through organic matter. This hypothesis was tested in a 26-year chronosequence of seven lightly fertilized, oxidic soil materials restored to eucalypt forest communities after bauxite mining. Methods Total P (Pt) status, Hedley P fractions and partial chemical speciation (NaOH-EDTA extraction and analysed using solution 31P NMR spectroscopy) were determined in the restored soils. Results Concentrations of Pt and most Hedley fractions changed with restoration period, declined with depth and were strongly positively correlated with C and N concentrations. Biological P dominated the Labile and Intermediate P fractions while Long-term P was dominantly inorganic. Organic P concentrations in NaOH-EDTA extracts and their chemical natures were similar in restored and unburned native forest sites. Phosphomonoesters were the dominant class of organic P. Conclusions Surprisingly rapid P accretion and fractional changes occurred over 26 years, largely in the surface soils and closely associated with organic matter status. Alkaline hydrolysis products of phosphodiesters and pyrophosphate indicated the importance of microbial P cycling. The important consequences for long-term ecosystem development and biological diversity require further study

Improving the diagnostic accuracy of referrals for papilloedema (DIPP) study: protocol for a mixed-methods study.

INTRODUCTION: Papilloedema can be the first sign of life-threatening disease, for example, brain tumours. Due to the potential seriousness of this clinical sign, the detection of papilloedema would normally prompt urgent hospital referral for further investigation. The problem is that many benign structural variations of optic nerve anatomy can be mistaken for papilloedema, so-called pseudopapilloedema. The consequence is that many people are referred to hospital because they are incorrectly identified to have papilloedema when they don't. As a result, hospital referrals of people with suspected papilloedema in England have increased sharply, leading to increased demand for overstretched hospital services and potentially longer waiting times for hospital appointments for those who do have papilloedema.The work programme is aimed at the development of guidelines and educational materials that will help support health professionals to correctly identify people with papilloedema. This article describes the protocol for gathering evidence of current referral practices and pathways for people suspected to have papilloedema in England and the development of guidelines based on this evidence and extensive engagement with community- and hospital-based healthcare professionals, patients, and the public. METHODS AND ANALYSIS: Both qualitative and quantitative data will be collected from Freedom of Information requests to Integrated Care Boards across England about how they organise their community and hospital services for people with suspected papilloedema, with and without headache. Surveys and qualitative interviews of relevant community and hospital healthcare professionals based in England will collect data on how and when people with papilloedema and pseudopapilloedema with or without headache are currently identified and referred to hospital, if needed. This information will be used to inform a Delphi process with the aim of reaching consensus among health professional experts, commissioners and patients on what the most evidence-based and safe diagnostic and referral practices should be for people with suspected papilloedema. The tailored guidelines will be written for healthcare professionals and patients. We will create a range of educational materials and a website designed for health professionals and patients to support the national roll-out and implementation of DIPP study guidelines. ETHICS AND DISSEMINATION: Ethical approval was granted by the University of Bristol Faculty of Health Sciences Ethics committee (FREC reference: 12457) and Health Research Authority (IRAS no.: 320395). Results of the study will be published on our DIPP study website and disseminated to our stakeholder groups through peer-reviewed journal publications and conference presentations

Views and experiences of managing eczema:systematic review and thematic synthesis of qualitative studies*

Background: The number of qualitative studies on eczema has increased rapidly in recent years. Systematically reviewing these can provide greater understandings of people’s perceptions of eczema and eczema treatments. Objectives: We sought to systematically review and thematically synthesize qualitative studies exploring views and experiences of people with eczema and parents/carers of children with eczema. Methods: We searched MEDLINE, EMBASE, PsycINFO and CINAHL from the earliest date available to February 2019. We selected papers focusing on views and experiences of eczema and eczema treatments, and barriers/facilitators to eczema self-management. We excluded papers focusing on health service provision models or health professionals’ views. Results: We synthesized 39 papers (reporting 32 studies) from 13 countries. We developed four analytical themes: (1) Eczema not viewed as a long-term condition; (2) Significant psychosocial impact not acknowledged by others; (3) Hesitancy (patient/carer uncertainty) about eczema treatments; and (4) Insufficient information and advice. Our findings suggest that people with eczema and their carers experience frustration at having to manage a condition that is often seen by others as mundane but has significant psychosocial impact and is difficult to manage due to concerns about, and burden of, treatment. This frustration can be exacerbated by experiences of conflicting and/or insufficient information and advice from health professionals, family and others. Conclusions: Effective self-management of eczema could be supported by addressing beliefs and concerns about treatments; seeking positive ways to promote a ‘control not cure’ message; acknowledging psychosocial impacts of eczema and treatment burden; and providing clear consistent advice or signposting towards reliable information.</p

Merkel Cell Polyomavirus DNA in Respiratory Specimens from Children and Adults

Merkel cell polyomavirus (MCPyV) DNA was detected in 7 (1.3%) of 526 respiratory tract samples from patients in Australia with upper or lower respiratory tract symptoms. Partial T antigen and major capsid protein sequences of MCPyV identified in respiratory secretions showed high homology (99%–100%) to those found in Merkel cell carcinoma