Participatory Data Collection Technique for Capturing Beginning Farmer Program Outcomes

This article describes an innovative evaluation plan we employed to capture outcomes of a multiyear beginning farmer program and, specifically, highlights the facilitation technique we used to document short-term and intermediate goals of the program that matched U.S. Department of Agriculture grant requirements and Extension administration priorities. Developing a comprehensive, two-phase evaluation plan based on a well-conceived logic model was a key factor in the success of the New FARM program. Our midterm and end-of-program evaluations addressed often sought, but sometimes difficult to obtain, intermediate goals from the logic model and demonstrated program effectiveness to a variety of funders

The New FARM Program: A Model for Supporting Diverse Emerging Farmers and Early-Career Extension Professionals

As early-career Extension educators challenged by societal, structural, agricultural, and fiscal trends, we designed a multiyear educational program to support the diverse needs of emerging specialty crop producers in northwest Michigan. This article presents outcomes of that program. We explore how Extension professionals can develop impactful programs that address the varied needs of the next generation of agricultural producers. We provide an overview of the New FARM program, addressing the rationale, program objectives, program logistics, evaluation results, and implications. We hope the New FARM program will serve as a useful model for early-career Extension professionals

On the Use of TMS to Investigate the Pathophysiology of Neurodegenerative Diseases

Neurodegenerative diseases are a collection of disorders that result in the progressive degeneration and death of neurons. They are clinically heterogenous and can present as deficits in movement, cognition, executive function, memory, visuospatial awareness and language. Transcranial magnetic stimulation (TMS) is a non-invasive brain stimulation tool that allows for the assessment of cortical function in vivo. We review how TMS has been used for the investigation of three neurodegenerative diseases that differ in their neuroanatomical axes: (1) Motor cortex—corticospinal tract (motor neuron diseases), (2) Non-motor cortical areas (dementias), and (3) Subcortical structures (parkinsonisms). We also make four recommendations that we hope will benefit the use of TMS in neurodegenerative diseases. Firstly, TMS has traditionally been limited by the lack of an objective output and so has been confined to stimulation of the motor cortex; this limitation can be overcome by the use of concurrent neuroimaging methods such as EEG. Given that neurodegenerative diseases progress over time, TMS measures should aim to track longitudinal changes, especially when the aim of the study is to look at disease progression and symptomatology. The lack of gold-standard diagnostic confirmation undermines the validity of findings in clinical populations. Consequently, diagnostic certainty should be maximized through a variety of methods including multiple, independent clinical assessments, imaging and fluids biomarkers, and post-mortem pathological confirmation where possible. There is great interest in understanding the mechanisms by which symptoms arise in neurodegenerative disorders. However, TMS assessments in patients are usually carried out during resting conditions, when the brain network engaged during these symptoms is not expressed. Rather, a context-appropriate form of TMS would be more suitable in probing the physiology driving clinical symptoms. In all, we hope that the recommendations made here will help to further understand the pathophysiology of neurodegenerative diseases

Preconditioning Stimulus Intensity Alters Paired-Pulse TMS Evoked Potentials.

Motor cortex (M1) paired-pulse TMS (ppTMS) probes excitatory and inhibitory intracortical dynamics by measurement of motor-evoked potentials (MEPs). However, MEPs reflect cortical and spinal excitabilities and therefore cannot isolate cortical function. Concurrent TMS-EEG has the ability to measure cortical function, while limiting peripheral confounds; TMS stimulates M1, whilst EEG acts as the readout: the TMS-evoked potential (TEP). Whilst varying preconditioning stimulus intensity influences intracortical inhibition measured by MEPs, the effects on TEPs is undefined. TMS was delivered to the left M1 using single-pulse and three, ppTMS paradigms, each using a different preconditioning stimulus: 70%, 80% or 90% of resting motor threshold. Corticospinal inhibition was present in all three ppTMS conditions. ppTMS TEP peaks were reduced predominantly under the ppTMS 70 protocol but less so for ppTMS 80 and not at all for ppTMS 90. There was a significant negative correlation between MEPs and N45 TEP peak for ppTMS 70 reaching statistical trends for ppTMS 80 and 90. Whilst ppTMS MEPs show inhibition across a range of preconditioning stimulus intensities, ppTMS TEPs do not. TEPs after M1 ppTMS vary as a function of preconditioning stimulus intensity: smaller preconditioning stimulus intensities result in better discriminability between conditioned and unconditioned TEPs. We recommend that preconditioning stimulus intensity should be minimized when using ppTMS to probe intracortical inhibition

Preconditioning stimulus intensity alters paired‐pulse tms evoked potentials

Motor cortex (M1) paired‐pulse TMS (ppTMS) probes excitatory and inhibitory intracor-tical dynamics by measurement of motor‐evoked potentials (MEPs). However, MEPs reflect cortical and spinal excitabilities and therefore cannot isolate cortical function. Concurrent TMS‐EEG has the ability to measure cortical function, while limiting peripheral confounds; TMS stimulates M1, whilst EEG acts as the readout: the TMS‐evoked potential (TEP). Whilst varying preconditioning stimulus intensity influences intracortical inhibition measured by MEPs, the effects on TEPs is undefined. TMS was delivered to the left M1 using single‐pulse and three, ppTMS paradigms, each using a different preconditioning stimulus: 70%, 80% or 90% of resting motor threshold. Corticospinal inhibition was present in all three ppTMS conditions. ppTMS TEP peaks were reduced predominantly under the ppTMS 70 protocol but less so for ppTMS 80 and not at all for ppTMS 90. There was a significant negative correlation between MEPs and N45 TEP peak for ppTMS 70 reaching statistical trends for ppTMS 80 and 90. Whilst ppTMS MEPs show inhibition across a range of preconditioning stimulus intensities, ppTMS TEPs do not. TEPs after M1 ppTMS vary as a function of preconditioning stimulus intensity: smaller preconditioning stimulus intensities result in better discriminability between conditioned and unconditioned TEPs. We recommend that preconditioning stimulus intensity should be minimized when using ppTMS to probe intracortical inhibition

Investigation of the demand for a 7-day (extended access) primary care service : an observational study from pilot schemes in England

Objectives: To understand how the uptake of an extended primary care service in the evenings and weekend varied by day of week and over time. Secondary objectives were to understand patient demographics of users of the service and how these varied by type of appointment and to core hour users. Design: Observational study. Setting: Primary care extended access appointments data in 13 centres in Greater Manchester, England, during 2016. Participants: Appointments could be booked by 1 261 326 patients registered with a family practitioner in five Clinical Commissioning Group geographic areas. Main outcome measures: Primary outcome measure was whether an appointment was used (booked and attended), secondary outcome measures included whether used appointments were prebooked or booked the same day, and delivered by a family or nurse practitioner. Additional analyses compared patient demographics with patients reporting the use of core hour primary care services. Results: 65.33% of 42 472 appointments were booked and attended (used). Usage of appointments was lowest on a Sunday at 46.73% (18.07 percentage points lower usage than on Mondays (95% CI −32.46 to −3.68)). Prebooked appointments were less likely to be booked among age group 0–9 and to result in patients not attending an appointment. Family practitioner appointments were increasingly less likely to be booked with age in comparison to nurse appointments. Patients attending extended access appointments tended to be younger in comparison to core hour patients. Conclusions: There is spare capacity in the extended access service, particularly on Sundays, suggesting reconfigurations of the service may be needed to improve efficiency of delivering the service. Patient demographics suggest the service is used by a relatively younger population than core hour services. Patient demographics varied with the types of appointment provided, these findings may help healthcare providers improve usage by tailoring appointment provision to local populations

Plasticity induced by pairing brain stimulation with motor-related states only targets a subset of cortical neurones

Movement-related brain stimulation (MRBS) interventions associate endogenously generated movement-related brain states with external brain stimuli to induce targeted plastic changes in the motor cortex (M1) [[1], [2], [3], [4]]. These studies have emphasised the importance of the timing of stimulation relative to movement onset. However, none has examined whether the effects are specific to the cortical circuits activated by the stimuli. The question arises because previous work has shown that different sets of inputs to corticospinal neurones can be activated using TMS. Stimulation with a posterior-anterior (PA) direction activates a set of neurones that have a shorter latency connection to corticospinal neurones than those activated with an anterior-posterior (AP) current [5]. Previous MRBS studies have paired movement onset with PA pulses [1]. The present work tests whether the after-effects of MRBS are specific to PA-sensitive neurones, or whether those activated by AP pulses are also affected. Here we applied AP or PA TMS pulses applied just prior to the onset of volitional index finger movements in two experiments conducted on separate days in the same group of individuals [3]. Corticospinal excitability changes induced by these interventions were assessed using AP and PA TMS pulses in the effector muscle and in a control muscle

GSH23.0-0.7+117, a neutral hydrogen shell in the inner Galaxy

GSH23.0-0.7+117 is a well-defined neutral hydrogen shell discovered in the VLA Galactic Plane Survey (VGPS). Only the blueshifted side of the shell was detected. The expansion velocity and systemic velocity were determined through the systematic behavior of the HI emission with velocity. The center of the shell is at (l,b,v)=(23.05,-0.77,+117 km/s). The angular radius of the shell is 6.8', or 15 pc at a distance of 7.8 kpc. The HI mass divided by the volume of the half-shell implies an average density n_H = 11 +/- 4 cm^{-3} for the medium in which the shell expanded. The estimated age of GSH23.0-0.7+117 is 1 Myr, with an upper limit of 2 Myr. The modest expansion energy of 2 * 10^{48} erg can be provided by the stellar wind of a single O4 to O8 star over the age of the shell. The 3 sigma upper limit to the 1.4 GHz continuum flux density (S_{1.4} < 248 mJy) is used to derive an upper limit to the Lyman continuum luminosity generated inside the shell. This upper limit implies a maximum of one O9 star (O8 to O9.5 taking into account the error in the distance) inside the HI shell, unless most of the incident ionizing flux leaks through the HI shell. To allow this, the shell should be fragmented on scales smaller than the beam (2.3 pc). If the stellar wind bubble is not adiabatic, or the bubble has burst (as suggested by the HI channel maps), agreement between the energy and ionization requirements is even less likely. The limit set by the non-detection in the continuum provides a significant challenge for the interpretation of GSH23.0-0.7+117 as a stellar wind bubble. A similar analysis may be applicable to other Galactic HI shells that have not been detected in the continuum.Comment: 18 pages, 6 figures. Figures 1 and 4 separately in GIF format. Accepted for publication in Astrophysical Journa

Automated lesion segmentation with BIANCA: Impact of population-level features, classification algorithm and locally adaptive thresholding

White matter hyperintensities (WMH) or white matter lesions exhibit high variability in their characteristics both at population- and subject-level, making their detection a challenging task. Population-level factors such as age, vascular risk factors and neurodegenerative diseases affect lesion load and spatial distribution. At the individual level, WMH vary in contrast, amount and distribution in different white matter regions. In this work, we aimed to improve BIANCA, the FSL tool for WMH segmentation, in order to better deal with these sources of variability. We worked on two stages of BIANCA by improving the lesion probability map estimation (classification stage) and making the lesion probability map thresholding stage automated and adaptive to local lesion probabilities. Firstly, in order to take into account the effect of population-level factors, we included population-level lesion probabilities, modelled with respect to a parametric factor (e.g. age), in the classification stage. Secondly, we tested BIANCA performance when using four alternative classifiers commonly used in the literature with respect to K-nearest neighbour algorithm (currently used for lesion probability map estimation in BIANCA). Finally, we propose LOCally Adaptive Threshold Estimation (LOCATE), a supervised method for determining optimal local thresholds to apply to the estimated lesion probability map, as an alternative option to global thresholding (i.e. applying the same threshold to the entire lesion probability map). For these experiments we used data from a neurodegenerative cohort, a vascular cohort and the cohorts available publicly as a part of a segmentation challenge. We observed that including population-level parametric lesion probabilities with respect to age and using alternative machine learning techniques provided negligible improvement. However, LOCATE provided a substantial improvement in the lesion segmentation performance, when compared to the global thresholding. It allowed to detect more deep lesions and provided better segmentation of periventricular lesion boundaries, despite the differences in the lesion spatial distribution and load across datasets. We further validated LOCATE on a cohort of CADASIL (Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) patients, a genetic form of cerebral small vessel disease, and healthy controls, showing that LOCATE adapts well to wide variations in lesion load and spatial distribution

Prevention is better than cure, but...: Preventive medication as a risk to ordinariness?

Preventive health remains at the forefront of public health concerns; recent initiatives, such as the NHS health check, may lead to recommendations for medication in response to the identification of 'at risk' individuals. Little is known about lay views of preventive medication. This paper uses the case of aspirin as a prophylactic against heart disease to explore views among people invited to screening for a trial investigating the efficacy of such an approach. Qualitative interviews (N=46) and focus groups (N=5, participants 31) revealed dilemmas about preventive medication in the form of clashes between norms: first, in general terms, assumptions about the benefit of prevention were complicated by dislike of medication; second, the individual duty to engage in prevention was complicated by the need not to be over involved with one's own health; third, the potential appeal of this alternative approach to health promotion was complicated by unease about the implications of encouraging irresponsible behaviour among others. Though respondents made different decisions about using the drug, they reported very similar ways of trying to resolve these conflicts, drawing upon concepts of necessity and legitimisation and the special ordinariness of the particular dru