Dynamic association between perfusion and white matter integrity across time since injury in Veterans with history of TBI.

ObjectiveCerebral blood flow (CBF) plays a critical role in the maintenance of neuronal integrity, and CBF alterations have been linked to deleterious white matter changes. Although both CBF and white matter microstructural alterations have been observed within the context of traumatic brain injury (TBI), the degree to which these pathological changes relate to one another and whether this association is altered by time since injury have not been examined. The current study therefore sought to clarify associations between resting CBF and white matter microstructure post-TBI.Methods37 veterans with history of mild or moderate TBI (mmTBI) underwent neuroimaging and completed health and psychiatric symptom questionnaires. Resting CBF was measured with multiphase pseudocontinuous arterial spin labeling (MPPCASL), and white matter microstructural integrity was measured with diffusion tensor imaging (DTI). The cingulate cortex and cingulum bundle were selected as a priori regions of interest for the ASL and DTI data, respectively, given the known vulnerability of these regions to TBI.ResultsRegression analyses controlling for age, sex, and posttraumatic stress disorder (PTSD) symptoms revealed a significant time since injury × resting CBF interaction for the left cingulum (p < 0.005). Decreased CBF was significantly associated with reduced cingulum fractional anisotropy (FA) in the chronic phase; however, no such association was observed for participants with less remote TBI.ConclusionsOur results showed that reduced CBF was associated with poorer white matter integrity in those who were further removed from their brain injury. Findings provide preliminary evidence of a possible dynamic association between CBF and white matter microstructure that warrants additional consideration within the context of the negative long-term clinical outcomes frequently observed in those with history of TBI. Additional cross-disciplinary studies integrating multiple imaging modalities (e.g., DTI, ASL) and refined neuropsychiatric assessment are needed to better understand the nature, temporal course, and dynamic association between brain changes and clinical outcomes post-injury

Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology.

To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication divides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable across the hospital setting

The effect of mineral and organic nutrient input on yields and nitrogen balances in western Kenya

Author Posting. © The Author(s), 2015. This is the author's version of the work. It is posted here by permission of Elsevier for personal use, not for redistribution. The definitive version was published in Agriculture, Ecosystems & Environment 214 (2015): 10-20, doi:10.1016/j.agee.2015.08.006.Soil fertility declines constrain crop productivity on smallholder farms in sub-Saharan Africa. Government and non-government organizations promote the use of mineral fertilizer and improved seed varieties to redress nutrient depletion and increase crop yields. Similarly, rotational cropping with nitrogen (N)-fixing legume cover crops or trees is promoted to improve soil fertility and crop yields. We examined maize grain yields and partial N balances on 24 smallholder maize farms in western Kenya, where interventions have increased access to agricultural inputs and rotational legume technologies. On these farms, mineral fertilizer inputs ranged from 0 to 161 kg N ha-1 (mean = 48 kg N ha-1), and maize grain yields ranged from 1-7 tons ha-1 (mean = 3.4 t ha-1). Partial N balances ranged from large losses (-112 kg N ha-1) to large gains (93 kg N ha-1)with a mean of -3 kg N ha-1. Maize grain yields increased significantly with N inputs (from fertilizer and legumes) in 2012 but not in 2013 when rainfall was lower. Nitrogen inputs of 40 kg N ha-1 were required to produce 3 tons of maize ha-1. N balances varied both among farms and between years, highlighting the importance of tracking inputs and outputs on multiple farms over multiple years before drawing conclusions about nutrient management, soil fertility outcomes and food security. The addition of N from legume rotations was a strong predictor of grain yields and positive N balances in lower-yielding farms in both years. This suggested that legume rotations may be particularly important for buffering yields from climate variability and maintaining N balances in low rainfall years.This research was funded by an Earth Institute at Columbia University Cross-Cutting Initiative Grant, a National Science Foundation PIRE grant (IIA-0968211), and by the Bill and Melinda Gates Foundation (Gates Special Initiative Grant)

Farm management, not soil microbial diversity, controls nutrient loss from smallholder tropical agriculture

© The Author(s), 2015. This article is distributed under the terms of the Creative Commons Attribution License. The definitive version was published in Frontiers in Microbiology 6 (2015): 90, doi:10.3389/fmicb.2015.00090.Tropical smallholder agriculture is undergoing rapid transformation in nutrient cycling pathways as international development efforts strongly promote greater use of mineral fertilizers to increase crop yields. These changes in nutrient availability may alter the composition of microbial communities with consequences for rates of biogeochemical processes that control nutrient losses to the environment. Ecological theory suggests that altered microbial diversity will strongly influence processes performed by relatively few microbial taxa, such as denitrification and hence nitrogen losses as nitrous oxide, a powerful greenhouse gas. Whether this theory helps predict nutrient losses from agriculture depends on the relative effects of microbial community change and increased nutrient availability on ecosystem processes. We find that mineral and organic nutrient addition to smallholder farms in Kenya alters the taxonomic and functional diversity of soil microbes. However, we find that the direct effects of farm management on both denitrification and carbon mineralization are greater than indirect effects through changes in the taxonomic and functional diversity of microbial communities. Changes in functional diversity are strongly coupled to changes in specific functional genes involved in denitrification, suggesting that it is the expression, rather than abundance, of key functional genes that can serve as an indicator of ecosystem process rates. Our results thus suggest that widely used broad summary statistics of microbial diversity based on DNA may be inappropriate for linking microbial communities to ecosystem processes in certain applied settings. Our results also raise doubts about the relative control of microbial composition compared to direct effects of management on nutrient losses in applied settings such as tropical agriculture.SAW, MA, CN, and CAP were supported by NSF PIRE grant OISE-0968211. GeoChip analysis was supported by the Office of the Vice President for Research at the University of Oklahoma and NSF MacroSystems Biology program EF-1065844 to JZ

Organically Managed Coffee Agroforests Have Larger Soil Phosphorus but Smaller Soil Nitrogen Pools than Conventionally Managed Agroforests

The cultivation of crops in the presence of trees (agroforestry) and organic agriculture are management strategies thought to reduce nutrient losses to the environment and increase soil organic matter. Little is known, however, about the differences between organic and conventionally managed agroforests. This research examines how soil nutrient pools and mechanisms for nutrient retention may vary between these two different types of coffee agroforests. We determined variation in soil nutrient pools and nutrient retention capacity among (1) coffee farms in Costa Rica receiving mineral (conventional management) and organic inputs (organic management) and (2) different combinations of shade tree species. Soil nutrient pools and retention capacity were altered by fertilizer management. Soil nitrogen (N) and carbon (C) pools were significantly larger in conventional agroforests, but C:N ratios were similar among agroforests. Soil phosphorus (P) pools were significantly higher in organic agroforests. Overall, C and N concentrations were strongly positively correlated with oxalate-extractable aluminum concentrations. We did not observe many strong species effects; however, soil cation exchange capacity was higher under Coffea–Musa combinations than under Coffea and N-fixing Erythrina combinations. Thus, mechanisms are in place to promote nutrient retention in agroforestry systems, but these mechanisms can be altered by management practices with consequences for long-term nutrient storage

Fertilizer Type and Species Composition Affect Leachate Nutrient Concentrations in Coffee Agroecosystems

Intensification of coffee (Coffea arabica) production is associated with increases in inorganic fertilizer application and decreases in species diversity. Both the use of organic fertilizers and the incorporation of trees on farms can, in theory, reduce nutrient loss in comparison with intensified practices. To test this, we measured nutrient concentrations in leachate at 15 and 100 cm depths on working farms. We examined (1) organically managed coffee agroforests (38 kg N ha−1 year−1; n = 4), (2) conventionally managed coffee agroforests (96 kg N ha−1 year−1; n = 4), and (3) one conventionally managed monoculture coffee farm in Costa Rica (300 kg N ha−1 year−1). Concentrations of nitrate (NO3 −-N) and phosphate (PO4 3−-P) were higher in the monoculture compared to agroforests at both depths. Nitrate concentrations were higher in conventional than organic agroforests at 15 cm only. Soil solutions collected under nitrogen (N)-fixing Erythrina poeppigiana had elevated NO3 −-N concentrations at 15 cm compared to Musa acuminata (banana) or Coffea. Total soil N and carbon (C) were also higher under Erythrina. This research shows that both fertilizer type and species affect concentrations of N and P in leachate in coffee agroecosystems

Interactive effects of vascular risk burden and advanced age on cerebral blood flow.

Vascular risk factors and cerebral blood flow (CBF) reduction have been linked to increased risk of cognitive impairment and Alzheimer's disease (AD); however the possible moderating effects of age and vascular risk burden on CBF in late life remain understudied. We examined the relationships among elevated vascular risk burden, age, CBF, and cognition. Seventy-one non-demented older adults completed an arterial spin labeling MR scan, neuropsychological assessment, and medical history interview. Relationships among vascular risk burden, age, and CBF were examined in a priori regions of interest (ROIs) previously implicated in aging and AD. Interaction effects indicated that, among older adults with elevated vascular risk burden (i.e., multiple vascular risk factors), advancing age was significantly associated with reduced cortical CBF whereas there was no such relationship for those with low vascular risk burden (i.e., no or one vascular risk factor). This pattern was observed in cortical ROIs including medial temporal (hippocampus, parahippocampal gyrus, uncus), inferior parietal (supramarginal gyrus, inferior parietal lobule, angular gyrus), and frontal (anterior cingulate, middle frontal gyrus, medial frontal gyrus) cortices. Furthermore, among those with elevated vascular risk, reduced CBF was associated with poorer cognitive performance. Such findings suggest that older adults with elevated vascular risk burden may be particularly vulnerable to cognitive change as a function of CBF reductions. Findings support the use of CBF as a potential biomarker in preclinical AD and suggest that vascular risk burden and regionally-specific CBF changes may contribute to differential age-related cognitive declines

Risk factors for poor virological outcome at 12 months in a workplace-based antiretroviral therapy programme in South Africa: A cohort study

<p>Abstract</p> <p>Background</p> <p>Reasons for the variation in reported treatment outcomes from antiretroviral therapy (ART) programmes in developing countries are not clearly defined.</p> <p>Methods</p> <p>Among ART-naïve individuals in a workplace ART programme in South Africa we determined virological outcomes at 12 months, and risk factors for suboptimal virological outcome, defined as plasma HIV-1 viral load >= 400 copies/ml.</p> <p>Results</p> <p>Among 1760 individuals starting ART before July 2004, 1172 were in follow-up at 12 months of whom 953 (81%) had a viral load measurement (median age 41 yrs, 96% male, median baseline CD4 count 156 × 10⁶/l). 71% (681/953) had viral load < 400 copies/ml at 12 months. In a multivariable analysis, independent predictors of suboptimal virological outcome at 12 months were <1 log decrease in viral load at six weeks (odds ratio [OR] 4.71, 95% confidence interval [CI] 2.56–8.68), viral load at baseline (OR 3.63 [95% CI 1.88–7.00] and OR 3.54 [95% CI 1.79–7.00] for 10,001–100,000 and >100,000 compared to <= 10,000 copies/ml, respectively), adherence at six weeks (OR 3.50 [95% CI 1.92–6.35]), WHO stage (OR 2.08 [95% CI 1.28–3.34] and OR 2.03 [95% CI 1.14–3.62] for stage 3 and 4 compared to stage 1–2, respectively) and site of ART delivery. Site of delivery remained an independent risk factor even after adjustment for individual level factors. At 6 weeks, of 719 patients with self-reported adherence and viral load, 72 (10%) reported 100% adherence but had <1 log decrease in viral load; conversely, 60 (8%) reported <100% adherence but had >= 1 log decrease in viral load.</p> <p>Conclusion</p> <p>Virological response at six weeks after ART start was the strongest predictor of suboptimal virological outcome at 12 months, and may identify individuals who need interventions such as additional adherence support. Self reported adherence was less strongly associated but identified different patients compared with viral load at 6 weeks. Site of delivery had an important influence on virological outcomes; factors at the health system level which influence outcome need further investigation to guide development of effective ART programmes.</p