• Early-career faculty promotion depends on mentoring and collaborating relationships, which is challenging due to high clinical burden. • Despite distancing requirements, institutions can foster introductions for mentoring and collaboration through a virtual platform. • A multi-institutional consortium can create opportunities for their faculty by developing joint conferences, journal clubs, and seminars.

Anaerobic soil disinfestation (ASD) is a pre-plant biological soil disinfestation technique proposed for the simultaneous control of soilborne pathogens, nematodes, and weeds in several horticultural crops grown in conventional and organic systems. The technique is applied by amending the soil with a labile carbon source, tarping the soil with totally impermeable film, and irrigating the soil to saturation. The rapid shift of redox potential stimulates the growth of anaerobic microorganisms and the anaerobic decomposition of the C source, with the consequent production of metabolites (organic acids, aldehydes, alcohols, ammonia, and volatile organic compounds), which results in the suppression of many soilborne pathogens and pests. The changes in the soil microbial population, redox potential, and pH that occur during ASD may also have an impact on nutrient cycling, thereby affecting soil fertility, availability of nutrients for the crop, and potential loss of nutrients into the environment. Understanding the nutrient dynamics and the factors that influence the availability and/or loss of nutrients during and after ASD treatment is critical for the sustainable application of this technique on a large scale. The objective of this work was to review the factors that govern the nutrient cycling in relation to ASD treatment, discuss potential solutions to optimize crop nutrient management and minimize the risks of nutrient loss, and identify future research priorities. While there are concerns about N2O emissions and nutrient leaching, the results of previous studies and of ongoing research activities conducted at multiple sites suggest that the risks of nutrient loss are not higher than those associated with standard chemical soil fumigation practices. Instead, there is clear evidence that ASD has both short- and long-term effects on the soil fertility and, excluding some risks of phytotoxicity at transplanting, ASD has been demonstrated to have positive effects on plant growth and crop yield.

Anaerobic soil disinfestation (ASD) is a non-chemical alternative to soil fumigation based on the combined concepts of biofumigation, biosolarization, soil saturation, and forced shifts in the microbial community that are highly dependent upon soil temperature, moisture, and the availability of a labile carbon source. This method is currently being investigated in many countries, with its origins in the Netherlands and Japan. Different organic amendments are being evaluated as carbon sources for ASD, including rice bran in California and sugarcane molasses in Florida, USA. In Florida, composted poultry litter (CPL) and sugarcane molasses are applied with 5 cm of initial irrigation, and beds are then covered with totally impermeable film (TIF) and allowed to incubate for 3 weeks. Levels of anaerobicity are monitored throughout the treatment time with a cumulative Eh target of 50,000 mVh for control of some soilborne plant-pathogenic fungi. In order to address researchable issues related to the implementation and adoption of ASD, a regional project was initiated in the southeastern United States in which a multi -disciplinary team conducted ASD field trials to answer specific grower-driven questions concerning ASD. Using tomato as the target crop, field trials were established at multiple locations in order to determine whether ASD could be: conducted utilizing opaque TIF; established prior to a spring production system when soil temperatures are cooler than for fall production; and combined with herbicides without causing crop phytotoxicity. In addition, concerns over nitrogen loss to the atmosphere as well as issues regarding expense of effective labile carbon sources are addressed.

BACKGROUND:The GAS study is an international RCT to evaluate neurodevelopmental outcome comparing general plus regional anesthesia versus regional anesthesia alone in 722 neonates and infants who had inguinal hernia repair up to 60 weeks of postmenstrual age. This paper comprises a secondary descriptive analysis of hernias, aspects of surgery and outcomes. METHODS:The incidence of unilateral and bilateral hernias, side preponderance, predictive factors for bilateral hernias and surgical approaches were collated. Follow-up outcome data were examined at 2 years. RESULTS:Of 711 eligible patients, there were 679 with hernia data showing that 321 hernias were right-sided, 190 left and 168 bilateral. Male to female ratio was 5:1. Of those with unilateral hernias, 25.8% underwent contralateral exploration and in these cases a patent processus vaginalis was found in 68.9%. Bilateral hernias were more common in younger and female patients. At 2 years there was a recurrence rate of 0.99% and in 2.7% of patients a hernia was evident on the contralateral side (metachrony), and this was unrelated to the anesthesia technique. CONCLUSIONS:Bilateral hernias are associated with lower gestational age at birth and female gender. There was a low incidence of complications and the anesthesia technique did not affect surgical outcome. LEVEL OF EVIDENCE:Level 1 evidence from prospective treatment study.

Preoperative evaluation (POE) and preparation of the surgical patient has received increased interest over the past decade, first with the growing awareness of Enhanced Recovery After Surgery programs,1–4 and more recently, with the concept of the Perioperative Surgical Home,5–7 as promoted by the American Society of Anesthesiologists. Although surgical patients have always received a thorough evaluation by anesthesiologists before surgery, this frequently happens in the hours immediately before surgery, with no opportunity to identify and correct comorbid conditions. All too often we recognize that a patient is poorly prepared (A1c of 9) but proceed to surgery to avoid the financial penalty of an unbooked operating room, significant inconvenience for the patient who may have taken time off work, and so on. It is nearly impossible to tie poor preparation to a poor outcome in a single patient, but studies have demonstrated improved outcomes in patients who have a visit to an anesthesiology-led preoperative clinic.8,9 Evaluation of a patient in a preoperative assessment clinic allows for timely identification of risk and appropriate intervention, whether that is to obtain further cardiac or pulmonary testing that can guide intraoperative management, or initiating iron therapy to manage anemia and reduce the risk of transfusion, or even engaging a surgeon in the risk-benefit analysis. But preoperative clinics are expensive, and there are patients who will have minimal benefit.10 Fiscal responsibility dictates that POE happens in patients who stand to benefit, and that patients unlikely to benefit are identified and not seen. As stated by the American Society of Anesthesiologists Practice Advisory for Preanesthesia Evaluation, the evaluation is meant to uncover or identify conditions that may affect perioperative care, allow verification of already known disease or treatment that might affect perioperative care, and permit formulation of specific plans for perioperative care. Clearly, a patient with no or minimal disease (ASA class I or II), or those undergoing very low-risk procedures (cataract surgery) can be adequately evaluated the day of surgery. How, then, do we effectively and efficiently identify those who need to be seen? Enneking and colleagues11 provide a new tool for our review, termed patient-centered anesthesia triage system (PCATS), to efficiently identify patients who should be seen in a preoperative clinic versus those who can be seen on the day of surgery. Unlike previous tools, their tool relies on 4 pieces of data readily available in any patient’s chart, with no patient or provider contact. This reduces the cost of screening, because a scheduling clerk can retrieve information and make a decision independent of provider input. The 4 criteria are (1) number of prescription medications taken daily; (2) age; (3) body mass index (BMI); and (4) complexity of the surgery, based on expected duration, blood loss, and length of stay/recovery destination. The authors report only the development of the tool, with retrospective analysis of 350 surgical patients. Multiple definitions of BMI (>30, >35, >40), age (>80, <18 and >80, or <1 and >80), number of prescriptions (≥5, ≥7, ≥10), and surgical complexity (minimal, moderate, high) were tested for their ability to identify ASA class; final definition for each criterion to be included in PCATS was based on χ2 analysis, area under the curve of a receiver operator curve, and Akaike information criteria. Final criteria were (1) ≥5 prescription medications daily; age >80; BMI >35; and high complexity of surgery; the clinical value of the PCATS to discriminate between ASA I, II and III, IV was tested using receiver operator curve analysis, sensitivity, specificity, positive predictive value, and negative predictive value. The presence of any of the PCATS criteria demonstrated a sensitivity of 0.88 to identify a patient with ASA class III or higher, a specificity of 0.74, and positive predictive value of 0.94, and a negative predictive value of 0.58. In simple terms, the PCATS was very good at identifying patients who were ASA III or IV with a positive predictive value of 0.94, but less effective at eliminating lower-risk patients (negative predictive value of only 0.58). This study and results deserve (and likely will receive) significant discussion! First of all, the authors chose to test the ability of PCATS to identify ASA III or IV class patients rather than how well it predicts whether an independent, experienced anesthesiologist would send the patient for a preoperative visit. This type of study was done by Ludbrook and colleagues12 who tested whether a call center and extended checklist could adequately prescreen patients. One could argue that the ASA classification is more objective than the “does this patient need to come to PAC?” question, but there have been significant questions raised in the past about the reliability of the ASA classification. However, the precise definition of ASA class III and IV, that is, “significant systemic disease (ASA III) that is a constant threat to life (ASA IV),” seems to clearly indicate the type of person who should be evaluated in a preoperative clinic setting. The fact that the PCATS can very effectively identify ASA III and IV patients gives reassurance that nearly all of these patients would be identified and scheduled for POE, and that this process can be done very simply by a scheduling clerk. The relatively poor negative predictive value is of little concern, because one would rather include a number of false positives (wrongly identify low-risk patients as ASA III, IV) than miss identifying patients who truly are ASA III and IV. Second, this process would not identify patients with a difficult airway; however, no intervention would be done before surgery, and a full airway examination should be as effective the day of surgery as in a preoperative clinic. The fact that complexity of surgery by itself would rank a patient as needing a visit would appropriately identify patients who are ASA I or II and on <5 medications but who are scheduled for a serious surgery (pheochromocytoma, pectus excavatum). Further work clearly needs to be done. Validation by other sites with different patient populations should be undertaken. It would also be interesting to track patients who “passed” and were not seen in clinic, and determine whether any had unrecognized conditions that would have been identified by a preoperative visit. Further work should also be done to identify whether PCATS can be further simplified—perhaps the number of medications by itself is as effective as the 4 elements included here, although complexity of surgery, as noted above, may serve as a useful criterion.13 But this work has significant value in that it indicates that we can effectively and efficiently identify patients of ASA class III or IV, and provide them with the benefits that accrue from a preoperative clinic visit. DISCLOSURES Name: Joyce A. Wahr, MD. Contribution: This author helped write and revise the manuscript. Name: Joss J. Thomas, MD. Contribution: This author helped write and revise the manuscript. This manuscript was handled by: Nancy Borkowski, DBA, CPA, FACHE, FHFMA.

Introduction Tonsillopharyngitis is the most common ear, nose and throat emergency admission, with 80,000 episodes recorded in England in 2015-2016. Despite this, there is a paucity of evidence addressing the supportive management of tonsillopharyngitis in inpatients. The aim of this retrospective multicentre observational study was to consider the Best Supportive Management for Adults Referred with Tonsillopharyngitis (BeSMART) in the inpatient setting, and to establish any associations between practice and outcomes. Methods Seven hospitals in North West England and North East Scotland participated in the study. Overall, 236 adult patients admitted with tonsillopharyngitis were included. The main outcome measures were interval to return to soft diet, length of stay (LOS), pain scores and readmissions. Results Women were more likely to seek professional help before presenting to secondary care (p=0.04). Patients admitted at the weekend were more likely to have a shorter LOS (p=0.03). There was no relationship between day of admission and seniority or specialty of the doctor initially seen. Prescription of corticosteroid, analgesia and a higher initial intravenous fluid infusion rate were not related to a shorter LOS. Conclusions This study is the first to yield valuable insights into the inpatient management of tonsillopharyngitis. This work represents part of an ongoing project to establish the evidence for common medical interventions for sore throat. Patient and professional surveys as well as a prospective interventional study are planned for the future.

Carbonated fumigants have been shown to distribute quickly and uniformly in sandy soils and improve pest control efficacy for annual crops. Low permeability films, such as VaporSafe® (TIF), could further improve fumigant dispersion by effectively retaining the fumigant in soil; however, there is a concern that the TIF can lead to higher off-tarp edge emissions. An orchard field trial was conducted to determine the off-tarp emissions, distribution, efficacy, and fate of carbonated Telone® C35 [63.4% 1,3-dichloropropene (1,3-D), 34.7% chloropicrin (CP)] that was shank-injected at 46cm soil depth. Treatments included carbonated fumigants at full- or 2/3 rates and a full rate of regular (nitrogen-pressurized) fumigants covered with standard polyethylene (PE) film, TIF, or no surface seal. Fumigant emissions at the regular tarp edge (25cm from the shank line) peaked at 3.98μgm−2s−1 for 1,3-D and 0.05μgm−2s−1 for CP. The addition of a TIF tarp extension (to 85cm from the shank line) reduce peak off-tarp emissions to <1 and <0.03μgm−2s−1 for 1,3-D and CP, respectively. Fumigant concentration under TIF was usually at least twice that under PE regardless of carbonation. Carbonation at 345KPa with 1.5% of dissolved CO2 did not significantly improve fumigant dispersion in soil profile compared to the conventional nitrogen pressurization. In a citrus nematode bioassay, only the 2/3 rate of carbonated fumigation treatment sealed with PE failed to control nematodes at 25cm away from shank line. This research indicates that a 60-cm TIF extension can effectively reduce off-tarp edge emissions in strip fumigation treatments. While the adaptability of carbonation of fumigants is still questionable, further research efforts are needed in finding effective solutions to control plant parasitic nematodes, which remain a challenge in orchard fumigation.

Anaerobic soil disinfestation (ASD) is proposed as a pre-plant, non-chemical soil disinfestation technique to control several soilborne phytosanitary issues. Limited information is available on the impact of ASD on soil fertility, plant growth, and potential nutrient loss. The objectives of the current study were to evaluate the effects of ASD applied using composted poultry litter (CPL) and molasses as amendments, on soil redox potential, pH, temperature, soil nutrient content, plant biomass and nutrient accumulation, and nitrous oxide (N2O) emissions. A field study was conducted on fresh-market tomato (Solanum lycopersicum L.) at two sites, Immokalee and Citra, FL, comparing ASD applied using a mix of CPL at the rate of 22 Mg ha(-1) and two rates of molasses [13.9 (ASD1) and 27.7 m(3) ha(-1) (ASD2)] as a carbon-source to chemical soil fumigation (CSF). ASD treatment had a significant impact on soil redox potential, but did not affect soil pH or temperature. Soil treatment did not affect nitrous oxide emissions from intact polyethylene mulched beds at either location. Emissions ranged from 0 to 0.378 mu g m(-2) h(-1) and from 8.8 to 39.8 mu g m(-2) h(-1) in Immokalee and Citra, respectively. However, on day 21 after punching holes in the polyethylene film to transplant, N2O emissions ranged from 1.56 to 4.83 and from 303.4 to 1480.1 mu g m(-2) h(-1) in Immokalee and Citra, respectively. Emissions were higher in ASD than in CSF plots in Citra, but not in Immokalee. Molasses and CPL used in ASD treatments increased soil nutrients content, and particularly the availability of P and K. Results show no clear evidence of an increased risk of N loss with ASD compared to CSF. However, pre- and post-planting nutrient management should be adjusted to take into account the nutrients provided through the molasses and CLP application. (C) 2017 Elsevier B.V. All rights reserved.

(Anesthesiology. 2017;127(5):788–799) In the United States, >250,000 infants are exposed to anesthesia each year. While general anesthesia causes functional and histopathologic changes in the central nervous systems (CNS) of late fetal and neonatal animals, it is not clear if these findings apply to humans. This study assessed possible associations of surgery and anesthesia in infants with later brain structure abnormalities in children who have no potential confounding risk factors. They hypothesized anesthesia and surgery may be associated with decreased white and gray matter volumes and and white matter integrity.

This study investigated the impact of two different wood biochars (BioC1 and BioC2) on the extractability and biodegradation of C-14-naphthalene in soil. Both biochars had contrasting properties due to difference in feedstocks and pyrolytic conditions (450-500 degrees C and 900-1000 degrees C, designated as BioC1 and BioC2, respectively). This study investigated effects of biochar on the relationship between C-14-naphthalene mineralisation and calcium chloride (CaCl2 ), hydroxypropyl- beta-cyclodextrin (HPCD) or methanol extraction in soil amended with 0%, 0.1%, 0.5% and 1% BioC1 and BioC2 after 1, 18, 36 and 72 d contact times. Total extents of C-14-naphthalene mineralisation and extraction were reduced with increasing concentrations of biochar; however, BioC2 showed greater sorptive capacity. Good linear correlation existed between total extents of C-14-naphthalene mineralisation and HPCD extractions in BioC1 (slope = 0.86, r(2) = 0.92) and BioC2 ( slope = 0.86, r(2) = 0.94) amended soils. However CaCl2 and methanol extractions underestimated and overestimated extents of mineralisation, respectively. These results indicate that biochar can reduce the bioaccessibility of PAHs and the corresponding risk of exposure to biota, whilst HPCD extraction estimated the bioaccessible fraction of PAHs in soil. Bioaccessibility assessment is vital in evaluation of biodegradation potential and suitability of bioremediation as a remediation option. (C) 2016 Elsevier B.V. All rights reserved.

In 2007, the Department of Anesthesia at the University of Iowa established an anesthesiologist-supervised nurse-managed sedation program. In 2008, the use of propofol and dexmedetomidine by nurses was approved in Iowa. We reviewed 11,038 elective sedation cases done between January 1, 2007, and June 30, 2014. Caseload increased from 170 to 470 cases/quarter. Propofol use increased from 0% to approximately equal to 70% of cases and dexmedetomidine from 0% to approximately equal to 25% of cases. There were no safety issues. The number of nurses working each day (on average) increased from 2.2 to 4.7, but supervising providers remained at 1/day. There were no changes in general anesthesia or monitored anesthesia care cases performed for comparable procedures. Trained, supervised nurses can safely administer propofol or dexmedetomidine to selected patients for a wide variety of procedures.

Vector meson production in ultra-peripheral pA and AA collisions at the CERN Large Hadron Collider (LHC) are very sensitive to Parton Distribution Functions (PDF) as well as to their leading-order, next-to-leading-order, and medium corrections. This process is a complimentary tool to explore the effects of different PDFs in particle production in proton-nucleus and nucleus-nucleus central collisions. Existing and forthcoming data available, e.g., from ALICE and CMS, may be used in conjunction with our theoretical predictions to constrain the PDFs. We make predictions for rapidity distributions and for cross sections of J/ψ , ψ(2S) and Υ production at √(s_NN)=2.76 TeV and √(s_NN)=5 TeV. We use the second energy as representative for the Run 2 of PbPb collisions at the LHC.

BACKGROUND:Many orchards use fumigation to control soilborne pests prior to replanting. Controlling emissions is mandatory to reduce air pollution in California. This research evaluated the effects of plastic film type [polyethylene (PE) or totally impermeable film (TIF)], application rate of Telone C35 [full (610 kg ha(-1) ), 2/3 or 1/3 rates] and carbonation at 207 kPa on fumigant transport (emission and in soil) and efficacy.RESULTS:While increasing fumigant concentrations under the tarp, TIF reduced emissions >95% (∼2% and <1% of total applied 1,3-dichloropropene and chloropicrin respectively) relative to bare soil, compared with ∼30% reduction by PE. All fumigation treatments, regardless of film type, provided good nematode control above 100 cm soil depth; however, nematode survival was high at deeper depths. Weed emergence was mostly affected by tarping and fumigant rate, with no effects from the carbonation.CONCLUSION:TIF can effectively reduce fumigant emissions. Carbonation under the studied conditions did not improve fumigant dispersion and pest control. The 2/3 rate with TIF controlled nematodes as effectively as the full rate in bare soil or under the PE film to 100 cm soil depth. However, control of nematodes in deeper soil remains a challenge for perennial crops.

Anaerobic soil disinfestation (ASD) is considered a promising sustainable alternative to chemical soil fumigation (CSF), and has been shown to be effective against soilborne diseases, plant-parasitic nematodes, and weeds in several crop production systems. Nevertheless, limited information is available on the effects of ASD on crop yield and quality. Therefore, a field study was conducted on fresh-market tomato ( Solanum lycopersicum L.) in two different locations in Florida (Immokalee and Citra), to evaluate and compare the ASD and CSF performances on weed and nematodes control, and on fruit yield and quality. In Immokalee, Pic-Clor 60 (1,3-dichloropropene + chloropicrin) was used as the CSF, whereas in Citra, the CSF was Paldin™ [dimethyl disulfide (DMDS) + chloropicrin]. Anaerobic soil disinfestation treatments were applied using a mix of composted poultry litter (CPL) at the rate of 22 Mg·ha −1 , and two rates of molasses [13.9 (ASD1) and 27.7 m 3 ·ha −1 (ASD2)] as a carbon (C) source. In both locations, soil subjected to ASD reached highly anaerobic conditions, and cumulative soil anaerobiosis was 167% and 116% higher in ASD2 plots than in ASD1 plots, in Immokalee and Citra, respectively. In Immokalee, the CSF provided the most significant weed control, but ASD treatments also suppressed weeds enough to prevent an impact on yield. In Citra, all treatments, including the CSF, provided poor weed control relative to the Immokalee site. In both locations, the application of ASD provided a level of root-knot nematode ( Meloidogyne sp.) control equivalent to, or more effective than the CSF. In Immokalee, ASD2 and ASD1 plots provided 26.7% and 19.7% higher total marketable yield as compared with CSF plots, respectively. However, in Citra, total marketable yield was unaffected by soil treatments. Tomato fruit quality parameters were not influenced by soil treatments, except for fruit firmness in Immokalee, which was significantly higher in fruits from ASD treatments than in those from CSF soil. Fruit mineral content was similar or higher in ASD plots as compared with CSF. In fresh-market tomato, ASD applied using a mixture of CPL and molasses may be a sustainable alternative to CSF for maintaining or even improving marketable yield and fruit quality.