How to establish an endoscopic bariatric practice

Obesity is a chronic,progressive,and relapsing disease of excess adiposity that contributes to more than two hundred medical conditions and is projected to affect more than half the adult population of the United States by the year 2030.Given the limited penetrance of traditional bariatric surgery,as well as the cost and adherence barriers to anti-obesity medications,there is growing interest in the rapidly evolving field of endoscopic bariatric therapies(EBTs).EBTs are minimally invasive,same-day,per-oral endoscopic procedures and include endoscopic sleeve gastroplasty,intragastric balloons,and endoscopic bariatric revisional procedures.This field represents an exciting and innovative subspe-cialty within gastroenterology.However,building a successful endoscopic bariatric practice requires intentional,coordinated,and sustained efforts to overcome the numerous obstacles to entry.Common barriers include acquisition of the technical and cognitive skillset,practice limitations including the availability of nutrition counseling,facility capabilities,direct-to-consumer marketing,and financial pressures such as facility and anesthesia fees.As the highest-volume center for metabolic and bariatric endoscopy in the United States,we provide insights into successfully establishing an endoscopic bariatric program.

Assessment of Municipal Solid Waste Management in the Farmgate Area of Dhaka North City Corporation

This investigation is focused on conducting a thorough analysis of Municipal Solid Waste Management (MSWM). MSWM encompasses a range of interdisciplinary measures that govern the various stages involved in managing unwanted or non-utilizable solid materials, commonly known as rubbish, trash, junk, refuse, and garbage. These stages include generation, storage, collection, recycling, transportation, handling, disposal, and monitoring. The waste materials mentioned in this context exhibit a wide range of items, such as organic waste from food and vegetables, paper, plastic, polyethylene, iron, tin cans, deceased animals, byproducts from demolition activities, manure, and various other discarded materials. This study aims to provide insights into the possibilities of enhancing solid waste management in the Farmgate area of Dhaka North City Corporation (DNCC). To accomplish this objective, the research examines the conventional waste management methods employed in this area. It conducts extensive field surveys, collecting valuable data through interviews with local residents and key individuals involved in waste management, such as waste collectors, dealers, intermediate dealers, recyclers, and shopkeepers. The results indicate that significant amounts of distinct waste categories are produced daily. These include food and vegetable waste, which amount to 52.1 tons/day;polythene and plastic, which total 4.5 tons/day;metal and tin-can waste, which amounts to 1.4 tons/day;and paper waste, which totals 5.9 tons/day. This study highlights the significance of promoting environmental consciousness to effectively shape the attitudes of urban residents toward waste disposal and management. It emphasizes the need for collaboration between authorities and researchers to improve the current waste management system.

Integrated agronomic practices management improved grain formation and regulated endogenous hormone balance in summer maize (Zea mays L.)

Compared with single agronomic practices management during grain formation, knowledge about integrated agronomic practices management on grain-filling characteristics and physiological function of endogenous hormones was limited. In order to clarify this issue, two field experiments, integrated agronomic practices management(IAPM), T1(local conventional cultivation practices), T2(an optimized combination of cropping systems and fertilizer treatment), T3(treatment based on high-yield studies), and T4(further optimized combination of cropping systems and fertilizer treatment), and nitrogen rate testing(NAT)(four nitrogen rates, 0, 129.0, 184.5, and 300.0 kg N ha–1) were performed with summer maize hybrid Zhengdan 958(ZD958). Results showed that with increased nitrogen rate, the endogenous hormone balance was promoted and the grain-filling characteristics were improved sufficiently to resulting in a significant increase in grain yield. However, the grain-filling characteristics deteriorated and yield was reduced with excessive nitrogen fertilization. However, IAPM could promote hormone balance and improve grain filling characteristic. The indole-3-acetic acid(IAA), zeatin riboside(ZR), and gibberellin(GA3) contents under T2 and T4 treatments were higher and the abscisic acid(ABA) content was lower, and the ZR and GA3 contents under T3 were higher than those under T1. Those resulted in the maximum grain-filling rate(Wmax) and the active grain-filling period(P) under T2, T3 and T4 were significantly increased than those under T1, and hence promoted kernel weight and grain yield. So IAPM promoted hormone balance by improving tillage model, optimizing fertilizer rate and fertilization period, appropriately increasing planting density and delaying harvest, which promoted grain filling rate and lengthened active grain-filling period, finally increased grain yield.

Management Practices and Production Constraints of Indigenous Somali Cattle Breed in Shabelle Zone, Somali Regional State, Ethiopia

This study was conducted in Shabelle zone of Somali Regional State to assess management practices and production constraints of indigenous Somali Cattle. A total of 200 household heads were selected from four cattle potential districts;Dhanan, Ber’ano, Godey & Adadle. The relevant information was collected through semi-structured questionnaire, focus group discussion, key informants interview, and personal observations. Majority of the respondents were illiterate. The average cattle holding size was 8.97 heads/household and cattle were mainly kept for milk production. The major feed resources in the study area were natural pasture and crop residue, and communal grazing was the most important feeding system in the area. Feed shortage was a problem hindering cattle production in the study area during dry season mainly January up to March. Animals traveled long distances to watering points (>5 km) during dry season, while in wet season, animals were watered in nearby water sources. Cattle housing was open kraal fenced with the thorned plenty acacia trees and calves were housed separately from other cattle. Breeding in the study area was uncontrolled and was bred with their own or neighbors’ bull. Age at first mating, age at first calving and calving interval were 3.25 years, 4.05 years and 16.56 months, respectively. The daily milk yield and lactation length were 2.22 liters and 8.07 months, respectively. The production and reproduction performance of Somali cattle was relatively higher than other local breeds in the country mainly in terms of milk yield and fertility potential under the existing environmental conditions. The major constraints of cattle production were feed shortage, disease, water scarcity, lack of veterinary services, marketing problem and predator. Among those constraints, inadequate supply of quality feed, diseases and water shortage were the main reasons for low productivity of cattle and are the major factors limiting productivity. Therefore, to sustain the production system in the study areas, it is recommended to improve the current condition of communal rangelands through management of degraded areas by awareness creation on the value of these common resources and development of rules and regulation to sustain the existing resource and implement over the utilization of communal/pastoral rangeland management systems to reduce constraints such as shortage of feed, drought and grazing land deterioration which perpetuated through time due to land-use changes and seasonal fluctuation).

Management Practices, Utilization and Challenges of Donkey in Godey Town, Somali Regional State, Ethiopia

The study was conducted in Godey town of Shebelle zone, Somali Regional State, Ethiopia. The objective of the study was to assess management practices, utilization, and challenges of donkey. A total of 200 households who own working donkeys were selected purposely for this study. Data were collected using semi-structured questionnaires, key informants interviews, focus group discussions with communities who own donkeys and personal observations. The study revealed that the majority of the respondents were illiterate which might be associated with poor education access in the area. The study further revealed that 92% of working donkeys were involved in drought work, whereas 18% were used for pack work. The common feed resources for donkeys were feeds obtained from natural pasture, green maize leaves, hay, household wastes and grain supplements. Pipe water, river water, and pond water were the main water sources for working donkeys in the study area. About 91% of households kept their donkeys in an open backyard, while 9% of them kept them in a separate shed built adjacent to or a short distance away from the family home. Donkeys provide cart services in the study area, transporting various items weighing more than 300 kg in order to obtain a high benefit in a short period of time and are more than six days per week. Working donkeys in the current study area had a life span of fewer than 6 years, 7 - 10 years, and more than 10 years, with 18.5%, 75.5%, and 6%, respectively. The most important constraints that affect donkey production and utilization in the study area were a lack of feed, health problems (sickness, wounds, etc.), overloading and overworking, poor road and harnessing problems, and poor attitude/lack of awareness. As a result, in order to enhance working donkey management concerns, area-based development interventions that can overcome current constraints should be employed.

Study on Management Practices and Constraints of Black Head Somali Sheep Reared in Awbarre District of Fafen Zone, Somali Region, Ethiopia

The study was conducted to assess management practices and constraints of Black head Somali sheep in Awbarre district of Fafen zone, Somali regional state, Ethiopia. A total of 120 households were purposively selected for this study using purposive sampling technique. The data were collected through the questionnaire, key informants interview, focus group discussions & field observations. The primary purpose of keeping sheep was for income generation followed by saving, meat production, milk, social and cultural functions. The main feeds for sheep during wet season were communal & private natural pastures. In dry season, communal natural pasture, crop residues & private natural pasture were used. The major source of water during wet season was dam/pond, whereas in the dry season spring & pipe water were used. The majority of the respondents (85.8%) used houses enclosed with thorn woody trees and houses enclosed with stone/brick fence were also reported. Majority of the respondents used controlled mating system and sheep are bred to lamb when forage is plentiful because they are less drought tolerant than goats and to avoid unwanted lambing in dry season. Majority (90%) of respondents own their breeding ram and those who have no breeding males used their neighbors’ rams and borrow from others. The breeding rams were born in the flock implying that animals within the flock are very closely related which leads to inbreeding. The most important health problems affecting sheep were circling disease, sheep pox, tick lameness (tick paralysis), Peste des Petits Ruminants (PPR), bloating, and Foot & mouth disease (FMD). The major constraints hindering sheep production in the study area were shortage of veterinary service, feed shortage, scarcity of water, predators, diseases, and marketing. Therefore, to improve and increase the productivity of sheep production in the study area, better management practices and establishing of veterinary service centers are necessary.

Effects of Management Practices on Agronomic Parameters in Cocoa Agroecosystems at Peripheral Zone of Ebo Forest Reserve, Littoral Region, Cameroon

The study was carried out to assess the effect of management practices on agronomic parameters of cocoa agroecosystems in the peripheral zone of Ebo Forest Reserve. Purposive random sampling was conducted to establish experimental plots on the farms of willing farmers. Demonstration plots were established and agronomic parameters were monitored for “farmers’ practice (FP) and integrated crop pest and disease management (ICPM) practice” using indicators of Cocoa agro-ecosystem analysis (AESA). The FP and ICPM treatments were replicated in ten sites. From AESA records of agronomic parameters, the “observe, learn, decide and act” (OLDA) model was implemented in the ICPM treatments only. The effects of management practices were analyzed using a two-way analysis of variance (ANOVA), and treatment means compared using Turkey’s T-test at 5% probability. Results of ANOVA between the two Management practices showed that over 50% of the response variables were statistically significant. Means separated through GLM ANOVA with Tukey pairwise comparisons at α = 0.05 showed that 14 (53.8%) out of 26 response variables monitored were statistically significant between the two management practices. Pruning, shade management, phytosanitary harvest, rational use of pesticides, farm sanitation, pod harvesting, breaking, fermentation of beans and drying were regular in the ICPM treatment and time-bound in the FP treatment. The average total production varied from 385.83 kg/ha in FP treatment to 572.8 kg/ha in the ICPM treatment, still below the average standard of 1000 kg/ha. The OLDA model applied in ICPM treatment following AESA is a relevant tool to enhance sustainability in the management of cocoa agroecosystems. Farmers should be sensitized and trained on appropriate farm management techniques and enhance access to extension services as well as make available improved and grafted planting materials to ensure appropriate productivity levels.

South Asian dairy smallholders: A scoping review of practices and zoonoses

Objective: To identify and discuss on-farm management practices linked to bacterial zoonosis risk in smallholder dairy farmers in South Asia. Methods: This scoping review was conducted as per the PRISMA-ScR guidelines. Five hundred and two publications were retrieved from five online databases using a comprehensive search strategy. Studies were selected if they discussed a farm management practice which impacted human health within a South Asian country. Results: Twenty-two studies were included. Seven management practices relevant to farmers, livestock and their shared environment were identified including raw milk consumption, farm hygiene management, personal protective equipment uses, animal vaccination, cleaning udders, hand washing and disposal of afterbirth materials. Preventive practices were found to be utilized at lower frequencies compared to risk increasing practices. Awareness of bacterial zoonoses is particularly low within the region. Conclusions: Based on the results of this review, it was determined that improving farmer awareness of bacterial zoonotic diseases may favor several of the presented leverage points within the South Asian smallholder dairy system. Relying on formal school education to improve this awareness may not solve this problem, instead, more focus on accessible and affordable zoonoses education and farming programs is required.

The association between self-care management practices of patients with diabetes and their demographic factors in Makkah, Saudi Arabia

Background: Patient care management behavior in diabetes is an essential component of maintaining diabetes under control, and roughly 95% of illness management is typically undertaken by the patients themselves and/or their families. This study aimed to identify the association between self-care management practices of patients with diabetes and their demographic factors within the last three months. Methods: The design of this study was cross-sectional. 150 participants from four different hospitals in the Makkah region, Saudi Arabia participated in the study. Descriptive statistics, independent t-tests, and one-way analysis of variance were used to measure differences in self-care management practices concerning patients ’ demographic factors. Results: The results of the study showed that there were no significant differences in the mean score of five areas of self-care management patients ’ practices regarding diet, exercise, foot care, testing blood sugar, and medication concerning their gender ( P > 0.05), employment status ( P > 0.05), their marital status ( P > 0.05), their income ( P > 0.05), and comorbidities ( P > 0.05). There was also no significant difference in the mean score of patients ’ HgbA1c and demographic factors. However, patients with diabetes who have a university education have significantly higher mean scores of testing blood sugar than patients with diabetes who have below secondary school ( P = 0.019). Conclusion: Although the study reported no significant differences in the mean score of self-care practices of patients with diabetes regarding their gender, income, age, education (except testing Blood Sugar), marital status, income, and employment status. This is still needed to counsel and educate every patient regarding reasonable glycaemic control as the study included participants with poor diabetic control (HbA1c > 7). Furthermore, it is recommended to replicate the study with a large sample size to explore the significant differences.

Awareness,Attitude and Behavioural Intention of Medium and Large Scale Poultry Producers to Poultry Waste Management Practices in Lagos State:A Principal Component Analysis

The study analyzed awareness,attitude and behavioural intentions of medium and large scale poultry producers to poultry waste management practices in Lagos State with reference to problems of poor on-farm harness of excessive poultry waste,retrogression/unmet global environmental and economic waste management standards,exorbitant waste management charges imposed by LAWMA.Purposive and simple random sampling(using the lottery draw approach)was used in the selection of sixty(60)medium scale poultry farmers and forty(40)large scale poultry farmers,making a grand total of one hundred(100)medium and large scale poultry farmers interviewed in the study.A semi-structured questionnaire was used to collect data from the selected medium and large scale poultry farmers with the aid of a list provided by the Poultry Association of Nigeria(PAN),Lagos chapter.Principal Component Analysis(PCA)was used to analyse the data.In the principal component analysis for medium scale poultry farmers,the key component named was that LAWMA should offer special service for isolated dead bird collection(V75);and for large scale poultry farmers,the key component was that the disposal of poultry waste in an environmentally friendly way is LAWMA’s duty(V76).The study recommended that the government makes provisions to offer awareness campaigns in order to improve environmental knowledge and encourage environmental enthusiasm amongst society.

Management Practice and Comparison of Reproductive and Productive Performance of Dairy Cattle between Beneficiary and None Beneficiary of Estrus Synchronization and Mass Insemination in North Shewa Zone,Amhara Region,Ethiopia

The aim of this study was to assess the overall management practice and comparison of reproductive and productive performance between beneficiaries and none beneficiaries of oestrus synchronization and mass insemination(OSMI)of dairy cattle in north shewa zone of dairy cattle.Data were obtained by interviewing 270 estrus synchronization and mass insemination beneficiaries and 135 none beneficiaries’dairy farmers.Data were analyzed using Statistical Packaging for social science(SPSS)version 20.Natural pasture and crop residue were the most common feed resources in the study areas.River water was the major source of water for their cattle and well water was used when river water is not available.In their order of importance;FMD,mastitis,and abortion were the major diseases of cattle in the study area.The reproductive performance of dairy cows in OSMI beneficiaries were age at first service(30.81±7.6),calving interval(6.9±5.2),lactation length(8.95±2.46),day open(5.3±3.18)and number of service per conception(1.5±0.38)whereas in none beneficiary age at first service(32.88±6.64),calving interval(18.18±5.8),lactation length(9.6±0.54),day open(5.17±3.43)and number of service per conception(1.22±0.54)months.There was a significant(p<0.05)difference in milk yield between beneficiaries and none beneficiaries in HFC,HHFC and JERC dairy cows per day per cow.The major factors affecting reproductive performance of dairy cows are management,nutritional status,genotype,and disease.Therefor the productive and reproductive performance of the dairy cows reared by the participants were better than those of the nonparticipants.

Analysis of Practical Teaching Methods for Logistics Management Major in Higher Vocational Colleges-Taking the Procurement Management Practice Course as an Example

As a teacher majoring in Logistics Management in higher vocational colleges with deep understanding of the course for many years and taking the Procurement Management Practice course as an example,this study selects the after-school cases in the"'Purchase Price and Cost ControF5 chapter in the second edition textbook of Procurement Management Practice of Machinery Industry Press as the research subject of this case analysis.In addition,combined with the chapter content of this textbook,this paper expounds the teaching methods of practical training projects.In hope to provide some ideas for practical teaching,through research and analysis,there is a clearer understanding of the practical teaching of the core curriculum of Logistics Management major.

Management scheme influence and nitrogen addition effects on soil CO_(2),CH_(4),and N_(2)O fluxes in a Moso bamboo plantation

Background:It is still not clear whether the effects of N deposition on soil greenhouse gas(GHG)emissions are influenced by plantation management schemes.A field experiment was conducted to investigate the effects of conventional management(CM)versus intensive management(IM),in combination with simulated N deposition levels of control(ambient N deposition),30 kg N·ha^(−1)·year^(−1)(N30,ambient+30 kg N·ha^(−1)·year^(−1)),60 kg N·ha^(−1)·year^(−1)(N60,ambient+60 kg N·ha^(−1)·year^(−1)),or 90 kg N·ha^(−1)·year^(−1)(N90,ambient+90 kg N·ha^(−1)·year^(−1))on soil CO_(2),CH_(4),and N_(2)O fluxes.For this,24 plots were set up in a Moso bamboo(Phyllostachys edulis)plantation from January 2013 to December 2015.Gas samples were collected monthly from January 2015 to December 2015.Results:Compared with CM,IM significantly increased soil CO_(2) emissions and their temperature sensitivity(Q_(10))but had no significant effects on soil CH_(4) uptake or N_(2)O emissions.In the CM plots,N30 and N60 significantly increased soil CO_(2) emissions,while N60 and N90 significantly increased soil N_(2)O emissions.In the IM plots,N30 and N60 significantly increased soil CO_(2) and N_(2)O emissions,while N60 and N90 significantly decreased soil CH_(4) uptake.Overall,in both CM and IM plots,N30 and N60 significantly increased global warming potentials,whereas N90 did not significantly affect global warming potential.However,N addition significantly decreased the Q_(10) value of soil CO_(2) emissions under IM but not under CM.Soil microbial biomass carbon was significantly and positively correlated with soil CO_(2) and N_(2)O emissions but significantly and negatively correlated with soil CH_(4) uptake.Conclusion:Our results indicate that management scheme effects should be considered when assessing the effect of atmospheric N deposition on GHG emissions in bamboo plantations.

Effect of Land Management on Soil Hydraulic Conductivity in Gidan Kwano, Niger State, Nigeria

Hydraulic conductivity is one of the most important parameters for flow and transport related phenomena in soil and also a criterion for measuring soil ability to transfer water. There is concern arising from the suitability, efficiency and ease of the different measuring methods use under different land management practices. The purpose of this paper is to determine and evaluate soil hydraulic conductivity under different land management practices which include forest land (teak and Melina plantation), grassland and maize cultivated land using the constant head method. The measurement is at different depth of 0 - 15 cm, 15 - 25 cm, 25 - 50 cm, 50 - 75 cm. The limited means of each land use were used to compare the result obtained through statistical means. All tests were carried out using SPSS at a significance level of 0.05. An ANOVA test was conducted to check if each of the land use is significantly different. The soil in forest zone (Teak plantation and Gmalina plantation) had a significantly high bulk density as 1.7533 cm-3 and 1.6967 cm-3 respectively at depth 50 - 75 cm compared to the low bulk density in the grass, maize cultivated land as 1.5000 cm-3 and 1.4833 cm-3 respectively at depth 50 - 75 cm. However, soil hydraulic conductivity was significantly high in the grass site or soil at the surface with 2.8833 cm·h-1. Results obtained from the different land use serve as Knowledge of variability of soil that can assist in defining the best strategies for sustainable soil management through the provision of vital information for estimating soil susceptibility to erosion, hydrological modelling and efficient planning of irrigation projects.

Evaluation of Combined Landscape Restoration Practices on Soil Organic Carbon Stocks in Semiarid Regions of Burkina Faso

Forest and landscape restoration (FLR) practices have been reported to improve soil organic carbon stocks (SOCs) and contributing to climate change mitigation. This study aims to evaluate the impact of combined FLR practices, mainly developed in semiarid regions, on SOCs. The SOCs, soil texture, bulk density (ρ), pH, CO2 emissions, and herbaceous biomass were determined at a 0 - 30 cm depth. The experimental design comprised degraded land without FLR practices and three sets of combined FLR practices. These practices included “zaï” + stone bunds + organic manure + assisted natural regeneration (ANR) used to convert degraded land into forest (GF) and cropland (PARL);“zaï” + stone bunds + crop rotation + crop/fallow successions + ANR used to convert degraded land into cropland (OARL) and “zaï”+ stone bunds + organic manure used to convert degraded land into cropland (KARL). SOCs were highest (20.02 t C ha−1) under OARL compared with the other combinations of FLR practices. SOCs increased by 99% (+0.2 t C ha−1⋅yr−1), 58% (+0.3 t C ha−1⋅yr−1) and 13% (+0.2 t C ha−1⋅yr−1) under GF, OARL and KARL, respectively, and decreased by 15% (−0.1 t C ha−1⋅yr−1) under PARL. This study provides additional information explaining SOC variation in restored degraded land through the implementation of a combination of FLR practices. This is useful for recommending the combination “zaï” + stone bunds + crop rotation + crop/fallow successions + ANR to improve SOCs in the semiarid agroecosystem.

Critical Review of Talent Management in a Local Context:A Case Study

Talent management(TM)is the current buzzword for organisations that want to attain competitive advantage globally,including Saudi Arabia.The present study explores the status and the emergence of TM in Saudi Arabia in the last few years based on reviewing the pre-existing literature.In addition,an insight into the challenges specific to the management of talent in Saudi Arabia is discussed.Due to the traditional and conservative society of Saudi Arabia,along with its governmental policies such as Saudization and the Nitaqat system,it has become extremely challenging for private organisations to employ TM practices.This study provides insights into various TM practices employed in Saudi Arabia;however,none of the studies have provided any information about the types of TM practices to be employed for a better and more efficient organisational performance in the context of Saudi Arabia.It is concluded that the practice of TM in Saudi Arabia is extremely selective in private organisations and can be considered to be in its infancy.Moreover,the gaps in the research in these areas are identified,and based on those,recommendations are made for the scope of future work.This study contributes to a critical understanding on the suitable TM practices that can be applied in Saudi Arabia as well.It provides insights assisting to further research and practical applications.Our study finds its relevance among TM academicians,human resource(HR)departments,policy makers,government agencies,talent managers,and employers who are either already functional in Saudi Arabia or are planning to open business processes in Saudi Arabia in the near future.This can act as a strategic development when collaborated appropriately with the government authorities.

Practicality of power load management system in Chongqing City verified

Began from early 1992, Chongqing Power Supply Bureau had spent 3 and half years to build up a power load management system consisting of I master station, 6 relay stations, 1280 terminals and the distributed monitoring device. This system distributes in the hilly and mountainous areas where geographically complicated and the load widely scatters, it can supervise about 72% load and curtail more than 15% load

Assessment of the crucial factors influencing the responses of ammonia and nitrous oxide emissions to controlled release nitrogen fertilizer: A meta-analysis

Reducing ammonia(NH3) and nitrous oxide(N2O) emissions have great effects on mitigating nitrogen(N) nutrient loss and greenhouse gas emissions. Controlled release urea(CRU) can control the N release rate, which reduces reactive N loss and increases nitrogen use efficiency relative to conventional urea(CU). However, the crucial factors influencing the responses of NH3and N2O emissions to CRU relative to CU are still unclear. In this study, we evaluated the responses of NH3and N2O emissions to CRU based on collected field data with a meta-analysis. CRU reduced the NH3and N2O emissions by 32.7 and 25.0% compared with CU, respectively. According to subgroup analysis, CRU presented better mitigation of NH3and N2O emissions in soils with pH 6.5–7.5(–47.9 and –23.7%) relative to either pH<6.5(–28.5and –21.4%) or pH>7.5(–29.3 and –17.3%), and in the rice season(–34.8 and –29.1%) relative to the wheat season(–19.8 and –22.8%). The responses of NH3and N2O emissions to CRU increased from rainfed(–30.5 and –17.0%) to irrigated(–32.5 and –22.9%), and then to paddy(–34.8 and –29.1%) systems. In addition, the response of N2O emission mitigation increased with increases in soil total nitrogen(TN);however, soil TN did not significantly affect the response of NH3volatilization. The reduction in NH3emission was greater in sandy-textured soil(–57.7%) relative to loam-textured(–32.9%) and clay-textured(–32.3%) soils, whereas soil texture did not affect N2O emission. Overall, CRU was a good option for reducing the NH3and N2O emissions relative to CU in agricultural production. This analysis improves our understanding of the crucial environmental and management factors influencing the mitigation of NH3and N2O emissions under CRU application, and these site-specific factors should be considered when applying CRU to reduce reactive N loss and increase NUE.

What factors are important to new patients when selecting an orthopedic oncologist?

BACKGROUND Understanding how patients choose a provider may improve the overall experience by identifying ways to tailor a clinical practice.AIM To identify factors that patients consider important when choosing an orthopedic oncologist.METHODS New patients presenting to an orthopedic oncology clinic within a tertiary academic medical center from January 2019 to August 2020 were invited to complete an anonymous survey.The questionnaire consisted of 27 items including a Likert-type assessment of the importance of selection factors.RESULTS A total of 101 new patients with a median age of 66 years(range,14 years to 91 years)responded.Most were referred by another doctor(n=63,62.4%),and of the referring providers,the most frequent specialty was orthopedic surgery(n=32,51%).Using a Likert-type scale with 1 representing‘least important’and 5 representing‘most important’,the most important factor was the hospital reputation(mean,4.65;SD,0.85).Additional factors of importance were the number of years in practice(3.87±1.3)and a primary care provider referral(3.71±1.6).Patients younger than 40 years old found social media(P=0.016)and internet presence(P=0.035)of their surgeon to be more important than older patients.In contrast,older patients considered care within an academic center to be of greater importance than younger patients(P=0.014).CONCLUSION This investigation suggests a primary care referral,as well as hospital and physician reputation,are among the most important factors when selecting an orthopedic oncologist.Furthermore,social media utilization appears to be more important for younger patients.