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To evaluate the health status and quality of life of young patients who had cone reconstruction for Ebstein anomaly.
We reviewed all patients who had cone reconstruction from 2007 to 2016 at our institution. Prospective surveys were mailed to all eligible patients. Quality of life was assessed using the PedsQL 4.0 Generic Core Scales, including four domains: physical, emotional, social, and school functioning.
Of 116 eligible patients, 72 (62%) responded. About 96% reported their health as excellent or good, and 52% were symptom-free. Only 37% of patients were taking any medications, the most common of which was aspirin (30%). Only 19% had been hospitalised for cardiac reasons following cone reconstruction. The average self-reported quality of life was 85.3/100, whereas the average parent proxy-reported quality of life was 81.8/100. There was no difference by self or parent proxy-report in quality of life between cone reconstruction patients and healthy children; however, quality of life was significantly better compared with children with other chronic health conditions. By self-report and parent proxy-report, 15.1 and 16.7% of patients were deemed “at risk” for reduced quality of life, respectively. Socially, 63/64 (98%) patients over 5 years old were either full-time students or working full-time.
Children with Ebstein anomaly following cone reconstruction have excellent quality of life comparable with healthy peers and significantly better than other children with chronic health conditions. Families of children with Ebstein anomaly can expect excellent quality of life, long-term health status, and social functioning following cone reconstruction.
Benefits of reduced tillage and diverse crop rotations include reversing soil C loss, and improving soil quality and function. However, adoption of these strategies is lagging, particularly in the Upper Midwest, due to a perception that reduced tillage lowers crop yields. Therefore, an 8-year comparison of these conservation systems with a conventional, tilled, 2-year rotation system was conducted to evaluate effects on yields, system productivity (measured with potential gross returns) and weed seed densities. This study compared conventional moldboard plow + chisel till (CT) to reduced strip-tillage + no-tillage (ST), each with a 2-year (2y) or 4-year (4y) crop rotation, abbreviated as CT-2y, CT-4y, ST-2y and ST-4y. The 2y rotation was corn (Zea mays L.) and soybean (Glycine max [L.] Merr.); the 4y rotation was corn, soybean, spring wheat (Triticum aestivum L.) underseeded with alfalfa (Medicago sativa L.) and alfalfa. Only corn grain was significantly influenced by tillage strategy; CT systems yielded more than ST systems, regardless of rotation. Soybean grain yields were similar among CT-2y, CT-4y, ST-4y and lowest in the ST-2y. Yields of wheat and alfalfa were the same under both tillage strategies. Weed seed densities were higher in wheat and alfalfa, followed by corn then soybean, but were not influenced by tillage or rotation, nor universally negatively correlated to yield. Due to greater corn yields, overall system productivity was highest in CT-2y, the same between CT-4y and ST-2y, and lowest in ST-4y. Within years, productivity of CT-2y was different from only one other system at a time in 3 of 8 years and had the same productivity as all systems in another 3 of 8 years. Additionally, the similarity of productivity among three of four systems in 6 of 8 years indicated reduced tillage and diverse rotations have potential for adoption. Results support the need for research on a rotational tillage strategy, i.e., moldboard plowing before corn, to improve overall productivity if using ST before soybean, wheat and alfalfa.
Tillage is decreasing globally due to recognized benefits of fuel savings and improved soil health in the absence of disturbance. However, a perceived inability to control weeds effectively and economically hinders no-till adoption in organic production systems in the Upper Midwest, USA. A strip-tillage (ST) strategy was explored as an intermediate approach to reducing fuel use and soil disturbance, and still controlling weeds. An 8-year comparison was made between two tillage approaches, one primarily using ST the other using a combination of conventional plow, disk and chisel tillage [conventional tillage (CT)]. Additionally, two rotation schemes were explored within each tillage system: a 2-year rotation (2y) of corn (Zea mays L.), and soybean (Glycine max [L.] Merr.) with a winter rye (Secale cereale L.) cover crop; and a 4-year rotation (4y) of corn, soybean, spring wheat (Triticum aestivum L.) underseeded with alfalfa (Medicago sativa L.), and a second year of alfalfa. These treatments resulted in comparison of four main management systems CT-2y, CT-4y, ST-2y and ST-4y, which also were managed under fertilized and non-fertilized conditions. Yields, whole system productivity (evaluated with potential gross returns), and weed seed densities (first 4 years) were measured. Across years, yields of corn, soybean and wheat were greater by 34% or more under CT than ST but alfalfa yields were the same. Within tillage strategies, corn yields were the same in 2y and 4y rotations, but soybean yields, only under ST, were 29% lower in the fertilized 4y than 2 yr rotation. In the ST-4y system yields of corn and soybean were the same in fertilized and non-fertilized treatments. Over the entire rotation, system productivity was highest in the fertilized CT-2y system, but the same among fertilized ST-4y, and non-fertilized ST-2y, ST-4y, and CT-4y systems. Over the first 4 years, total weed seed density increased comparatively more under ST than CT, and was negatively correlated to corn yields in fertilized CT systems and soybean yields in the fertilized ST-2y system. These results indicated ST compromised productivity, in part due to insufficient weed control, but also due to reduced nutrient availability. ST and diverse rotations may yet be viable options given that overall productivity of fertilized ST-2y and CT-4y systems was within 70% of that in the fertilized CT-2y system. Closing the yield gap between ST and CT would benefit from future research focused on organic weed and nutrient management, particularly for corn.