The traditional cropping system in semiarid regions of the Canadian prairies involves frequent summer fallowing with several tillage operations to control weeds during the fallow period. Recently, there has been a trend toward reduced tillage and more intensive cropping, but the impact of this shift in management on sequestration of atmospheric CO2 remains uncertain. In 1995 and 1996, we measured fluxes of CO2 in a tillage experiment that had been initiated in 1982 on a silt loam (Typic Haploboroll) in southwestern Saskatchewan. The experiment comprised two spring wheat (Triticum aestivum L.) rotations (continuous wheat [Cont. W] and fallow–wheat [F–W]), each with conventional tillage (CT) and no‐till (NT) treatments. In Cont. W, CO2 fluxes tended to be lower under NT than under CT (mean annual flux was ≈20 to 25% less for NT than CT). In F–W, tillage effects on mean annual CO2 flux were significant (P < 0.05) in the wheat phase only (NT ≈ 10% less than CT). Tillage had negligible effect on C inputs in crop residues. Lower CO2 fluxes under NT than under CT were attributed to slower decomposition of crop residues placed on the surface of NT soil than when they were incorporated. With good growing conditions (and thus large inputs of residues) between 1989 and 1996, there was an accumulation of partially decomposed residues on the surface of NT soil. Carbon in surface residues represented about one‐half of the C gained by NT soil. In Cont. W, surface residue C (in 1996) amounted to 3.6 t ha−1 under NT vs 1.4 t ha−1 under CT. Residue C amounts were smaller in the F–W system: 1.7 t ha−1 (NT) and 0.7 t ha−1 (CT). Based on our results, producers on medium‐textured soils in the semiarid Canadian prairies who switch from the traditional wheat production system (conventionally tilled fallow–wheat) to continuous no‐till cropping could, potentially, sequester 5 to 6 t C ha−1 in soil organic matter and surface residues in 13 to 14 yr.

OBJECTIVES Older people approaching end of life are commonly prescribed multiple medications, many of which may be inappropriate or futile. Our objective was to examine the effect of applying the STOPPFrail, a recently developed deprescribing tool, to the medication regimens of older patients with advanced frailty. DESIGN Randomized controlled trial. SETTING Two acute hospitals in Ireland. PARTICIPANTS Adults 75 years or older (n = 130) with advanced frailty and polypharmacy (five or more drugs), transferring to long‐term nursing home care. INTERVENTION A STOPPFrail‐guided deprescribing plan was presented to attending physicians who judged whether or not to implement recommended medication changes. MEASUREMENTS The primary outcome was the change in the number of regular medications at 3 months. Secondary outcomes included unscheduled hospital presentations, falls, quality of life, monthly medication costs, and mortality. RESULTS Intervention (n = 65) and control group (n = 65) participants were prescribed a mean (plus or minus standard deviation [SD]) of 11.5 (±3.0) and 10.9 (±3.5) medications, respectively, at baseline. The mean (SD) change in the number of medications at 3 months was −2.6 (±2.73) in the intervention group and −.36 (±2.60) in the control group (mean difference = 2.25 ± .54; 95% confidence interval [CI] = 1.18‐3.32; P < .001). The mean change in monthly medication cost was –$74.97 (±$148.32) in the intervention group and –$13.22 (±$110.40) in the control group (mean difference $61.74 ± $26.60; 95% CI = 8.95‐114.53; P = .02). No significant differences were found between groups for any of the other secondary outcomes. CONCLUSION STOPPFrail‐guided deprescribing significantly reduced polypharmacy and medication costs in frail older people. No significant differences between groups were observed with regard to falls, hospital presentations, quality of life, and mortality, although the trial was likely underpowered to detect differences in these outcomes. J Am Geriatr Soc 68:762–769, 2020

Background and Purpose-Reliable etiologic classification of ischemic stroke may enhance clinical trial design and identification of subtype-specific environmental and genetic risk factors. Although new classification systems (Causative Classification System [CCS] and ASCO [A for atherosclerosis, S for small vessel disease, C for cardiac source, O for other cause]) have been developed to improve subtype assignment, few comparative data exist from large studies. We hypothesized that both CCS and ASCO would reduce the proportion of patients classified as cause undetermined compared with the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) scheme in a large population-based stroke study. Methods-A single rater classified all first-ever ischemic strokes in the North Dublin Population Stroke Study, a population-based study of 294 529 North Dublin residents. Published algorithms for TOAST, CCS, and ASCO were applied. Results-In 381 first-ever ischemic stroke patients, CCS assigned fewer patients as cause undetermined (26.2% versus 39.4%; PϽ0.000001), with increased assignment of cardio-aortic embolism (relative increase 6.9%; Pϭ0.004), large artery atherosclerosis (relative increase 44.1%; Pϭ0.00006), small artery occlusion (relative increase 27.3%; Pϭ0.00006), and other causes (relative increase 91.7%; Pϭ0.001) compared with TOAST. When ASCO grade 1 evidence was applied, fewer patients were classified as small artery disease (relative decrease 29.1%; Pϭ0.007) and more as large artery/atherothrombotic (relative increase 17.6%; Pϭ0.03). ASCO grade 1 did not reduce the proportion of cause undetermined cases compared with TOAST (42.3% versus 39.4%; Pϭ0.2). Agreement between systems ranged from good (ϭ0.61 for TOAST/ASCO grade 1 small artery category) to excellent (ϭ0.95 for TOAST/CCS and ASCO grade 1/CCS cardio/aorto-embolism category). Application of ASCO grades 1 to 3 indicated evidence of large artery/atherosclerosis (73.3%), cardio-embolism (31.3%), small artery (64.7%), and other cause (12%) in TOASTundetermined cases. Conclusion-Both CCS and ASCO schemes showed good-to-excellent agreement with TOAST, but each had specific characteristics compared with TOAST for subtype assignment and data retention. The feasibility of a single combined classification system should be considered. (Stroke. 2010;41:1579-1586.)Key Words: cerebral infarct Ⅲ subtypes Ⅲ causative classification system Ⅲ TOAST Ⅲ ASCO K ey outcomes such as disability, fatality, and recurrence after ischemic stroke differ according to subtype defined by stroke mechanism. 1,2 Identification of the underlying cause of stroke is an important element of daily clinical practice, guiding treatment decisions and prognosis for individual patients. Accurate and reproducible assignment of the likely mechanism of ischemic stroke is also important in clinical trials investigating benefit in specific patient groups 3 (eg, cardioembolic or atherosclerotic stroke) and in epidemiological studies investigating associations between environ- The Trial of ORG 10172 in Acut...

Soil organic matter contributes to the productivity and physical well-being of soils. An 11-yr study was conducted on a clay soil in the Brown soil zone in southwestern Saskatchewan to determine the influence of tillage and cropping frequency on soil organic C and total N content. Carbon and N behaved in a similar manner. Cropping frequency did not affect soil organic C or total N content, but soil C and N were greater under no-tillage (NT) than under mechanically tilled continuous wheat (Triticum aestivum L.) (Cont W) and fallow-wheat (F-W) rotations. Effects were apparent in the 0– to 7.5– and 7.5– to 15-cm depths. Over the 11-yr period, F-W (minimum tillage) gained no additional C; Cont W (conventional tillage) gained 2 t C ha−1, and both Cont W (NT) and F-W (NT) gained 5 t C ha−1. Changes in organic C and N were greatest in the final 4 yr of the experiment when crop residue production was greatest. Using data from two similar experiments conducted during the same period on soils differing in texture, we demonstrated that C gains were directly related to clay content of the soils. Thus, when attempting to estimate C storage in soils, we must consider both residue input and soil clay content. Key words: Organic C, total N, organic matter, soil texture, bulk density