A new indicator of drought‐induced water stress is introduced and applied at the county level in the USA. Unlike most existing drought metrics, we directly consider current daily water demands and renewable daily water supply to estimate the potential stress. Water stress indices developed include the Normalized Deficit Cumulated to represent multiyear droughts by computing the maximum cumulative deficit between demand and supply over the study period (1949–2009) and the Normalized Deficit Index representing drought associated with maximum cumulative deficit each year. These water stress indices map directly to storage requirements needed to buffer multiyear and within‐year climate variability and can reveal the dependence on exogenous water transferred by rivers/canals to the area. Future climate change and variability can be also incorporated into this framework to inform climate‐driven drought for additional storage development and potential applications of water trading across counties.

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Background and Aims: Constipation and abdominal pain are commonly encountered in opioid-induced bowel dysfunction (OBD). The underlying mechanisms are incompletely understood, and treatments are not satisfactory. As OBD patients often have fecal retention, we aimed to determine whether fecal retention plays a pathogenic role in the development of constipation and abdominal pain in OBD, and if so to investigate the mechanisms. Methods: A rodent model of OBD was established by daily morphine treatment at 10 mg/kg for 7 days. Bowel movements, colonic muscle contractility, visceromotor response to colorectal distention, and cell excitability of colon-projecting dorsal root ganglion neurons were determined in rats fed in normal pellet food, or in clear liquid diet. Results: Morphine treatment (Mor) reduced fecal outputs starting on day 1, and caused fecal retention afterwards. Compared to controls, Mor rats demonstrated suppressed muscle contractility, increased neuronal excitability and visceral hypersensitivity. Expression of cyclooxygenase-2 (COX-2) and nerve growth factor (NGF) was up-regulated in smooth muscle of the distended colon in Mor rats. However, prevention of fecal retention by feeding rats with clear liquid diet blocked up-regulation of COX-2 and NGF, restored muscle contractility, and attenuated visceral hypersensitivity in Mor rats. Moreover, inhibition of COX-2 improved smooth muscle function and fecal outputs, whereas anti-NGF antibody administration attenuated visceral hypersensitivity in Mor rats. Conclusions: Morphine-induced fecal retention is an independent pathogenic factor for motility dysfunction and visceral hypersensitivity in OBD rats. Liquid diet may have therapeutic potential for OBD by preventing fecal retention-induced mechano-transcription of COX-2 and NGF.

Background The conduct of high-quality pilot studies can help inform the success of larger clinical trials. Guidelines have been recently developed for the reporting of pilot trials. Objective This methodological survey evaluates the completeness of reporting in pilot randomized controlled trials in chronic kidney disease patients on hemodialysis (HD patients) and explores factors associated with better completion of reporting. Methods The authors searched Pubmed on July 1, 2018, for all pilot trials conducted in HD patients. Reporting quality was assessed against the 40-item Consolidated Standards of Reporting Trials (CONSORT) Extension for Pilot Trials. Study factors including year and country of publication, intervention, number of centers, type of funding, and journal endorsement of CONSORT were also examined. Results The mean number of items reported from the CONSORT extension for pilot trials across all included articles was 18.4 (standard deviation [SD] = 4.4). In the adjusted analysis, studies reported in later years (IRR = 1.026, 95% CI [1.018, 1.034], p < 0.001) and an increase of 20 persons in sample size (adjusted IRR = 1.021, 95% CI [1.010, 1.031], p < 0.001) were associated with a significantly higher number of CONSORT pilot items reported. Conclusions Current reporting completeness of pilot trials in HD patients is suboptimal. Endorsing the CONSORT extension specific to pilot and feasibility studies and ensuring that pilot trials focus on the feasibility objectives may improve reporting completeness of these trials. Electronic supplementary material The online version of this article (10.1186/s40814-019-0436-3) contains supplementary material, which is available to authorized users.