The application and provision of prehospital care in disasters and mass-casualty incident response in Europe is currently being explored for opportunities to improve practice. The objective of this translational science study was to align common principles of approach and action and to identify how technology can assist and enhance response. To achieve this objective, the application of a modified Delphi methodology study based on statements derived from key findings of a scoping review was undertaken. This resulted in 18 triage, eight life support and damage control interventions, and 23 process consensus statements. These findings will be utilized in the development of evidence-based prehospital mass-casualty incident response tools and guidelines.

Misdiagnosis of bacterial pneumonia increases risk of exposure to inappropriate antibiotics and adverse events. We developed a diagnosis calculator (https://calculator.testingwisely.com) to inform clinical diagnosis of community-acquired bacterial pneumonia using objective indicators, including incidence of disease, risk factors, and sensitivity and specificity of diagnostic tests, that were identified through literature review.

Repetitive transcranial magnetic stimulation (rTMS) is used for treatment of late-life depression. In the FOUR-D study, sequential bilateral theta-burst stimulation (TBS) had comparable remission rates to standard bilateral rTMS. Data were analysed from the FOUR-D trial to compare remission rates between two types of rTMS based on the number and class of prior medication trials. The remission rate was higher in participants with ≤1 previous trial (43.9%) than in participants with 2 previous trials (26.5%) or ≥3 previous trials (24.6%; χ² = 6.36, d.f. = 2, P = 0.04). Utilising rTMS earlier in late-life depression may lead to better outcomes.

In a survey of infection prevention programs, leaders reported frequent clinical and infection prevention practice modifications to avoid coronavirus disease 2019 (COVID-19) exposure that exceeded national guidance. Future pandemic responses should emphasize balanced approaches to precautions, prioritize educational campaigns to manage safety concerns, and generate an evidence-base that can guide appropriate infection prevention practices.

We assess emerging relationships between production decisions and market channel selection among a small sample of hemp growers (22) in Colorado and Kentucky using qualitative interviews. We found producers differences by market channel, product and state. For instance, producers who relied on intermediated marketing strategies cultivated more acres on average and used fewer distinct market channels and strategies than those relying on direct markets. Product differences were found regarding processing, storage and perishability. Respondents identified four factors critical to their choice of market channels for their hemp products: research, profitability, trust and knowledge. The findings can help inform public and private decision-making regarding best hemp marketing practices and future needs of the hemp industry.

Gaps in the implementation of effective interventions impact nearly all cancer prevention and control strategies in the US including Massachusetts. To close these implementation gaps, evidence-based interventions must be rapidly and equitably implemented in settings serving racially, ethnically, socioeconomically, and geographically diverse populations. This paper provides a brief overview of The Implementation Science Center for Cancer Control Equity (ISCCCE) and describes how we have operationalized our commitment to a robust community-engaged center that aims to close these gaps. We describe how ISCCCE is organized and how the principles of community-engaged research are embedded across the center. Principles of community engagement have been operationalized across all components of ISCCCE. We have intentionally integrated these principles throughout all structures and processes and have developed evaluation strategies to assess whether the quality of our partnerships reflects the principles. ISCCCE is a comprehensive community-engaged infrastructure for studying efficient, pragmatic, and equity-focused implementation and adaptation strategies for cancer prevention in historically and currently disadvantaged communities with built-in methods to evaluate the quality of community engagement. This engaged research center is designed to maximize the impact and relevance of implementation research on cancer control in community health centers.

Do all PhD students aspire to an academic career? Do PhD programs appropriately prepare students for the realities of the job market? There is a well-established gap between political science PhD graduates and tenure-track academic postings. The mismatch between PhD graduates and academic positions may point to alternative models of doctoral education as a possible solution. However, the survey of Canadian and Australian PhD students described in this article suggests that issues and challenges are common regardless of the model of doctoral education. Canadian PhDs report more mentoring activity, but they also are more fixated on securing academic positions. However, we find important gender differences across countries: men are more interested in an academic career and only a (disproportionately male) minority is confident that they will succeed in securing a faculty career. This raises questions about diversity in the future of the profession. This research suggests that although students have different experiences under different doctoral models, issues of academic jobs and a mismatch are common in both systems.

Satellite remote sensing is transforming coastal science from a “data-poor” field into a “data-rich” field. Sandy beaches are dynamic landscapes that change in response to long-term pressures, short-term pulses, and anthropogenic interventions. Until recently, the rate and breadth of beach change have outpaced our ability to monitor those changes, due to the spatiotemporal limitations of our observational capacity. Over the past several decades, only a handful of beaches worldwide have been regularly monitored with accurate yet expensive in situ surveys. The long-term coastal-change data of these few well-monitored beaches have led to in-depth understanding of many site-specific coastal processes. However, because the best-monitored beaches are not representative of all beaches, much remains unknown about the processes and fate of the other >99% of unmonitored beaches worldwide. The fleet of Earth-observing satellites has enabled multiscale monitoring of beaches, for the very first time, by providing imagery with global coverage and up to daily frequency. The long-standing and ever-expanding archive of satellite imagery will enable coastal scientists to investigate coastal change at sites vulnerable to future sea-level rise, that is, (almost) everywhere. In the past decade, our capability to observe coastal change from space has grown substantially with computing and algorithmic power. Yet, further advances are needed in automating monitoring using machine learning, deep learning, and computer vision to fully leverage this massive treasure trove of data. Extensive monitoring and investigation of the causes and effects of coastal change at the requisite spatiotemporal scales will provide coastal managers with additional, valuable information to evaluate problems and solutions, addressing the potential for widespread beach loss due to accelerated sea-level rise, development, and reduced sediment supply. Monitoring from Earth-observing satellites is currently the only means of providing seamless data with high spatiotemporal resolution at the global scale of the impending impacts of climate change on coastal systems.

Shallow firn cores, in addition to a near-basal ice core, were recovered in 2018 from the Quelccaya ice cap (5470 m a.s.l) in the Cordillera Vilcanota, Peru, and in 2017 from the Nevado Illimani glacier (6350 m a.s.l) in the Cordillera Real, Bolivia. The two sites are ~450 km apart. Despite meltwater percolation resulting from warming, particle-based trace element records (e.g. Fe, Mg, K) in the Quelccaya and Illimani shallow cores retain well-preserved signals. The firn core chronologies, established independently by annual layer counting, show a convincing overlap indicating the two records contain comparable signals and therefore capture similar regional scale climatology. Trace element records at a ~1–4 cm resolution provide past records of anthropogenic emissions, dust sources, volcanic emissions, evaporite salts and marine-sourced air masses. Using novel ultra-high-resolution (120 μm) laser technology, we identify annual layer thicknesses ranging from 0.3 to 0.8 cm in a section of 2000-year-old radiocarbon-dated near-basal ice which compared to the previous annual layer estimates suggests that Quelccaya ice cores drilled to bedrock may be older than previously suggested by depth-age models. With the information collected from this study in combination with past studies, we emphasize the importance of collecting new surface-to-bedrock ice cores from at least the Quelccaya ice cap, in particular, due to its projected disappearance as soon as the 2050s.

Background: Under ideal circumstances, multiplex molecular respiratory panels can support early all discontinuation of unnecessary antibiotics by facilitating diagnosis of viral infection. Our goal was to identify clinic situations in which a positive respiratory panel was associated with antibiotic de-escalation. We focused on gram-negative antibiotics in recognition of the urgent threat posed by gram-negative resistance. Methods: The sample included hospitalized adults tested by respiratory panel while receiving gram-negative antibiotics at the University of Maryland Medical Center from 2015 to 2020. Only the first respiratory panel performed during hospitalization was included. The primary outcome was the combination of a positive result on respiratory panel indicating detection of a viral pathogen and de-escalation of gram-negative antibiotics. De-escalation was assessed based on antibiotics administered on day 3 after testing and was defined by discontinuation or switch to an agent with a narrower spectrum of activity. Least absolute shrinkage and selection operator (LASSO) regression was used to construct the multivariable logistic regression model. Classification and regression tree (CART) analysis was used to identify subgroups with a higher likelihood of the primary outcome. Results: Of 8,326 patients, 1,462 (17.6%) tested positive by respiratory panel. The most common pathogen was rhinovirus (7.9% of the sample). Gram-negative–targeted antibiotics were de-escalated in 4,456 cases (53.5% of the sample), including 887 patients with a positive result on respiratory panel indicating a viral pathogen (60.7% of patients with a positive viral result). LASSO regression was used to select 12 variables (Table 1). Admitting diagnosis of pneumonia (OR, 1.42), comorbid substance abuse (OR, 1.39), chronic pulmonary disease (OR, 1.39), and admission from home (OR, 1.34) were associated with antibiotic de-escalation in conjunction with a positive respiratory panel. Leukocytosis (OR, 0.59), hematologic malignancy (OR, 0.64), mechanical ventilation at time of testing (OR, 0.68), and hypotension (OR, 0.77) were associated with decreased likelihood of antibiotic de-escalation in conjunction with a positive respiratory panel. CART analysis identified patients tested within 40 hours of admission as having a higher likelihood of a positive result in conjunction with antibiotic de-escalation. Among patients tested within 40 hours of admission, the probability of a positive result followed by antibiotic de-escalation was 11.9% (95% CI, 11.1%–12.8%). For patients tested >40 hours after admission, the probability was 6.0% (95% CI, 4.8%–7.2%). Conclusions: Targeted use of respiratory panel testing may increase the likelihood of an informative result that can drive decision making related to antibiotic use. Our exploratory analysis suggests that respiratory panel testing in the first 2 days

Funding: None

Disclosures: None

Early in the COVID-19 pandemic, the World Health Organization stressed the importance of daily clinical assessments of infected patients, yet current approaches frequently consider cross-sectional timepoints, cumulative summary measures, or time-to-event analyses. Statistical methods are available that make use of the rich information content of longitudinal assessments. We demonstrate the use of a multistate transition model to assess the dynamic nature of COVID-19-associated critical illness using daily evaluations of COVID-19 patients from 9 academic hospitals. We describe the accessibility and utility of methods that consider the clinical trajectory of critically ill COVID-19 patients.