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Commercialization of crops resistant to application of dicamba is a cause of major concern for sweetpotato producers regarding potential negative impacts due to herbicide drift or sprayer contamination events. A field study was initiated in 2014 and repeated in 2015 to assess impacts of reduced rates of BAPMA or DGA salt of dicamba, glyphosate, or a combination of these individually in separate trials with glyphosate on sweetpotato. Reduced rates of 1/10, 1/100, 1/250, 1/500, 1/750, and 1/1000 of the 1x use rate of each dicamba formulation at 0.56 kg ha-1, glyphosate at 1.12 kg ha-1, and the combination of the two at aforementioned rates were applied to ‘Beauregard’ sweetpotato at storage root formation (10 d after transplanting) in one trial or storage root development (30 d after transplanting) in a separate trial. Injury with each salt of dicamba (BAPMA or DGA) applied alone or with glyphosate was generally equal or greater than glyphosate applied alone at equivalent rates, indicating that injury is most attributable to the dicamba in the combination. There was a quadratic increase in crop injury and quadratic decrease in crop yield (with respect to most yield grades) observed with increase herbicide rate of dicamba applied alone or in combination with glyphosate applied at storage root development. However, this relationship as well as the significance of herbicide rate was not observed on crop injury or sweetpotato yield when herbicide application occurred at storage root formation stage with a few exceptions. In general, crop injury and yield reduction was greatest at the highest rate (1/10x) of either salt of dicamba applied alone or in combination with glyphosate, although injury observed at lower rates would be cause for concern after initial observation by sweetpotato producers. However, in some cases yield reduction of no.1 and marketable grades was observed following 1/250, 1/100, or 1/10x application rate of dicamba alone or with glyphosate when applied at storage root development.
Ice mélange has been postulated to impact glacier and fjord dynamics through a variety of mechanical and thermodynamic couplings. However, observations of these interactions are very limited. Here, we report on glaciological and oceanographic data that were collected from 2016 to 2017 at LeConte Glacier and Bay, Alaska, and serendipitously captured the formation, flow and break-up of ephemeral ice mélange. Sea ice formed overnight in mid-February. Over the subsequent week, the sea ice and icebergs were compacted by the advancing glacier terminus, after which the ice mélange flowed quasi-statically. The presence of ice mélange coincided with the lowest glacier velocities and frontal ablation rates in our record. In early April, increasing glacier runoff and the formation of a sub-ice-mélange plume began to melt and pull apart the ice mélange. The plume, outgoing tides and large calving events contributed to its break-up, which took place over a week and occurred in pulses. Unlike observations from elsewhere, the loss of ice mélange integrity did not coincide with the onset of seasonal glacier retreat. Our observations provide a challenge to ice mélange models aimed at quantifying the mechanical and thermodynamic couplings between ice mélange, glaciers and fjords.
In 2019, a 42-year-old African man who works as an Ebola virus disease (EVD) researcher traveled from the Democratic Republic of Congo (DRC), near an ongoing EVD epidemic, to Philadelphia and presented to the Hospital of the University of Pennsylvania Emergency Department with altered mental status, vomiting, diarrhea, and fever. He was classified as a “wet” person under investigation for EVD, and his arrival activated our hospital emergency management command center and bioresponse teams. He was found to be in septic shock with multisystem organ dysfunction, including circulatory dysfunction, encephalopathy, metabolic lactic acidosis, acute kidney injury, acute liver injury, and diffuse intravascular coagulation. Critical care was delivered within high-risk pathogen isolation in the ED and in our Special Treatment Unit until a diagnosis of severe cerebral malaria was confirmed and EVD was definitively excluded.
This report discusses our experience activating a longitudinal preparedness program designed for rare, resource-intensive events at hospitals physically remote from any active epidemic but serving a high-volume international air travel port-of-entry.
There is a substantial proportion of patients who drop out of treatment before they receive minimally adequate care. They tend to have worse health outcomes than those who complete treatment. Our main goal is to describe the frequency and determinants of dropout from treatment for mental disorders in low-, middle-, and high-income countries.
Respondents from 13 low- or middle-income countries (N = 60 224) and 15 in high-income countries (N = 77 303) were screened for mental and substance use disorders. Cross-tabulations were used to examine the distribution of treatment and dropout rates for those who screened positive. The timing of dropout was examined using Kaplan–Meier curves. Predictors of dropout were examined with survival analysis using a logistic link function.
Dropout rates are high, both in high-income (30%) and low/middle-income (45%) countries. Dropout mostly occurs during the first two visits. It is higher in general medical rather than in specialist settings (nearly 60% v. 20% in lower income settings). It is also higher for mild and moderate than for severe presentations. The lack of financial protection for mental health services is associated with overall increased dropout from care.
Extending financial protection and coverage for mental disorders may reduce dropout. Efficiency can be improved by managing the milder clinical presentations at the entry point to the mental health system, providing adequate training, support and specialist supervision for non-specialists, and streamlining referral to psychiatrists for more severe cases.
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the hyperkinetic movements of motor and phonic tics manifested in young age. Currently approved treatments in the United States are antipsychotics: haloperidol, pimozide, and aripiprazole, which are associated with serious side effects, including tardive dyskinesia (TD). Deutetrabenazine, a vesicular monoamine transporter type 2 (VMAT2) inhibitor, was approved in 2017 by the US FDA for the treatment of chorea associated with Huntington’s disease and TD. Three ongoing studies (Alternatives for Reducing Tics in TS [ARTISTS]) are evaluating the efficacy, safety, and tolerability of deutetrabenazine in reducing tics in TS in children and adolescents (age 6-16 years).
ARTISTS 1, a phase 2/3, response-driven, dose-titration, placebo-controlled study, randomizes patients (N=116) 1:1 to deutetrabenazine or placebo for 12 weeks. ARTISTS 2, a phase 3, fixed-dose study, randomizes patients (N=150) 1:1:1 to deutetrabenazine high or low dose, or placebo for 8 weeks. The primary efficacy outcome in these pivotal studies is change from baseline to end of treatment in the Total Tic Score (TTS) of the Yale Global Tic Severity Scale (YGTSS). Additional efficacy endpoints and safety/tolerability are also evaluated. ARTISTS is a 56-week, open-label, single-arm, long-term safety/tolerability study in patients who have successfully completed either ARTISTS 1 or ARTISTS 2.
Not available yet.
TS can have potentially long-term life impact, and there remains unmet medical need for effective and well-tolerated treatments. Three ARTISTS studies will evaluate the efficacy, safety, and tolerability of deutetrabenazine in patients with tics in TS.
The studies are sponsored by Teva Pharmaceuticals and operationalized by Teva’s development partner, Nuvelution TS Pharma INC.
The objective of this paper was to examine the implementation and effectiveness of a community-based intervention for hoarding disorder (HD) using Cognitive Rehabilitation and Exposure/Sorting Therapy (CREST).
This was a mixed-method, pre-post quasi-experimental study informed by the Practical, Robust Implementation and Sustainability Model for implementation science.
Program activities took place in San Diego County, mainly within clients’ homes or community, with some activities in-office.
Participants were aged 60 years or older, met eligibility for Medi-Cal or were uninsured, and met criteria for HD.
A manualized, mobile protocol that incorporated CREST was utilized.
The Clutter Image Rating and Hoarding Rating Scale were used as effectiveness outcomes. An investigator-created staff questionnaire was used to evaluate implementation.
Thirty-seven clients were reached and enrolled in treatment and 15 completed treatment during the initial 2 years of the program. There were significant changes in hoarding severity and clutter volume. Based on the initial 2 years of the program, funding was provided for expansion to cover additional San Diego County regions and hire more staff clinicians in year three.
Preliminary data suggest that the CREST intervention can be successfully implemented in a community setting with positive results for older adults with HD.
Plastics generally play a very important role in a plethora of industries, fields and our everyday lives. In spite of their cheapness, availability and important contributions to lives, they however, pose a serious threat to the environment due to their mostly non-biodegradable nature. Recycling into useful products can reduce the amount of plastic waste. Thermal degradation (Pyrolysis) of plastics is becoming an increasingly important recycling method for the conversion of plastic materials into valuable chemicals and oil products. In this work, waste Polyethylene terephthalate (PET) water bottles were thermally converted into useful gaseous and liquid products. A simple pyrolysis reactor system has been used for the conversions with the liquid product yield of 65 % at a temperature range of 400°C to 550°C. The chemical analysis of the pyrolytic oil showed the presence of functional groups such as alkanes, alkenes, alcohols, ethers, carboxylic acids, esters, and phenyl ring substitution bands. The main constituents were 1-Tetradecene, 1-Pentadecene, Cetene, Hexadecane, 1-Heptadecene, Heptadecane, Octadecane, Nonadecane, Eicosane, Tetratetracontane, 1-Undecene, 1-Decene). The results are promising and can be maximized by additional techniques such as hydrogenation and hydrodeoxygenation to obtain value-added products.
Whether mild traumatic brain injury (mTBI) sustained by children results in persistent or recurrent symptoms, over and above those experienced by children who solely sustain mild extracranial injuries, remains debated. The current prospective longitudinal case-controlled study aimed to examine the relative influence of injury and noninjury factors on symptoms in preschool and primary school-aged children who sustained an mTBI or mild extracranial injury at least 8 month earlier.
Participants were 64 parents of children (31 mTBI, 33 trauma controls) who sustained injury between ages 2 and 12, whose postconcussive symptoms across the first 3-month postinjury have been previously described. The current study assessed postconcussive symptoms at 8 or more months postinjury (M = 24.3, SD = 8.4) and examined a range of injury and noninjury predictive factors.
At or beyond 8-month postinjury, symptom numbers in the mTBI group were comparable with those of the group who sustained mild extracranial injury. Educational attainment of parents (below or above high-school attainment level) was the only predictor of symptoms at follow-up, with preexisting learning difficulties approaching significance as a predictor.
While our earlier study found that mTBI was associated with symptoms at 3-month postinjury, follow-up at more than 8 months showed mTBI no longer predicted symptom reporting. While mTBI contributes significantly to the presence of symptoms in the first few months postinjury, researchers and healthcare practitioners in this field need to consider the potential impact of noninjury factors on persistent or recurrent symptoms after mTBI.
The retention of meltwater in the accumulation area of the Greenland ice sheet and other Arctic ice masses buffers their contribution to sea level change. However, sustained warming also results in impermeable ice layers or ‘ice slabs’ that seal the underlying pore space. Here, we use a 1-D, physically based, high-resolution model to simulate the surface mass balance (SMB), percolation, refreezing, ice layer formation and runoff from across the high-elevation area of Devon Ice Cap, Canada, from 2001 to 2016. We vary the thickness of the ‘impermeable’ ice layer at which underlying firn becomes inaccessible to meltwater. Thick near-surface ice layers are established by an initial deep percolation, the formation of decimetre ice layers and the infilling of interleaving pore space. The cumulative SMB increases by 48% by varying impermeable layer thickness between 0.01 and 5 m. Within this range we identify narrower range (0.25–1 m) that can simulate both the temporal variability in SMB and the observed near-surface density structure. Across this range, cumulative SMB variation is limited to 6% and 45–49% of mass retention takes place within the annually replenished snowpack. Our results indicate cooler summers after intense mid-2000s warming have led to a partial replenishment of pore space.
Epilepsy is a common neurological condition that shows a marked genetic predisposition. The advent of next-generation sequencing (NGS) has transformed clinical genetic testing by allowing the rapid screen for causative variants in multiple genes. There are currently no NGS-based multigene panel diagnostic tests available for epilepsy as a licensed clinical diagnostic test in Ontario, Canada. Eligible patient samples are sent out of country for testing by commercial laboratories, which incurs significant cost to the public healthcare system.
An expert Working Group of medical geneticists, pediatric neurologists/epileptologists, biochemical geneticists, and clinical molecular geneticists from Ontario was formed by the Laboratories and Genetics Branch of the Ontario Ministry of Health and Long-Term Care to develop a programmatic approach to implementing epilepsy panel testing as a provincial service.
The Working Group made several recommendations for testing to support the clinical delivery of care in Ontario. First, an extension of community healthcare outcomes-based program should be incorporated to inform and educate ordering providers when requesting and interpreting a genetic panel test. Second, any gene panel testing must be “evidence-based” and takes into account varied clinical indications to reduce the chance of uncertain and secondary results. Finally, an ongoing evaluative process was recommended to ensure continued test improvement for the future.
This epilepsy panel testing implementation plan will be a model for genetic care directed toward a specific set of conditions in the province and serve as a prototype for genetic testing for other genetically heterogeneous diseases.
The National Institute of Health has mandated good clinical practice (GCP) training for all clinical research investigators and professionals. We developed a GCP game using the Kaizen-Education platform. The GCP Kaizen game was designed to help clinical research professionals immerse themselves into applying International Conference on Harmonization GCP (R2) guidelines in the clinical research setting through case-based questions.
Students were invited to participate in the GCP Kaizen game as part of their 100% online academic Masters during the Spring 2019 semester. The structure of the game consisted of 75 original multiple choice and 25 repeated questions stemming from fictitious vignettes that were distributed across 10 weeks. Each question presented a teachable rationale after the answers were submitted. At the end of the game, a satisfaction survey was issued to collect player satisfaction data on the game platform, content, experience as well as perceptions of GCP learning and future GCP concept application.
There were 71 total players who participated and answered at least one question. Of those, 53 (75%) answered all 100 questions. The game had a high Cronbach’s alpha, and item analyses provided information on question quality, thus assisting us in future quality edits before re-testing and wider dissemination.
The GCP Kaizen game provides an alternative method for mandated GCP training using principles of gamification. It proved to be a reliable and an effective educational method with high player satisfaction.