New technologies and disruptions related to Coronavirus disease-2019 have led to expansion of decentralized approaches to clinical trials. Remote tools and methods hold promise for increasing trial efficiency and reducing burdens and barriers by facilitating participation outside of traditional clinical settings and taking studies directly to participants. The Trial Innovation Network, established in 2016 by the National Center for Advancing Clinical and Translational Science to address critical roadblocks in clinical research and accelerate the translational research process, has consulted on over 400 research study proposals to date. Its recommendations for decentralized approaches have included eConsent, participant-informed study design, remote intervention, study task reminders, social media recruitment, and return of results for participants. Some clinical trial elements have worked well when decentralized, while others, including remote recruitment and patient monitoring, need further refinement and assessment to determine their value. Partially decentralized, or “hybrid” trials, offer a first step to optimizing remote methods. Decentralized processes demonstrate potential to improve urban-rural diversity, but their impact on inclusion of racially and ethnically marginalized populations requires further study. To optimize inclusive participation in decentralized clinical trials, efforts must be made to build trust among marginalized communities, and to ensure access to remote technology.

In 2019, nearly 70 percent of Medicaid beneficiaries received their health insurance coverage through a private, managed care organization (MCO). Twenty-five years earlier, 9.5 percent of Medicaid beneficiaries were enrolled in MCOs. This dramatic growth in Medicaid managed care enrollment represents the delegation of significant power by federal and state governments over a critical social program to private actors and market forces. Medicare, too, experienced a similar pattern of transformation. Together, Medicaid and Medicare, two critical pillars of American social policy, paid more than half a trillion dollars to private insurance companies in 2019 to provide public health insurance to 75 million people. This manuscript examines the policy consequences of building private firms directly into the structure of American social policies. In contrast to existing work on “submerged” or “delegated” policies, this manuscript highlights the structural power that such policies bestow on the government's private partners and develops a new theory of structural power in which firms are able to constrain health policy reform through their threats to disrupt the delivery of public policies and social benefits to millions of people across the United States.

Among nursing home outbreaks of coronavirus disease 2019 (COVID-19) with ≥3 breakthrough infections when the predominant severe acute respiratory coronavirus virus 2 (SARS-CoV-2) variant circulating was the SARS-CoV-2 δ (delta) variant, fully vaccinated residents were 28% less likely to be infected than were unvaccinated residents. Once infected, they had approximately half the risk for all-cause hospitalization and all-cause death compared with unvaccinated infected residents.

Patients with single-ventricle CHD undergo a series of palliative surgeries that culminate in the Fontan procedure. While the Fontan procedure allows most patients to survive to adulthood, the Fontan circulation can eventually lead to multiple cardiac complications and multi-organ dysfunction. Care for adolescents and adults with a Fontan circulation has begun to transition from a primarily cardiac-focused model to care models, which are designed to monitor multiple organ systems, and using clues from this screening, identify patients who are at risk for adverse outcomes. The complexity of care required for these patients led our centre to develop a multidisciplinary Fontan Management Programme with the primary goals of earlier detection and treatment of complications through the development of a cohesive network of diverse medical subspecialists with Fontan expertise.

On August 25, 2017, Hurricane Harvey made landfall near Corpus Christi, Texas. The ensuing unprecedented flooding throughout the Texas coastal region affected millions of individuals.1 The statewide response in Texas included the sheltering of thousands of individuals at considerable distances from their homes. The Dallas area established large-scale general population sheltering as the number of evacuees to the area began to amass. Historically, the Dallas area is one familiar with “mega-sheltering,” beginning with the response to Hurricane Katrina in 2005.2 Through continued efforts and development, the Dallas area had been readying a plan for the largest general population shelter in Texas. (Disaster Med Public Health Preparedness. 2019;13:33–37)

Dermaptera (earwigs) are described from the Triassic of Australia and England, and from the Jurassic and Cretaceous of England. Phanerogramma heeri (Giebel) is transferred from Coleoptera and it and Brevicula gradus Whalley are re-described. Seven new taxa are named based on tegmina: Phanerogramma australis sp. nov. and P. dunstani sp. nov. from the Late Triassic of Australia; P. gouldsbroughi sp. nov. from the Triassic/Jurassic of England; Brevicula maculata sp. nov. and Trivenapteron moorei gen. et sp. nov. from the Early Jurassic of England; and Dimapteron corami gen et sp. nov. and Valdopteron woodi gen. et sp. nov. from the Early Cretaceous of England. Phanerogramma, Dimapteron and Valdopteron are tentatively placed in the family Dermapteridae, and Trivenapteron is incertae sedis. Most of the specimens of Phanerogramma heeri are from the Brodie Collection and labelled ‘Lower Lias'; however, some were collected from the underlying Penarth Group, thus this species spans the Triassic/Jurassic boundary. The palaeobiogeography of the Late Triassic and Early Jurassic of England is discussed.

As human population size and demand for seafood and other marine resources increase, understanding the influence of human activities in the ocean and on land becomes increasingly critical to the management and conservation of marine resources. In order to account for human influence on marine ecosystems while making management decisions, linkages between various anthropogenic pressures and ecosystem components need to be determined. Those linkages cannot be drawn until it is known how different pressures have been changing over time. This paper identifies indicators and develops time series for 22 anthropogenic pressures acting on the USA's portion of the California Current ecosystem. Time series suggest that seven pressures have decreased and two have increased over the short term, while five pressures were above and two pressures were below long-term means. Cumulative indices of anthropogenic pressures suggest a slight decrease in pressures in the 2000s compared to the preceding few decades. Dynamic factor analysis revealed four common trends that sufficiently explained the temporal variation found among all anthropogenic pressures. This reduced set of time series will be a useful tool to determine whether links exist between individual or multiple pressures and various ecosystem components.

When well directed, science is the greatest agency for the welfare of mankind. John Wesley Powell, the director of the United States Geological Survey (USGS), delivered this message to Congress in 1884. The purpose of Powell's testimony to Congress was not to argue for the erection of an organizational framework for American science, but to defend the one that had been put in place decades earlier. At the time of Powell's testimony, the United States had already begun to assume the mantle of the greatest scientific nation on the planet. “I have studied the question closely,” declared W. H. Smyth, the president of the Royal Geographical Society of London, “and do not hesitate to pronounce the conviction that though the Americans were last in the field, they have, per saltum, leaped into the very front of the rank.” The organizational structure at the heart of America's rapid scientific rise was initially constructed by scientists serving in the nineteenth-century American bureaucracy—by men like John W. Powell. Often seen as a source of state incapacity, in this instance, the federal bureaucracy was the most important force in American scientific development.