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Prior to the COVID-19 pandemic, our research group initiated a pediatric practice-based randomized trial for the treatment of childhood obesity in rural communities. Approximately 6 weeks into the originally planned 10-week enrollment period, the trial was forced to pause all study activity due to the COVID-19 pandemic. This pause necessitated a substantial revision in recruitment, enrollment, and other study methods in order to complete the trial using virtual procedures. This descriptive paper outlines methods used to recruit, enroll, and manage clinical trial participants with technology to obtain informed consent, obtain height and weight measurements by video, and maintain participant engagement throughout the duration of the trial.
The study team reviewed the IRB records, protocol team meeting minutes and records, and surveyed the site teams to document the impact of the COVID-19 shift to virtual procedures on the study. The IRB approved study changes allowed for flexibility between clinical sites given variations in site resources, which was key to success of the implementation.
All study sites faced a variety of logistical challenges unique to their location yet successfully recruited the required number of patients for the trial. Ultimately, virtual procedures enhanced our ability to establish relationships with participants who were previously beyond our reach, but presented several challenges and required additional resources.
Lessons learned from this study can assist other study groups in navigating challenges, especially when recruiting and implementing studies with rural and underserved populations or during challenging events like the pandemic.
Healthcare personnel with severe acute respiratory coronavirus virus 2 (SARS-CoV-2) infection were interviewed to describe activities and practices in and outside the workplace. Among 2,625 healthcare personnel, workplace-related factors that may increase infection risk were more common among nursing-home personnel than hospital personnel, whereas selected factors outside the workplace were more common among hospital personnel.
Exotic annual grasses such as medusahead [Taeniatherum caput-medusae (L.) Nevski] and downy brome (Bromus tectorum L.) dominate millions of hectares of grasslands in the western United States. Applying picloram, aminopyralid, and other growth regulator herbicides at late growth stages reduces seed production of most exotic annual grasses. In this study, we applied aminopyralid to T. caput-medusae to determine how reducing seed production in the current growing season influenced cover in the subsequent growing season. At eight annual grassland sites, we applied aminopyralid at 55, 123, and 245 g ae ha−1 in spring just before T. caput-medusae heading. The two higher rates were also applied pre-emergence (PRE) in fall to allow comparisons with this previously tested timing. When applied in spring during the roughly 10-d period between the flag leaf and inflorescence first becoming visible, just 55 g ae ha−1 of aminopyralid greatly limited seed production and subsequently reduced T. caput-medusae cover to nearly zero. Fall aminopyralid applications were less effective against T. caput-medusae, even at a rate of 245 g ae ha−1. The growing season of application, fall treatments, but not spring treatments, sometimes reduced cover of desirable winter annual forage grasses. The growing season after application, both spring and fall treatments tended to increase forage grasses, though spring treatments generally caused larger increases. Compared with other herbicide treatment options, preheading aminopyralid treatments are a relatively inexpensive, effective approach for controlling T. caput-medusae and increasing forage production.
The History, Electrocardiogram (ECG), Age, Risk Factors, and Troponin (HEART) score is a decision aid designed to risk stratify emergency department (ED) patients with acute chest pain. It has been validated for ED use, but it has yet to be evaluated in a prehospital setting.
A prehospital modified HEART score can predict major adverse cardiac events (MACE) among undifferentiated chest pain patients transported to the ED.
A retrospective cohort study of patients with chest pain transported by two county-based Emergency Medical Service (EMS) agencies to a tertiary care center was conducted. Adults without ST-elevation myocardial infarction (STEMI) were included. Inter-facility transfers and those without a prehospital 12-lead ECG or an ED troponin measurement were excluded. Modified HEART scores were calculated by study investigators using a standardized data collection tool for each patient. All MACE (death, myocardial infarction [MI], or coronary revascularization) were determined by record review at 30 days. The sensitivity and negative predictive values (NPVs) for MACE at 30 days were calculated.
Over the study period, 794 patients met inclusion criteria. A MACE at 30 days was present in 10.7% (85/794) of patients with 12 deaths (1.5%), 66 MIs (8.3%), and 12 coronary revascularizations without MI (1.5%). The modified HEART score identified 33.2% (264/794) of patients as low risk. Among low-risk patients, 1.9% (5/264) had MACE (two MIs and three revascularizations without MI). The sensitivity and NPV for 30-day MACE was 94.1% (95% CI, 86.8-98.1) and 98.1% (95% CI, 95.6-99.4), respectively.
Prehospital modified HEART scores have a high NPV for MACE at 30 days. A study in which prehospital providers prospectively apply this decision aid is warranted.
The U.S. Food and Drug Administration (FDA) traditionally has kept confidential significant amounts of information relevant to the approval or non-approval of specific drugs, devices, and biologics and about the regulatory status of such medical products in FDA’s pipeline.
To develop practical recommendations for FDA to improve its transparency to the public that FDA could implement by rulemaking or other regulatory processes without further congressional authorization. These recommendations would build on the work of FDA’s Transparency Task Force in 2010.
In 2016-2017, we convened a team of academic faculty from Harvard Medical School, Brigham and Women’s Hospital, Yale Medical School, Yale Law School, and Johns Hopkins Bloomberg School of Public Health to develop recommendations through an iterative process of reviewing FDA’s practices, considering the legal and policy constraints on FDA in expanding transparency, and obtaining insights from independent observers of FDA.
The team developed 18 specific recommendations for improving FDA’s transparency to the public. FDA could adopt all these recommendations without further congressional action.
The development of the Blueprint for Transparency at the U.S. Food and Drug Administration was funded by the Laura and John Arnold Foundation.
Organic agricultural systems increase the complexity of weed management, leading organic farmers to cite weeds as one of the greatest barriers to organic production. Integrated Weed Management (IWM) systems have been developed to address the ecological implications of weeds and weed management in cropping systems, but adoption is minimal. Organic agriculture offers a favorable context for application of IWM, as both approaches are motivated by concern for environmental quality and agricultural sustainability. However, adoption of IWM on organic farms is poorly understood due to limited data on weed management practices used, absence of an IWM adoption metric, and insufficient consideration given to the unique farming contexts within which weed management decisions are made. Therefore, this study aimed to (1) characterize organic weed management systems; (2) identify motivations for, and barriers to, selection of weed management practices; and (3) generate guiding principles for effective targeting of weed management outreach. We surveyed Midwestern organic growers to determine how specified psychosocial, demographic, and farm structure factors influence selection of weed management practices. Cluster analysis of the data detected three disparate, yet scaled, approaches to organic weed management. Clusters were distinguished by perspective regarding weeds and the number of weed management practices used. Categorization of individual farms within the identified approaches was influenced by primary farm products as well as farmer education, years farming, and information-seeking behavior. The proposed conceptual model allows weed management educators to target outreach for enhanced compatibility of farming contexts and weed management technologies.
Weed science has contributed much to agriculture, forestry and natural resource management during its history. However, if it is to remain relevant as a scientific discipline, it is long past time for weed scientists to move beyond a dominating focus on herbicide efficacy testing and address the basic science underlying complex issues in vegetation management at many levels of biological organization currently being solved by others, such as invasion ecologists and molecular biologists. Weed science must not be circumscribed by a narrowly-defined set of tools but rather be seen as an integrating discipline. As a means of assessing current and future research interests and funding trends among weed scientists, the Weed Science Society of America conducted an online survey of its members in summer of 2007. There were 304 respondents out of a membership of 1330 at the time of the survey, a response rate of 23%. The largest group of respondents (41%) reported working on research problems primarily focused on herbicide efficacy and maintenance, funded mainly by private industry sources. Another smaller group of respondents (22%) reported focusing on research topics with a complex systems focus (such as invasion biology, ecosystem restoration, ecological weed management, and the genetics, molecular biology, and physiology of weedy traits), funded primarily by public sources. Increased cooperation between these complementary groups of scientists will be an essential step in making weed science increasingly relevant to the complex vegetation management issues of the 21st century.
Effective weed seedbank management requires mechanistic understanding of ecological determinants of seed persistence in the soil seedbank. Chemical and physical defense of common lambsquarters, field pennycress, giant foxtail, kochia, velvetleaf, and yellow foxtail seeds were quantified in relation to short- and long-term seedbank persistence. Seed content of ortho-dihydroxyphenols (o-DHP), a class of putative seed defense compounds, varied more than threefold between the least protected species (common lambsquarters, 9.2 µg g seed−1) and the most protected species (kochia, 34.1 µg g seed−1). Seed o-DHP was inversely related (r = −0.77, P < 0.001) to seed half-life in the soil and to short-term seed persistence in burial assays (r = −0.82, P < 0.05). The relative importance of chemical seed protection in comparison to physical seed protection, as represented by the ratio of seed o-DHP concentration to seed coat thickness, decreased linearly with increasing short-term seed persistence (r = −0.96, P < 0.01) and nonlinearly with increasing long-term seed persistence in the soil seedbank (y = 0.16 + 0.21/(0.0432 + x), R2 = 0.99, P < 0.001). Mechanical damage to the seed coat, via piercing, slicing, or grinding treatments, increased short-term mortality during burial for all six species. Mortality of pierced seeds was negatively associated (r = −0.35, P < 0.05) with seed phenol concentration and positively associated with seed half-life (r = 0.42, P < 0.01) and seed coat thickness (r = 0.36, P < 0.05). Seed phenolics, as a class, supported the results for o-DHPs. Overall, these findings suggest a potential weakness, with respect to seedbank management, in the way weed seed defenses are constructed. Weed species with transient seedbanks appear to invest more in chemical defense than those species with highly persistent seedbanks. As a result, seeds in the latter category are relatively more dependent upon physical seed protection for persistence in the soil seedbank, and more vulnerable to management tactics that reduce the physical integrity of the weed seed coat.
Uncontrolled kochia plants that regrow after small-grain harvest can produce substantial numbers of seeds. An average of 4,100 seeds per plant were produced between harvest (late July to mid August) and the first killing frost (late September) at three locations in Montana. Field experiments were conducted to determine the optimal timing of postharvest herbicide applications to prevent kochia from producing viable seeds. Herbicide treatments were applied at three timings from late August to mid September. The most effective treatments were glyphosate (631 g/ha) and paraquat (701 g/ha) applied at the second application timing (late August to early September). These treatments reduced kochia seed production by 92% or greater at each site. Kochia regrowth by this time had sufficient leaf area for herbicide absorption, but few viable seed had been produced. Herbicide treatments at the first and third application timings were generally less effective and more variable in reducing kochia seed production. Sulfentrazone (157 g/ha) and 2,4-D (561 g/ha) were not as effective at reducing seed production as other herbicide treatments.
This paper presents our experience of managing children with a tracheostomy in a multidisciplinary team clinic consisting of an ENT consultant, paediatric respiratory consultant, a nurse specialist, and speech and language therapist.
A retrospective case note review was conducted of all children seen in the multidisciplinary team tracheostomy clinic (at a tertiary paediatric hospital) between February 2009 and September 2014.
Ninety-seven patients were examined. The most common indications for tracheostomy were: lower airway and respiratory problems (66 per cent), upper airway obstruction (64 per cent), and neurodevelopmental problems (60.8 per cent).
Children with a tracheostomy are a diverse group of patients. The most common indications for paediatric tracheostomy have changed from infective causes to airway obstruction and anomalies, long-term ventilation requirement, and underlying neuromuscular or respiratory problems. Our unified approach empowers the carers and patient, as a home management plan, long-term plan and goals are generated at the end of each appointment.
Here we present the first results from the Siding Spring Southern Seyfert Spectroscopic Snapshot Survey (S7) which aims to investigate the physics of ∼140 radio-detected southern active Galaxies with z<0.02 through Integral Field Spectroscopy using the Wide Field Spectrograph (WiFeS). This instrument provides data cubes of the central 38×25 arc sec. of the target galaxies in the waveband 340–710nm with the unusually high resolution of R=7000 in the red (530–710nm), and R=3000 in the blue (340–560nm). These data provide the morphology, kinematics and the excitation structure of the extended narrow-line region, probe relationships with the black hole characteristics and the host galaxy, measures host galaxy abundance gradients and the determination of nuclear abundances from the HII regions. From photoionisation modelling, we may determine the shape of the ionising spectrum of the AGN, discover whether AGN metallicities differ from nuclear abundances determined from HII regions, and probe grain destruction in the vicinity of the AGN. Here we present some preliminary results and modelling of both Seyfert galaxies observed as part of the survey.