Background: Multiplex molecular tests for infectious diseases can provide highly sensitive results rapidly; however, these tests may more readily detect asymptomatic colonization. There are reports of non-FDA approved laboratory-developed multiplex tests for the diagnosis of urinary tract infections (UTI). Differentiating UTI from asymptomatic bacteriuria is challenging, especially in older adults. The increased sensitivity of multiplex tests may exacerbate this challenge. We sought to describe the use of multiplex testing for UTIs in Medicare claims. Methods: Multiplex testing was identified using carrier claims submitted by non-institutional providers using the Chronic Conditions Warehouse for 2016 – 2022. Because there are no CPT-4 codes specifying UTI multiplex testing, we included claims as described in Figure 1 and categorized claims based on the primary ICD-10-CM diagnosis. The payment amounts for line items related to testing for infectious agents were summed. Laboratories were counted using CLIA numbers listed on corresponding claims. Beneficiaries residing in a nursing home at the time of their claim were identified using stay information derived from the Minimum Dataset 3.0. For comparison, similar characteristics among carrier claims with a CPT-4 code indicating urine culture were also described. Results: Claims for unspecified multiplex molecular tests overall have increased, driven by increases in claims with a primary UTI diagnosis (from 8,521 in 2016 to 386,943 in 2022), while urine cultures have not (Figure 1). In 2022, 65% of all unspecified multiplex tests were linked to a diagnosis of UTI; UTI multiplex claims were associated with 647 laboratories. For UTI claims, the median cost per claim for line items related to multiplex testing was $589 compared to $13 for urine culture-related line items. Overall, 8% of UTI multiplex claims were for beneficiaries residing in a nursing home. Conclusions: Claims for non-FDA approved unspecified multiplex tests associated with a primary diagnosis of UTI have increased >45-times between 2016-2021 and have >45-times higher median costs than urine cultures. The use of this testing in the Medicare population, including nursing home residents, is of potential concern given that inappropriate treatment of asymptomatic bacteriuria has been described to be common in older adults. Research is needed to outline use cases where UTI multiplex testing may be beneficial. Appropriate use of diagnostic testing is important to minimize diagnostic errors and avoid unnecessary antibiotic use.

Mars exploration motivates the search for extraterrestrial life, the development of space technologies, and the design of human missions and habitations. Here, we seek new insights and pose unresolved questions relating to the natural history of Mars, habitability, robotic and human exploration, planetary protection, and the impacts on human society. Key observations and findings include:

1. – high escape rates of early Mars' atmosphere, including loss of water, impact present-day habitability;

2. – putative fossils on Mars will likely be ambiguous biomarkers for life;

3. – microbial contamination resulting from human habitation is unavoidable; and

4. – based on Mars' current planetary protection category, robotic payload(s) should characterize the local martian environment for any life-forms prior to human habitation.

Some of the outstanding questions are:

1. – which interpretation of the hemispheric dichotomy of the planet is correct;

2. – to what degree did deep-penetrating faults transport subsurface liquids to Mars' surface;

3. – in what abundance are carbonates formed by atmospheric processes;

4. – what properties of martian meteorites could be used to constrain their source locations;

5. – the origin(s) of organic macromolecules;

6. – was/is Mars inhabited;

7. – how can missions designed to uncover microbial activity in the subsurface eliminate potential false positives caused by microbial contaminants from Earth;

8. – how can we ensure that humans and microbes form a stable and benign biosphere; and

9. – should humans relate to putative extraterrestrial life from a biocentric viewpoint (preservation of all biology), or anthropocentric viewpoint of expanding habitation of space?

Studies of Mars' evolution can shed light on the habitability of extrasolar planets. In addition, Mars exploration can drive future policy developments and confirm (or put into question) the feasibility and/or extent of human habitability of space.

The Hospital Surge Preparedness and Response Index is an all-hazards template developed by a group of emergency management and disaster medicine experts from the United States. The objective of the Hospital Surge Preparedness and Response Index is to improve planning by linking action items to institutional triggers across the surge capacity continuum. This responder tool is a non-exhaustive, high-level template: administrators should tailor these elements to their individual institutional protocols and constraints for optimal efficiency. The Hospital Surge Preparedness and Response Index can be used to provide administrators with a snapshot of their facility’s current service capacity in order to promote efficiency and situational awareness both internally and among regional partners.

Combinatorial Design such as configuration design, design optioneering, component selection, and generative design, is common across engineering. Generating solutions for a combinatorial design task often involves the application of classical computing solvers that can either map or navigate design spaces. However, it has been observed that classical computing resource power-law scales with many design space models. This observation suggests classical computing may not be capable of modelling our future design space needs.

To meet future design space modelling needs, this paper examines quantum computing and the characteristics that enables its resources to scale polynomially with design space size. The paper then continues to present a combinatorial design problem that is subsequently represented, constrained and solved by quantum computing. The results of which are the derivation of an initial set of circuits that represent design space constraints. The study shows the game-changing possibilities of quantum computing as an engineering design tool and is the start of an exciting new journey for design research.

A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.

We read with interest the recent editorial, “The Hennepin Ketamine Study,” by Dr. Samuel Stratton commenting on the research ethics, methodology, and the current public controversy surrounding this study.1 As researchers and investigators of this study, we strongly agree that prospective clinical research in the prehospital environment is necessary to advance the science of Emergency Medical Services (EMS) and emergency medicine. We also agree that accomplishing this is challenging as the prehospital environment often encounters patient populations who cannot provide meaningful informed consent due to their emergent conditions. To ensure that fellow emergency medicine researchers understand the facts of our work so they may plan future studies, and to address some of the questions and concerns in Dr. Stratton’s editorial, the lay press, and in social media,2 we would like to call attention to some inaccuracies in Dr. Stratton’s editorial, and to the lay media stories on which it appears to be based.

Ho JD, Cole JB, Klein LR, Olives TD, Driver BE, Moore JC, Nystrom PC, Arens AM, Simpson NS, Hick JL, Chavez RA, Lynch WL, Miner JR. The Hennepin Ketamine Study investigators’ reply. Prehosp Disaster Med. 2019;34(2):111–113

One of the biggest medical challenges after the detonation of a nuclear device will be implementing a strategy to assess the severity of radiation exposure among survivors and to triage them appropriately. Those found to be at significant risk for radiation injury can be prioritized to receive potentially lifesaving myeloid cytokines and to be evacuated to other communities with intact health care infrastructure prior to the onset of severe complications of bone marrow suppression. Currently, the most efficient and accessible triage method is the use of sequential complete blood counts to assess lymphocyte depletion kinetics that correlate with estimated whole-body dose radiation exposure. However, even this simple test will likely not be available initially on the scale required to assess the at-risk population. Additional variables such as geographic location of exposure, sheltering, and signs and symptoms may be useful for initial sorting. An interdisciplinary working group composed of federal, state, and local public health experts proposes an Exposure And Symptom Triage (EAST) tool combining estimates of exposure from maps with clinical assessments and single lymphocyte counts if available. The proposed tool may help sort survivors efficiently at assembly centers near the damage and fallout zones and enable rapid prioritization for appropriate treatment and transport. (Disaster Med Public Health Preparedness. 2018; 12: 386–395)

Greenhouse and field studies demonstrated that naptalam reduced paraquat activity by as much as 30% on sicklepod, smallflower morningglory, Florida beggarweed, and peanut Sequential application experiments, i.e. naptalam applied 2 or 24 h prior to an application of paraquat, as well as absorption studies utilizing 14C-paraquat, indicated that the antagonism was due largely to reduced paraquat absorption. Scanning electron microscopy revealed that application of naptalam, as well as naptalam applied with paraquat, resulted in amorphous deposits on the leaf surface which may account for the antagonism.

Postemergence treatments utilizing various combinations of fluazifop-P, paraquat, and 2,4-DB were compared to a preplant-incorporated (PPI) application of benefin followed by a ground-cracking application of alachlor and dinoseb plus naptalam and a postemergence application of 2,4-DB for weed control, peanut yield, and net economic return to land, overhead, and management. The greatest peanut yields (3-yr average of 4510 kg/ha) and net returns (3-yr average of $521/ha) were provided by a postemergence system that utilized one ground-cracking and one postemergence application of paraquat and one postemergence application of fluazifop-P and 2,4-DB. Seven postemergence systems provided equivalent or greater yield and net returns than the PPI and dinoseb plus naptalam system. Fresh weight reductions of Texas panicum, sicklepod, Florida beggarweed, and pitted morningglory from postemergence weed control systems were equivalent to reductions obtained from the PPI and dinoseb plus naptalam system. The addition of paraquat and 2,4-DB to the PPI and dinoseb plus naptalam system improved the 3-yr average peanut yield and net economic return by 510 kg/ha and $136/ha, respectively, compared to the same system without paraquat and 2,4-DB.

Pyridate was evaluated alone and as a component in herbicide systems for weed control and peanut tolerance. Pyridate at 1.0 and 1.5 kg ai ha-1 applied postemergence controlled 79 and 96% of Florida beggarweed, respectively. Pyridate was less effective on sicklepod than 2,4-DB. Peanuts exhibited no visible foliar injury or yield reduction with pyridate at 1.5 kg ha-1, the highest rate evaluated. Comprehensive weed control and maximum yield required that pyridate be tank mixed with 2,4-DB at 0.22 kg ae ha-1.

Tolerance of species to foliar applications of the ethyl ester of chlorimuron as determined in greenhouse studies with 21-day-old seedlings was: soybean = peanut > prickly sida > sicklepod > Florida beggarweed > common cocklebur. Absorption of foliar-applied 14C-chlorimuron 72 h after application was similar in soybean, peanut, sicklepod, common cocklebur, and prickly sida, but much less in Florida beggarweed. Slight symplasmic and apoplasmic translocation of the herbicide was evident in all species. Metabolism of chlorimuron 72 h after application was greatest in soybean and least in common cocklebur. Species tolerance to chlorimuron was directly correlated (r2 = 0.93) to the amount of unmetabolized chlorimuron (dpm/g dry wt) in the plant. Peanut exhibited increased tolerance to chlorimuron with age; this result was attributed to reduced absorption and translocation and more extensive metabolism of the absorbed herbicide by older plants.

Studies were conducted to investigate the reproductive biology and herbicide response of horsenettle (Solanum carolinense L. # SOLCA) and robust horsenettle (Solanum dimidiatum Raf. # SOLDM) that are common in peanut (Arachis hypogaea L.) production. Of these two species, horsenettle had a higher rate of seed germination, greater ability for seedling establishment in a competitive situation (pasture), greater ability to regenerate from smaller root fragments, and greater ability to regenerate from progressively greater depths in soil. Horsenettle was relatively more sensitive to glyphosate [N-(phosphonomethyl)glycine] (1.1 and 2.2 ai kg/ha), propylene glycol butyl ether esters of 2,4-D [(2,4-dichlorophenoxy)acetic acid] (0.8 and 1.7 ae kg/ha), and the ethanolamine salt of 2,4-D (1.7 ae kg/ha) than robust horsenettle. Conversely, robust horsenettle was more sensitive to dicamba [3,6-dichloro-2-methoxybenzoic acid)] (0.3 and 0.6 ae kg/ha). In a field study, dicamba applied annually in July or August for 2 yr at a rate of at least 1.1 kg/ha controlled 92% or more.

Field studies were conducted from 1985 to 1987 to evaluate postemergence herbicide systems with preemergence systems to control Texas panicum, Florida beggarweed, sicklepod, and pitted morningglory in peanuts. Adding paraquat at 0.14 kg ai/ha to postemergence herbicide systems reduced fresh weight of Florida beggarweed 92% (18% increase over the same systems without paraquat), sicklepod 95% (21% increase), and pitted morningglory 95% (11% increase). Herbicide systems containing paraquat improved peanut yields by 230 kg/ha and net returns by $52/ha over herbicide systems not containing paraquat. Fluazifop-P and sethoxydim systems reduced Texas panicum fresh weight (at least 96%) more than a preemergence system (92% reduction) that used benefin applied preplant incorporated and alachlor plus naptalam and dinoseb applied at cracking (GC) or a postemergence system that used alachlor and naptalam plus dinoseb GC and paraquat applied early postemergence (86% reduction). Systems containing fluazifop-P provided greater yields (4190 kg/ha) and net returns ($383/ha) than systems containing sethoxydim (4010 kg/ha, $305/ha) when averaged across all rates of application.

Field experiments were conducted from 1985 to 1987 to evaluate herbicide systems for minimum-tillage and conventional-tillage peanut production. While acceptable weed control could be achieved in both tillage systems, minimum-tillage systems generally had to be more herbicide intensive. Preemergence or preplant-incorporated within-the-row applications of either ethalfluralin or pendimethalin plus postemergence applications of paraquat and sethoxydim provided Texas panicum control equivalent to preplant-incorporated applications of ethalfluralin or pendimethalin. Early-postemergence paraquat applications improved Florida beggarweed and pitted morningglory control in conventional-tillage systems at least 15% compared to the same systems without paraquat Control of bristly starbur and sicklepod in conventional-tillage systems did not increase with paraquat application. Broadleaf weed control did not differ between tillage systems, except pitted morningglory control was lower in the minimum-tillage system. Conventional-tillage peanuts produced yields 800 to 1900 kg/ha higher, depending on herbicide system, and also provided greater net returns than minimum-tillage peanuts. The greater yield and net returns in conventional- versus minimum-tillage systems were not attributed to weed control or disease problems.

Imazethapyr was applied at 0.14 kg ae/ha to soybean, peanut, sicklepod. Florida beggarweed, and redroot pigweed as either a soil, foliar, or soil plus foliar application. Soybean and peanut were the most tolerant species; redroot pigweed was the most sensitive, with sicklepod and Florida beggarweed being intermediate. Foliar or foliar plus soil applications were more effective in reducing sicklepod and Florida beggarweed fresh weights than soil application alone. Foliar absorption of 14C-imazethapyr 72 h after treatment was greater than 90% for soybean, peanut, sicklepod, and redroot pigweed, but only 77% in Florida beggarweed. For the species evaluated, the amount translocated from the treated leaf ranged from 5 to 16% after 72 h. Within this same time period, an average of 90% of the root-absorbed imazethapyr had been translocated to the shoot in all species except peanut. The half-life of imazethapyr was 6.6, 6.5, 14.4, 24.0, and 32.1 days in soybean, peanut, Florida beggarweed, sicklepod, and redroot pigweed, respectively. Tolerance was most closely associated with imazethapyr half-life within these species.