In 2016, the National Center for Advancing Translational Science launched the Trial Innovation Network (TIN) to address barriers to efficient and informative multicenter trials. The TIN provides a national platform, working in partnership with 60+ Clinical and Translational Science Award (CTSA) hubs across the country to support the design and conduct of successful multicenter trials. A dedicated Hub Liaison Team (HLT) was established within each CTSA to facilitate connection between the hubs and the newly launched Trial and Recruitment Innovation Centers. Each HLT serves as an expert intermediary, connecting CTSA Hub investigators with TIN support, and connecting TIN research teams with potential multicenter trial site investigators. The cross-consortium Liaison Team network was developed during the first TIN funding cycle, and it is now a mature national network at the cutting edge of team science in clinical and translational research. The CTSA-based HLT structures and the external network structure have been developed in collaborative and iterative ways, with methods for shared learning and continuous process improvement. In this paper, we review the structure, function, and development of the Liaison Team network, discuss lessons learned during the first TIN funding cycle, and outline a path toward further network maturity.

OBJECTIVES/GOALS: To assess barriers and recommendations for improving delivery of care for chronic obstructive pulmonary disease (COPD) in rural clinics, we assessed COPD care metrics and obtained perspectives of primary care providers (PCPs) who practice in rural clinics. METHODS/STUDY POPULATION: Quantitative retrospective analysis of patients with COPD using VA data. We included patients whose primary care clinic is located in a rural VA Midwest Health Care Network (HCN) facility and quantified binary measures for receipt of: spirometry, pulmonary specialty care, and optimal inhaler therapy (regimen with LAMA or LABA monotherapy) Qualitative semi-structured individual interviews of PCPs (physicians, nurse practitioners, and physician assistants) whose clinics are located in a rural VA Midwest HCN facility. We elicited perceived barriers to and recommendations for receiving spirometry, pulmonary specialty care, and optimal inhaler therapy from PCPs. RESULTS/ANTICIPATED RESULTS: 6,350 rural patients had a new diagnosis of COPD in 2016-2019. 48.4% had spirometry, 14.4% had pulmonary encounters, and among patients who were prescribed long-acting inhaler therapy, 48.8% received optimal inhaler regimens. Rural PCPs (n=14) highlighted lack of access to spirometry, pulmonary specialty care, and clinic staff support in local clinics and suggested: 1) leveraging the expertise of pharmacists in COPD management and 2) improving access to resources, including use of telehealth technologies. DISCUSSION/SIGNIFICANCE: Less than 50% of rural COPD patients received recommended diagnostic testing and therapy. Resource limitations in rural clinics were the main barrier. The main recommendation was to leverage pharmacists’ expertise in COPD care. These findings provide a pathway forward to improving rural COPD care.

Monitoring the prevalence and abundance of parasites over time is important for addressing their potential impact on host life histories, immunological profiles and their influence as a selective force. Only long-term ecological studies have the potential to shed light on both the temporal trends in infection prevalence and abundance and the drivers of such trends, because of their ability to dissect drivers that may be confounded over shorter time scales. Despite this, only a relatively small number of such studies exist. Here, we analysed changes in the prevalence and abundance of gastrointestinal parasites in the wild Soay sheep population of St. Kilda across 31 years. The host population density (PD) has increased across the study, and PD is known to increase parasite transmission, but we found that PD and year explained temporal variation in parasite prevalence and abundance independently. Prevalence of both strongyle nematodes and coccidian microparasites increased during the study, and this effect varied between lambs, yearlings and adults. Meanwhile, abundance of strongyles was more strongly linked to host PD than to temporal (yearly) dynamics, while abundance of coccidia showed a strong temporal trend without any influence of PD. Strikingly, coccidian abundance increased 3-fold across the course of the study in lambs, while increases in yearlings and adults were negligible. Our decades-long, intensive, individual-based study will enable the role of environmental change and selection pressures in driving these dynamics to be determined, potentially providing unparalleled insight into the drivers of temporal variation in parasite dynamics in the wild.

Background: Medications are frequently prescribed for neuropsychiatric symptoms (NPS) associated with dementia, although information on the efficacy and safety of medications for NPS specifically in long-term care (LTC) settings is limited. The objective of this study was to provide a current review of the efficacy and safety of pharmacological treatments for NPS in LTC.

Methods: We searched MEDLINE, EMBASE, PsychINFO, and the Cochrane Library for randomized controlled trials comparing medications with either placebo or other interventions in LTC. Study quality was described using the Cochrane collaboration risk of bias tool. The efficacy of medications was evaluated using NPS symptom rating scales. Safety was evaluated through rates of trial withdrawals, trial withdrawals due to adverse events, and mortality.

Results: A total of 29 studies met inclusion criteria. The most common medications evaluated in studies were atypical antipsychotics (N = 15), typical antipsychotics (N = 7), anticonvulsants (N = 4), and cholinesterase inhibitors (N = 3). Statistically significant improvements in NPS were noted in some studies evaluating risperidone, olanzapine, and single studies of aripiprazole, carbamazepine, estrogen, cyproterone, propranolol, and prazosin. Study quality was difficult to rate in many cases due to incomplete reporting of details. Some studies reported higher rates of trial withdrawals, adverse events, and mortality associated with medications.

Conclusions: We conclude that there is limited evidence to support the use of some atypical antipsychotics and other medications for NPS in LTC populations. However, the generally modest efficacy and risks of adverse events highlight the need for the development of safe and effective pharmacological and non-pharmacological interventions for this population.

Background: Cognitive impairment and depression are common and disabling non-motor symptoms of Parkinson's disease (PD). Previous studies have shown associations between them but the nature of the relationship remains unclear. In chronic illness, problem- or task-oriented coping strategies are associated with better outcome but often require higher level cognitive functioning. The present study investigated, in a sample of patients with PD, the relationships between cognitive function, choice of coping strategies, and a broad index of outcome including depression, anxiety, and health-related quality of life (QoL). It was hypothesized that the coping strategy used could mediate the association between cognition and outcome.

Methods: 347 participants completed the Coping Inventory for Stressful Situations, the Hospital Anxiety and Depression Scale, the Parkinson's Disease Questionnaire-8, the Unified Parkinson's Disease Rating Scale, and the Addenbrooke's Cognitive Examination–Revised. Structural Equation Modeling was used to test the hypothesized model of cognition, coping, and outcome based on a direct association between cognition and outcome and an indirect association mediated by coping.

Results: Overall, poorer cognition predicted less use of task-oriented coping, which predicted worse outcome (a latent variable comprised of higher depression and anxiety and lower QoL). The analyses suggested a small indirect effect of cognition on outcome mediated by coping.

Conclusions: The findings suggest that patients who fail to employ task-oriented coping strategies may be at greater risk of depression, anxiety, and poor health-related QoL. Even mild to moderate cognitive impairment may contribute to reduced use of task-oriented coping. Suitably adapted cognitive–behavioral approaches may be useful to enable the use of adaptive coping strategies in such patients.

Leaf fluctuating asymmetry (FA) is considered an important indicator of environmentally induced stress in plants, but the relationship between herbivory and FA levels is not clear. In this study we compared leaf size and shape, leaf area consumed by herbivorous insects, and FA levels between individuals of Heliocarpus pallidus (Tiliaceae) from two adjacent and contrasting habitat types (deciduous and riparian) in the Chamela–Cuixmala tropical dry-forest biosphere reserve. Ten individuals of H. pallidus were collected in each habitat type. Leaf shape was assessed using geometric morphometric techniques. Results indicated statistically significant differences in leaf shape between individuals from the two habitat types. In individuals from the riparian habitat leaf area (mean = 42.3 ± 1.2 cm2), herbivory levels (mean = 25.5% ± 1.8%) and FA levels (mean = 0.38 ± 0.04 cm) were significantly higher than in individuals from the deciduous habitat (17.2 ± 3.5 cm2; 9.6% ± 1.0% and 0.18 ± 0.04 cm, respectively). Within habitats, significant correlations were found between total leaf area and percentage leaf area removed by insects (R2 = 0.92 in riparian habitats, R2 = 0.9 in deciduous habitats), and between percentage leaf area removed and FA (R2 = 0.70 in riparian habitats, R2 = 0.79 in deciduous habitats). As has been suggested for other plant species, it is possible that the more favourable conditions in the riparian habitat enhance leaf growth, resulting in higher FA. Also, individuals in this habitat might be characterized by lower chemical defence and/or higher nutritional quality, which would explain the higher herbivory levels.

This article uses British Columbia forest policy to test our ability to distinguish between policy change and policy learning using the Advocacy Coalition Framework (ACF) developed by Paul Sabatier. The authors find the ACF a useful way of approaching policy change in this sector, but argue that finer discriminations are needed to detect policy learning. They argue that Sabatier underestimates the extent to which the legitimation function of key ideas forces dominant advocacy coalitions to respond to criticisms in ways that promote learning. They conclude that, in this case, adaptive strategies undertaken by a dominant advocacy coalition in response to criticism has resulted in policy-oriented learning that may cause a major policy shift without an externally induced crisis in the forest policy sector.

In “Putting Ideas in Their Place,” George Hoberg raises some important and persistent questions about the explanation of policy change. In particular, he suggests that our attempt to demonstrate the role played by ideas in changing forest policy in British Columbia using Paul Sabatier's Advocacy Coalition Framework (ACF) gives excessive weight to ideas at the expense of more traditional concerns with power and interest. Although it is unclear whether he places the blame on the ACF itself or merely on the way we have employed it, the burden of his critique is that we fail to live up to our commitment to show how ideas and interests can be combined in a more comprehensive form of explanation than one which appeals to interests alone. Worse still, by our reckless overstatement of the case for ideas, we risk creating a “straw monster,” thereby warping the judgment of an entire generation of political scientists.

Speed/distance meters were deployed on adeliée, gentoo and chinstrap penguins Pygoscelis adeliae, P. papua and P. antarctica, breeding near Anvers Island, Antarctica. Underwater speeds and distances travelled were interspecifically very similar (means of ca. 7–8 km h-1 and 15–45 km, respectively). These results are compared with published data on penguin behaviour at sea obtained by using identical methodology. A simple model, based on penguin activity at sea data, is developed to derive range limits for penguins. Derived range limits are substantially lower than previous estimates but accord well with distributional data obtained by transects.