The objective of this qualitative assessment, utilising the constant comparative method, was to identify satisfiers and dissatisfiers that influence paediatric cardiac ICU nurse retention and recognise areas for improvement. Interviews for this study were performed in a single, large academic children’s hospital from March of 2020 through July of 2020. Each bedside paediatric cardiac ICU nurse underwent a single semi-structured interview. Among 12 interviews, four satisfiers were identified: paediatric cardiac ICU patient population, paediatric cardiac ICU care team, personal accomplishment, and respect. Four dissatisfiers were identified: moral distress, fear, poor team dynamics, and disrespect. Through this process of inquiry, grounded theory was developed regarding strategies to improve paediatric cardiac ICU nurse retention. Tactics outlined here should be used to support retention in the unique environment of the paediatric cardiac ICU.

The internet has expanded opportunities for wildlife traders to conduct business globally, but monitoring this activity is often challenging. As monitoring techniques frequently employ language-based searches for particular words, it is important to understand the language traders use, particularly the nomenclature used to refer to traded species. We recorded advert data from four UK websites, focusing on reptiles, which constitute a large proportion of the international pet trade. We analysed whether the language types used by advertisers to refer to individual reptiles were associated with certain trader characteristics. We found English common names were the most frequent name type used to refer to species, regardless of the geographical location of the seller and the CITES Appendix listing of the species. However, scientific names were recorded in twice as many adverts for threatened and Near Threatened species as in adverts for non-threatened species, and only scientific names were used for three families: Anguidae, Pseudaspididae and Sphaerodactylidae. These findings could inform the creation of tailored keyword detection tools, which must account for the numerous language types in use within online wildlife trade communities. Future studies should examine the nuances of language used by other online wildlife trader communities in other contexts, such as different online platforms or different languages. The ultimate aim of these language detection tools will be to track in detail trends in the online reptile trade, offering a better understanding of potentially unsustainable trade patterns and helping authorities to enforce laws against illegal online reptile trade.

Herbicide resistance has been studied extensively in agronomic crops across North America but is rarely examined in vegetables. It is widely assumed that the limited number of registered herbicides combined with the adoption of diverse weed management strategies in most vegetable crops effectively inhibits the development of resistance. It is difficult to determine whether resistance is truly less common in vegetable crops or whether the lack of reported cases is due to the lack of resources focused on detection. This review highlights incidences of resistance that are thought to have arisen within vegetable crops. It also includes situations in which herbicide-resistant weeds were likely selected for within agronomic crops but became a problem when vegetables were grown in sequence or in adjacent fields. Occurrence of herbicide resistance can have severe consequences for vegetable growers, and resistance management plans should be adopted to limit selection pressure. This review also highlights resistance management techniques that should slow the development and spread of herbicide resistance in vegetable crops.

Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.

This paper presents a physics-based macroscale model for the densification of dry snow which provides for a smooth transition between densification by grain-boundary sliding (stage 1) and densification by power-law creep (stage 2). The model uses established values of the stage 1 and 2 densification rates away from the transition zone and two transition parameters with a simple physical basis: the transition density and the half-width of the transition zone. It has been calibrated using density profiles from the SUMup database and physically based expressions for the transition parameters have been derived. The transition model produces better predictions of the depth of the nominal bubble close-off horizon than the Herron and Langway model, both in its classical form and in a recent version with re-optimised densification rates.

Intrauterine preeclampsia exposure affects the lifelong cardiometabolic health of the child. Our study aimed to compare the growth (from birth to 6 months) of infants exposed to either a normotensive pregnancy or preeclampsia and explore the influence of being born small for gestational age (SGA). Participants were children of women participating in the Post-partum, Physiology, Psychology and Paediatric follow-up cohort study. Birth and 6-month weight and length z-scores were calculated for term and preterm (<37 weeks) babies, and change in weight z-score, rapid weight gain (≥0.67 increase in weight z-score) and conditional weight gain z-score were calculated. Compared with normotensive exposed infants (n = 298), preeclampsia exposed infants (n = 84) were more likely to be born SGA (7% versus 23%; P < 0.001), but weight gain from birth to 6 months, by any measure, did not differ between groups. Infants born SGA, irrespective of pregnancy exposure, were more likely to have rapid weight gain and had greater increases in weight z-score compared with those not born SGA. Preeclampsia exposed infants born SGA may benefit from interventions designed to prevent future cardiometabolic disease.

Distinguished Oral

Background: Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, California (SHIELD OC) was a CDC-funded regional decolonization intervention from April 2017 through July 2019 involving 38 hospitals, nursing homes (NHs), and long-term acute-care hospitals (LTACHs) to reduce MDROs. Decolonization in NH and LTACHs consisted of universal antiseptic bathing with chlorhexidine (CHG) for routine bathing and showering plus nasal iodophor decolonization (Monday through Friday, twice daily every other week). Hospitals used universal CHG in ICUs and provided daily CHG and nasal iodophor to patients in contact precautions. We sought to evaluate whether decolonization reduced hospitalization and associated healthcare costs due to infections among residents of NHs participating in SHIELD compared to nonparticipating NHs. Methods: Medicaid insurer data covering NH residents in Orange County were used to calculate hospitalization rates due to a primary diagnosis of infection (counts per member quarter), hospital bed days/member-quarter, and expenditures/member quarter from the fourth quarter of 2015 to the second quarter of 2019. We used a time-series design and a segmented regression analysis to evaluate changes attributable to the SHIELD OC intervention among participating and nonparticipating NHs. Results: Across the SHIELD OC intervention period, intervention NHs experienced a 44% decrease in hospitalization rates, a 43% decrease in hospital bed days, and a 53% decrease in Medicaid expenditures when comparing the last quarter of the intervention to the baseline period (Fig. 1). These data translated to a significant downward slope, with a reduction of 4% per quarter in hospital admissions due to infection (P < .001), a reduction of 7% per quarter in hospitalization days due to infection (P < .001), and a reduction of 9% per quarter in Medicaid expenditures (P = .019) per NH resident. Conclusions: The universal CHG bathing and nasal decolonization intervention adopted by NHs in the SHIELD OC collaborative resulted in large, meaningful reductions in hospitalization events, hospitalization days, and healthcare expenditures among Medicaid-insured NH residents. The findings led CalOptima, the Medicaid provider in Orange County, California, to launch an NH incentive program that provides dedicated training and covers the cost of CHG and nasal iodophor for OC NHs that enroll.

Funding: None

Disclosures: Gabrielle M. Gussin, University of California, Irvine, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

Hophornbeam copperleaf (Acalypha ostryifolia Riddell) is an erect, herbaceous, dicot species in the Euphorbiaceae, or spurge, family that constitutes more than 200 genera and some 6,000 species (Mayfield and Webster 2013). Although the euphorbs have a cosmopolitan distribution, none are found in the Arctic (Mabberley 1997). Members of the Euphorbiaceae may be trees, shrubs, herbs (occasionally aquatic), or vines; sometimes succulent and cactus-like; and often have glands on vegetative plant parts (Mabberley 1997; Zomlefer 1994). Genera in the spurge family include Croton, Euphorbia, Ricinus, and Acalypha. Acalypha consists of 450 species that are native to both the Eastern and Western hemispheres (Zomlefer 1994). Acalypha was the name used by Hippocrates because the leaves resemble those of nettles, whereas ostryifolia alludes to the resemblance of leaves to plants in the genus Ostrya (hophornbeam trees; Burrows and Tyrl 2013; Haddock 2014; Hilty 2018). As plants mature in the fall, the leaves can turn reddish-brown, which may indicate why “copperleaf” is included in the species’ common name (Hilty 2018). Hophornbeam copperleaf is native to North America; it occurs in the United States ranging from Arizona east to Florida, north to Pennsylvania, and west to Nebraska (Anonymous 2019). It occurs in a variety of habitats including agronomic fields, cultivated areas, landscapes, roadsides, river and stream banks, thickets, pastures, and waste sites (Bryson and DeFelice 2010; Haddock 2014; Hilty 2018). This plant’s other common names include copperleaf, pineland three-seed mercury, Virginia copperleaf, hornbeam mercury, hornbeam three-seed mercury, mercury, and rough-pod copperleaf (Bryson and DeFelice 2010; Haddock 2014; Hilty 2018; Steckel 2006).

Project management expertise is employed across many professional sectors, including clinical research organizations, to ensure that efforts undertaken by the organization are completed on time and according to specifications and are capable of achieving the needed impact. Increasingly, project leaders (PLs) who possess this expertise are being employed in academic settings to support clinical and preclinical translational research team science. Duke University’s clinical and translational science enterprise has been an early adopter of project management to support clinical and preclinical programs. We review the history and evolution of project management and the PL role at Duke, examine case studies that illustrate their growing value to our academic research environment, and address challenges and solutions to employing project management in academia. Furthermore, we describe the critical role project leadership plays in accelerating and increasing the success of translational team science and team approaches frequently required for systems biology and “big data” scientific studies. Finally, we discuss perspectives from Duke project leadership professionals regarding the training needs and requirements for PLs working in academic clinical and translational science research settings.

Astrophysics Telescope for Large Area Spectroscopy Probe is a concept for a National Aeronautics and Space Administration probe-class space mission that will achieve ground-breaking science in the fields of galaxy evolution, cosmology, Milky Way, and the Solar System. It is the follow-up space mission to Wide Field Infrared Survey Telescope (WFIRST), boosting its scientific return by obtaining deep 1–4 μm slit spectroscopy for ∼70% of all galaxies imaged by the ∼2 000 deg2 WFIRST High Latitude Survey at z > 0.5. Astrophysics Telescope for Large Area Spectroscopy will measure accurate and precise redshifts for ∼200 M galaxies out to z < 7, and deliver spectra that enable a wide range of diagnostic studies of the physical properties of galaxies over most of cosmic history. Astrophysics Telescope for Large Area Spectroscopy Probe and WFIRST together will produce a 3D map of the Universe over 2 000 deg2, the definitive data sets for studying galaxy evolution, probing dark matter, dark energy and modifications of General Relativity, and quantifying the 3D structure and stellar content of the Milky Way. Astrophysics Telescope for Large Area Spectroscopy Probe science spans four broad categories: (1) Revolutionising galaxy evolution studies by tracing the relation between galaxies and dark matter from galaxy groups to cosmic voids and filaments, from the epoch of reionisation through the peak era of galaxy assembly; (2) Opening a new window into the dark Universe by weighing the dark matter filaments using 3D weak lensing with spectroscopic redshifts, and obtaining definitive measurements of dark energy and modification of General Relativity using galaxy clustering; (3) Probing the Milky Way’s dust-enshrouded regions, reaching the far side of our Galaxy; and (4) Exploring the formation history of the outer Solar System by characterising Kuiper Belt Objects. Astrophysics Telescope for Large Area Spectroscopy Probe is a 1.5 m telescope with a field of view of 0.4 deg2, and uses digital micro-mirror devices as slit selectors. It has a spectroscopic resolution of R = 1 000, and a wavelength range of 1–4 μm. The lack of slit spectroscopy from space over a wide field of view is the obvious gap in current and planned future space missions; Astrophysics Telescope for Large Area Spectroscopy fills this big gap with an unprecedented spectroscopic capability based on digital micro-mirror devices (with an estimated spectroscopic multiplex factor greater than 5 000). Astrophysics Telescope for Large Area Spectroscopy is designed to fit within the National Aeronautics and Space Administration probe-class space mission cost envelope; it has a single instrument, a telescope aperture that allows for a lighter launch vehicle, and mature technology (we have identified a path for digital micro-mirror devices to reach Technology Readiness Level 6 within 2 yr). Astrophysics Telescope for Large Area Spectroscopy Probe will lead to transformative science over the entire range of astrophysics: from galaxy evolution to the dark Universe, from Solar System objects to the dusty regions of the Milky Way.

Australian undergraduate programmes are implementing curriculum aimed at better preparing graduates to work in Indigenous health settings, but the efficacy of these programmes is largely unknown. To begin to address this, we obtained baseline data upon entry to tertiary education (Time 1) and follow-up data upon completion of an Indigenous studies health unit (Time 2) on student attitudes, preparedness to work in Indigenous health contexts and transformative experiences within the unit. The research involved 336 health science first-year students (273 females, 63 males) who completed anonymous in-class paper questionnaires at both time points. Paired sample t-tests indicated significant change in student attitudes towards Indigenous Australians, perceptions of Indigenous health as a social priority, perceptions of the adequacy of health services for Indigenous Australians and preparedness to work in Indigenous health settings. Hierarchical multiple regression analyses indicated that after controlling for Time 1 measures, the number of precursor steps to transformative learning experienced by students accounted for significant variance in measures of attitudes and preparedness to work in Indigenous health contexts at Time 2. The knowledge gained further informs our understanding of both the transformative impact of such curriculum, and the nature of this transformation in the Indigenous studies health context.

The goal of this research was to identify, summarize, and evaluate pediatric disaster preparedness resources in the United States and to identify areas that need improvement or further development. Using standard literature, gray literature and website reviews, relevant resources were identified and the 50 most relevant resources were studied in depth. Each resource was given a grade of A, B, or C based on content, format, quality, and thoroughness. These resources were divided into 3 categories: (1) hospital resources, (2) school resources, and (3) training/education resources. Half of the 50 resources (25) were given a grade of A, indicating the highest level of quality and thoroughness, with pertinent information presented in a clear format. Sixteen of the resources were given a rating of B, while 9 of the resources were given a rating of C. Over 60% of the resources did not contain culturally sensitive information and more than 60% of the resources did not contain preparedness information for children with disabilities. Resources specific to hospitals and schools were limited in number and quality available, while training/education resources were widely available. In addition, 60% of resources were not specific to schools, children’s hospitals, or to certain occupations (ie, nurses, doctors, teachers, principals). Based on these results, gaps in cultural sensitivity were identified and limitations in resources for children with disabilities and for schools and hospitals currently exist. All these areas require further development in the field of pediatric disaster preparedness (Disaster Med Public Health Preparedness. 2019;13:330–337)

Australian undergraduate programmes implementing Indigenous studies courses suggest transformative educational outcomes for students; however, the mechanism behind this is largely unknown. To begin to address this, we obtained baseline data upon entry to tertiary education (Time 1) and follow-up data upon completion of an Indigenous studies health unit (Time 2) on student learning approaches, student-teacher rapport, classroom community, critical reflection (CR) and transformative experiences within the unit. Three-hundred-thirty-six health science first-year students (273 females, 63 males) completed anonymous in-class paper questionnaires at both time points. Hierarchical multiple regression analysis indicated that (a) CR was the strongest predictor of transformative learning experiences, (b) the relationship between deep learning approach upon entry to tertiary education and transformative learning experiences was mediated by CR and (c) rapport and classroom community accounted for significant variance in CR. These results suggest that students benefit from tutors’ ability to develop rapport and classroom community, leading to greater capacity for student CR. This in turn promotes transformative learning possibilities within the Indigenous studies learning environment. These findings provide a further rationale for institutions to embed Indigenous knowledge into courses and highlight the importance of evaluating their effect and quality.

In comparing laboratory techniques, absorption and translocation of 14C-haloxyfop was not affected by droplet size or treatment area. Treatment with haloxyfop prior to application of 14C-haloxyfop resulted in 27% less translocation of radiolabel from the treated leaf and 43% less acropetal translocation compared with plants receiving only the radiolabeled herbicide. Leaf washing with distilled water, distilled water plus haloxyfop, distilled water plus surfactant, distilled water plus haloxyfop plus surfactant, 100% ethanol, 100% methanol, or methanol:water (1:1 v/v) removed similar amounts of radiolabel, while chloroform removed more. Considering some of the differences found with these techniques, pretreatment with nonlabeled herbicide should be routine practice and water used as the standard solvent.

Three approaches to data analysis were compared to describe competitive interactions between wheat and Italian ryegrass. Replacement series were performed using the two species at total densities of 100, 200, and 400 plants/ m2, and separate monoculture experiments for each species at densities from 33 to 800 plants/m2. Approaches to data analysis included: 1) conventional analysis of replacement series experiments, 2) development of synthetic no-interaction responses from monoculture experiments for comparison with results from mixtures, and 3) responses of the reciprocal yield of individual plants to variation in densities of the two species. Wheat was the superior competitor to ryegrass; however, the three approaches varied in ability to quantify this competitive relationship. The conventional replacement series analysis was least sensitive in describing the influences of either density or proportion on the plant association. The synthetic no-interaction approach provided the most detailed analysis of the influence of proportion on the species interaction. The reciprocal yield approach provided the simplest and most sensitive analysis of the joint influences of density and proportion. The latter approach also provided the most quantitative analysis of the influence of density on the species interaction. Plant density and species proportion are important variables for interpreting the process of plant competition.

Glasshouse studies were undertaken to determine the effect of imposed moisture stress on the phytotoxicity of haloxyfop; the absorption, translocation, and metabolism of 14C-haloxyfop; and 14C-photoassimilate partitioning in johnsongrass and large crabgrass. Following foliar applications of haloxyfop at 30 and 25 g ai ha–1 to large crabgrass and johnsongrass, respectively, control 15 days after treatment was 92% for nonstressed plants and less than 12% for water-stressed plants. Foliar absorption of 14C-haloxyfop was reduced by moisture stress 1, 3, 5, and 24 h after treatment (HAT) in large crabgrass and 1, 3, 5, 48, and 72 HAT in johnsongrass. Regardless of stress treatment, absorption in both species reached a maximum by 24 HAT. Translocation of the radiolabel from the treated leaf to plant parts above and below the node of the treated leaf was inhibited by moisture stress in large crabgrass and johnsongrass at all harvest intervals beginning 5 and 24 HAT, respectively. Metabolism of 14C-haloxyfop was not altered by moisture stress. Fixation of 14CO2 and subsequent distribution of the 14C-photoassimilates were reduced by moisture stress. Decreases in photoassimilate translocation were similar to reductions in 14C-haloxyfop translocation. Moisture stress reduced the phytotoxicity of haloxyfop in the two grasses, and the reduced activity of haloxyfop appeared to be partially related to changes in herbicide absorption and translocation.

The fungus Colletotrichum coccodes (Wallr.) Hughes was isolated from diseased plants of eastern black nightshade (Solanum ptycanthum Dun. ♯ SOLPT) growing in the field. In greenhouse experiments, the isolate was highly pathogenic to eastern black nightshade and less so to seven other weedy species within the Solanaceae. No disease symptoms were observed on seedlings of tomato (Lycopersicon esculentum Mill.), potato (Solanum tuberosum L.), or 10 other species inoculated with the isolate. Dew periods of 16 h or longer were required for maximum disease development. This requirement could limit the practical use of this pathogen as a my coherbicide.

A considerable body of evidence suggests that early caregiving may affect the short-term functioning and longer term development of the hypothalamic–pituitary–adrenocortical axis. Despite this, most research to date has been cross-sectional in nature or restricted to relatively short-term longitudinal follow-ups. More important, there is a paucity of research on the role of caregiving in low- and middle-income countries, where the protective effects of high-quality care in buffering the child's developing stress regulation systems may be crucial. In this paper, we report findings from a longitudinal study (N = 232) conducted in an impoverished periurban settlement in Cape Town, South Africa. We measured caregiving sensitivity and security of attachment in infancy and followed children up at age 13 years, when we conducted assessments of hypothalamus–pituitary–adrenocortical axis reactivity, as indexed by salivary cortisol during the Trier Social Stress Test. The findings indicated that insecure attachment was predictive of reduced cortisol responses to social stress, particularly in boys, and that attachment status moderated the impact of contextual adversity on stress responses: secure children in highly adverse circumstances did not show the blunted cortisol response shown by their insecure counterparts. Some evidence was found that sensitivity of care in infancy was also associated with cortisol reactivity, but in this case, insensitivity was associated with heightened cortisol reactivity, and only for girls. The discussion focuses on the potentially important role of caregiving in the long-term calibration of the stress system and the need to better understand the social and biological mechanisms shaping the stress response across development in low- and middle-income countries.