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Older adults with treatment-resistant depression (TRD) benefit more from treatment augmentation than switching. It is useful to identify moderators that influence these treatment strategies for personalised medicine.
Aims
Our objective was to test whether age, executive dysfunction, comorbid medical burden, comorbid anxiety or the number of previous adequate antidepressant trials could moderate the superiority of augmentation over switching. A significant moderator would influence the differential effect of augmentation versus switching on treatment outcomes.
Method
We performed a preplanned moderation analysis of data from the Optimizing Outcomes of Treatment-Resistant Depression in Older Adults (OPTIMUM) randomised controlled trial (N = 742). Participants were 60 years old or older with TRD. Participants were either (a) randomised to antidepressant augmentation with aripiprazole (2.5–15 mg), bupropion (150–450 mg) or lithium (target serum drug level 0.6 mmol/L) or (b) switched to bupropion (150–450 mg) or nortriptyline (target serum drug level 80–120 ng/mL). Treatment duration was 10 weeks. The two main outcomes of this analysis were (a) symptom improvement, defined as change in Montgomery–Asberg Depression Rating Scale (MADRS) scores from baseline to week 10 and (b) remission, defined as MADRS score of 10 or less at week 10.
Results
Of the 742 participants, 480 were randomised to augmentation and 262 to switching. The number of adequate previous antidepressant trials was a significant moderator of depression symptom improvement (b = −1.6, t = −2.1, P = 0.033, 95% CI [−3.0, −0.1], where b is the coefficient of the relationship (i.e. effect size), and t is the t-statistic for that coefficient associated with the P-value). The effect was similar across all augmentation strategies. No other putative moderators were significant.
Conclusions
Augmenting was superior to switching antidepressants only in older patients with fewer than three previous antidepressant trials. This suggests that other intervention strategies should be considered following three or more trials.
Mass Gathering Medicine focuses on mitigating issues at Mass Gathering Events. Medical skills can vary substantially among staff, and the literature provides no specific guidance on staff training. This study highlights expert opinions on minimum training for medical staff to formalize preparation for a mass gathering.
Methods
This is a 3-round Delphi study. Experts were enlisted at Mass Gathering conferences, and researchers emailed participation requests through Stat59 software. Consent was obtained verbally and on Stat59 software. All responses were anonymous. Experts generated opinions. The second and third rounds used a 7-point linear ranking scale. Statements reached a consensus if the responses had a standard deviation (SD) of less than or equal to 1.0.
Results
Round 1 generated 137 open-ended statements. Seventy-three statements proceeded to round 2. 28.7% (21/73) found consensus. In round 3, 40.3% of the remaining statements reached consensus (21/52). Priority themes included venue-specific information, staff orientation to operations and capabilities, and community coordination. Mass casualty preparation and triage were also highlighted as a critical focus.
Conclusions
This expert consensus framework emphasizes core training areas, including venue-specific operations, mass casualty response, triage, and life-saving skills. The heterogeneity of Mass Gatherings makes instituting universal standards challenging. The conclusions highlight recurrent themes of priority among multiple experts.
After Hurricane Ida, faith-based organizations were vital to disaster response. However, this community resource remains understudied. This exploratory study examines local faith-based organizational involvement in storm recovery by evaluating response activities, prevalence and desire for formal disaster education, coordination with other organizations, effect of storm damage on response, and observations for future response.
Methods
An exploratory survey was administered to community leaders throughout the Bayou Region of Louisiana consisting of questions regarding demographics, response efforts, coordination with other organizations, formal disaster training, the impact of storm damage on ability to respond, and insights into future response.
Results
Faith-based organizations are active during storm response. There is a need and desire for formal disaster education. Many organizations experienced storm damage but continued serving their community. Other emerging themes included: importance of clear communications, building stronger relationships with other organizations prior to a disaster, and coordination of resources.
Conclusions
Faith-based organizations serve an important role in disaster response. Though few have formal training, they are ready and present in the area of impact, specifically in hurricane response. In the midst of organizational and personal damage, these organizations respond quickly and effectively to provide a necessary part of the disaster management team.
Posttraumatic stress disorder (PTSD) has been associated with advanced epigenetic age cross-sectionally, but the association between these variables over time is unclear. This study conducted meta-analyses to test whether new-onset PTSD diagnosis and changes in PTSD symptom severity over time were associated with changes in two metrics of epigenetic aging over two time points.
Methods
We conducted meta-analyses of the association between change in PTSD diagnosis and symptom severity and change in epigenetic age acceleration/deceleration (age-adjusted DNA methylation age residuals as per the Horvath and GrimAge metrics) using data from 7 military and civilian cohorts participating in the Psychiatric Genomics Consortium PTSD Epigenetics Workgroup (total N = 1,367).
Results
Meta-analysis revealed that the interaction between Time 1 (T1) Horvath age residuals and new-onset PTSD over time was significantly associated with Horvath age residuals at T2 (meta β = 0.16, meta p = 0.02, p-adj = 0.03). The interaction between T1 Horvath age residuals and changes in PTSD symptom severity over time was significantly related to Horvath age residuals at T2 (meta β = 0.24, meta p = 0.05). No associations were observed for GrimAge residuals.
Conclusions
Results indicated that individuals who developed new-onset PTSD or showed increased PTSD symptom severity over time evidenced greater epigenetic age acceleration at follow-up than would be expected based on baseline age acceleration. This suggests that PTSD may accelerate biological aging over time and highlights the need for intervention studies to determine if PTSD treatment has a beneficial effect on the aging methylome.
Palmer amaranth, a competitive weed in cotton and soybeans, poses challenges due to its rapid growth, high fertility, and herbicide resistance. Effective management strategies targeting sex ratios could reduce seed production by female plants. Protoporphyrinogen oxidase (PPO-) inhibiting herbicides play a role in the evolving resistance of Amaranthus spp. in the US Midwest. These herbicides may also affect the male-to-female ratio of Palmer amaranth. A 2-yr field experiment (2015 and 2016) was conducted in a soybean field in Collinsville, IL, evaluating various preemergence and postemergence PPO-inhibiting herbicide treatments. Untreated Palmer amaranth populations exhibited a bias toward females. Preemergence application of sulfentrazone and flumioxazin effectively reduced Palmer amaranth density (1.66 plants m–2) throughout the season, whereas postemergence applications of fomesafen and lactofen provided limited control (27 and 31 plants m–2, respectively). Early-season mortality was high (96%) among Palmer amaranth seedlings, especially with pyroxasulfone + fluthiacet-methyl treatment. Fomesafen increased female biomass (28.8%) while reducing male biomass compared to the nontreated control. In 2015, pyroxasulfone + fluthiacet-methyl and acetochlor altered the male-to-female sex ratio compared to the nontreated control, with pyroxasulfone + fluthiacet-methyl reducing the proportion of females (–0.11 M/F) and acetochlor slightly increasing the proportion of males (0.03 M/F), though not different from a 1:1 ratio. In 2016, pendimethalin and flumioxazin (71 g ai ha–1) resulted in a strong female-biased sex ratio, with an almost exclusively female population. In both years, the nontreated control plots (–0.58 and –0.55 M/F) maintained a naturally female-biased sex ratio, deviating significantly from a 1:1 ratio. These findings suggest that specific herbicide treatments can alter the sex ratio. Understanding sex determination in Palmer amaranth holds promise for developing more effective control strategies in the future.
Foliar-applied postemergence applications of glufosinate are often applied to glufosinate-resistant crops to provide nonselective weed control without significant crop injury. Rainfall, air temperature, solar radiation, and relative humidity near the time of application have been reported to affect glufosinate efficacy. However, previous research may have not captured the full range of weather variability to which glufosinate may be exposed before or following application. Additionally, climate models suggest more extreme weather will become the norm, further expanding the weather range to which glufosinate can be exposed. The objective of this research was to quantify the probability of successful weed control (efficacy ≥85%) with glufosinate applied to some key weed species across a broad range of weather conditions. A database of >10,000 North American herbicide evaluation trials was used in this study. The database was filtered to include treatments with a single postemergence application of glufosinate applied to waterhemp [Amaranthus tuberculatus (Moq.) Sauer], morningglory species (Ipomoea spp.), and/or giant foxtail (Setaria faberi Herrm.) <15 cm in height. These species were chosen because they are well represented in the database and listed as common and troublesome weed species in both corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] (Van Wychen 2020, 2022). Individual random forest models were created. Low rainfall (≤20 mm) over the 5 d before glufosinate application was detrimental to the probability of successful control of A. tuberculatus and S. faberi. Lower relative humidity (≤70%) and solar radiation (≤23 MJ m−1 d−1) on the day of application reduced the probability of successful weed control in most cases. Additionally, the probability of successful control decreased for all species when average air temperature over the first 5 d after application was ≤25 C. As climate continues to change and become more variable, the risk of unacceptable control of several common species with glufosinate is likely to increase.
This study aimed to understand the current landscape of USA-based disaster medicine (DM) programs through the lens of alumni and program directors (PDs). The data obtained from this study will provide valuable information to future learners as they ponder careers in disaster medicine and allow PDs to refine curricular offerings.
Methods
Two separate surveys were sent to USA-based DM program directors and alumni. The surveys gathered information regarding current training characteristics, career trajectories, and the outlook of DM training.
Results
The study had a 57% response rate among PDs, and 42% response rate from alumni. Most programs are 1-year and accept 1-2 fellows per class. More than 60% of the programs offer additional advanced degrees. Half of the respondents accept international medical graduates (IMGs). Only 25% accept non-MD/DO/MBBs trained applicants. Most of the alumni hold academic and governmental positions post-training. Furthermore, many alumni report that fellowship training offered an advantage in the job market and allowed them to expand their clinical practice.
Conclusions
The field of disaster medicine is continuously evolving owing to the increased recognition of the important roles DM specialists play in healthcare. The fellowship training programs are experiencing a similar evolution with an increasing trend toward standardization. Furthermore, graduates from these programs see their training as a worthwhile investment in career opportunities.
Foliar-applied postemergence herbicides are a critical component of corn (Zea mays L.) and soybean [Glycine max (L.) Merr.] weed management programs in North America. Rainfall and air temperature around the time of application may affect the efficacy of herbicides applied postemergence in corn or soybean production fields. However, previous research utilized a limited number of site-years and may not capture the range of rainfall and air temperatures that these herbicides are exposed to throughout North America. The objective of this research was to model the probability of achieving successful weed control (≥85%) with commonly applied postemergence herbicides across a broad range of environments. A large database of more than 10,000 individual herbicide evaluation field trials conducted throughout North America was used in this study. The database was filtered to include only trials with a single postemergence application of fomesafen, glyphosate, mesotrione, or fomesafen + glyphosate. Waterhemp [Amaranthus tuberculatus (Moq.) Sauer], morningglory species (Ipomoea spp.), and giant foxtail (Setaria faberi Herrm.) were the weeds of focus. Separate random forest models were created for each weed species by herbicide combination. The probability of successful weed control deteriorated when the average air temperature within the first 10 d after application was <19 or >25 C for most of the herbicide by weed species models. Additionally, drier conditions before postemergence herbicide application reduced the probability of successful control for several of the herbicide by weed species models. As air temperatures increase and rainfall becomes more variable, weed control with many of the commonly used postemergence herbicides is likely to become less reliable.
This study analyzes disparities in initial health care responses in Turkey and Syria following the 2023 earthquakes.
Methods
Using Humanitarian Data Exchange, Crude Mortality Rates (CMR) and injury rates in both countries were calculated, and temporal trends of death tolls and injuries in the first month post- catastrophe were compared. World Health Organization (WHO) Flash Appeal estimated funding requirements, and ratios of humanitarian aid personnel in Urban Search and Rescue (USAR) teams per population from ReliefWeb and MAPACTION data were used to gauge disparities.
Results
56 051 096 individuals were exposed, with Turkey having 44 million vs 12 million in Syria. Turkey had higher CMR in affected areas (10.5 vs. 5.0 per 10,000), while Syria had higher CMR in intensely seismic regions (9.3 vs. 7.7 per 1,000). Turkey had higher injury rates (24.6 vs. 9.9 per 10 000). Death and injury rates plateaued in Syria after 3 days, but steadily rose in Turkey. Syria allocated more funding for all priorities per population except health care facilities’ rehabilitation. Turkey had 219 USAR teams compared to Syria’s 6, with significantly more humanitarian aid personnel (23 vs. 2/100,000).
Conclusions
Significant disparities in the initial health care response were observed between Turkey and Syria, highlighting the need for policymakers to enhance response capabilities in conflict-affected events to reduce the impact on affected populations.
Narrative Abstract
The 2023 Turkish-Syrian earthquakes, the most devastating in the region since 1939, heightened challenges in Syria’s health care system amid ongoing conflict, disrupting Gaziantep’s humanitarian aid supply route. The initial health care responses post-earthquakes in Turkey and Syria were analyzed through a descriptive study, where Crude Mortality Rates (CMR) and injury rates during the first week were calculated. The World Health Organization’s funding priorities and the ratio of humanitarian aid personnel in Urban Search and Rescue teams per population were assessed. Turkey had 4-fold higher earthquake exposure and experienced higher CMR and injuries per population, while Syria had higher CMR in intensely seismic regions. Temporal trends showed plateaued death and injury rates in Syria within 3 days, while Turkey’s continued to increase. Syria required more funding across nearly all priorities while Turkey had more humanitarian aid personnel per population. Significant health care response disparities were observed, emphasizing the imperative for policymakers to enhance initial responses in conflict-affected events.
Preemergence herbicides associated with cereal rye (Secale cereale L.) cover crop (hereafter “cereal rye”) can be an effective waterhemp [Amaranthus tuberculatus (Moq.) Sauer.] and Palmer amaranth (Amaranthus palmeri S. Watson) management strategy in soybean [Glycine max (L.) Merr.] production. Delaying cereal rye termination until soybean planting (planting green) optimizes biomass production and weed suppression but might further impact the fate of preemergence herbicides. Limited research is available on the fate of preemergence herbicides applied over living cereal rye in the planting green system. Field experiments were conducted in Illinois, Kansas, Pennsylvania, and Wisconsin to evaluate the fate of flumioxazin and pyroxasulfone and Amaranthus spp. residual control under different cover crop management practices in soybean in 2021 and 2022 (8 site-years). A flumioxazin + pyroxasulfone herbicide premix was applied preemergence at soybean planting under no-till without cereal rye, cereal rye early terminated before soybean planting, and cereal rye terminated at soybean planting. Flumioxazin and pyroxasulfone concentrations in the soil were quantified at 0, 7, and 21 d after treatment (DAT), and Amaranthus spp. density was determined at postemergence herbicide application. The presence of cereal rye biomass intercepted flumioxazin and pyroxasulfone at preemergence application and reduced concentration in the soil when compared with no-till, mainly at 0 DAT. Main differences in herbicide concentration were observed between no-till and cereal rye treatments rather than cereal rye termination times. Despite reducing herbicide concentration in the soil, the presence of the cereal rye biomass did not affect early-season residual Amaranthus spp. control. The adoption of effective preemergence herbicides associated with a properly managed cereal rye cover crop is an effective option for integrated Amaranthus spp. management programs in soybean production systems.
Two independent temporal-spatial clusters of hospital-onset Rhizopus infections were evaluated using whole-genome sequencing (WGS). Phylogenetic analysis confirmed that isolates within each cluster were unrelated despite epidemiological suspicion of outbreaks. The ITS1 region alone was insufficient for accurate analysis. WGS has utility for rapid rule-out of suspected nosocomial Rhizopus outbreaks.
Over the last 20 years disasters have increasingly involved children, and pediatric disaster medicine research is growing. However, this research is largely reactive, has not been categorized in terms of the disaster cycle, and the quality of the research is variable. To understand the gaps in current literature and highlight areas for future research, we conducted a scoping review of pediatric disaster medicine literature. This work will help create recommendations for future pediatric disaster medicine research.
Method:
Using a published framework for scoping reviews, we worked with a medical librarian and a multi-institutional team to define the research question, develop eligibility criteria, and to identify a search strategy. We conducted a comprehensive Medline search from 2001-2022, which was distributed to nine reviewers. Each article was independently screened for inclusion by two reviewers. Discrepancies were resolved by a third reviewer.
Inclusion criteria included articles published in English, related to all stages of the disaster cycle, and disaster education, focused on or included pediatric populations; published in academic, peer-reviewed journals, and policies from professional societies.
Results:
967 pediatric disaster medicine articles were imported for screening and 35 duplicates were removed. 932 articles were screened for relevance and 109 were excluded. In 2000, three articles met inclusion criteria and 66 in 2021. We noticed reactive spikes in the number of articles after major disasters. Most articles focused on preparedness and response, with only a few articles on recovery, mitigation, and prevention. Methodology used for most studies was either qualitative or retrospective. Most were single site studies and there were < 10 meta-analyses over the 20 years.
Conclusion:
This scoping review describes the trends in and quality of existing pediatric disaster medicine literature. By identifying the gaps in this body of literature, we can better prioritize future research.
The emergence of a leading alternative during the course of a decision is known to bias the evaluation of new information in a manner that favors that alternative. We report 3 studies that address the sensitivity of predecisional information distortion and its effects in hypothetical risky decisions with regard to 4 potential influences: choice domain, repeated choice, memory requirements, and intermediate progress questions. In Experiment 1 (N = 515), the magnitude of information distortion was similar in 5 choice domains (varied between participants) involving monetary gambles, song downloads, frequent-flyer miles, political decisions, or medical decisions. Information distortion mediated the relationship between our manipulation of initial preferences and participants’ final choices, with the magnitude of the indirect effect being roughly similar across domains. These results replicate and extend previous findings. Additionally, distortion decreased significantly over 4 similar decision problems (within participants), but remained significant in the fourth problem. In Experiment 2 (N = 214), information distortion increased significantly when previously viewed information remained available, apparently because reiterating that information strengthened emerging preferences. In Experiment 3 (N = 223), the removal of intermediate progress questions that measure information distortion and emerging preferences did not significantly affect final choices, again replicating previous results. We conclude that predecisional information distortion is a relatively stable and robust phenomenon that deserves a prominent role in descriptive theories of choice.
We study the effect of proximity to other wineries on the formation of new wineries and how this effect depends on winemaking history in a location. Clustering is common in the wine industry, but it also depends on other factors, such as proximity to vineyards and high-reputation wineries. Using panel data with annual observations from 1994 to 2014 on 598 zip codes within Washington State, we estimate empirical models that control for proximity to wineries, proximity to vines, proximity to income, and the presence of star wineries. We find that the elasticity of the number of wineries with respect to proximity to wineries outside the zip code hinges on the length of local winemaking history. For locations with 11 or more winery years prior to our sample, the elasticity is at least 0.44. The presence of elite wineries is also found to have an effect, with about 0.5 additional wineries per year starting in a zip code per star winery. The effect of history suggests that policies to seed winery start-ups will help cluster formation, but only with a substantial critical mass of winemaking activity.
In April 2019, the U.S. Fish and Wildlife Service (USFWS) released its recovery plan for the jaguar Panthera onca after several decades of discussion, litigation and controversy about the status of the species in the USA. The USFWS estimated that potential habitat, south of the Interstate-10 highway in Arizona and New Mexico, had a carrying capacity of c. six jaguars, and so focused its recovery programme on areas south of the USA–Mexico border. Here we present a systematic review of the modelling and assessment efforts over the last 25 years, with a focus on areas north of Interstate-10 in Arizona and New Mexico, outside the recovery unit considered by the USFWS. Despite differences in data inputs, methods, and analytical extent, the nine previous studies found support for potential suitable jaguar habitat in the central mountain ranges of Arizona and New Mexico. Applying slightly modified versions of the USFWS model and recalculating an Arizona-focused model over both states provided additional confirmation. Extending the area of consideration also substantially raised the carrying capacity of habitats in Arizona and New Mexico, from six to 90 or 151 adult jaguars, using the modified USFWS models. This review demonstrates the crucial ways in which choosing the extent of analysis influences the conclusions of a conservation plan. More importantly, it opens a new opportunity for jaguar conservation in North America that could help address threats from habitat losses, climate change and border infrastructure.
Disasters have many deleterious effects and are becoming more frequent. From a health-care perspective, disasters may cause periods of stress for hospitals and health-care systems. Telemedicine is a rapidly growing technology that has been used to improve access to health-care during disasters. Telemedicine applied in disasters is referred to as disaster telemedicine. Our objective was to conduct a scoping literature review on current use of disaster telemedicine to develop recommendations addressing the most common barriers to implementation of a telemedicine system for regional disaster health response in the United States. Publications on telemedicine in disasters were collected from online databases. This included both publications in English and those translated into English. Predesigned inclusion/exclusion criteria and a PRISMA flow diagram were applied. The PRISMA flow diagram was used on the basis that it would help streamline the available literature. Literature that met the criteria was scored by 2 reviewers who rated relevance to commonly identified disaster telemedicine implementation barriers, as well as how disaster telemedicine systems were implemented. We also identified other frequently mentioned themes and briefly summarized recommendations for those topics. Literature scoring resulted in the following topics: telemedicine usage (42 publications), system design and operating models (43 publications), as well as difficulties with credentialing (5 publications), licensure (6 publications), liability (4 publications), reimbursement (5 publications), and technology (24 publications). Recommendations from each category were qualitatively summarized.
To assess the time to achieve reliable reporting of electronic health record data compared with manual reporting during validation.
Design:
Secondary analysis of aggregate data for number of patients present, number of patients with a central venous catheter, and number of patients with an indwelling urinary catheter during validation of an electronic health record reporting tool.
Setting:
Mayo Clinic Health System in Wisconsin.
Participants:
Mayo Clinic infection prevention and control staff, unit champions, and all inpatients.
Methods:
We simultaneously collected electronic and manual counts of device data and compared discrepancies to determine their source. If manual data entry was incorrect, manual counts were coded as inaccurate. If electronically abstracted data did not reflect an accurate count, errors were attributed to the system. Data were compared using standard statistical methods.
Results:
Within 30 days after beginning validation of electronic reporting for central venous catheter days and urinary catheter days, electronic counts were durably more reliable than manual counts.
Conclusions:
Manual validation for capturing and reporting electronic data and reporting can be shorter than the 90 days currently mandated by National Healthcare Safety Network criteria. Compared with a longer validation period, a shorter validation period may yield substantial savings while achieving the same validity.
The technology around generating efficient and sustainable energy is rapidly evolving; hydrogen and fuel cells are versatile examples within a portfolio of options. This article provides an overview of the early-stage materials R&D in hydrogen and fuel cells at the US Department of Energy (DOE) Fuel Cell Technologies Office within the Office of Energy Efficiency & Renewable Energy. The article highlights technology status and progress toward achieving DOE targets, discusses R&D needs and challenges, and provides specific examples where advanced materials research is relevant to addressing those challenges. For broader context, materials R&D advances are discussed in the context of DOE’s H2@Scale initiative, which is enabling innovations to generate cost-competitive hydrogen as an energy carrier, enabling renewables, as well as nuclear, fossil fuels, and the grid, to enhance the economics of both baseload power plants and intermittent solar and wind, enhancing resiliency and avoiding curtailment.
The Cambridge Handbook of Policing in the United States provides a comprehensive collection of essays on police and policing, written by leading experts in political theory, sociology, criminology, economics, law, public health, and critical theory. It unveils a range of experiences - from the police chief of a major metropolitan force to ordinary people targeted for policing on the street - and asks important questions about whether and why we need the police, before analyzing the law of policing, police use of force, and police violence, paying particular attention to the issue of discrimination against marginalized and vulnerable communities at the blunt end of police interference. The book also discusses technological innovations and proposals for reform. Written in accessible language, this interdisciplinary work will be a valuable resource for anyone interested in understanding the present and future of policing in the United States.
In this article, we present an educational intervention that embeds ethics education within research laboratories. This structure is designed to assist students in addressing ethical challenges in a more informed way, and to improve the overall ethical culture of research environments. The project seeks (a) to identify factors that students and researchers consider relevant to ethical conduct in science, technology, engineering, and math (STEM) and (b) to promote the cultivation of an ethical culture in experimental laboratories by integrating research stakeholders in a bottom-up approach to developing context-specific, ethics-based guidelines. An important assumption behind this approach is that direct involvement in the process of developing laboratory specific ethical guidelines will positively influence researchers’ understanding of ethical research and practice issues, their handling of these issues, and the promotion of an ethical culture in the respective laboratory. The active involvement may increase the sense of ownership and integration of further discussion on these important topics. Based on the project experiences, the project team seeks to develop a module involving the bottom-up building of codes-of-ethics-based guidelines that can be used by a broad range of institutions and that will be distributed widely.