This study aimed to assess the impact of hypertensive disorders of pregnancy on infant neurodevelopment by comparing 6-month and 2-year psychomotor development outcomes of infants exposed to gestational hypertension (GH) or preeclampsia (PE) versus normotensive pregnancy (NTP). Participating infants were children of women enrolled in the Postpartum Physiology, Psychology and Paediatric (P4) cohort study who had NTPs, GH or PE. 6-month and 2-year Ages and Stages Questionnaires (ASQ-3) scores were categorised as passes or fails according to domain-specific values. For the 2-year Bayley Scales of Infant and Toddler Development (BSID-III) assessment, scores > 2 standard deviations below the mean in a domain were defined as developmental delay. Infants (n = 369, male = 190) exposed to PE (n = 75) versus GH (n = 20) and NTP (n = 274) were more likely to be born small for gestational age and premature. After adjustment, at 2 years, prematurity status was significantly associated with failing any domain of the ASQ-3 (p = 0.015), and maternal tertiary education with increased cognitive scores on the BSID-III (p = 0.013). However, PE and GH exposure were not associated with clinically significant risks of delayed infant neurodevelopment in this study. Larger, multicentre studies are required to further clarify early childhood neurodevelopmental outcomes following hypertensive pregnancies.

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.

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.

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.

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.

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.