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Current evidence underscores a need to transform how we do clinical research, shifting from academic-driven priorities to co-led community partnership focused programs, accessible and relevant career pathway programs that expand opportunities for career development, and design of trainings and practices to develop cultural competence among research teams. Failures of equitable research translation contribute to health disparities. Drivers of this failed translation include lack of diversity in both researchers and participants, lack of alignment between research institutions and the communities they serve, and lack of attention to structural sources of inequity and drivers of mistrust for science and research. The Duke University Research Equity and Diversity Initiative (READI) is a program designed to better align clinical research programs with community health priorities through community engagement. Organized around three specific aims, READI-supported programs targeting increased workforce diversity, workforce training in community engagement and cultural competence, inclusive research engagement principles, and development of trustworthy partnerships.
Weeds are one of the greatest challenges to snap bean (Phaseolus vulgaris L.) production. Anecdotal observation posits certain species frequently escape the weed management system by the time of crop harvest, hereafter called residual weeds. The objectives of this work were to (1) quantify the residual weed community in snap bean grown for processing across the major growing regions in the United States and (2) investigate linkages between the density of residual weeds and their contributions to weed canopy cover. In surveys of 358 fields across the Northwest (NW), Midwest (MW), and Northeast (NE), residual weeds were observed in 95% of the fields. While a total of 109 species or species-groups were identified, one to three species dominated the residual weed community of individual fields in most cases. It was not uncommon to have >10 weeds m−2 with a weed canopy covering >5% of the field’s surface area. Some of the most abundant and problematic species or species-groups escaping control included amaranth species such as smooth pigweed (Amaranthus hybridus L.), Palmer amaranth (Amaranthus palmeri S. Watson), redroot pigweed (Amaranthus retroflexus L.), and waterhemp [Amaranthus tuberculatus (Moq.) Sauer]; common lambsquarters (Chenopodium album L.); large crabgrass [Digitaria sanguinalis (L.) Scop.]; and ivyleaf morningglory (Ipomoea hederacea Jacq.). Emerging threats include hophornbeam copperleaf (Acalypha ostryifolia Riddell) in the MW and sharppoint fluvellin [Kickxia elatine (L.) Dumort.] in the NW. Beyond crop losses due to weed interference, the weed canopy at harvest poses a risk to contaminating snap bean products with foreign material. Random forest modeling predicts the residual weed canopy is dominated by C. album, D. sanguinalis, carpetweed (Mollugo verticillata L.), I. hederacea, amaranth species, and A. ostryifolia. This is the first quantitative report on the weed community escaping control in U.S. snap bean production.
While clinical research intends to improve health outcomes for all, access to research participation is often limited and inequitable. Geographic proximity is a recognized barrier, thus, systemic infrastructure solutions through federal programs including General Clinical Research Centers and Clinical and Translational Science Awards have sought to improve accessibility. Even with such support, academic medical centers often have limited clinical research-dedicated space apart from shared exam rooms in difficult-to-navigate hospitals or clinics. In 2019, the Duke University School of Medicine looked beyond its medical center campus to identify free-standing sites within Durham communities for participant study visits. Catalyzed by the COVID-19 pandemic, Duke Research at Pickett, a 22 000-square-foot building with a laboratory, 30 exam rooms, and on-site parking, opened in October 2020 to support vaccine and treatment trials. Upon the lifting of many COVID-19 restrictions, and in partnership with the Research Equity and Diversity Initiative (READI) Community Advisory Council, the building was transformed to encourage community gatherings, education, and training programs. To date, Duke Research at Pickett has hosted 2692 participants in 78 research trials and 14 community-engaged activities.
The delivery of healthcare is complex. The intricacies of the healthcare system routinely place physicians and other healthcare providers in high-risk environments. High reliability organizations (HROs) offer insight into managing an environment with persistent risk. HROs develop a precise mindset and a corresponding set of operational patterns. A Daily Management System (DMS) is crucial for ensuring the operational capability needed to deliver safe and reliable care every day. The DMS has nine key components driven by organizational direction and values, and manifested through leaders’ standard routines. The intent of the system is to create a culture that is preoccupied with failure and has a tenacity for continuous improvement. The DMS allows all team members to participate actively in the journey toward highly reliable and safe patient care. This chapter will illustrate components of the system, explain their connectivity, and offer advice on implementation. The results of using a DMS in a department will be demonstrated, showing how a DMS contributes to the development of an HRO, with safety as a core value.
While there is an increasing prevalence of dieting in the overall population, weight loss (WL) practices could be a risk factor for weight gain (WG) in normal-weight (NW) individuals. The aim of the present work was to systematically review all the studies implicating diet restriction and body weight (BW) evolution in NW people. The literature search was registered in PROSPERO (CRD42021281442) and was performed in three databases from April 2021 to June 2022 for articles involving healthy NW adults. From a total of 1487 records initially identified, eighteen were selected in the systematic review. Of the eight dieting interventional studies, only one found a higher BW after weight recovery, but 75 % of them highlighted metabolic adaptations in response to WL favouring weight regain and persisting during/after BW recovery. Eight of the ten observational studies showed a relationship between dieting and major later WG, while the meta-analysis of observational studies results indicated that ‘dieters’ have a higher BW than ‘non-dieters’. However, considering the high methodological heterogeneity and the publication bias of the studies, this result should be taken with caution. Moreover, the term ‘diet’ was poorly described, and we observed a large heterogeneity of the methods used to assess dieting status. Present results suggest that dieting could be a major risk factor for WG in the long term in NW individuals. There is, however, a real need for prospective randomised controlled studies, specifically assessing the relationship between WL induced by diet and subsequent weight in this population.
The aim of this study was to explore the experiences of family carers supporting a relative living with dementia during and after the move to technology-enriched supported accommodation (TESA). The paper explores the informal carers (ICs) roles, the factors prompting the move to TESA, alongside their perceptions of their relatives’ experience of the move and of life in a technology-enriched environment. Within a qualitative study 25 semi-structured interviews were conducted with ICs and data were analysed following a thematic approach. Four themes were identified, reflecting the shift in roles and identity of both ICs and persons living with dementia. The move to TESA was linked to a perceived reduction in care-giving pressures, with positive outcomes reported for both the ICs and the people living with dementia. Smart home technologies in the facilities did not appear to impact on the decision-making during transition, however, they were valued as part of the lived experience for the people living with dementia within the TESA facilities. These findings are relevant to policy makers, commissioners and providers of services to highlight the engagement of all stakeholders in the provision of care for people living with dementia and their families early from diagnosis in order to facilitate person-centred practices in community settings.
This paper presents the experiences of formal carers working in technology-enriched supported accommodation for people living with dementia, examining their care-giving role from a person-centred care perspective. Within a qualitative study, 21 semi-structured interviews were conducted with formal carers and data were analysed following a thematic approach. Four main themes were identified that mapped to the attributes of the person-centred practice framework (PCPF): promoting choice and autonomy, staffing model, using assistive technology and feeling that ‘you're doing a good job’. Central to person-centred practice in these settings was the promotion of choice, autonomy and independence. The dichotomy between safety and independence was evident, curtailing the opportunities within the environmental enablers and associated embedded assistive technologies. Formal carers reported considerable job satisfaction working in these settings. The small-scale, home-like facilities seemed to have a positive effect on job satisfaction. These findings are relevant to policy makers, commissioners and service providers, highlighting the facilitators of person-centred care in community dwellings for people living with dementia and the role of formal carers in promoting this approach.
Basic symptoms, defined as subjectively perceived disturbances in thought, perception and other essential mental processes, have been established as a predictor of psychotic disorders. However, the relationship between basic symptoms and family history of a transdiagnostic range of severe mental illness, including major depressive disorder, bipolar disorder and schizophrenia, has not been examined.
Aims
We sought to test whether non-severe mood disorders and severe mood and psychotic disorders in parents is associated with increased basic symptoms in their biological offspring.
Method
We measured basic symptoms using the Schizophrenia Proneness Instrument – Child and Youth Version in 332 youth aged 8–26 years, including 93 offspring of control parents, 92 offspring of a parent with non-severe mood disorders, and 147 offspring of a parent with severe mood and psychotic disorders. We tested the relationships between parent mental illness and offspring basic symptoms in mixed-effects linear regression models.
Results
Offspring of a parent with severe mood and psychotic disorders (B = 0.69, 95% CI 0.22–1.16, P = 0.004) or illness with psychotic features (B = 0.68, 95% CI 0.09–1.27, P = 0.023) had significantly higher basic symptom scores than control offspring. Offspring of a parent with non-severe mood disorders reported intermediate levels of basic symptoms, that did not significantly differ from control offspring.
Conclusions
Basic symptoms during childhood are a marker of familial risk of psychopathology that is related to severity and is not specific to psychotic illness.
Background:ATP8A2 mutations have only recently been associated with human disease. We present the clinical features from the largest cohort of patients with this disorder reported to date. Methods: An observational study of 9 unreported and 2 previously reported patients with biallelic ATP8A2 mutations was carried out at multiple centres. Results: The mean age of the cohort was 9.4 years old (range: 2.5-28 yrs). All patients demonstrated developmental delay, severe hypotonia and movement disorders: chorea/choreoathetosis (100%), dystonia (27%) or facial dyskinesia (18%). Hypotonia was apparent at birth (70%) or before 6 months old (100%). Optic atrophy was observed in 75% of patients who had a funduscopic examination. MRI of the brain was normal for most patients with a small proportion showing mild cortical atrophy (30%), delayed myelination (20%) and/or hypoplastic optic nerves (20%). Epilepsy was seen in two older patients. Conclusions:ATP8A2 gene mutations have emerged as a cause of a novel phenotype characterized by developmental delay, severe hypotonia and hyperkinetic movement disorders. Optic atrophy is common and may only become apparent in the first few years of life, necessitating repeat ophthalmologic evaluation. Early recognition of the cardinal features of this condition will facilitate diagnosis of this disorder.
It has been suggested that offspring of parents with bipolar disorder are at increased risk for disruptive mood dysregulation disorder (DMDD), but the specificity of this association has not been established.
Aims
We examined the specificity of DMDD to family history by comparing offspring of parents with (a) bipolar disorder, (b) major depressive disorder and (c) a control group with no mood disorders.
Method
We established lifetime diagnosis of DMDD using the Schedule for Affective Disorders and Schizophrenia for School Aged Children for DSM-5 in 180 youth aged 6–18 years, including 58 offspring of parents with bipolar disorder, 82 offspring of parents with major depressive disorder and 40 control offspring.
Results
Diagnostic criteria for DMDD were met in none of the offspring of parents with bipolar disorder, 6 of the offspring of parents with major depressive disorder and none of the control offspring. DMDD diagnosis was significantly associated with family history of major depressive disorder.
Conclusions
Our results suggest that DMDD is not specifically associated with a family history of bipolar disorder and may be associated with parental depression.
Chemical options for weed control in commercial cowpea production are limited. Repeated long-term use of the acetolactate synthase (ALS) inhibitor, imazethapyr, has resulted in selection for ALS-resistant populations of Palmer amaranth. Experiments were conducted at Bixby, OK, and Kibler, AR, from 2001 to 2003 to evaluate the tolerance of cowpea cultivars and advanced breeding lines to fomesafen, a potential alternative for controlling ALS-resistant Palmer amaranth and other problematic broadleaf weeds. Eight commercial cultivars and 42 advanced breeding lines were entered in the preliminary screening, using 0.84 kg/ha fomesafen. Six breeding lines were selected for the first replicated trial and three (00-582, 00-584, and 00-609) were advanced to across-location experiments. Fomesafen doses of 0, 0.17, 0.34, and 0.67 kg/ha were tested across locations. ‘Early Scarlet’ was used as commercial standard. The advanced lines had equal or higher yield potential (1,182 to 1,936 kg/ha) than Early Scarlet (1,108 kg/ha) across locations. Of the cultivars tested, line 00-609 was the best yielder, whereas 00-584 had the highest tolerance to fomesafen. At the commercial fomesafen rate of 0.34 kg/ha, 00-584 had higher yield (974 and 1,735 kg/ha, respectively, at Bixby, OK, and Kibler, AR) than the nontreated, weed-free, Early Scarlet. Thus, fomesafen can be used on the tolerant line, 00-584, without reducing yield potential relative to Early Scarlet.
WeedSOFT® is a decision support system that was developed to help farmers and consultants in Nebraska with the selection of optimal weed management strategies. WeedSOFT® evolved from HERB, a bioeconomic model for soybean that was developed in North Carolina. The program is composed of four independent modules, namely, ADVISOR, EnviroFX, MapVIEW, and WeedVIEW. ADVISOR helps the user select a treatment based on maximum yield or maximum net gain. EnviroFX and MapVIEW provide environmentally relevant herbicide information and county soil maps that indicate vulnerability to groundwater contamination. WeedVIEW is a visual library of color images and line drawings of 46 common weed species. Over 500 farmers and consultants in Nebraska and adjacent states use WeedSOFT®. As a result of the current regionalization effort, the user base is expected to increase rapidly during the next 2 or 3 yr. This article explains the algorithms implemented in the current version of WeedSOFT®.
We examined the cross-language relations among Spanish-speaking preschoolers’ (N = 125; M age = 53 months, SD = 4.58) English and Spanish vocabulary, letter–word, and math skills; the changes they exhibited in those skills during 1 year of preschool; and the extent to which Spanish skills were associated with English skill gains. The results revealed that children's Spanish and English vocabulary skills were unassociated across languages, whereas their letter–word and math skills were positively associated. Children exhibited gains in vocabulary, letter–word, and math skills in English, with letter–word and math skills in Spanish at the start of preschool being positively associated with the development of those skills in English. Children also gained math skills in Spanish. However, their Spanish vocabulary and letter–word skills did not appear to change. Vocabulary skills showed positive within-language relations with children's letter–word and math skills. The findings highlight cross-language linkages between Spanish-speaking preschoolers’ academic skills in English and Spanish and how Spanish skills associate with their English academic readiness.