The prolonged COVID-19 pandemic has created unique and complex challenges in operational and capacity planning for pediatric emergency departments, as initial low pediatric patient volumes gave way to unpredictable patient surges during Delta and Omicron variants. Compounded by widespread hospital supply chain issues, staffing shortages due to infection and attrition, and a concurrent pediatric mental health crisis, the surges have pushed pediatric emergency department leaders to re-examine traditionally defined clinical processes, and adopt innovative operational strategies. This study describes the strategic surge response and lessons learned by 3 major freestanding academic pediatric emergency departments in the western United States to help inform current and future pediatric pandemic preparedness.

The Buffalo National River in northwest Arkansas preserves an extensive Quaternary record of fluvial bedrock incision and aggradation across lithologies of variable resistance. In this work, we apply optically stimulated luminescence (OSL) dating to strath and fill terraces along the Buffalo River to elucidate the role of lithology and climate on the development of the two youngest terrace units (Qtm and Qty). Our OSL ages suggest a minimum strath planation age of ca. 250 ka for the Qtm terraces followed by a ca. 200 ka record of aggradation. Qtm incision likely occurred near the last glacial maximum (LGM), prior to the onset of Qty fill terrace aggradation ca. 14 ka. Our terrace ages are broadly consistent with other regional terrace records, and comparison with available paleoclimatic archives suggests that terrace aggradation and incision occurred during drier and wetter hydrological conditions, respectively. Vertical bedrock incision rates were also calculated using OSL-derived estimates of Qtm strath planation and displayed statistically significant spatial variability with bedrock lithology, ranging from ~35 mm/ka in the higher resistance reaches and ~16 mm/ka in the lower resistance reaches. In combination with observations of valley width and terrace distribution, these results suggest that vertical processes outpace lateral ones in lithologic reaches with higher resistance.

OBJECTIVES/SPECIFIC AIMS: To evaluate the ability of various techniques to track changes in body fluid volumes before and after a rapid infusion of saline. METHODS/STUDY POPULATION: Eight healthy participants (5M; 3F) completed baseline measurements of 1) total body water using ethanol dilution and bioelectrical impedance analysis (BIA) and 2) blood volume, plasma volume and red blood cell (RBC) volume using carbon monoxide rebreathe technique and I-131 albumin dilution. Subsequently, 30mL saline/kg body weight was administered intravenously over 20 minutes after which BIA and ethanol dilution were repeated. RESULTS/ANTICIPATED RESULTS: On average, 2.29±0.35 L saline was infused with an average increase in net fluid input-output (I/O) of 1.56±0.29 L. BIA underestimated measured I/O by −3.4±7.9%, while ethanol dilution did not demonstrate a measurable change in total body water. Carbon monoxide rebreathe differed from I-131 albumin dilution measurements of blood, plasma and RBC volumes by +0.6±2.8%, −5.4±3.6%, and +11.0±4.7%, respectively. DISCUSSION/SIGNIFICANCE OF IMPACT: BIA is capable of tracking modest changes in total body water. Carbon monoxide rebreathe appears to be a viable alternative for the I-131 albumin dilution technique to determine blood volume. Together, these two techniques may be useful in monitoring fluid status in patients with impaired fluid regulation.

Herbicide-resistant Amaranthus spp. continue to cause management difficulties in soybean. New soybean technologies under development, including resistance to various combinations of glyphosate, glufosinate, dicamba, 2,4-D, isoxaflutole, and mesotrione, will make possible the use of additional herbicide sites of action in soybean than is currently available. When this research was conducted, these soybean traits were still regulated and testing herbicide programs with the appropriate soybean genetics in a single experiment was not feasible. Therefore, the effectiveness of various herbicide programs (PRE herbicides followed by POST herbicides) was evaluated in bare-ground experiments on glyphosate-resistant Palmer amaranth and glyphosate-resistant waterhemp (both tall and common) at locations in Arkansas, Illinois, Indiana, Missouri, Nebraska, and Tennessee. Twenty-five herbicide programs were evaluated; 5 of which were PRE herbicides only, 10 were PRE herbicides followed by POST herbicides 3 to 4 wks after (WA) the PRE application (EPOST), and 10 were PRE herbicides followed by POST herbicides 6 to 7 WA the PRE application (LPOST). Programs with EPOST herbicides provided 94% or greater control of Palmer amaranth and waterhemp at 3 to 4 WA the EPOST. Overall, programs with LPOST herbicides resulted in a period of weed emergence in which weeds would typically compete with a crop. Weeds were not completely controlled with the LPOST herbicides because weed sizes were larger (≥ 15 cm) compared with their sizes at the EPOST application (≤ 7 cm). Most programs with LPOST herbicides provided 80 to 95% control at 3 to 4 WA applied LPOST. Based on an orthogonal contrast, using a synthetic-auxin herbicide LPOST improves control of Palmer amaranth and waterhemp over programs not containing a synthetic-auxin LPOST. These results show herbicides that can be used in soybean and that contain auxinic- or HPPD-resistant traits will provide growers with an opportunity for better control of glyphosate-resistant Palmer amaranth and waterhemp over a wide range of geographies and environments.

Common lambsquarters tolerance to glyphosate is problematic because of the species' widespread distribution, competitive ability with many crop species, the widespread use of glyphosate in agriculture, and the weed's potential to develop decreased sensitivity to multiple herbicide sites of action. The mechanism that confers common lambsquarters tolerance to glyphosate is not known. Therefore, we conducted experiments to determine the mechanism of tolerance to glyphosate in an accession of common lambsquarters from Indiana relative to a sensitive accession from Wisconsin. The ED50 (the effective dose that reduced shoot mass 50% relative to nontreated plants) value for the tolerant accession (1.6 kg ae ha−1 ± 0.4 standard error of the mean [SEM]) was eightfold greater than the ED50 for the sensitive accession (0.2 kg ae ha−1 ± 0.2 SEM) 28 d after treatment. The glyphosate target-site (EPSPS) DNA sequence at proline 106, shikimate accumulation as an estimate of EPSPS sensitivity, and EPSPS protein abundance did not differ between accessions. Absorption of 14C-glyphosate was slightly greater in the tolerant accession than it was in the sensitive accession at 48 and 72 h after treatment (HAT). However, the tolerant accession translocated a smaller percentage of absorbed 14C-glyphosate to the tissue above the treated leaf, which included the shoot apical meristem, at 24, 48, and 72 HAT (P ≤ 0.05, 0.01, and 0.10, respectively). These results suggest an important role of reduced translocation in conferring tolerance of common lambsquarters to glyphosate.

Experiments were conducted to determine whether antagonism between atrazine and glyphosate on shattercane observed in field studies could be duplicated under greenhouse conditions on ‘Rox Orange’ forage sorghum and whether it could be overcome by the addition of ammonium sulfate, other adjuvants, or additional glyphosate. Atrazine or surfactant added to glyphosate did not significantly affect sorghum dry weights compared to glyphosate alone. The Colby equation for synergism indicated that atrazine did not antagonize sorghum control with glyphosate in the greenhouse. Glyphosate at 0.43 kg ae/ha plus ammonium sulfate provided greater control of sorghum than glyphosate at 0.43 kg/ha without ammonium sulfate; however, glyphosate at 0.84 kg/ha plus ammonium sulfate did not provide greater control of sorghum than glyphosate at 0.84 kg/ha without ammonium sulfate. Reduced activity of glyphosate at 0.43 kg/ha in the absence of ammonium sulfate was likely due to an abundance of calcium cations in the carrier water that associated with glyphosate molecules and subsequently reduced herbicide uptake by plants. Thus, antagonism observed under cool conditions in field studies was not evident in controlled-temperature greenhouse studies.

Field experiments were conducted near DeKalb and Urbana, IL, and Columbia, MO, in 1997 and 1998 to evaluate weed management systems in glyphosate- and glufosinate-resistant soybean planted in 18-cm rows. Overall weed control was improved to a greater extent when the rate of glufosinate was increased from 300 to 400 g ai/ha than when the rate of glyphosate increased from 630 to 840 g ae/ha. Sequential applications of glufosinate improved control over single applications, whereas sequential treatments of glyphosate generally provided no advantages over single applications. When averaged across all weed species in these trials, the systems that provided 95% or higher average control were sequential applications of glufosinate, sequential applications of glyphosate, and clomazone followed by (fb) glyphosate. Single applications of glufosinate provided somewhat variable control of giant foxtail, common lambsquarters, ragweed, and common cocklebur similar to that observed with pendimethalin fb imazethapyr. The addition of fomesafen to glufosinate did not improve control of any of the weeds in this study with the exception of velvetleaf at DeKalb. The addition of clomazone to glufosinate treatments resulted in slightly better giant foxtail and velvetleaf control. Single applications of glyphosate provided somewhat variable control of giant ragweed at DeKalb in 1997 and ivyleaf morningglory and common cocklebur control at Columbia. The addition of fomesafen to glyphosate provided an increase in ivyleaf morningglory and common cocklebur control at Columbia but did not improve control of any other species. The addition of clomazone to glyphosate-based programs resulted in slightly higher velvetleaf, common cocklebur, and ivyleaf morningglory control. In the glyphosate-based herbicide programs there were no substantial differences in relative yield, with all programs protecting over 95% of soybean yield. Glufosinate-based programs were effective in protecting 85 to 92% of soybean yield.

Field experiments were conducted in 1997 and 1998 near Columbia and Novelty, MO, and at Urbana, IL, to evaluate corn injury, weed control, corn yield, and estimated economic returns with weed management programs in glufosinate-resistant corn. Herbicide programs included acetochlor preemergence (PRE) followed by glufosinate alone or with atrazine postemergence (POST) and total POST programs consisting of single and sequential applications of glufosinate alone or tank mixed with acetochlor, atrazine, or acetochlor plus atrazine. Metolachlor PRE followed by dicamba plus atrazine early POST (EPOST) and metolachlor plus atrazine PRE were included for comparison. In the total POST treatments, mid-POST applications controlled shattercane and common cocklebur better than EPOST applications. However, yield reductions as high as 23% occurred because of early-season weed interference, although weeds were controlled later in the season. Applying atrazine with glufosinate generally increased control of giant foxtail, common cocklebur, morningglory species, and common waterhemp compared to glufosinate alone, but did not increase control of common lambsquarters, velvetleaf, or Pennsylvania smartweed. Corn yield was positively correlated with weed control (r = 0.88) and more strongly dependent on grass (r = 0.82) than broadleaf (r = 0.70) weed control. Net incomes were positively correlated to corn yield (r = 0.73). Four of the top six net income-producing treatments included two herbicide applications. Three of the treatments were PRE followed by POST programs, and the fourth was a sequential POST treatment of glufosinate.

Palmer amaranth and waterhemp have become increasingly troublesome weeds throughout the United States. Both species are highly adaptable and emerge continuously throughout the summer months, presenting the need for a residual PRE application in soybean. To improve season-long control of Amaranthus spp., 19 PRE treatments were evaluated on glyphosate-resistant Palmer amaranth in 2013 and 2014 at locations in Arkansas, Indiana, Nebraska, Illinois, and Tennessee; and on glyphosate-resistant waterhemp at locations in Illinois, Missouri, and Nebraska. The two Amaranthus species were analyzed separately; data for each species were pooled across site-years, and site-year was included as a random variable in the analyses. The dissipation of weed control throughout the course of the experiments was compared among treatments with the use of regression analysis where percent weed control was described as a function of time (the number of weeks after treatment [WAT]). At the mean (i.e., average) WAT (4.3 and 3.2 WAT for Palmer amaranth and waterhemp, respectively) isoxaflutole + S-metolachlor + metribuzin had the highest predicted control of Palmer amaranth (98%) and waterhemp (99%). Isoxaflutole + S-metolachlor + metribuzin, S-metolachlor + mesotrione, and flumioxazin + pyroxasulfone had a predicted control ≥ 97% and similar model parameter estimates, indicating control declined at similar rates for these treatments. Dicamba and 2,4-D provided some, short-lived residual control of Amaranthus spp. When dicamba was added to metribuzin or S-metolachlor, control increased compared to dicamba alone. Flumioxazin + pyroxasulfone, a currently labeled PRE, performed similarly to treatments containing isoxaflutole or mesotrione. Additional sites of action will provide soybean growers more opportunities to control these weeds and reduce the potential for herbicide resistance.

Field experiments were conducted in 1997 and 1998 near Columbia and Novelty, MO, and Urbana, IL, to evaluate crop injury, weed control, corn yield, and net economic returns provided by weed control programs in glyphosate-resistant corn. The herbicide programs evaluated included acetochlor preemergence (PRE) followed by (fb) glyphosate with or without atrazine postemergence (POST) and total POST programs consisting of single and sequential applications of glyphosate alone and tank-mixed with actochlor, atrazine, or both. Metolachlor PRE fb dicamba plus atrazine POST and metolachlor plus atrazine PRE were included for comparison. In the total POST treatments, mid-post (MPOST) applications provided better control than early-post (EPOST) applications on weeds that germinated throughout the growing season such as shattercane and common cocklebur, but also resulted in yield reductions of up to 23% caused by early-season weed competition. The addition of atrazine to glyphosate POST generally increased control of common cocklebur, morningglory species, and common waterhemp. EPOST or PRE fb EPOST applications generally provided higher yields than MPOST treatments, although MPOST treatments often provided equal or greater weed control at midseason. Treatments including two herbicide applications tended to provide greater weed control, yield, and profit than those with a single application. Input costs for glyphosate-resistant corn are slightly higher than nontransgenic hybrids. However, net economic returns are similar and the use of glyphosate POST allows greater flexibility in POST weed management decisions.

This experiment compared growth, physiological, and reproductive responses of beef heifers with (MI) or without (CON) access to a creep-feeder, as a manner to stimulate metabolic imprinting while nursing their dams. On day 0, 60 Angus×Hereford heifers were ranked by BW and age (140±3 kg and 68±3 days), and assigned to pairs so all ranking criteria were similar between heifers within each pair. On day 1, pairs were randomly assigned to MI (n=15) or CON (n=15). From day 1 to 51, MI pairs and their dams were allocated to 15 drylot pens where heifers had ad libitum access to a corn-based supplement through a creep-feeder. The CON pairs and their dams were maintained in an adjacent single drylot pen. From day 52 to 111, treatments were managed as a single group on a semiarid range pasture. On day 111, heifers were weaned and allocated to two pastures (one pasture/treatment), receiving hay and a corn-based concentrate until day 326. Heifer BW was recorded before and at the end of the creep-feeding period (day 1 to 51), and on days 112 and 326. On days 0, 51, 111, 187, 261, and 325, jugular blood was collected and real-time ultrasonography for longissimus muscle depth and backfat thickness assessment was performed. Blood was also collected every 10 days from days 113 to 323 for puberty evaluation via plasma progesterone. Liver and subcutaneous fat biopsies were performed on days 51, 111, 261 and 325. Average daily gain was greater (P<0.01) for MI than CON from day 1 to 51, tended (P=0.09) to be greater for CON than MI from day 112 to 326, while BW on day 326 was similar between treatments. On day 51, MI had greater (P⩽0.01) plasma IGF-I and glucose concentrations, as well as mRNA expression of hepatic pyruvate carboxylase and adipose fatty acid synthase than CON. On days 261 and 325, plasma insulin concentrations were greater (P⩽0.03) in CON than MI. Mean mRNA expression of hepatic IGF-I and adipose peroxisome proliferator-activated receptor gamma were greater (P⩽0.05) in MI than CON. No treatment effects were detected for puberty attainment rate. In conclusion, supplementing nursing heifers via creep-feeding for 50 days altered physiological and biochemical variables suggestive of a metabolic imprinting effect, but did not hasten their puberty attainment.

Objective: Previous studies reveal that many terminally ill patients never receive hospice care. Among those who do receive hospice, many enroll very close to the time of death. Nationally, between 1992 and 1998, the median length of stay at hospice declined 27%, from 26 to 19 days. In our prior study of 206 patients diagnosed with terminal cancer and using hospice, we found that one-third enrolled with hospice within 1 week prior to death. Late hospice enrollment can have deleterious effects on patients and their family members. The aim of the present study was to characterize common experiences of patients and primary family caregivers as they transition to hospice, focusing on caregiver perceptions of factors that might contribute to delays in hospice enrollment.

Methods: We conducted in-depth interviews with a purposive sample of 12 caregivers selected from a population of primary family caregivers of patients with terminal cancer who enrolled with hospice in Connecticut between September 2000 and September 2001. Respondents represented different ages, genders, and kinship relationships with patients. Respondents were asked about the patient's care trajectory, how they first learned about hospice, and their experiences as they transitioned to hospice. NUD*IST software was used for qualitative data coding and analysis.

Results: Constant comparative analysis identified three themes common to the experience of transitioning to hospice: (1) caregivers' acceptance of the impending death, (2) challenges in negotiating the health care system across the continuum of care, and (3) changing patient–family dynamics.

Significance of results: Identification of these themes from the caregivers' perspective generates hypotheses about potential delays in hospice and may ultimately be useful in the design of interventions that are consistent with caregivers' needs.

Recently on the microscopy list server, a question came up as to how to compensate for charging in SEM micrographs. Several good answers were suggested. Some of them were 1) recoating the sample to prevent the build up of charge on the sample in the first place, and image it again, 2) use an environmental SEM (ESEM) in the “wet” mode to eliminate the charging phenomena, 3) use a different detector, such as a backscattered electron detector, which is much less sensitive to charging phenomena, and 4) apply adjustments to the digital image using software such as Adobe PhotoshopÆ to minimize the effect of the charging problem.