Coronavirus disease-2019 precipitated the rapid deployment of novel therapeutics, which led to operational and logistical challenges for healthcare organizations. Four health systems participated in a qualitative study to abstract lessons learned, challenges, and promising practices from implementing neutralizing monoclonal antibody (nMAb) treatment programs. Lessons are summarized under three themes that serve as critical building blocks for health systems to rapidly deploy novel therapeutics during a pandemic: (1) clinical workflows, (2) data infrastructure and platforms, and (3) governance and policy. Health systems must be sufficiently agile to quickly scale programs and resources in times of uncertainty. Real-time monitoring of programs, policies, and processes can help support better planning and improve program effectiveness. The lessons and promising practices shared in this study can be applied by health systems for distribution of novel therapeutics beyond nMAbs and toward future pandemics and public health emergencies.

Efficient evidence generation to assess the clinical and economic impact of medical therapies is critical amid rising healthcare costs and aging populations. However, drug development and clinical trials remain far too expensive and inefficient for all stakeholders. On October 25–26, 2023, the Duke Clinical Research Institute brought together leaders from academia, industry, government agencies, patient advocacy, and nonprofit organizations to explore how different entities and influencers in drug development and healthcare can realign incentive structures to efficiently accelerate evidence generation that addresses the highest public health needs. Prominent themes surfaced, including competing research priorities and incentives, inadequate representation of patient population in clinical trials, opportunities to better leverage existing technology and infrastructure in trial design, and a need for heightened transparency and accountability in research practices. The group determined that together these elements contribute to an inefficient and costly clinical research enterprise, amplifying disparities in population health and sustaining gaps in evidence that impede advancements in equitable healthcare delivery and outcomes. The goal of addressing the identified challenges is to ultimately make clinical trials faster, more inclusive, and more efficient across diverse communities and settings.

The U.S. Department of Agriculture–Agricultural Research Service (USDA-ARS) has been a leader in weed science research covering topics ranging from the development and use of integrated weed management (IWM) tactics to basic mechanistic studies, including biotic resistance of desirable plant communities and herbicide resistance. ARS weed scientists have worked in agricultural and natural ecosystems, including agronomic and horticultural crops, pastures, forests, wild lands, aquatic habitats, wetlands, and riparian areas. Through strong partnerships with academia, state agencies, private industry, and numerous federal programs, ARS weed scientists have made contributions to discoveries in the newest fields of robotics and genetics, as well as the traditional and fundamental subjects of weed–crop competition and physiology and integration of weed control tactics and practices. Weed science at ARS is often overshadowed by other research topics; thus, few are aware of the long history of ARS weed science and its important contributions. This review is the result of a symposium held at the Weed Science Society of America’s 62nd Annual Meeting in 2022 that included 10 separate presentations in a virtual Weed Science Webinar Series. The overarching themes of management tactics (IWM, biological control, and automation), basic mechanisms (competition, invasive plant genetics, and herbicide resistance), and ecosystem impacts (invasive plant spread, climate change, conservation, and restoration) represent core ARS weed science research that is dynamic and efficacious and has been a significant component of the agency’s national and international efforts. This review highlights current studies and future directions that exemplify the science and collaborative relationships both within and outside ARS. Given the constraints of weeds and invasive plants on all aspects of food, feed, and fiber systems, there is an acknowledged need to face new challenges, including agriculture and natural resources sustainability, economic resilience and reliability, and societal health and well-being.

Due to adverse snow and cloud conditions, only a few inventories are available for the maritime glaciers in New Zealand. These are difficult to compare as different approaches and baseline data have been used to create them. In consequence, glacier fluctuations in New Zealand over the past two decades are only known for a few glaciers based on field observations. Here we present the results of a new inventory for the ‘year 2000’ (some scenes are from 2001 and 2002) that is based on glacier outlines from a recently published inventory for the year 2016 and allowed consistent change assessment for nearly 3000 glaciers over this period. The year 2000 inventory was created by manual on-screen digitizing using Landsat ETM+ satellite imagery (15 m panchromatic band) in the background and the year 2016 outlines as a starting point. Major challenges faced were late and early seasonal snow, clouds and shadow, the geo-location mismatch between Landsat and Sentinel-2 as well as the correct interpretation of ice patches and ice under debris cover. In total, we re-mapped 2967 glaciers covering an area of 885.5 km2 in 2000, which is 91.7 km2 (or 10.4%) more than the 793.8 km2 mapped in 2016. Area change rates (mean rate −0.65% a−1) increase towards smaller glaciers. Strongest area loss from 2000 to 2016 occurred at elevations ~1900 m but the highest relative loss was found below 800 m a.s.l. In total, 109 glaciers split into two or more entities and 264 had wasted away by 2016.

Tricuspid atresia with common arterial trunk is a very rare association in complex CHD. This association has even more infrequently been documented concomitantly with interrupted aortic arch. We present the diagnosis and initial surgical management of an infant with a fetal diagnosis of tricuspid atresia and common arterial trunk, with additional postnatal finding of interrupted aortic arch with interruption between the left common carotid and left subclavian artery. Due to the infant’s small size, she was initially palliated with bilateral pulmonary artery bands and a ductal stent. This was followed by septation of the common arterial trunk and interrupted aortic arch repair and 4 mm right subclavian artery to main pulmonary artery shunt placement at two months of age. She was discharged home on day of life 81.

An end of summer snowline (EOSS) photographic dataset for Aotearoa New Zealand contains over four decades of equilibrium line altitude (ELA) observations for more than 50 index glaciers. This dataset provides an opportunity to create a climatological ELA reference series that has several applications. Our work screened out EOSS sites that had low temporal coverage and also removed limited observations when the official survey did not take place. Snowline data from 41 of 50 glaciers in the EOSS dataset were retained and included in a normalised master snowline series that spans 1977–2020. Application of the regionally representative normalised master snowline series in monthly and seasonally resolved climate response function analyses showed consistently strong relationships with austral warm-season temperatures for land-based stations west of the Southern Alps and the central Tasman Sea. There is a trend towards higher regional snowlines since the 1990s that has been steepening in recent decades. If contemporary decadal normalised master snowline series trends are maintained, the average Southern Alps snowline elevation will be displaced at least 200 m higher than normal by the 2025–2034 decade. More frequent extremely high snowlines are expected to drive more extreme cumulative mass-balance losses that will reduce the glacierised area of Aotearoa New Zealand.

We identified quality indicators (QIs) for care during transitions of older persons (≥ 65 years of age). Through systematic literature review, we catalogued QIs related to older persons’ transitions in care among continuing care settings and between continuing care and acute care settings and back. Through two Delphi survey rounds, experts ranked relevance, feasibility, and scientific soundness of QIs. A steering committee reviewed QIs for their feasible capture in Canadian administrative databases. Our search yielded 326 QIs from 53 sources. A final set of 38 feasible indicators to measure in current practice was included. The highest proportions of indicators were for the emergency department (47%) and the Institute of Medicine (IOM) quality domain of effectiveness (39.5%). Most feasible indicators were outcome indicators. Our work highlights a lack of standardized transition QI development in practice, and the limitations of current free-text documentation systems in capturing relevant and consistent data.

ABSTRACT IMPACT: This work will standardize necessary image pre-processing for diagnostic and prognostic clinical workflows dependent on quantitative analysis of conventional magnetic resonance imaging. OBJECTIVES/GOALS: Conventional magnetic resonance imaging (MRI) poses challenges for quantitative analysis due to a lack of uniform inter-scanner voxel intensity values. Head and neck cancer (HNC) applications in particular have not been well investigated. This project aims to systematically evaluate voxel intensity standardization (VIS) methods for HNC MRI. METHODS/STUDY POPULATION: We utilize two separate cohorts of HNC patients, where T2-weighted (T2-w) MRI sequences were acquired before beginning radiotherapy for five patients in each cohort. The first cohort corresponds to patients with images taken at various institutions with a variety of non-uniform acquisition scanners and parameters. The second cohort corresponds to patients from a prospective clinical trial with uniformity in both scanner and acquisition parameters. Regions of interest from a variety of healthy tissues assumed to have minimal interpatient variation were manually contoured for each image and used to compare differences between a variety of VIS methods for each cohort. Towards this end, we implement a new metric for cohort intensity distributional overlap to compare region of interest similarity in a given cohort. RESULTS/ANTICIPATED RESULTS: Using a simple and interpretable metric, we have systematically investigated the effects of various commonly implementable VIS methods on T2-w sequences for two independent cohorts of HNC patients based on region of interest intensity similarity. We demonstrate VIS has a substantial effect on T2-w images where non-uniform acquisition parameters and scanners are utilized. Oppositely, it has a modest to minimal impact on T2-w images generated from the same scanner with the same acquisition parameters. Moreover, with a few notable exceptions, there does not seem to be a clear advantage or disadvantage to using one VIS method over another for T2-w images with non-uniform acquisition parameters. DISCUSSION/SIGNIFICANCE OF FINDINGS: Our results inform which VIS methods should be favored in HNC MRI and may indicate VIS is not a critical factor to consider in circumstances where similar acquisition parameters can be utilized. Moreover, our results can help guide downstream quantitative imaging tasks that may one day be implemented in clinical workflows.

The only complete inventory of New Zealand glaciers was based on aerial photography starting in 1978. While there have been partial updates using 2002 and 2009 satellite data, most glaciers are still represented by the 1978 outlines in contemporary global glacier databases. The objective of this project is to establish an updated glacier inventory for New Zealand. We have used Landsat 8 OLI satellite imagery from February and March 2016 for delineating clean glaciers using a semi-automatic band ratio method and debris-covered glaciers using a maximum likelihood classification. The outlines have been checked against Sentinel-2 MSI data, which have a higher resolution. Manual post processing was necessary due to misclassifications (e.g. lakes, clouds), mapping in shadowed areas, and combining the clean and debris-covered parts into single glaciers. New Zealand glaciers cover an area of 794 ± 34 km2 in 2016 with a debris-covered area of 10%. Of the 2918 glaciers, seven glaciers are >10 km2 while 71% is <0.1 km2. The debris cover on those largest glaciers is >40%. Only 15 glaciers are located on the North Island. For a selection of glaciers, we were able to calculate the area reduction between the 1978 and 2016 inventories.

Recent years have seen an exponential increase in the variety of healthcare data captured across numerous sources. However, mechanisms to leverage these data sources to support scientific investigation have remained limited. In 2013 the Pediatric Heart Network (PHN), funded by the National Heart, Lung, and Blood Institute, developed the Integrated CARdiac Data and Outcomes (iCARD) Collaborative with the goals of leveraging available data sources to aid in efficiently planning and conducting PHN studies; supporting integration of PHN data with other sources to foster novel research otherwise not possible; and mentoring young investigators in these areas. This review describes lessons learned through the development of iCARD, initial efforts and scientific output, challenges, and future directions. This information can aid in the use and optimisation of data integration methodologies across other research networks and organisations.

Objective: Concussion in children and adolescents is a prevalent problem with implications for subsequent physical, cognitive, behavioral, and psychological functioning, as well as quality of life. While these consequences warrant attention, most concussed children recover well. This study aimed to determine what pre-injury, demographic, and injury-related factors are associated with optimal outcome (“wellness”) after pediatric concussion. Method: A total of 311 children 6–18 years of age with concussion participated in a longitudinal, prospective cohort study. Pre-morbid conditions and acute injury variables, including post-concussive symptoms (PCS) and cognitive screening (Standardized Assessment of Concussion, SAC), were collected in the emergency department, and a neuropsychological assessment was performed at 4 and 12 weeks post-injury. Wellness, defined by the absence of PCS and cognitive inefficiency and the presence of good quality of life, was the main outcome. Stepwise logistic regression was performed using 19 predictor variables. Results: 41.5% and 52.2% of participants were classified as being well at 4 and 12 weeks post-injury, respectively. The final model indicated that children who were younger, who sustained sports/recreational injuries (vs. other types), who did not have a history of developmental problems, and who had better acute working memory (SAC concentration score) were significantly more likely to be well. Conclusions: Determining the variables associated with wellness after pediatric concussion has the potential to clarify which children are likely to show optimal recovery. Future work focusing on wellness and concussion should include appropriate control groups and document more extensively pre-injury and injury-related factors that could additionally contribute to wellness. (JINS, 2019, 25, 375–389)