The zero suicide approach is based on the belief that all deaths from suicide in healthcare settings are preventable. We caution that the narrow focus on suicide prevention as a key indicator for measuring mental health system performance may have adverse consequences.

Early soybean planting and cover crop adoption in the U.S. Midwest prompt investigation into the impact of these practices on weed community dynamics and best management practices. While previous research has explored different aspects of giant ragweed control, the specific integration among soil management practices, including cover crop adoption, soybean planting timing, and herbicide use, has not been thoroughly investigated. This study assessed the effects of soil management, soybean planting time, and preemergence (PRE) herbicide application on giant ragweed control and soybean yield in Wisconsin and Nebraska in 2022 and 2023. The study included a factorial arrangement of four soil management treatments (conventional tillage, no-till, and fall-planted cereal rye early terminated and terminated at planting [planting green]), two soybean planting times, and two PRE herbicide treatments (PRE and no PRE). POST herbicides were applied when ∼50% of giant ragweed plants within each treatment reached ∼10 cm in height. In Nebraska, cereal rye and tillage treatments without a PRE had at least 67% lower giant ragweed density than no-till at POST. In no-till, densities were at least 60% lower with PRE compared to no PRE. In Wisconsin, cereal rye did not reduce giant ragweed density at POST compared to no-till, likely due to relatively low biomass accumulation. In contrast, delayed soybean planting reduced giant ragweed density for most treatments but lowered soybean yield in no-till and planting-green treatments. The PRE herbicides had either no effect or positive effects on reducing giant ragweed density and increasing soybean yield. Overall, this study suggests that soil management and soybean planting timing are crucial for effective giant ragweed management in Wisconsin, where biotypes with a long emergence window during the spring and summer are present, while in Nebraska, soil management and soybean planting timing are less critical due to giant ragweed biotypes with an early and short emergence window in the spring.

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 to prior to or following application. Additionally, climate models suggest more extreme weather will become the norm, further expanding this weather range glufosinate can be exposed to. 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 POST application of glufosinate applied to waterhemp (Amaranthus tuburculatus (Moq.) J. D. Sauer), morningglory species (Ipomoea spp.), and/or giant foxtail (Setaria faberi Herm.) <15cm 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 five days prior to glufosinate application was detrimental to the probability of successful control of A. tuburculatus and S. faberi. Lower relative humidity (≤70%) and solar radiation (≤23 MJ m-1 day-1) 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 five days after application was ≤25C. As climate continues to change and become more variable, the risk of unacceptable control of several common species with glufosinate is likely to increase.

People simultaneously entangled in multiple state systems are often subject to contradictory legal mandates that can foster distrust and incentivize system avoidance. This study focuses on those indebted to both the child support system and the criminal legal system, a situation we describe as dual debt. We ask whether and how the imposition of legal debts with punitive surveillance and collections mechanisms fosters alienation in the form of legal cynicism and estrangement, which we refer to jointly as legal anomie. Drawing from interview data in Minnesota, we find that legal anomie and system avoidance are mutually reinforcing processes, as debts in these systems triggered consequences that pushed people out of the formal labor market and heightened their distrust of legal institutions. The case of dual debt demonstrates how alienating and contradictory policy systems can foster both legal anomie and system avoidance, particularly in the context of economic and social precarity.

Background: Febrile neutropenia (FN) is the most common complication of chemotherapy-induced neutropenia that affects over 80% of patients with hematologic malignancies. National guidance and randomized controlled trial data demonstrate empiric antimicrobial therapy (EAT) can be discontinued after 72 hours of apyrexia and clinical recovery regardless of absolute neutrophil count (ANC). A 2019 internal study identified opportunity for improvement for targeted de-escalation. We aimed to reevaluate duration of EAT in patients with FN without a documented source of infection. Methods: A pharmacovigilance platform identified 110 patients from January to September 2023 without identified source of infection. Data collection was performed via manual chart review. Historic patient data from our 2019 cohort (n=50) was available in our research repository. The primary outcome was the duration of EAT in patients with at least 72 hours of apyrexia and clinical recovery, defined as normalization of vital signs. Secondary outcomes included adverse events associated with EAT, and initiation of intravenous vancomycin. Results: Baseline characteristics for 2023 were similar to historic, median age was 67.5 years, 56% were male, and median ANC at fever onset was 150 cells/μL. EAT was continued in 29 patients (58%) despite defervescence and stabilization versus 35 (70%) in 2019 (figure 1). Average duration (LOT) of EAT beyond clinical stabilization was 6 versus 7 days. Adverse effects due to EAT occurred in 13 patients in 2023 (26%) versus 4 (8%); of which, C. difficile infection (CDI) was the greatest contributor. Vancomycin was initiated in 31 patients (62%), 22 having no identifiable indication. Conclusions: Rates of EAT de-escalation for neutropenic patients after 72 hours of apyrexia and clinical stability improved by 12% as compared to 2019. Mean days of overall EAT was 3 days less in 2023. With a notable increase in CDI rates in 2023, dedicated time for antimicrobial stewardship review, clinician education and guideline driven alerts for review will be explored to help further improve practice.

Phenological studies for Cuban bulrush [Oxycaryum cubense (Poepp. & Kunth) Lye] have been limited to the monocephalous form in Lake Columbus (Mississippi). Accordingly, there is little available information on potential phenological differences among O. cubense forms (monocephalous vs. polycephalous) and populations in other geographic locations in the United States. Therefore, seasonal patterns of biomass and starch allocation in O. cubense were quantified from two populations in Lake Columbus on the Tennessee-Tombigbee Waterway in Mississippi (monocephalous), two populations from Lake Martin in Louisiana (polycephalous), and two populations from Orange Lake in Florida (polycephalous). Monthly samples of O. cubense inflorescence, emergent, and submersed tissue were harvested from two plots per state from October 2021 to September 2022. During monthly data collection, air temperature and photoperiod were recorded. Starch allocation patterns were similar among all sites, with starch storage being less than 1.5% dry weight for all plant tissues. Biomass was greatest in Lake Columbus (monocephalous; 600.7 g dry weight [DW] m−2) followed by Lake Martin (polycephalous; 392.3 g DW m−2) and Orange Lake (polycephalous; 233.85 g DW m−2). Peak inflorescence biomass occurred in the winter for the Lake Martin and Orange Lake populations and in the summer for the Lake Columbus population. Inflorescence biomass in Lake Columbus had a positive relationship (r2 = 0.53) with warmer air temperatures. Emergent and submersed biomass generally had negative relationships with both photoperiod and temperature (r2 = 0.02 to 0.77) in all sites. Peak biomass was also negatively related to temperature and photoperiod. Results from this study indicate that there are differences in biomass allocation between the two growth forms of O. cubense and that growth can occur at temperatures below freezing. Low temperature tolerance may allow this species to expand its range farther north than previously suspected.

Suicide is a leading cause of death in the United States, particularly among adolescents. In recent years, suicidal ideation, attempts, and fatalities have increased. Systems maps can effectively represent complex issues such as suicide, thus providing decision-support tools for policymakers to identify and evaluate interventions. While network science has served to examine systems maps in fields such as obesity, there is limited research at the intersection of suicidology and network science. In this paper, we apply network science to a large causal map of adverse childhood experiences (ACEs) and suicide to address this gap. The National Center for Injury Prevention and Control (NCIPC) within the Centers for Disease Control and Prevention recently created a causal map that encapsulates ACEs and adolescent suicide in 361 concept nodes and 946 directed relationships. In this study, we examine this map and three similar models through three related questions: (Q1) how do existing network-based models of suicide differ in terms of node- and network-level characteristics? (Q2) Using the NCIPC model as a unifying framework, how do current suicide intervention strategies align with prevailing theories of suicide? (Q3) How can the use of network science on the NCIPC model guide suicide interventions?

Soils developed on Pleistocene andesitic lava flows and fluvial detritus in the Atlantic coastal plain of Costa Rica display a clay mineral assemblage that includes 10 Å and 7 Å halloysite and lesser amounts of kaolinite and dioctahedral vermiculite. Other secondary minerals include gibbsite, goethite, hematite, maghemite, allophane and amorphous Al hydroxides. Active floodplain soils are dominated by 10 Å halloysite and contain less allophane, while soil clays from Pleistocene terraces consist of a mixture of 10 Å and 7 Å halloysite as well as less dioctahedral vermiculite, kaolinite, and amorphous Al hydroxides. Residual soils formed on Pleistocene lava flows are dominated by 7 Å halloysite with less abundant kaolinite, dioctahedral vermiculite, 10 Å halloysite and amorphous Al hydroxides. This sequence suggests transformations of 10 Å halloysite to 7 Å halloysite and allophane to amorphous Al hydroxides with time. The presence of 10 Å halloysite in Pleistocene terrace soils implies slow reaction rates or metastability.

Quantitative X-ray diffraction (QXRD) analysis indicates a decrease in the amount of plagioclase feldspar from 34 wt.% in the 1–2 year floodplain to 0–1.6% in terrace and residual soils. Plagioclase weathering is paralleled by the formation of dioctahedral clay, allophane and Al hydroxides. Analysis by QXRD also indicates that crystalline minerals comprise 70–95% of the soil fraction, implying 5–30% X-ray-amorphous material. These data are verified by selective extraction using ammonium oxalate, which indicates 8–30% amorphous material. Chemical analysis of the extractant by inductively coupled plasmaatomic emission spectrometry indicates that allophane (Al:Si ratios of 0.92–3.82) occurs in floodplain and some terrace soils while amorphous Al hydroxides appear to coexist with allophane in Pleistocene terrace and residual soils with Al:Si ratios of 6.53–8.53. Retention of Mg to a greater extent than Na, Ca and K suggests Mg incorporation into hydroxide sheets in dioctahedral vermiculite as well as substitution into hydroxides.

Drill-interseeding cover crops into corn (Zea mays L.) is an emerging establishment method in northern U.S. production regions. However, cover crop performance in interseeded systems remains variable, and creating environments that are conducive to cover crop but not weed growth is challenging. Cultural practices that partition resources between corn and interseeded cover crops have potential to improve performance if weeds are adequately managed. This study evaluated interactions among corn hybrids differing in leaf architecture (upright, pendulum), corn row spacing (76 cm, 152 cm), and interseeding timing (V3, V6) on light transmittance, relative fitness of cover crop species (cereal rye [Secale cereale L.], annual ryegrass (Lolium multiflorum Lam), red clover [Trifolium pratense L.]) and weeds, and corn grain yield at three U.S. Northeast locations. Results showed that light transmittance through the corn canopy was greater in 152-cm row spacing compared with 76-cm row spacing at the V6 growth stage, with the magnitude of difference increasing at the V10 corn growth stage. Corn hybrids had a marginal effect on light transmittance. The effect of row spacing and interseeding timing on fall cover crop biomass varied across cover crop species and locations. In 76-cm rows, interseeding earlier (V3) increased cover crop biomass production. The relative fitness of cover crops was greater than that of weeds in each combination of cultural practices that included narrow spacing (76 cm), whereas the relative fitness of weeds was greater than that of cover crops when interseeding in wide rows (152 cm). The effect of row spacing on corn yield varied among locations, with higher yields observed in 76-cm row spacing compared with 152-cm at two of three locations. Our results show that interseeding early (V3) on 76-cm row spacing can balance cover crop and corn production management goals, while placing cover crops at a relative fitness advantage over weeds.

We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.

Background: Previously, our hospital manually built a static antibiogram from a surveillance system (VigiLanz) culture report. In 2019, a collaboration between the antimicrobial stewardship team (AST) and the infection control (IC) team set out to leverage data automation to create a dynamic antibiogram. The goal for the antibiogram was the ability to easily distribute and update for hospital staff, with the added ability to perform advanced tracking and surveillance of organism and drug susceptibilities for AST and IC. By having a readily available, accurate, and Clinical and Laboratory Standards Institute (CLSI)–compliant antibiogram, clinicians have the best available data on which to base their empiric antibiotic decisions. Methods: First, assessment of required access to hospital databases and selection of a visualization software (MS Power BI) was performed. Connecting SQL database feeds to Power BI enabled creation of a data model using DAX and M code to comply with the CLSI, generating the first isolate per patient per year. Once a visual antibiogram was created, it was validated against compiled antibiograms using data from the microbiology laboratory middleware (bioMerieux, Observa Integrated Data Management Software). This validation process uncovered some discrepancies between the 2 reference reports due to cascade reporting of susceptibilities. The Observa-derived data were used as the source of truth. The antibiogram prototype was presented to AST/IC members, microbiology laboratory leadership, and other stakeholders to assess functionality. Results: Following feedback and revisions by stakeholders, the new antibiogram was published on a hospital-wide digital platform (Fig. 1). Clinicians may view the antibiogram at any time on desktops from a firewall (or password)–protected intranet. The antibiogram view defaults to the current calendar year and users may interact with the antibiogram rows and columns without disrupting the integrity of the background databases or codes. Each year, simple refreshing of the Power BI antibiogram and changing of the calendar year allows us to easily and accurately update the antibiogram on the hospital-wide digital platform. Conclusions: This interdisciplinary collaboration resulted in a new dynamic, CLSI-compliant antibiogram with improved usability, increased visibility, and straightforward updating. In the future, a mobile version of the antibiogram may further enhance accessibility, bring more useful information to providers, and optimize AST/IC guidelines and education.

Disclosures: None

Background: The off-target effects linezolid have the potential to cause serotonin syndrome when given in conjunction with serotonergic agents. Despite package insert labeling as a contraindication, several postmarketing studies have demonstrated a low incidence of serotonin syndrome with the concomitant use of linezolid and other serotonergic agents. Linezolid provides a convenient oral option for gram-positive infections. However, due to concerns for serotonin syndrome, the use of linezolid is sometimes avoided. Methods: We performed a single-center, retrospective, medical record review of all adult inpatients from September 2021 to September 2022. Patients included had 1 administration of linezolid and 1 inpatient administration of a selective serotonin reuptake inhibitor (SSRI) or serotonin and norepinephrine reuptake inhibitor (SNRI) within 14 days. The primary outcome was the incidence of serotonin syndrome as defined by the Hunter serotonin toxicity criteria, which were retrospectively applied to each patient based on medical-record documentation. We compared patients receiving 1 versus multiple serotonergic agents. Secondary outcomes included duration of hospitalization and adverse outcomes based on concerns for serotonin syndrome such as need for rescue, ICU admission, or change in medication. Results: Of the 50 included patients from a convenience sample, 27 (54%) were on linezolid and >1 serotonergic agent. Patients had similar baseline characteristics (Table 1). The most common concomitant agent used was an SSRI. Other agents that predispose patients to serotonin syndrome included opioid analgesics and other classes of antidepressants (Fig. 1). Serotonin syndrome occurred within 48 hours in 1 patient on an SNRI and a continuous fentanyl drip. There was no need for rescue or ICU admission due to serotonin syndrome. No patients were readmitted due to serotonin syndrome, and no differences were observed in hospital lengths of stay. Conclusions: Exposure to a single serotonergic agent combined with receipt of linezolid was not associated with any cases of serotonin syndrome. Exposure to multiple serotonergic agents was not associated with a high incidence of serotonin syndrome. This small series supports previous reports demonstrating relative safety of linezolid given with serotonergic agents and encourages review of interruptive drug–drug interaction alerts for linezolid within the electronic ordering system.

Disclosures: None

Background: Nirmatrelvir-ritonavir received emergency use authorization (EUA) for the prevention of progression of COVID-19 in December 2021. Most data supporting this authorization are limited to the outpatient setting in unvaccinated patients, and high-quality head-to-head comparisons to other antivirals such as remdesivir are lacking. Patients at high risk of disease progression, such as advanced age, smokers, and those with cardiovascular disease, diabetes, obesity, or cancer continue to be admitted to acute-care settings for various indications, and some are incidentally found to have mild COVID-19. The objective of this project was to compare rates of progression of mild-to-moderate COVID-19 for inpatients treated with remdesivir versus nirmatrelvir-ritonavir. Methods: This study was a single-center, retrospective cohort study that included patients aged ≥18 years with PCR-confirmed SARS-CoV-2 infection who were initiated on nirmatrelvir-ritonavir within 5 days or remdesivir within 7 days of symptom onset between June 2022 and August 2022. The primary outcome was the worsening of symptoms via the WHO ordinal clinical severity scale for COVID-19. Secondary outcomes included escalation of care or readmission due to COVID-19, discharge prior to treatment completion, and any adverse drug reactions (ADRs). Within our institutional guidelines, prior approval is needed for COVID-19 treatment through collaboration between the primary team and antimicrobial stewards. Nirmatrelvir-ritonavir is the preferred agent for both in- and outpatients unless the patient had drug interactions or lack of enteral access, in which case remdesivir was considered. Results: In total, 58 patients were screened and 50 patients were included, 25 patients in each arm. Most were non-Hispanic, white males with at least 1 comorbidity. Compared to the remdesivir arm, the nirmatrelvir-ritonavir arm had more patients with at least a primary COVID-19 vaccine (44% vs 34%). Also, 88% of patients in each arm had a baseline ordinal score of 4, and 12% had a score of 5. Ordinal score changes between the start and end of therapy were similar between groups, and neither had an increase in oxygen requirements (Fig. 1). No readmissions were due to COVID-19, and both medications were well tolerated. Refer to Fig. 2 for secondary outcomes. Conclusions: Nirmatrelvir-ritonavir and remdesivir showed similar safety and efficacy in the treatment of hospitalized patients with mild-to-moderate COVID-19. Current evidence-based guidelines and treatment costs favor nirmatrelvir-ritonavir for patients who can receive this drug.

Disclosures: None

No-till planting organic soybean [Glycine max (L.) Merr.] into roller-crimped cereal rye (Secale cereale L.) can have several advantages over traditional tillage-based organic production. However, suboptimal cereal rye growth in fields with large populations of weeds may result in reduced weed suppression, weed–crop competition, and soybean yield loss. Ecological weed management theory suggests that integrating multiple management practices that may be weakly effective on their own can collectively provide high levels of weed suppression. In 2021 and 2022, a field experiment was conducted in central New York to evaluate the performance of three weed management tactics implemented alone and in combination in organic no-till soybean planted into both cereal rye mulch and no mulch: (1) increasing crop seeding rate, (2) interrow mowing, and (3) weed electrocution. A nontreated control treatment that did not receive any weed management and a weed-free control treatment were also included. Cereal rye was absent from two of the five fields where the experiment was repeated; however, the presence of cereal rye did not differentially affect results, and thus data were pooled across fields. All treatments that included interrow mowing reduced weed biomass by at least 60% and increased soybean yield by 14% compared with the nontreated control. The use of a high seeding rate or weed electrocution, alone or in combination, did not improve weed suppression or soybean yield relative to the nontreated control. Soybean yield across all treatments was at least 22% lower than in the weed-free control plot. Future research should explore the effects of the tactics tested on weed population and community dynamics over an extended period. Indirect effects from interrow mowing and weed electrocution should also be studied, such as the potential for improved harvestability, decreased weed seed production and viability, and the impacts on soil organisms and agroecosystem biodiversity.