The COVID-19 pandemic accelerated the development of decentralized clinical trials (DCT). DCT’s are an important and pragmatic method for assessing health outcomes yet comprise only a minority of clinical trials, and few published methodologies exist. In this report, we detail the operational components of COVID-OUT, a decentralized, multicenter, quadruple-blinded, randomized trial that rapidly delivered study drugs nation-wide. The trial examined three medications (metformin, ivermectin, and fluvoxamine) as outpatient treatment of SARS-CoV-2 for their effectiveness in preventing severe or long COVID-19. Decentralized strategies included HIPAA-compliant electronic screening and consenting, prepacking investigational product to accelerate delivery after randomization, and remotely confirming participant-reported outcomes. Of the 1417 individuals with the intention-to-treat sample, the remote nature of the study caused an additional 94 participants to not take any doses of study drug. Therefore, 1323 participants were in the modified intention-to-treat sample, which was the a priori primary study sample. Only 1.4% of participants were lost to follow-up. Decentralized strategies facilitated the successful completion of the COVID-OUT trial without any in-person contact by expediting intervention delivery, expanding trial access geographically, limiting contagion exposure, and making it easy for participants to complete follow-up visits. Remotely completed consent and follow-up facilitated enrollment.

In a survey of infection prevention programs, leaders reported frequent clinical and infection prevention practice modifications to avoid coronavirus disease 2019 (COVID-19) exposure that exceeded national guidance. Future pandemic responses should emphasize balanced approaches to precautions, prioritize educational campaigns to manage safety concerns, and generate an evidence-base that can guide appropriate infection prevention practices.

A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.

Patients often demonstrate attentional and action-intentional biases in both the transverse and coronal planes. In addition, when making forelimb movements in the transverse plane, normal participants also have spatial and magnitude asymmetries, but forelimb spatial asymmetries have not been studied in coronal space. Thus, to learn if when normal people make vertical movements they have right–left spatial and magnitude biases, seventeen healthy, blindfolded volunteers had their hands (holding pens) placed vertically in their midsagittal plane, 10 inches apart, on pieces of paper positioned above, below, and at eye-level. Participants were asked to move their hands together vertically and meet in the middle. Participants demonstrated less angular deviation in the below-eye condition than in the other spatial conditions, when moving down than up, and with their right than left hand. Movements toward eye level from upper or lower space were also more accurate than movements in the other directions. Independent of hand, lines were longer with downward than upward movements and the right hand moved more distance than the left. These attentional-intentional asymmetries may be related to gravitational force, hand-hemispheric dominance, and spatial “where” asymmetries; however, the mechanisms accounting for these asymmetries must be ascertained by future research. (JINS, 2011, 17, 732–739)

The above-water food webs of arthropod communities in irrigated rice fields on Luzon Island, Philippines, were studied over the growing season at five sites (Los Baños, Cabanatuan, Bayombong, Kiangan, Banaue) ranging in elevation from 22 m to 1524 m. Arthropod populations were vacuum-sampled at roughly weekly intervals from the date after seedlings were transplanted to flowering at each site. Site- and time-specific webs were constructed from a 687-taxa cumulative Philippines web and time-series of species present. Taxonomic composition, food web structure, and arthropod phenology were broadly similar across different sites. Arthropod abundance was inversely associated with altitude across the five sites, but numbers of taxa and links and six food web statistics showed no obvious increasing or decreasing trend with altitude. The rise of taxa, links and mean food chain length over the growing season at each site reflected an increase in plant size with age and, at some sites, an orderly accumulation of newly arriving herbivore, predator, parasitoid and omnivore species. At each site, herbivores built up faster than predators and parasitoids, and predators arrived faster than parasitoids; the difference between the latest and earliest sampling dates of first arrivals, averaged over the five sites, was 38, 63 and 73 days for herbivores, predators and parasitoids, respectively. Site-to-site consistencies in food web properties and first arrivals suggest that such patterns may be influenced more by crop age than by geography or altitude. Sampled predator, parasitoid and omnivore taxa potentially encountered only a subset of their lifetime prey and predator species at any particular time in the rice field. Prey lists cumulated over time may underestimate the temporal specificity of predation by potential biological control agents. Research opportunities linking rice food webs and integrated pest management with East Indies biogeography are proposed.

The transition process of a small-amplitude wave packet, generated by a controlled short-duration air pulse, to the formation of a turbulent spot is traced experimentally in a laminar boundary layer. The vertical and spanwise structures of the flow field are mapped at several downstream locations. The measurements, which include all three velocity components, show three stages of transition. In the first stage, the wave packet can be treated as a superposition of two- and three-dimensional waves according to linear stability theory, and most of the energy is centred around a mode corresponding to the most amplified wave. In the second stage, most of the energy is transferred to oblique waves which are centred around a wave having half the frequency of the most amplified linear mode. During this stage, the amplitude of the wave packet increases from 0.5 % to 5 % of the free-stream velocity. In the final stage, a turbulent spot develops and the amplitude of the disturbance increases to 27 % of the free-stream velocity.

Theoretical aspects of the various stages are considered. The amplitude and phase distributions of various modes of all three velocity components are compared with the solutions provided by linear stability theory. The agreement between the theoretical and measured distributions is very good during the first two stages of transition. Based on linear stability theory, it is shown that the two-dimensional mode of the streamwise velocity component is not necessarily the most energetic wave. While linear stability theory fails to predict the generation of the oblique waves in the second stage of transition, it is demonstrated that this stage appears to be governed by Craik-type subharmonic resonances.

A surface-wave/internal-wave mode coupled model is constructed to describe the energy transfer from a linear surface wave field on the ocean to a linear internal wave field. Expressed in terms of action-angle variables the dynamic equations have a particularly useful form and are solved both numerically and in some analytic approximations. The growth time for internal waves generated by the resonant interaction of surface waves is calculated for an equilibrium spectrum of surface waves and for both the Garrett-Munk and two-layer models of the undersea environment. We find energy transfer rates as a function of undersea parameters which are much faster than those based on the constant Brunt-ViiisSila model used by Kenyon (1968) and which are consistent with the experiments of Joyce (1974). The modulation of the surface-wave spectrum by internal waves is also calculated, yielding a ‘mottled’ appearance of the ocean surface similar to that observed in photographs taken from an ERTS1 satellite (Ape1 et al. 1975b).

Future microprocessor technologies will require interlayer dielectric (ILD) materials with a dielectric constant (κ-value) less than 2.5. Organosilicate glass (OSG) materials must be nanoporous to meet this demand. However, the introduction of nanopores creates many integration challenges. These challenges include 1) integrating nanoporous films with low mechanical strength into conventional process flows, 2) managing etch profiles, 3) processinduced damage to the nanoporous ILD, and 4) controlling the metal/nanoporous ILD interface. This paper reviews research to maximize mechanical strength by engineering optimal pore structures, controlling trench bottom roughness induced by etching and understanding its relationship to pore size, repairing plasma damage using silylation chemistry, and sealing a nanoporous surface for barrier metal (liner) deposition.

Endotoxins from Bacillus thuringiensis (Bt) produced in transgenic pest-resistant Bt crops are generally not toxic to predatory and parasitic arthropods. However, elimination of Bt-susceptible prey and hosts in Bt crops could reduce predator and parasitoid abundance and thereby disrupt biological control of other herbivorous pests. Here we report results of a field study evaluating the effects of Bt sprays on non-target terrestrial herbivore and natural enemy assemblages from three rice (Oryza sativa L.) fields on Luzon Island, Philippines. Because of restrictions on field-testing of transgenic rice, Bt sprays were used to remove foliage-feeding lepidopteran larvae that would be targeted by Bt rice. Data from a 546-taxa Philippines-wide food web, matched abundance plots, species accumulation curves, time-series analysis, and ecostatistical tests for species richness and ranked abundance were used to compare different subsets of non-target herbivores, predators, and parasitoids in Bt sprayed and water-sprayed (control) plots. For whole communities of terrestrial predators and parasitoids, Bt sprays altered parasitoid richness in 3 of 3 sites and predator richness in 1 of 3 sites, as measured by rarefaction (in half of these cases, richness was greater in Bt plots), while Spearman tests on ranked abundances showed that correlations, although significantly positive between all treatment pairs, were stronger for predators than for parasitoids, suggesting that parasitoid complexes may have been more sensitive than predators to the effects of Bt sprays. Species accumulation curves and time-series analyses of population trends revealed no evidence that Bt sprays altered the overall buildup of predator or parasitoid communities or population trajectories of non-target herbivores (planthoppers and leafhoppers) nor was evidence found for bottom-up effects in total abundances of non-target species identified in the food web from the addition of spores in the Bt spray formulation. When the same methods were applied to natural enemies (predators and parasitoids) of foliage-feeding lepidopteran and non-lepidopteran (homopteran, hemipteran and dipteran) herbivores, significant differences between treatments were detected in 7 of 12 cases. However, no treatment differences were found in mean abundances of these natural enemies, either in time-series plots or in total (seasonal) abundance. Analysis of guild-level trajectories revealed population behavior and treatment differences that could not be predicted in whole-community studies of predators and parasitoids. A more conclusive test of the impact of Bt rice will require field experiments with transgenic plants, conducted in a range of Asian environments, and over multiple cropping seasons.

A retrospective review of 240 patients with T1/T2 squamous cell carcinomas of the larynx was performed. Seventy-two per cent had glottic primaries, 27 per cent had supraglottic tumours and one per cent had subglottic disease. Sixty-nine per cent presented with T1 disease and 31 per cent had T2 staged tumours. All patients were treated with definitive radiotherapy between 1973 and 1997.

With a median follow-up of 68 months, 68 patients (28 per cent) have developed 72 other cancers. Ten of 68 presented with synchronous primaries (15 per cent). Thirty per cent of glottic patients and 25 per cent of the supraglottic/subglottic patients developed second cancers. The most frequent second malignancy was lung cancer: 28/72 (39 per cent). Fifteen patients developed second head and neck cancers (21 per cent). Other second primary sites included oesophagus (eight), prostate (six), colorectal (five), breast (two) and others (eight). The median time from radiotherapy until the development of a second cancer was 31 months. The Kaplan-Meier survival estimate at five years was significantly less for those patients developing second cancers (55 per cent) compared to those not developing second malignancies (70 per cent), (p<0.05). The median survival from the development of a second cancer was 14 months. More died as a result of a second cancer (41 patients) than their primary laryngeal cancer (40 patients). Second cancers are common and deadly in patients with early stage laryngeal carcinoma.