The silver bullet that wasn't: Rapid agronomic weed adaptations to glyphosate in North America

The rapid adoption of glyphosate-resistant crops at the end of the 20th century caused a simplification of weed management that relied heavily on glyphosate for weed control. However, the effectiveness of glyphosate has diminished. A greater understanding of trends related to glyphosate use will shed new light on weed adaptation to a product that transformed global agriculture. Objectives were to (1) quantify the change in weed control efficacy from postemergence (POST) glyphosate use on troublesome weeds in corn and soybean and (2) determine the extent to which glyphosate preceded by a preemergence (PRE) improved the efficacy and consistency of weed control compared to glyphosate alone. Herbicide evaluation trials from 24 institutions across the United States of America and Canada from 1996 to 2021 were compiled into a single database. Two subsets were created; one with glyphosate applied POST, and the other with a PRE herbicide followed by glyphosate applied POST. Within each subset, mean and variance of control ratings for seven problem weed species were regressed over time for nine US states and one Canadian province. Mean control with POST glyphosate alone decreased over time while variability in control increased. Glyphosate preceded by a labeled PRE herbicide showed little change in mean control or variability in control over time. These results illustrate the rapid adaptation of agronomically important weed species to the paradigm-shifting product glyphosate. Including more diversity in weed management systems is essential to slowing weed adaptation and prolonging the usefulness of existing and future technologies.

Uptake and Discontinuation of Pre-Exposure Prophylaxis Among Uninsured Transgender and Cisgender Women: A Public-Private Partnership Model in North Carolina

HIV pre-exposure prophylaxis (PrEP) remains underutilized among cis and trans women. The PrEP Initiative Program (PIP) is a novel public-private partnership implemented at 12 local clinics in North Carolina. PIP provides HIV/sexually transmitted infection (STI) testing and clinical and laboratory monitoring for PrEP to uninsured/underinsured clients. We sought to understand service-related differences among both cis and trans women enrolled in PIP, including STIs diagnoses, clinic type, sources of referral, services needed, and reasons for PrEP discontinuation. The Kaplan-Meier curves display retention on PrEP over the duration of the program. Since 2018, 142 women (cis n = 113; trans n = 29) enrolled, and 136 started PrEP. The majority were ages 25-34 years (31.7%) or 18-24 years (29.6%), Black (57.8%) or Latinx (24.7%). Approximately 20.6% of recipients reported at least one STI while enrolled. Overall, trans women requested fewer services than cis women. After accounting for the amount of time each patient was taking PrEP, there were higher rates of trans women diagnosed with syphilis than cis women. Rates of persons with other STIs were not notably different between trans and cis women. Clinic access varied by gender: 69% of trans women were enrolled at only one site. Trans women were retained significantly longer: The Kaplan-Meier adjusted median time to discontinuation was 560 and 238 days for trans and cis women, respectively. PIP successfully reached historically marginalized and uninsured cis and trans women who may benefit from PrEP. Further investigations into factors contributing to recruitment and retention of women in HIV prevention programs are needed.

Defining the Current Deployment of Neonatal Infusion Pumps in Low- and Lower-Middle-Income Countries: A Rapid Review

There has been limited review of the reported deployment of infusion pumps in low- and lower-middle-income countries. This paper aims to identify the current distribution of infusion pumps in low- and lower-middle-income countries (LLMICs) used to treat neonates. A rapid review was conducted using material sourced from ProQuest, Pubmed, Web of Science, and IEEE Xplore. Twenty-six search results met the inclusion criteria. Within these, 41 neonatal healthcare facilities were discussed with 17 of the facilities having infusion pumps available, 13 limited access, and 11 none. Infusion pump use remains limited in Sub-Saharan Africa so efforts should be made to deploy specialist neonatal care improvement packages, potentially including infusion pumps designed for LLMICs. The effects of COVID-19, to neonatal care LLMICs, should be accessed to ensure progress has not regressed. These proposals aim to aid in the continued improvement of neonatal care globally and reduce newborn mortalities.

The trimmed mean in non-parametric regression function estimation

This article studies a trimmed version of the Nadaraya–Watson estimator for the unknown non-parametric regression function. The characterization of the estimator through the minimization problem is established, and its pointwise asymptotic distribution is derived. The robustness property of the proposed estimator is also studied through the breakdown point. Moreover, similar to the trimmed mean in the location model, and for a wide range of trimming proportion, the proposed estimator possesses good efficiency and high breakdown point, which is out of the ordinary properties for any estimator. Furthermore, the usefulness of the proposed estimator is shown for two benchmark real data and various simulated data.

An online survey and interview of GPs in the UK for assessing their satisfaction regarding the medical training curriculum and NICE guidelines for the management of menopause

Background:

The UK is home to 13 million menopausal women. The aim of this study was to determine the views of GPs on their levels of confidence and comfort when advising or treating menopausal women and assess the need for further training.

Method:

An anonymous online questionnaire was sent out to GPs working within the NHS across the UK between January 2021 and March 2021. The questionnaire was circulated via GP e-mail lists, Facebook, and LinkedIn, and included an option for respondents to volunteer for a semi-structured interview.

Results:

The questionnaire had 173 responses. 52% of GPs indicated that they were not offered enough support to be able to advise and treat women with menopausal symptoms appropriately. 77.5% of GPs expressed that there is a need to improve training provided on menopause in medical school and GP training. 60.7% of GPs felt comfortable managing menopausal women and offering them management options. 22.5% of the respondents felt that the NICE guidelines are easy and clear guidance for clinical practice. Five GPs were further interviewed, and the analysis of the responses showed the perceived need by the GPs for improvements in medical training regarding menopause.

Conclusion:

There is a need for better support and medical training for GPs to help them advice and treat women with menopausal symptoms. This is key for ensuring that every woman in the UK feels supported in their journey during the menopausal transition and is offered evidence-based advice to help them make informed decisions.

Risk Factors and Laboratory Findings Associated With Diabetic Ketoacidosis in Hospitalized Pediatric Patients

Background: Diabetic ketoacidosis (DKA), the most serious and acute complication of type 1 diabetes, has an incidence of 6%-8% among known pediatric type 1 diabetes patients, although risk factors associated with severe DKA in the pediatric population are poorly understood [1].

Method: A single-institution, retrospective chart analysis of pediatric DKA patients admitted to our pediatric intensive care unit (PICU) was conducted in South Alabama between October 2017 and April 2021. Laboratory findings were obtained from venous samples collected from the patients on admission.

Results: Of 429 admissions, 256 unique patients were admitted with DKA to PICU during the 3.5-year period; 55.9% of them were males. The median (IQR) age of the patients was 12 (10-15) years, and their median HbA1c level was 11.02 (10%-12%), which was similar to Medicaid and private insurance statistics (11.1 [9.87-12.2] vs 11 [9.65-12], p = 0.4). Serum pH on presentation was 7.17 (7.08-7.25), and serum bicarbonate was 10 (7-14) mmol/L. White blood cell (WBC) count, platelet count, and mean platelet volume (MPV) had a negative correlation with serum pH (r = -0.52, p < 0.001, r = -0.25, p = 0.01 and r = -0.11, p = 0.03, respectively). The blood urea nitrogen (BUN):creatinine ratio had a positive correlation with serum pH (r = 0.16, p < 0.001). Twenty-nine admissions (6.8%) with a median age of 16 (13-17) years required imaging for altered mental status, and none of these patients were diagnosed with cerebral edema.

Conclusion: DKA is associated with noncompliance among pediatric patients, irrespective of their type of insurance. Markers of oxidative stress (WBC, platelets, and MPV) were associated with increased severity of DKA. The BUN:creatinine ratio may not provide accurate hydration status among DKA patients. Clinicians need to have a lower threshold for head imaging among younger patients.

OxVent: Design and evaluation of a rapidly-manufactured Covid-19 ventilator

BACKGROUND

The manufacturing of any standard mechanical ventilator cannot rapidly be upscaled to several thousand units per week, largely due to supply chain limitations. The aim of this study was to design, verify and perform a pre-clinical evaluation of a mechanical ventilator based on components not required for standard ventilators, and that met the specifications provided by the Medicines and Healthcare Products Regulatory Agency (MHRA) for rapidly-manufactured ventilator systems (RMVS).

METHODS

The design utilises closed-loop negative feedback control, with real-time monitoring and alarms. Using a standard test lung, we determined the difference between delivered and target tidal volume (VT) at respiratory rates between 20 and 29 breaths per minute, and the ventilator's ability to deliver consistent VT during continuous operation for >14 days (RMVS specification). Additionally, four anaesthetised domestic pigs (3 male-1 female) were studied before and after lung injury to provide evidence of the ventilator's functionality, and ability to support spontaneous breathing.

FINDINGS

Continuous operation lasted 23 days, when the greatest difference between delivered and target VT was 10% at inspiratory flow rates >825 mL/s. In the pre-clinical evaluation, the VT difference was -1 (-90 to 88) mL [mean (LoA)], and positive end-expiratory pressure (PEEP) difference was -2 (-8 to 4) cmH2O. VT delivery being triggered by pressures below PEEP demonstrated spontaneous ventilation support.

INTERPRETATION

The mechanical ventilator presented meets the MHRA therapy standards for RMVS and, being based on largely available components, can be manufactured at scale.

FUNDING

Work supported by Wellcome/EPSRC Centre for Medical Engineering,King's Together Fund and Oxford University.

HLA Desensitization Based on Results of the Luminex Technique in Kidney Transplant - A Single-center Experience

Background:

There is little experience of human leucocyte antigen (HLA) desensitization in India based on the Luminex single-antigen bead (SAB) testing. We retrospectively analyzed our patients, who underwent HLA desensitization based on Luminex SAB results.

Method:

Between 2014 and 2018, patients with complement-dependent cytotoxicity cross-match (CDC-XM) negativity but flow cytometry crossmatch (FC-XM) positivity were further analyzed with Luminex SAB for donor-specific antibodies (DSAs). A total of 12 patients who had DSA mean fluorescent intensity (MFI) of >1000 and <10,000 were included in the study. Our protocol for desensitization consisted of plasmapheresis (PP) followed by low dose intravenous immunoglobulin (IV IG) 100 mg/kg and induction with antithymocyte globulin (ATG). Patients were taken for transplant when either MFI was <1000 and/or FC-XM was negative.

Results:

All 12 patients were first transplant and 10 had a history of some sensitizing event; pregnancy in 4, blood transfusions in 4, and both in 2 patients. FC-XM was positive for T-cell in 4, B-cell in 6, and both in 2 patients. On evaluation by Luminex SAB, 6 patients had MFI from 1000 to 2000, and 6 had MFI of >2000. All underwent desensitization successfully. Two patients had an increase in posttransplant DSA titers requiring posttransplant PP. The mean follow-up was 26.6 ± 13.9 months. On follow-up, only one patient developed acute T cell-mediated rejection 1 year after transplant, which responded to pulse steroids. There was no graft or patient loss until the last follow-up.

Conclusion:

This study shows that HLA desensitization is feasible and successful in the Indian setting if patients are properly selected.

Genomic-based epidemiology reveals independent origins and gene flow of glyphosate resistance in Bassia scoparia populations across North America

Genomic-based epidemiology can provide insight into the origins and spread of herbicide resistance mechanisms in weeds. We used kochia (Bassia scoparia) populations resistant to the herbicide glyphosate from across western North America to test the alternative hypotheses that (i) a single EPSPS gene duplication event occurred initially in the Central Great Plains and then subsequently spread to all other geographical areas now exhibiting glyphosate-resistant kochia populations or that (ii) gene duplication occurred multiple times in independent events in a case of parallel evolution. We used qPCR markers previously developed for measuring the structure of the EPSPS tandem duplication to investigate whether all glyphosate-resistant individuals had the same EPSPS repeat structure. We also investigated population structure using simple sequence repeat markers to determine the relatedness of kochia populations from across the Central Great Plains, Northern Plains and the Pacific Northwest. We found that the original EPSPS duplication genotype was predominant in the Central Great Plains where glyphosate resistance was first reported. We identified two additional EPSPS duplication genotypes, one having geographical associations with the Northern Plains and the other with the Pacific Northwest. The EPSPS duplication genotype from the Pacific Northwest seems likely to represent a second, independent evolutionary origin of a resistance allele. We found evidence of gene flow across populations and a general lack of population structure. The results support at least two independent evolutionary origins of glyphosate resistance in kochia, followed by substantial and mostly geographically localized gene flow to spread the resistance alleles into diverse genetic backgrounds.

Trends in maternal mortality in India over two decades in nationally representative surveys

OBJECTIVE

To assess national and regional trends and causes-specific distribution of maternal mortality in India.

DESIGN

Nationally representative cross-sectional surveys.

SETTING

All of India from 1997 to 2020.

SAMPLE

About 10 000 maternal deaths among 4.3 million live births over two decades.

METHODS

We analysed trends in the maternal mortality ratio (MMR) from 1997 through 2020, estimated absolute maternal deaths and examined the causes of maternal death using nationally representative data sources. We partitioned female deaths (aged 15-49 years) and live birth totals, based on the 2001-2014 Million Death Study to United Nations (UN) demographic totals for the country.

MAIN OUTCOME MEASURES

Maternal mortality burden and distribution of causes.

RESULTS

The MMR declined in India by about 70% from 398/100 000 live births (95% CI 378-417) in 1997-98 to 99/100 000 (90-108) in 2020. About 1.30 million (95% CI 1.26-1.35 million) maternal deaths occurred between 1997 and 2020, with about 23 800 (95% CI 21 700-26 000) in 2020, with most occurring in poorer states (63%) and among women aged 20-29 years (58%). The MMRs for Assam (215), Uttar Pradesh/Uttarakhand (192) and Madhya Pradesh/Chhattisgarh (170) were highest, surpassing India's 2016-2018 estimate of 113 (95% CI 103-123). After adjustment for education and other variables, the risks of maternal death were highest in rural and tribal areas of north-eastern and northern states. The leading causes of maternal death were obstetric haemorrhage (47%; higher in poorer states), pregnancy-related infection (12%) and hypertensive disorders of pregnancy (7%).

CONCLUSIONS

India could achieve the UN 2030 MMR goals if the average rate of reduction is maintained. However, without further intervention, the poorer states will not.

TWEETABLE ABSTRACT

We estimated that 1.3 million Indian women died from maternal causes over the last two decades. Although maternal mortality rates have fallen by 70% overall, the poorer states lag behind.

Effect of EPSPS gene copy number and glyphosate selection on fitness of glyphosate-resistant Bassia scoparia in the field

The widespread evolution of glyphosate-resistant (GR) Bassia scoparia in the U.S. Great Plains poses a serious threat to the long-term sustainability of GR sugar beet. Glyphosate resistance in B. scoparia is due to an increase in the EPSPS (5-enolpyruvyl-shikimate-3-phosphate) gene copy number. The variation in EPSPS gene copies among individuals from within a single GR B. scoparia population indicated a differential response to glyphosate selection. With the continued use of glyphosate in GR sugar beet, the effect of increasing glyphosate rates (applied as single or sequential applications) on the fitness of GR B. scoparia individuals with variable EPSPS gene copies was tested under field conditions. The variation in EPSPS gene copy number and total glyphosate rate (single or sequential applications) did not influence any of the reproductive traits of GR B. scoparia, except seed production. Sequential applications of glyphosate with a total rate of 2214 g ae ha-1 or higher prevented seed production in B. scoparia plants with 2-4 (low levels of resistance) and 5-6 (moderate levels of resistance) EPSPS gene copies. Timely sequential applications of glyphosate (full recommended rates) can potentially slow down the evolution of GR B. scoparia with low to moderate levels of resistance (2-6 EPSPS gene copies), but any survivors (highly-resistant individuals with ≥ 8 EPSPS gene copies) need to be mechanically removed before flowering from GR sugar beet fields. This research warrants the need to adopt ecologically based, multi-tactic strategies to reduce exposure of B. scoparia to glyphosate in GR sugar beet.

A Quality Improvement Initiative to Reduce Surgical Site Infections in Patients Undergoing Delayed Sternal Closure After Pediatric Cardiac Surgery

Sternal wound infections (SWI) in delayed sternal closure (DSC) patients are a healthcare burden after congenital heart surgery. There are no guidelines specific for pediatric DSC patients to prevent this costly complication. The hypothesis was that the modifications to a bundled approach for DSC patients would decrease the SWI rate. For this prospective cohort study, DSC patients were postoperatively admitted to a pediatric cardiac care unit from February 2017 to January 2018. Using a modified protocol for prevention of SWI, the infection rates pre- and post-modified protocol were compared. The primary outcome measure was SWI. Secondary outcome measures were compliance with modifications. Retrospective review of cases in pre-protocol modification era from January 1, 2014 to December 31, 2016 showed 377 pediatric cardiopulmonary bypass cases and 39 (10.4%) underwent DSC. During the post-protocol modification era, there were 129 cardiopulmonary bypass cases and 17 (13%) DSC cases. The SWI rate in DSC were 7.7% and 0% for pre-intervention and post-intervention, respectively (p = 0.52). The Bayesian confidence interval with Jeffreys prior gives a 95% confidence interval of 1.5% to 18.3% for pre-intervention and 0 to 13.5% for post-intervention. Compliance with the protocol bundle during the post protocol era was 93-100%. Although preliminary results are not statistically significant due to cohort size, the economic burden and increased LOS for each SWI is clinically significant. The early results of reduced infections for DSC patients using a modified bundle approach appear promising. Continued study and a multicenter project would be beneficial.

Electromagnetic Versus Blind Guidance of a Postpyloric Feeding Tube in Critically Ill Children

BACKGROUND AND OBJECTIVES

Postpyloric feeding tube placement is a time-consuming procedure associated with multiple attempts and radiation exposure. Our objective with this study is to compare the time, attempts, and radiation exposure using the electromagnetic versus blind method to place a postpyloric feeding tube in critically ill children. Our hypothesis is that using electromagnetic guidance decreases the procedure time, number of x-rays, and number of attempts, compared to the blind method.

METHODS

Eleven pediatric nurses participated in a randomized controlled intention-to-treat study at an academic pediatric medical, surgical, and congenital cardiac ICU. University of Texas Health Epidemiology and Biostatistics generated a randomization sequence with sealed envelopes. A standard (2-sided) F-test of association between the electromagnetic and blind method yielded 40 subjects with 86% power. Data were analyzed with Fisher's exact test for categorical variables and the Wilcoxon rank test for continuous variables, with data documented as median (interquartile range [IQR]).

RESULTS

We randomly assigned 52 patients to either the electromagnetic (n = 28) or blind method (n = 24). The number of attempts and radiographs was at a median of 2 (IQR: 1-2.25) using the blind method, compared to the electromagnetic method at a median of 1 (IQR: 1.0-1.0; P = .001). Successful guidance was 96.4% with the electromagnetic method, compared to only 66.7% with the blind technique (P = .008). The total time required was 2.5 minutes (IQR: 2.0-7.25) with the electromagnetic method, compared to 19 minutes (IQR: 9.25-27.0) for the blind method (P = .001).

CONCLUSIONS

Electromagnetic guidance is a superior, faster, and overall safer method to place a postpyloric feeding tube in critically ill children.

Fulminant Septic Shock with Pasteurella multocida in a Young Infant: No Bite, Scratch, or Lick!

This is a case of Pasteurella multocida septic shock encountered in a 7-week-old infant without any bites, scratch marks, or history of licks by pet animals (dog and cats in household). The infant required 3 days of vasopressor support and 4 days of mechanical ventilation to achieve normal hemodynamics. This is an unidentified route of transmission and our literature search for this topic discovered reported cases of life-threatening presentation with Pasteurella infections in the absence of a bite or any form of invasive contact with animals. We believe that this is an important public safety message to restrict animal contact of young infants to prevent severe infection.

P14.117 Cost efficient test algorithm for molecular subgrouping of medulloblastomas for day-to-day practice in resource limited countries

INTRODUCTION

Molecular classification of medulloblastomas(MB) is prognostically and therapeutically relevant and helps in better risk-stratification. Translation of this subgrouping to routine practice still remains a challenge. The most pathologist-accessible techniques for molecular subgrouping include immunohistochemistry(IHC), fluorescent in-situ hybridization(FISH) and Nanostring assay. Objectives:(1)Molecular subgrouping of MBs by IHC and FISH, and Nanostring Assay (2)To compare their efficacy against sequencing and DNA methylation, and cost for applicability in resource-constrained centers

METHODS

Ninety-five cases of MB with adequate tissue were included. Molecular subgrouping was performed by IHC for β-catenin, GAB1, YAP1, and p53; FISH for MYC amplification, and sequencing for CTNNB1, and by Nanostring Assay on the same set of MBs. Further, a subset of cases were subjected to 850k DNA methylation array.

RESULTS

IHC+FISH classified MBs into 15.8% WNT, 16.8% SHH, and 67.4% non-WNT/non-SHH subgroups; with MYC amplification identified in 20.3% cases of non-WNT/non-SHH. A single showed diffuse strong p53 positivity among the SHH subgroup. Nanostring successfully classified 91.5% MBs into 25.3% WNT, 17.2% SHH, 23% Group3 and 34.5% Group4. However, Nanostring assay failure was seen in eight cases, all of which were >8-years-old formalin-fixed paraffin-embedded tissue blocks. Concordant subgroup assignment was noted in 88.5% cases, while subgroup switching was seen in 11.5% cases. Both methods showed prognostic correlation. Among the 5 discrepant cases, which switched to WNT subgroup by Nanostring, only 2 were found to have CTNNB1 mutation. Methylation profiling performed on discordant cases revealed 1 out of 4 extra WNT identified by Nanostring to be WNT, others aligned with IHC subgroups; extra SHH by Nanostring turned out to be SHH by methylation.

CONCLUSIONS

Both IHC supplemented by FISH and Nanostring are robust methods for molecular subgrouping, albeit with few disadvantages. IHC cannot differentiate between Groups 3 and 4, while Nanostring cannot classify older-archived tumors, and is not available at most centres. WNT subgroup with the best prognosis is best detected by IHC or IHC followed by sequencing for confirmation. Nanostring Assay is better suitable to separate Group 3, the worst prognostic group from Group 4. Thus, both the methods complement each other and can be used in concert for high confidence allotment of molecular subgroups in clinical practice. The cost of IHC plus Nanostring will almost be the same as IHC plus FISH. We recommend a cost-efficient algorithmic approach using histopathological subtype and IHC as the first step followed by Nanostring or FISH, wherever suitable.

Response of Chloris truncata to moisture stress, elevated carbon dioxide and herbicide application

Herbicide resistance has been observed in Chloris truncata, an Australian native C4 grass and a summer-fallow weed, which is common in no-till agriculture situations where herbicides are involved in crop management. To investigate the role of drought and increased atmospheric carbon dioxide (CO2) in determining weed growth, three trials were conducted using a 'glyphosate-resistant' and a 'glyphosate-susceptible' biotype. The first two trials tested the effect of herbicide (glyphosate) application on plant survival and growth under moisture stress and elevated CO2 respectively. A third trial investigated the effect on plant growth and reproduction under conditions of moisture stress and elevated CO2 in the absence of herbicide. In the first trial, water was withheld from half of the plants prior to application of glyphosate to all plants, and in the second trial plants were grown in either ambient (450 ppm) or elevated CO2 levels (750 ppm) prior to, and following, herbicide application. In both biotypes, herbicide effectiveness was reduced when plants were subjected to moisture stress or if grown in elevated CO2. Plant productivity, as measured by dry biomass per plant, was reduced with moisture stress, but increased with elevated CO2. In the third trial, growth rate, biomass and seed production were higher in the susceptible biotype compared to the resistant biotype. This suggests that a superior ability to resist herbicides may come at a cost to overall plant fitness. The results indicate that control of this weed may become difficult in the future as climatic conditions change.

Multidimensional relationships of herbicides with insect-crop food webs

Controlling weeds is critical for improving the yield and quality of crops. Herbicides are the most commonly applied pesticides in agro-ecosystems. Herbicides affect insects directly as contact damage and indirectly by influencing food supplies. The innate susceptibility, life stages, and mode of feeding of insects can affect the herbicide-insect interaction. Interaction of herbicides with insect pest and beneficial insects is mainly indirect and absence of weeds either can reduce the insect population or causes switching of host plant and hence can also increase the population. The direct effect of herbicides depends on carrier or surfactant used. Presence of herbicides also provides surfactant to insecticides and increases impact of insecticides. At present, most reports on impact of herbicides indicate alterations in insect survival or egg production due to increase or decrease in host plant population as an indirect affect, only a handful studies reported a direct topical effect of these herbicides on egg, larvae/nymphs and adults of various insects. Further exploration of this interaction seems intriguing. Use of bio-herbicides, cultural control methods, and judicious use of herbicides could offer ecologically sustainable approaches to reduce impact of herbicides on insects.

Germination ecology of Chloris truncata and its implication for weed management

Chloris truncata is a significant weed in summer crops in the subtropical region of Australia. A study was conducted to evaluate the effect of environmental factors on germination and emergence of two populations of C. truncata. Overall, germination was not affected by the populations. Seeds germinated at a wide range of alternating day/night temperatures, suggesting that seeds can germinate throughout the spring, winter and autumn seasons. Seed germination was stimulated by the presence of light; however, 51 to 71% of these seeds still germinated in the dark. The sodium chloride concentration and osmotic potential required to inhibit germination of 50% of the population were 179 mM and -0.52 MPa, respectively. A high proportion of seeds germinated over a wide pH range (4 to 10). Seeds placed on the soil surface had greatest germination (67%) and a burial depth of 3 cm resulted in complete inhibition of emergence. The sorghum residue amount required to reduce emergence by 50% was 1.8 t ha^-1. The results suggest that, although this weed will be favored in no-till systems, residue retention on the soil surface will help in reducing its infestation. Seed bank buildup can be managed by burying seeds below the depth of emergence.

Effects of concurrent training on physical health and performance

The primary objective of this narrative review was to evaluate the current literature and to provide further insight into the role of concurrent training on various components of physical health or performance. Literature was obtained by electronic searches of databases using specific keywords. Combined effect of training sessions proved to be as beneficial as drug interactions. Results from cross-sectional, longitudinal, and intervention studies are reviewed and discussed with main focus on physical parameters, such as body composition, physiological parameters, molecular adaptation, athlete’s perspective, order of execution, interference phenomena and recovery. In conclusion, concurrent resistance and endurance training is an effective method for enhancing overall fitness as well as improving quality of life.

First report of Ser653Asn mutation endowing high-level resistance to imazamox in downy brome (Bromus tectorum L.)

BACKGROUND

Bromus tectorum L. is one of the most troublesome grass weed species in cropland and non-cropland areas of the northwestern USA. In summer 2016, a B. tectroum accession (R) that survived imazamox at the field-use rate (44 g ha^-1 ) in an imidazolinone-tolerant (IMI-tolerant or Clearfield™) winter wheat field was collected from a wheat field in Carter County, MT, USA. The aim of this study was to determine the resistance profile of the B. tectroum R accession to imazamox and other ALS inhibitors, and investigate the mechanism of resistance to imazamox.

RESULTS

The R B. tectorum accession had a high-level resistance (110.1-fold) to imazamox (IMI) and low to moderate-levels cross-resistance to pyroxsulam (TP) (4.6-fold) and propoxycarbazone (SCT) (13.9-fold). The R accession was susceptible to sulfosulfuron (SU) and quizalofop and clethodim (ACCase inhibitors), paraquat (PS I inhibitor), glyphosate (EPSPS inhibitor) and glufosinate (GS inhibitor). Sequence analysis of the ALS gene revealed a single, target-site Ser653Asn mutation in R plants. Pretreatment of malathion followed by imazamox at 44 or 88 g ha^-1 did not reverse the resistance phenotype.

CONCLUSION

This is the first report of evolution of cross-resistance to ALS-inhibiting herbicides in B. tectorum. A single-point mutation, Ser653Asn, was identified, conferring the high-level resistance to imazamox. © 2017 Society of Chemical Industry.

Emerging Challenges and Opportunities for Education and Research in Weed Science

In modern agriculture, with more emphasis on high input systems, weed problems are likely to increase and become more complex. With heightened awareness of adverse effects of herbicide residues on human health and environment and the evolution of herbicide-resistant weed biotypes, a significant focus within weed science has now shifted to the development of eco-friendly technologies with reduced reliance on herbicides. Further, with the large-scale adoption of herbicide-resistant crops, and uncertain climatic optima under climate change, the problems for weed science have become multi-faceted. To handle these complex weed problems, a holistic line of action with multi-disciplinary approaches is required, including adjustments to technology, management practices, and legislation. Improved knowledge of weed ecology, biology, genetics, and molecular biology is essential for developing sustainable weed control practices. Additionally, judicious use of advanced technologies, such as site-specific weed management systems and decision support modeling, will play a significant role in reducing costs associated with weed control. Further, effective linkages between farmers and weed researchers will be necessary to facilitate the adoption of technological developments. To meet these challenges, priorities in research need to be determined and the education system for weed science needs to be reoriented. In respect of the latter imperative, closer collaboration between weed scientists and other disciplines can help in defining and solving the complex weed management challenges of the 21st century. This consensus will provide more versatile and diverse approaches to innovative teaching and training practices, which will be needed to prepare future weed science graduates who are capable of handling the anticipated challenges of weed science facing in contemporary agriculture. To build this capacity, mobilizing additional funding for both weed research and weed management education is essential.

Remission of post-transplant focal segmental glomerulosclerosis with angiotensin receptor blockers

Recurrence of focal segmental glomerulosclerosis (FSGS) is common after kidney transplantation. Plasmapheresis (PP) is considered to be the most effective treatment; however, results are variable and relapse is common after stopping plasmapheresis. Here, we report an unusual case of recurrent FSGS, who achieved complete remission with angiotensin receptor blocker therapy.

Enhancement of the carrier mobility of conducting polymers by formation of their graphene composites

Improved carrier mobility and solar cell performance in graphene composites of conducting polymers is demonstrated and analyzed.

Targeting renin-angiotensin system in malignant hypertension in atypical hemolytic uremic syndrome

Hypertension is common in hemolytic uremic syndrome (HUS) and often difficult to control. Local renin-angiotensin activation is believed to be an important part of thrombotic microangiopathy, leading to a vicious cycle of progressive renal injury and intractable hypertension. This has been demonstrated in vitro via enhanced tissue factor expression on glomerular endothelial cells which is enhanced by angiotensin II. We report two pediatric cases of atypical HUS with severe refractory malignant hypertension, in which we targeted the renin-angiotensin system by using intravenous (IV) enalaprilat, oral aliskiren, and oral enalapril with quick and dramatic response of blood pressure. Both drugs, aliskiren and IV enalaprilat, were effective in controlling hypertension refractory to multiple antihypertensive medications. These appear to be promising alternatives in the treatment of severe atypical HUS-induced hypertension and hypertensive emergency.

Eculizumab for atypical hemolytic-uremic syndrome in India: First report from India and the challenges faced

Much progress has been made in understanding the pathophysiology and treatment of atypical hemolytic uremic syndrome (aHUS). Plasma therapy is the mainstay of treatment for aHUS. The availability of the first effective anti-complement therapeutic agent, eculizumab, has dramatically changed the outlook of this disease. However, its use in clinical practice raises important questions, such as who should receive the drug, when to start such therapy, and is it safe to stop treatment once the disease is controlled. We describe here for the 1^st time in India, use of eculizumab in a 12-year-old boy with aHUS. We also describe in this report challenges faced in procuring the drug, and an ideal, evidence-based method of treating aHUS in children.

EPSPS Gene Copy Number and Whole-Plant Glyphosate Resistance Level in Kochia scoparia

Glyphosate-resistant (GR) Kochia scoparia has evolved in dryland chemical fallow systems throughout North America and the mechanism of resistance involves 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS) gene duplication. Agricultural fields in four states were surveyed for K. scoparia in 2013 and tested for glyphosate-resistance level and EPSPS gene copy number. Glyphosate resistance was confirmed in K. scoparia populations collected from sugarbeet fields in Colorado, Wyoming, and Nebraska, and Montana. Glyphosate resistance was also confirmed in K. scoparia accessions collected from wheat-fallow fields in Montana. All GR samples had increased EPSPS gene copy number, with median population values up to 11 from sugarbeet fields and up to 13 in Montana wheat-fallow fields. The results indicate that glyphosate susceptibility can be accurately diagnosed using EPSPS gene copy number.

The impact of cigarette smoking on life expectancy between 1980 and 2010: a global perspective

INTRODUCTION

Tobacco smoking is among the leading causes of preventable mortality worldwide. We assessed the impact of smoking on life expectancy worldwide between 1980 and 2010.

METHODS

We retrieved cause-specific mortality data from the WHO Mortality Database by sex, year and age for 63 countries with high or moderate quality data (1980-2010). Using the time of the peak of the smoking epidemic by country, relative risks from the three waves of the Cancer Prevention Study were applied to calculate the smoking impact ratio and population attributable fraction. Finally, we estimated the potential gain in life expectancy at age 40 if smoking-related deaths in middle age (40-79 years) were eliminated.

RESULTS

Currently, tobacco smoking is related to approximately 20% of total adult mortality in the countries in this study (24% in men and 12% in women). If smoking-related deaths were eliminated, adult life expectancy would increase on average by 2.4 years in men (0.1 in Uzbekistan to 4.8 years in Hungary) and 1 year in women (0.1 in Kyrgyzstan to 2.9 years in the USA). The proportion of smoking-related mortality among men has declined in most countries, but has increased in the most populous country in the world, that is, China from 4.6% to 7.3%. Increases in the impact of tobacco on life expectancy were observed among women in high-income countries.

CONCLUSIONS

Recent trends indicate a substantial rise in the population-level impact of tobacco smoking on life expectancy in women and in middle-income countries. High-quality local data are needed in most low-income countries.

Differences in Germination, Growth, and Fecundity Characteristics of Dicamba-Fluroxypyr-Resistant and Susceptible Kochia scoparia

The widespread occurrence of herbicide-resistant (HR) Kochia scoparia is an increasing concern for growers in the US Great Plains and Canada. K. scoparia populations resistant to dicamba have been reported in six US states. Populations cross-resistant to dicamba and fluroxypyr have been reported from wheat fields in Montana, USA. It is unclear whether resistance to the auxinic herbicides (dicamba and/or fluroxypyr), can alter the fitness traits of K. scoparia. The objectives of this research were to compare the germination dynamics in response to thermal environment, vegetative growth and fecundity characteristics, and the relative competitive ability of dicamba-fluroxypyr–susceptible (S) vs.–resistant (R) K. scoparia selected from within a single segregating population (collected from wheat-fallow field in MT). S and R selected lines were developed after three generations of recurrent group selection. Compared to the S selected line, the R selected line had lower cumulative germination at all constant temperatures except 25°C, and at all alternating temperatures except 30/35°C. Also, the R selected line had delayed germination relative to the S selected line. The R had lower plant height, plant width, primary branches, total leaf area, stem diameter, and shoot dry weight compared with the S plants in the absence of competition. The reduction in seed production per plant resulted in a 39% fitness cost. The 1000-seed weight of R (1.6 g) was also less than that of S (2.6 g). When grown in an intraspecific competition at different mixture proportions, replacement series indices for the growth parameters further indicated that the R was less competitive than the S. Evident from this research, the dicamba-fluroxypyr–resistant R selected line is less likely to persist in a field population in the absence of the auxinic herbicides.

Growth and Reproduction of Glyphosate-Resistant and Susceptible Populations of Kochia scoparia

Evolution of glyphosate-resistant kochia is a threat to no-till wheat-fallow and glyphosate-resistant (GR) cropping systems of the US Great Plains. The EPSPS (5-enol-pyruvylshikimate-3-phosphate synthase) gene amplification confers glyphosate resistance in the tested Kochia scoparia (L.) Schrad populations from Montana. Experiments were conducted in spring to fall 2014 (run 1) and summer 2014 to spring 2015 (run 2) to investigate the growth and reproductive traits of the GR vs. glyphosate-susceptible (SUS) populations of K. scoparia and to determine the relationship of EPSPS gene amplification with the level of glyphosate resistance. GR K. scoparia inbred lines (CHES01 and JOP01) exhibited 2 to 14 relative copies of the EPSPS gene compared with the SUS inbred line with only one copy. In the absence of glyphosate, no differences in growth and reproductive parameters were evident between the tested GR and SUS inbred lines, across an intraspecific competition gradient (1 to 170 plants m-2). GR K. scoparia plants with 2 to 4 copies of the EPSPS gene survived the field-use rate (870 g ha-1) of glyphosate, but failed to survive the 4,350 g ha-1 rate of glyphosate (five-times the field-use rate). In contrast, GR plants with 5 to 14 EPSPS gene copies survived the 4,350 g ha-1 of glyphosate. The results from this research indicate that GR K. scoparia with 5 or more EPSPS gene copies will most likely persist in field populations, irrespective of glyphosate selection pressure.

Smokeless tobacco use: a meta-analysis of risk and attributable mortality estimates for India

BACKGROUND

Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case-control studies in India and elsewhere report excess mortality due to its use.

OBJECTIVE

The aim was to estimate the SLT use-attributable deaths in males and females, aged 35 years and older, in India.

MATERIALS AND METHODS

Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age-sex groups were obtained from UN estimates (2010 revision) for 2008. A meta-relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta-analysis on all-cause mortality from SLT use in India including four cohort and one case-control study. The studies included in the meta-analysis were adjusted for smoking, age and education.

RESULTS

The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27-1.42) and 1.17 (1.05-1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three-fifth (60%) of these deaths occurring among women.

CONCLUSION

SLT use caused over 350,000 deaths in India in 2010, and nearly three-fifth of SLT use-attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women.

Early corticosteroid withdrawal regimen in a living donor kidney transplantation program

Steroids have been the essential component of transplant immunosuppression. Recently, with availability of better immunosuppressive agents, many centers have started steroid free transplant with good success rates. We analyzed the outcomes of early corticosteroid withdrawal (CSW) protocol in our living donor kidney transplant programme. We included 73 patients on CSW protocol on basiliximab + tacrolimus and mycophenolate mofetil and compared them with 67 recipients on similar regimen with corticosteroids (CSs). CSW group received prednisolone 40 mg on day 1, which was stopped on day 5. Outcomes were evaluated in terms of acute rejection (AR), infections, new onset diabetes after transplant (NODAT), renal function and graft or patient loss. In CSW group, 15/73 (20.5%) patients developed AR, when compared to 5/67 (7.5%) in CS group, (P = 0.02). Biopsy proven acute rejection was seen in 12/72 (16.6%) in CSW group and 5/67 (7.5%) in CS (P = 0.1). One patient in CSW group developed antibody mediated rejection. NODAT was similar (9% in CS vs. 3.7% in CSW, P = 0.09), but infections were higher in CSW group (20.5% vs. 7.5%, P = 0.02). Mean serum creatinine was similar at 6 months (1.24 ± 0.6 in CS and 1.25 ± 0.3 in CSW, P = 0.9). Graft survival was 100% and 97% (P = 0.1) and patient survival was 98.6% and 98.5% (P = 0.9) in CSW and CS groups. Early corticosteroid withdrawal with basiliximab induction was associated with increased risk of AR but did not have any effect on short term graft and pateint survival.

Outbreak of cholera in Tilathi VDC Saptari Nepal

BACKGROUND

On 2011, Cluster of cholera cases was reported in the Tilathi VDC of Saptari, Nepal.

OBJECTIVE

The outbreak was investigated to identify the etiological agent and possible source of infection and guiding the prevention and control measures.

METHODS

Demographic and clinical details were collected from the suspected case-patients, and the outbreak was described by time, place, and person. Focus group discussion and Key informant interview were conducted to assess the practice of sanitation, source of drinking water and probable cause of diarrheal disease. Five stool samples and 10 water samples of tube well and ponds were collected and microbiological study was done in BPKIHS Dharan.

RESULTS

A total of 111 persons suffered with diarrhea and 02 died of it (attack rate 3.05%, case fatality rate 1.8%). All age groups were affected with disease (median age 26 yrs) and males were affected more than females. Descriptive epidemiology suggested the clustering of cases were around the pond where they clean utensils, take bath and wash clothes. The Vibrio cholerae 01 El Tor, Ogawa serotype was isolated in 03 out of 05 suspected stool samples and in all three of the pond water samples. They reported that most of the houses do not have the toilet and people do not wash their hands regularly with soap and water after defecation.

CONCLUSION

Vibrio cholerae was the causative agent behind the outbreak and probable source of infection was the problematic pond water which they used for different purpose. Immediate chlorination of the pond was recommended to halt further spread of the epidemics.