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BACKGROUND AND AIMS The use of forceps for removal of non-diminutive polyps is associated with incomplete resection compared to snare polypectomy. However, few studies have characterized the frequency of forceps polypectomy for non-diminutive polyps or identified strategies to improve this practice. To address this gap, we estimated prevalence and predictors of forceps polypectomy in clinical practice and examined the effectiveness of a multi-component intervention to reduce inappropriate forceps polypectomy. METHODS We retrospectively reviewed all colonoscopies with polypectomies performed at two U.S. health systems between 10/1/2017 and 9/30/2019. We used a mixed-effects logistic regression model to examine the effect of a multi-component intervention, including provider education and a financial incentive, to reduce inappropriate forceps polypectomy, defined as use of forceps polypectomy for polyps ≥5mm. RESULTS A total of 9968 colonoscopies with 25534 polypectomies were performed by 42 gastroenterologists during the study period. Overall, 8.5% (n=2176) of polyps were removed with inappropriate forceps polypectomy. Inappropriate forceps polypectomy significantly decreased after the intervention (OR 0.34, 95% CI 0.30-0.39), from 11.4% (n=1539) to 5.3% (n=637). Predictors of inappropriate forceps polypectomy included: inadequate bowel prep (OR 1.25, 95% CI 1.06 – 1.47), polyps in the right colon (vs. left: OR 1.29, 95% CI 1.09 – 1.51), and number of polyps removed (OR 0.96, 95% CI 0.94 – 0.97). Inappropriate forceps polypectomy also varied by gastroenterologist (median odds ratio 3.43). In a post-hoc analysis, the proportion of polyps >2mm removed with forceps decreased from 50.0% before the intervention to 43.0% after it (OR 0.62, 95% CI 0.58-0.68). CONCLUSIONS Inappropriate forceps polypectomy is common but modifiable. The proportion of non-diminutive polyps removed with forceps polypectomy should be considered as a quality measure.

In the absence of stress, crop growth depends on the amount of light intercepted by the canopy and the conversion efficiency [radiation use efficiency (RUE)]. This study tested the hypothesis that long-term genetic gain for grain yield was partly due to improved RUE. The hypothesis was tested using 30 elite maize hybrids commercialized in the US corn belt between 1930 and 2017. Crops grown under irrigation showed that pre-flowering crop growth increased at a rate of 0.11 g m–2 year–1, while light interception remained constant. Therefore, RUE increased at a rate of 0.0049 g MJ–1 year–1, translating into an average of 3 g m–2 year–1 of grain yield over 100 years of maize breeding. Considering that the harvest index has not changed for crops grown at optimal density for the hybrid, the cumulative RUE increase over the history of commercial maize breeding in the USA can account for ~32% of the documented yield trend for maize grown in the central US corn belt. The remaining RUE gap between this study and theoretical maximum values suggests that a yield improvement of a similar magnitude could be achieved by further increasing RUE.

Crop adaptation to the mixture of environments that defines the target population of environments is the result from a balanced resource allocation between roots, shoots and reproductive organs. Root growth places a critical role in the determination of this balance. Root growth and function responses to temperature can determine the strength of roots as sinks but also influence the crop’s ability to uptake water and nutrients. Surprisingly, this behavior has not been studied in maize since the middle of the last century, and the genetic determinants are unknown. Low temperatures often recorded in deep soil layers limit root growth and soil exploration and may constitute a bottleneck towards increasing drought tolerance, nitrogen recovery, sequestration of carbon and productivity in maize. High throughput phenotyping (HTP) systems were developed to investigate these responses and to examine genetic variability therein across diverse maize germplasm. Here we show that there is: 1) genetic variation of root growth under low temperature and below 10°C, and 2) genotypic variation in water transport under low temperature. Using simulation, we demonstrate that the measured variation for both traits contribute to drought tolerance and explain important components of yield variation in the US corn-belt. The trait set examined herein and HTP platform developed for its characterization reveal a unique opportunity to remove a major bottleneck for crop improvement, and adaptation to climate change.

During pregnancy, assessment of cardiac output (𝑄̇), a fundamental measure of cardiovascular function, provides important insight into maternal adaptation. However, methods for dynamic 𝑄̇ measurement require validation. The purpose of this study was to estimate the agreement of 𝑄̇ measured by echocardiography and Modelflow® at rest and during submaximal exercise in non-pregnant (n = 18), pregnant (n = 15, 22-26 weeks gestation) and postpartum women (n = 12, 12-16 weeks post-delivery). Simultaneous measurements of 𝑄̇ derived from echocardiography [criterion] and Modelflow® were obtained at rest and during low-moderate intensity (25% and 50% peak power output) cycling exercise and compared using Bland-Altman analysis and limits of agreement. Agreement between echocardiography and Modelflow® was poor in non-pregnant, pregnant and postpartum women at rest (mean difference ± SD: -1.1 ± 3.4; -1.2 ± 2.9; -1.9 ± 3.2 L.min-1), and this remained evident during exercise. The Modelflow® method is not recommended for 𝑄̇ determination in research involving young, healthy non-pregnant and pregnant women at rest or during dynamic challenge. Previously published 𝑄̇ data from studies utilising this method should be interpreted with caution.

Byrne, PJ, Moody, JA, Cooper, SM, and Kinsella, S. Acute effects of "composite" training on neuromuscular and fast stretch-shortening cycle drop jump performance in hurling players. J Strength Cond Res 35(12): 3474-3481, 2021-"Composite" training is a term developed by the authors and defined as the combination of a plyometric exercise with an explosive activity such as a sprint run, performed as a "combined repetition"/session. The purposes of this study were to investigate the acute effect of a "composite" training session on neuromuscular and fast stretch-shortening cycle bounce drop jumps (BDJs) in hurling players' immediately, after session, and after 7 days of recovery. Eight hurling players first completed a drop jump test to identify individual BDJ drop height, followed 72 hours later with a single "composite" training session. Three repetition maximum (3RM) back squat strength, BDJ, countermovement jump (CMJ), and sprint performance testing were performed 10 minutes before and immediately after session and 7 days after session. An analysis of variance reported a significant decrease in CMJ measures (height, velocity, and eccentric rate of force development) and sprint performance from presession to postsession (p ≤ 0.05). Moreover, a significant increase was evident for CMJ performance (height and power), sprint performance (5 and 20 m), 3RM back squat strength, and BDJ performance (reactive strength index and height) from postsession to post-7-day recovery (p ≤ 0.05). Pairwise comparisons indicated that absolute and relative 3RM strength significantly increased from presession to post-7 days (absolute 3RM: p = 0.0001; relative 3RM: p = 0.01). The findings indicate that "composite" training results in an immediate decline in CMJ measures after session possibly due to acute muscle fatigue, and supercompensation augments maximum lower-limb strength after 7 days of recovery.

A major focus for genomic prediction has been on improving trait prediction accuracy using combinations of algorithms and the training data sets available from plant breeding multi-environment trials (METs). Any improvements in prediction accuracy are viewed as pathways to improve traits in the reference population of genotypes and product performance in the target population of environments (TPE). To realize these breeding outcomes there must be a positive MET-TPE relationship that provides consistency between the trait variation expressed within the MET data sets that are used to train the genome-to-phenome (G2P) model for applications of genomic prediction and the realized trait and performance differences in the TPE for the genotypes that are the prediction targets. The strength of this MET-TPE relationship is usually assumed to be high, however it is rarely quantified. To date investigations of genomic prediction methods have focused on improving prediction accuracy within MET training data sets, with less attention to quantifying the structure of the TPE and the MET-TPE relationship and their potential impact on training the G2P model for applications of genomic prediction to accelerate breeding outcomes for the on-farm TPE. We extend the breeder’s equation and use an example to demonstrate the importance of the MET-TPE relationship as a key component for the design of genomic prediction methods to realize improved rates of genetic gain for the target yield, quality, stress tolerance and yield stability traits in the on-farm TPE.

Scottish cystoscopy service provision faces significant challenges in the years ahead driven by COVID-19’s impact on diagnostic waiting times, the development of national treatment centres to expand infrastructure/service delivery, and limited short-term medical capacity to support recovery. These factors have greatly increased demand for the rapid development of a supportive non-medical cystoscopist workforce [1]. There is currently no agreed national approach to non-medical cystoscopy training in Scotland despite clear guidance on competencies from the British Association of Urology Nurses (BAUN). Our proposed solution has been to collaboratively develop and pilot an accelerated learning programme, including a simulation ‘bootcamp’, that pump primes adaptation to the role and clinical training requirements through technical and non-technical skill rehearsal. We invited experts from clinical practice, education, and simulation to form a national short life working group ( Diagram of the national short life working group A unified model for pilot was developed, integrating clinical simulation, theory, and work-based learning (WBL). It focuses on core cystoscopy skills initially, providing the necessary knowledge and ‘hands on’ ability required for independent practice. The process is primed by a two-day ‘cystoscopy bootcamp’ using simulation-based education (SBE). This comprises of a variety of methods including high volume cystoscopy skill rehearsal of increasing realism, progressing to cadaver. Non-technical skills are simulated through bespoke scenarios relevant to the role including obtaining informed consent, team communication, and delivering bad news. Expert discussion and debriefing is interwoven throughout. Formal evaluation is ongoing with early reports of increased preparedness and quicker adaptation to the clinical environment. In addition to the anticipated benefits, bootcamp also established early peer support mechanisms and, through the engagement and networking of diverse faculty, fostered integration with the wider community of practice, and a commitment to building a continually improving, user-informed simulation programme. The method provides a cost-effective collaborative way to explore research, educational models, and the challenges of implementation in real time, through a multi-professional lens. The approach has been crucial to ownership, commitment and acceptance of the programme while fostering integrated cross discipline delivery. 1. Scottish Government Endoscopy and urology diagnostic recovery and renewal plan. 30 Nov 2021 Endoscopy and urology diagnostic: recovery and renewal plan – gov.scot (

Breeding climate-resilient crops with improved levels of abiotic and biotic stress resistance as a response to climate change presents both opportunities and challenges. Applying the framework of the “breeder’s equation,” which is used to predict the response to selection for a breeding program cycle, we review methodologies and strategies that have been used to successfully breed crops with improved levels of drought resistance, where the target population of environments (TPEs) is a spatially and temporally heterogeneous mixture of drought-affected and favorable (water-sufficient) environments. Long-term improvement of temperate maize for the US corn belt is used as a case study and compared with progress for other crops and geographies. Integration of trait information across scales, from genomes to ecosystems, is needed to accurately predict yield outcomes for genotypes within the current and future TPEs. This will require transdisciplinary teams to explore, identify, and exploit novel opportunities to accelerate breeding program outcomes; both improved germplasm resources and improved products (cultivars, hybrids, clones, and populations) that outperform and replace the products in use by farmers, in combination with modified agronomic management strategies suited to their local environments.

An overview of the appendices in NA28 and UBS5 reveals that the editors agreed regarding the number of quotations in Hebrews on 37 occasions. They disagreed, however, as to whether an intertext was a quotation or an allusion on nine occasions. The compilers of these lists did not provide a basis for their conclusions, and inability to agree on the number of intertexts could be due to multiple reasons. The purpose of this study, therefore, was to develop a set of criteria by which to identify quotations in Hebrews. Auctor’s quotations were determined to possess four characteristics: (1) introductory formula, (2) a recognizable source, (3) verbal correspondence with the hypotext and (4) syntactical tension. These four characteristics were then utilized to assess the nine disputed intertexts between NA28 and UBS5. By assessing the nine intertexts for the presence of the criteria, four out of the nine were determined to be quotations, whereas five were deemed to be allusions.

Transgenes that improve quantitative traits have traditionally been evaluated in one or a few genetic backgrounds across multiple environments. However, testing across multiple genetic backgrounds can be equally important to accurately quantify the value of a transgene for breeding objectives. Creating near-isogenic lines across a wide germplasm space is costly and time consuming, which renders it impractical during early stages of testing. In this experiment, we evaluate three approaches to sample the genetic space while concurrently testing across environments. We created both transgenic and non-transgenic doubled haploid lines, F2:3lines, and bulk F3families to determine if all methods resulted in similar estimation of transgene value and to identify the number of yield trial plots from each method necessary to obtain a stable estimate of the transgene value. With one exception, the three methods consistently estimated a similar effect of the transgene. We suggest that bulked F3lines topcrossed to a tester inbred is the most effective method to estimate the value of a transgene across both genetic space and environments.

Transgenes have been successfully commercialized for qualitatively inherited insect and herbicide resistance traits that show similar effects across genetic backgrounds. However, for quantitative traits like yield, genetic background may affect the measured transgene value. In this paper, we evaluated whether different genetic backgrounds impact the estimated value of a transgene for grain yield, ear height, and anthesis-silking interval for maize by developing isogenic pairs of lines with and without a transgene and testing them in hybrid combination with non-transgenic lines from a complementary heterotic group across eleven environments in the USA. Over all hybrid combinations, the transgene increased yield by 0.2 Mg ha−1. Across multiple non-transgenic lines of the opposing heterotic group, the transgene effect within a line pair ranged from an increase of 0.8 Mg ha−1for the NSS4 and SS7 transgenic lines to a reduction of 0.3 Mg ha−1for the NSS5 transgenic line when compared to their non-transgenic isoline. Transgenic hybrids were often taller than non-transgenic hybrids (P

Climate change will have a net negative and inequitable impact on agriculture. Genetics for crop improvement ranks in the top set of technologies that can contribute to human adaptation to climate change. However, a framework for how to breed crops for climate change adaptation is lacking. Here we propose a framework to develop new genotype (G) x management (M) technologies (G x M) to adapt to climate change, and to transition from current to future G x M technologies in a way that future food security does not come at the expense of current food security. The framework integrate genomic, agronomic, and environmental (E) predictors to accomplish two critical goals: 1-predict emergent phenotypes that stems from the dynamic interplay between G, E and M, and thus enable the breeder to consider the behavior of new genetic and trait combinations in environments that plants have not been exposed or tested before, and 2-identify G x M technologies that could increase food and nutritional security while regenerating natural and production resources. We highlight the need to invest in artificial intelligence and information technologies for breeders to harness multiple sources of information to create G x M technologies to address the diverse cultural and geographically granular societal needs.

Plant function arises from a complex network of structural and physiological traits. Explicit representation of these traits, as well as their connections with other biophysical processes, is required to advance our understanding of plant-soil-climate interactions. We used the Terrestrial Regional Ecosystem Exchange Simulator (TREES) to evaluate physiological trait networks in maize. Net primary productivity (NPP) and grain yield were simulated across five contrasting climate scenarios. Simulations achieving high NPP and grain yield in high precipitation environments featured trait networks conferring high water use strategies: deep roots, high stomatal conductance at low water potential (“risky” stomatal regulation), high xylem hydraulic conductivity, and high maximal leaf area index. In contrast, high NPP and grain yield was achieved in dry environments with low late-season precipitation via water conserving trait networks: deep roots, high embolism resistance, and low stomatal conductance at low leaf water potential (“conservative” stomatal regulation). We suggest that our approach, which allows for the simultaneous evaluation of physiological traits and their interactions (i.e., networks), has potential to improve crop growth predictions in different environments. In contrast, evaluating single traits in isolation of other coordinated traits does not appear to be an effective strategy for predicting plant performance.Summary statementOur process-based model uncovered two beneficial but contrasting trait networks for maize which can be understood by their integrated effect on water use/conservation. Modification of multiple, physiologically aligned, traits were required to bring about meaningful improvements in NPP and yield.

The Tropical Conservativism Hypothesis and Biogeographical Conservativism Hypothesis were tested in forest millipedes. Latitudinal diversity gradient (LDG) was measured in the genus Sphaerotherium and Tetraconasoma to distinguish between the two hypotheses. There was a marginally significant correlation between the number of species and latitudinal degrees away from the equator in Tetraconasoma (r=-0.78091517, Z score=-1.48168825, n=5, p=0.06921166), not Sphaerotherium (r=-0.73029674, Z score=-0.92936295, n=4, p=0.17635049). The relationship in Tetraconasoma was shown to be significant (Spearman's Rho rs=-0.89443, p (2-tailed) = 0.04052). An evolutionary preference for temperate environments appearing to have led to climatic constraints on dispersal based primarily on precipitation seasonality gradients was previously suggested. The antennal cone cells in the Tetraconasoma are suggested to be responsible for this sensory adaptive radiation and variation.

To identify types of nurse-led interventions for multimorbidity and which outcomes are positively affected by them.Mixed-methods systematic review following the Joanna Briggs Institute (JBI) methods for convergent-integrated reviews.CRD42020197956.Cochrane CENTRAL, CINAHL, Embase and MEDLINE were searched in October 2020. Grey literature sources included OpenGrey, the Journal of Multimorbidity and Comorbidity and reference mining.English-language reports of nurse-led interventions for people with multimorbidity were included based on author consensus. Two reviewers performed independent quality appraisal using JBI tools. Data were extracted and synthesized using a pre-existing taxonomy of interventions and core outcome set.Twenty studies were included, with a median summary quality score of 77.5%. Interventions were mostly case-management or transitional care interventions, with nurses in advanced practice, support to self-manage conditions, and an emphasis on continuity of care featuring frequently. Patient-centred outcomes such as quality of healthcare and health-related quality of life were mostly improved, with mixed effects on healthcare utilization, costs, mortality and other outcomes.Interventions such as case management are agreeable to patients and transitional care interventions may have a small positive impact on healthcare utilization. Interventions include long-term patient management or short-term interventions targeted at high-risk junctures. These interventions feature nurses in advanced practice developing care plans in partnership with patients, to simplify and improve the quality of care both in the long and short-term.This is the first mixed-methods review which includes all types of nurse-led interventions for multimorbidity and does not focus on specific comorbidities or elderly/frail populations. Using adapted consensus-developed frameworks for interventions and outcomes, we have identified the common features of interventions and their overall typology. We suggest these interventions are of value to patients and healthcare systems but require localization and granular evaluation of their components to maximize potential benefits.

As asthma symptoms worsen, patients typically rely on short-acting βWe conducted a multinational, phase 3, double-blind, randomized, event-driven trial to evaluate the efficacy and safety of albuterol-budesonide, as compared with albuterol alone, as rescue medication in patients with uncontrolled moderate-to-severe asthma who were receiving inhaled glucocorticoid-containing maintenance therapies, which were continued throughout the trial. Adults and adolescents (≥12 years of age) were randomly assigned in a 1:1:1 ratio to one of three trial groups: a fixed-dose combination of 180 μg of albuterol and 160 μg of budesonide (with each dose consisting of two actuations of 90 μg and 80 μg, respectively [the higher-dose combination group]), a fixed-dose combination of 180 μg of albuterol and 80 μg of budesonide (with each dose consisting of two actuations of 90 μg and 40 μg, respectively [the lower-dose combination group]), or 180 μg of albuterol (with each dose consisting of two actuations of 90 μg [the albuterol-alone group]). Children 4 to 11 years of age were randomly assigned to only the lower-dose combination group or the albuterol-alone group. The primary efficacy end point was the first event of severe asthma exacerbation in a time-to-event analysis, which was performed in the intention-to-treat population.A total of 3132 patients underwent randomization, among whom 97% were 12 years of age or older. The risk of severe asthma exacerbation was significantly lower, by 26%, in the higher-dose combination group than in the albuterol-alone group (hazard ratio, 0.74; 95% confidence interval [CI], 0.62 to 0.89; P = 0.001). The hazard ratio in the lower-dose combination group, as compared with the albuterol-alone group, was 0.84 (95% CI, 0.71 to 1.00; P = 0.052). The incidence of adverse events was similar in the three trial groups.The risk of severe asthma exacerbation was significantly lower with as-needed use of a fixed-dose combination of 180 μg of albuterol and 160 μg of budesonide than with as-needed use of albuterol alone among patients with uncontrolled moderate-to-severe asthma who were receiving a wide range of inhaled glucocorticoid-containing maintenance therapies. (Funded by Avillion; MANDALA ClinicalTrials.gov number, NCT03769090.).