Search

Abstract This parallel‐arm, phase I study investigated the potential cytochrome P450 (CYP)3A induction effect of NBI‐1065845 (TAK‐653), an investigational α‐amino‐3‐hydroxy‐5‐methyl‐4‐isoxazolepropionic acid receptor potentiator in phase II development for major depressive disorder. The midazolam treatment arm received the sensitive CYP3A substrate midazolam on Day 1, followed by NBI‐1065845 alone on Days 5–13; on Day 14, NBI‐1065845 was administered with midazolam, then NBI‐1065845 alone on Day 15. The oral contraceptive treatment arm received ethinyl estradiol–levonorgestrel on Day 1, then NBI‐1065845 alone on Days 5–13; on Day 14, NBI‐1065845 was administered with ethinyl estradiol–levonorgestrel, then NBI‐1065845 alone on Days 15–17. Blood samples were collected for pharmacokinetic analyses. The midazolam treatment arm comprised 14 men and 4 women, of whom 16 completed the study. Sixteen of the 17 healthy women completed the oral contraceptive treatment arm. After multiple daily doses of NBI‐1065845, the geometric mean ratios (GMRs) (90% confidence interval) for maximum observed concentration were: midazolam, 0.94 (0.79–1.13); ethinyl estradiol, 1.00 (0.87–1.15); and levonorgestrel, 0.99 (0.87–1.13). For area under the plasma concentration–time curve (AUC) from time 0 to infinity, the GMRs were as follows: midazolam, 0.88 (0.78–0.98); and ethinyl estradiol, 1.01 (0.88–1.15). For levonorgestrel, the GMR for AUC from time 0 to the last quantifiable concentration was 0.87 (0.78–0.96). These findings indicate that NBI‐1065845 is not a CYP3A inducer and support its administration with CYP3A substrates. NBI‐1065845 was generally well tolerated, with no new safety signals observed after coadministration of midazolam, ethinyl estradiol, or levonorgestrel.

Abstract Background Neoadjuvant treatment with nab‐paclitaxel and gemcitabine for potentially operable pancreatic adenocarcinoma has not been well studied in a prospective interventional trial and could down‐stage tumors to achieve negative surgical margins. Methods A single‐arm, open‐label phase 2 trial (NCT02427841) enrolled patients with pancreatic adenocarcinoma deemed to be borderline resectable or clinically node‐positive from March 17, 2016 to October 5, 2019. Patients received preoperative gemcitabine 1000 mg/m2 and nab‐paclitaxel 125 mg/m2 on Days 1, 8, 15, every 28 days for two cycles followed by chemoradiation with 50.4 Gy intensity‐modulated radiation over 28 fractions with concurrent fluoropyrimidine chemotherapy. After definitive resection, patients received four additional cycles of gemcitabine and nab‐paclitaxel. The primary endpoint was R0 resection rate. Other endpoints included treatment completion rate, resection rate, radiographic response rate, survival, and adverse events. Results Nineteen patients were enrolled, with the majority having head of pancreas primary tumors, both arterial and venous vasculature involvement, and clinically positive nodes on imaging. Among them, 11 (58%) underwent definitive resection and eight of 19 (42%) achieved R0 resection. Disease progression and functional decline were primary reasons for deferring surgical resection after neoadjuvant treatment. Pathologic near‐complete response was observed in two of 11 (18%) resection specimens. Among the 19 patients, the 12‐month progression‐free survival was 58%, and 12‐month overall survival was 79%. Common adverse events were alopecia, nausea, vomiting, fatigue, myalgia, peripheral neuropathy, rash, and neutropenia. Conclusion Gemcitabine and nab‐paclitaxel followed by long‐course chemoradiation represents a feasible neoadjuvant treatment strategy for borderline resectable or node‐positive pancreatic cancer.

Abstract This is the protocol for a Campbell systematic review. The primary objectives of this review is to answer the following research questions using formal research studies: What is the extent and quality of MFP intervention research? What are the effects on financial outcomes of financial services embedded within healthcare settings? What are the effects on health‐related outcomes of financial services embedded within healthcare settings?

Abstract The dengue mosquito, Aedes aegypti (Linnaeus, 1762), is a highly invasive and medically significant vector of dengue, yellow fever, chikungunya and Zika viruses, whose global spread can be attributed to increased globalization in the 15th through 20th century. Records of the invasion history of Ae. aegypti across Southeast Asia are sparse and there is little knowledge regarding the invasion routes that the species exploited to gain a foothold in the Indo‐Pacific. Likewise, a broad and geographically thorough investigation of Ae. aegypti population genetics in the Indo‐Pacific is lacking, despite this region being highly impacted by diseases transmitted by this species. We assess 11 nuclear microsatellites and mitochondrial COI sequences, coupled with widespread sampling through the Indo‐Pacific region to characterise population structure at a broad geographic scale. We also perform a comprehensive literature search to collate documentation of the first known records of Ae. aegypti at various locations in the Indo‐Pacific. We revealed additional spatial population genetic structure of Ae. aegypti in Southeast Asia, the Indo‐Pacific and Australasia compared with previous studies and find differentiation between multiple Queensland and Torres Strait Islands populations. We also detected additional genetic breaks within Australia, Indonesia and Malaysia. Characterising the structure of previously unexplored populations through this region enhances the understanding of the population structure of Ae. aegypti in Australasia and Southeast Asia and may assist predictions of future mosquito movement, informing control strategies as well as assessing the risk of new invasion pathways.

Abstract Bats are important pest control agents in agriculture. Yet, the underlying fine‐scale biotic and abiotic mechanisms that drive their foraging behaviors and responses to insect outbreaks are unclear. Herbivore‐induced plant volatiles (HIPVs) can attract both invertebrate and vertebrate natural enemies that use the chemical plant cues to locate insect prey. The ability of HIPVs to attract multiple species raises the question of whether they may also be a biotic factor influencing insectivorous bat activity. Additionally, abiotic factors, such as weather conditions, can affect bat activity in agricultural settings, but little is known about how bats respond to shifting environmental conditions on short timescales in this landscape context. Using a model crop system, soybean (Glycine max), our study asked three questions: (1) Which bat species are active in eastern Maryland soybean fields? (2) Is insectivorous bat activity affected by naturally occurring soybean HIPVs and/or synthetic soybean HIPVs (indole or farnesene)? (3) How is insectivorous bat activity affected by hourly weather conditions in this landscape? In soybean fields in eastern Maryland, we created paired treatment plots: HIPV plots (damaged plants or synthetic HIPV dispensers) and control plots (undamaged plants or empty dispensers). We measured bat activity using ultrasonic recorders, summarizing hourly and nightly activity, and detected 10 total species. The most abundant species were big brown/silver‐haired bats (Eptesicus fuscus/Lasionycteris noctivagans). Bat activity did not significantly differ between control and HIPV plots in any of the three experiments. Thus, our results do not support our expectation that bats in eastern Maryland use soybean HIPVs to locate insect prey. However, bat activity did increase with increasing average hourly temperature and wind speed. This initial study of bats and HIPVs, as well as the fine‐scale examination of weather conditions on bat activity, may serve as a guide for future research on bat–plant interactions that can support the development of new strategies for sustainable pest management.

Abstract Kentucky bluegrass (Poa pratensis L.) postharvest residue in northern Idaho has historically been burned to maintain stand life and profitability. Alternatives to open field burning are necessary to reduce adverse impacts of burning on air quality and several have been proposed. However, limited information is available on the impact of residue management on residue removal and nitrogen cycling. In this study, the impact of residue management on residue nutrient dynamics and nitrogen availability was evaluated within replicated full load burn (FLB), bale then burn (BB), bale then mow then harrow (BMH), and system (SYST) (BMH year 1, BB year 2, and FLB year 3) plots in Kootenai County, ID from 2002 to 2006. Standing and non‐standing residues were measured immediately following grass seed harvest and periodically thereafter in each plot. Averaged across years, non‐standing residue (thatch) removal ranged from −13% in BMH to 61% in FLB, and removal of standing biomass ranged from 6% in BMH to 92% in FLB. The combined removal of both non‐standing and standing residue was 18% with BMH, 57% with SYST, 69% with BB, and 75% with FLB. Plant N uptake ranged from 53 kg N ha−1 in FLB in 2006 to 131 in SYST (BMH) in 2003 and nitrogen use efficiency, calculated using partial factor productivity formula, ranged from 0.6 to 5.8 kg bluegrass seed per kg N fertilizer. Mean NO3−–N concentrations from lysimeters 10‐cm deep were 14 mg NO3−–N L−1 in FLB, 12 mg NO3−–N L−1 in BB, and 6 mg NO3−–N L−1 in BMH treatments for years 2003–2006. Greater concentrations of NO3−–N in burn treatments were available for plant uptake or leaching compared to the BMH treatment. The data indicate that the efficacy of any residue management system will vary from year to year and impact seed production in the following year. Nitrogen availability varied across residue management systems, suggesting N fertilizer product, rate, and timing to optimize N use efficiency may also need to vary.

Objective. Assess factors contributing to variation in the use of new and evolving diagnostic and interventional procedures for percutaneous coronary intervention (PCI). Background. Evidence-based practices for PCI have the potential to improve outcomes but are variably adopted. Finding possible drivers of PCI procedure-use variability is key for efforts aimed at establishing more uniform practice. Methods. Veterans Affairs Clinical Assessment, Reporting, and Tracking Program data were used to estimate a proportion of variation attributable to hospital-, operator-, and patient-level factors across (a) radial arterial access, (b) intravascular imaging/optical coherence tomography, and (c) atherectomy for PCI. We used random-effects models with hospital, operator, and patient random effects. Overlap between levels generated cumulative variability estimates greater than 100%. Results. A total of 445 operators performed 95,391 PCI procedures across 73 hospitals from 2011 to 2018. The rates of all procedures increased over this time. 24.45% of variability in the use of radial access was attributable to the hospital, 53.04% to the operator, and 57.83% to patient-level characteristics. 9.06% of the variability in intravascular imaging use was attributable to the hospital, 43.92% to the operator, and 21.20% to the patient. Lastly, 20.16% of the variability in use of atherectomy was attributed to the hospital, 34.63% to the operator, and 57.50% to the patient.Conclusions. The use of radial access, intracoronary imaging, and atherectomy is influenced by patient, operator, and hospital factors, but patient and operator-level effects predominate. Efforts to increase the use of evidence-based practices for PCI should consider interventions at these levels.

Background Venous thromboembolism (VTE) often occurs after hospitalization in medically ill patients, but the population benefit–risk of extended thromboprophylaxis remains uncertain. Methods and Results The MARINER (Medically Ill Patient Assessment of Rivaroxaban Versus Placebo in Reducing Post‐Discharge Venous Thrombo‐Embolism Risk) study (NCT02111564) was a randomized double‐blind trial that compared thromboprophylaxis with rivaroxaban 10 mg daily versus placebo for 45 days after hospital discharge in medically ill patients with a creatinine clearance ≥50 mL/min. The benefit–risk balance in this population was quantified by calculating the between‐treatment rate differences in efficacy and safety end points per 10 000 patients treated. Clinical characteristics of the study population were consistent with a hospitalized medical population at risk for VTE. Treating 10 000 patients with rivaroxaban resulted in 32.5 fewer symptomatic VTE and VTE‐related deaths but was associated with 8 additional major bleeding events. The treatment benefit was driven by the prevention of nonfatal symptomatic VTE (26 fewer events). There was no between‐treatment difference in the composite of critical site or fatal bleeding. Conclusions Extending thromboprophylaxis with rivaroxaban for 45 days after hospitalization provides a positive benefit–risk balance in medically ill patients at risk for VTE who are not at high risk for bleeding. Registration URL: https://clinicaltrials.gov/; Unique identifier: NCT02111564.

Background Patients resuscitated from out‐of‐hospital circulatory arrest (OHCA) frequently have cardiopulmonary resuscitation injuries identifiable by computed tomography, although the prevalence, types of injury, and effects on clinical outcomes are poorly characterized. Methods and Results We assessed the prevalence of resuscitation‐associated injuries in a prospective, observational study of a head‐to‐pelvis sudden‐death computed tomography scan within 6 hours of successful OHCA resuscitation. Primary outcomes included total injuries and time‐critical injuries (such as organ laceration). Exploratory outcomes were injury associations with mechanical cardiopulmonary resuscitation and survival to discharge. Among 104 patients with OHCA (age 56±15 years, 30% women), 58% had bystander cardiopulmonary resuscitation, and total cardiopulmonary resuscitation time was 15±11 minutes. The prevalence of resuscitation‐associated injury was high (81%), including 15 patients (14%) with time‐critical findings. Patients with resuscitation injury were older (58±15 versus 46±13 years; P

Abstract Pharmacology education currently lacks a research‐based consensus on which core concepts all graduates should know and understand, as well as a valid and reliable means to assess core conceptual learning. The Core Concepts in Pharmacology Expert Group (CC‐PEG) from Australia and New Zealand recently identified a set of core concepts of pharmacology education as a first step toward developing a concept inventory—a valid and reliable tool to assess learner attainment of concepts. In the current study, CC‐PEG used established methodologies to define each concept and then unpack its key components. Expert working groups of three to seven educators were formed to unpack concepts within specific conceptual groupings: what the body does to the drug (pharmacokinetics); what the drug does to the body (pharmacodynamics); and system integration and modification of drug–response. First, a one‐sentence definition was developed for each core concept. Next, sub‐concepts were established for each core concept. These twenty core concepts, along with their respective definitions and sub‐concepts, can provide pharmacology educators with a resource to guide the development of new curricula and the evaluation of existing curricula. The unpacking and articulation of these core concepts will also inform the development of a pharmacology concept inventory. We anticipate that these resources will advance further collaboration across the international pharmacology education community to improve curricula, teaching, assessment, and learning.

Abstract Conservation and development organizations around the world are increasingly promoting livelihood programs for rural communities as a means of creating sustainable alternatives to activities destructive to remaining wildlife and habitats. In impoverished communities in Colombia adjacent forest patches with critically endangered cotton‐top tamarins (Saguinus oedipus), this study evaluates alternative livelihood programs' impact on participating community members' income, wellbeing, sustainable resource use, and attitudes about cotton‐top tamarin conservation. We surveyed program participants, their neighbors, and members of reference communities nearby for comparison (n = 253). Participants in the alternative livelihood programs had significantly more access to resources and benefits compared to both the non‐participating neighbors and people from the reference communities. However, results revealed challenges of scaling up the programs to include more community members. Participants' attitudes toward sustainable resource use and cotton‐top tamarin conservation were not stronger than others who do not receive benefits from the alternative livelihoods programs, and at times were contrary to the conservation goals, revealing a gap in program training for newer participants. Conservation programs using alternative livelihood strategies can apply the lessons learned in our 16 years of implementation and this post hoc evaluation to strengthen the connection between alternative livelihoods and conservation goals.

Abstract Pharmacology education currently lacks an agreed knowledge curriculum. Evidence from physics and biology education indicates that core concepts are useful and effective structures around which such a curriculum can be designed to facilitate student learning. Building on previous work, we developed a novel, criterion‐based method to identify the core concepts of pharmacology education. Five novel criteria were developed, based on a literature search, to separate core concepts in pharmacology from topics and facts. Core concepts were agreed to be big ideas, enduring, difficult, applicable across contexts, and useful to solve problems. An exploratory survey of 33 pharmacology educators from Australia and New Zealand produced 109 terms, which were reduced to a working list of 26 concepts during an online workshop. Next, an expert group of 12 educators refined the working list to 19 concepts, by applying the five criteria and consolidating synonyms, and added three additional concepts that emerged during discussions. A confirmatory survey of a larger group resulted in 17 core concepts of pharmacology education. This list may be useful for educators to evaluate existing curricula, design new curricula, and to inform the development of a concept inventory to test attainment of the core concepts in pharmacology.

Abstract Assessing spatiotemporal variations in soil water is critical to many decisions in precision agriculture. In dryland crop production regions with marginal precipitation, growers use crop rotations and surface preparation practices to build soil water natural capital over preceding seasons for cash crop production. However, significant gaps exist in quantifying linkages between topography, soil properties, and site‐specific agronomic practices to crop water use, and to predict temporal changes in soil water storage. In this study, we used time‐lapse electromagnetic induction to measure apparent electrical conductivity (ECa) to infer spatiotemporal variability of soil water while comparing crop (winter wheat [Triticum aestivum L.], spring peas [Pisum sativum L.], and spring barley [Hordeum vulgare L.]) as well as tillage (no till and chisel plow) on a split‐plot design in the Palouse region of northern Idaho. Weekly measurements of ECa were converted to soil water content using multiple linear regression with the help of principal component analysis. Separating factors of temporal stability and variability allowed us to derive crop‐specific calibrated relationships between soil water content and the additional variables growing degree days, elevation, clay content, and silt content. Results suggest that spring peas retained the highest water content, followed by spring barley and winter wheat. Resultant maps show highly structured and consistent patterns in ECa being driven primarily by crop type that are apparent even in uncalibrated imagery. Although soil ECa tended to be greater in no‐tillage compared with chisel plow treatments, we found no significant differences in soil water content between the two. This may be partially due to the limited number of years of no‐till practice at this site.

Abstract Liquid ethane is present in the lakes and seas observed on Titan's surface by the Cassini‐Huygens mission. While interaction between liquid hydrocarbons and water ice is expected to result in the formation of clathrate hydrates, such reaction (and its kinetics) has not yet been demonstrated for cryogenic liquids under relevant planetary conditions. In this paper, we report the first experimental evidence for rapid formation of clathrates upon direct contact of liquid ethane with water ice at 1 bar using micro‐Raman spectroscopy. Kinetics experiments conducted in the temperature range 150–173 K yield an activation energy of 14.8 ± 2.2 kJ/mol, which is suggestive of a diffusion‐controlled mechanism for clathrate formation. This implies that a clathrate reservoir can form within seasonal time scales on Titan if liquid ethane comes into contact with a pre‐existing icy bedrock, which may hold important implications for the structure and dynamics of Titan's crust and its global evolution.

Background. Women with previous gestational diabetes mellitus (GDM) have evidence of postpartum β-cell dysfunction, which increases their risk of developing type 2 diabetes (T2DM) later in life. Elevated levels of circulating cell-free preproinsulin (INS) DNA correlate with dying β-cells in both mice and humans. The aim of this study was to determine if cell-free circulating INS DNA levels are higher in women with previous GDM who develop T2DM. Methods. We used droplet digital (dd) PCR to measure the levels of cell-free circulating methylated and unmethylated INS DNA in plasma from 97 women with normal glucose tolerance (NGT), 12 weeks following an index GDM pregnancy. Women were assessed for up to 10 years for the development of T2DM. Results. In the follow-up period, 22% of women developed T2DM. Compared with NGT women, total cell-free INS DNA levels were significantly higher in women who developed T2DM (P=0.02). There was no difference in cell-free circulating unmethylated and methylated INS DNA levels between NGT women and women who developed T2DM (P=0.09 and P=0.07, respectively). Conclusions. In women with a previous index GDM pregnancy, postpartum levels of cell-free circulating INS DNA are significantly higher in those women who later developed T2DM.

Capgras syndrome is characterized by the delusional belief that a familiar person has been replaced by a visually similar imposter or replica. Rarely, the delusional focus may be objects rather than people. Numerous etiologies have been described for Capgras to include seizures. Similarly, visual hallucinations, both simple and complex, can occur secondary to seizure activity. We present, to our knowledge, the first reported case of visual hallucinations and Capgras delusions for objects that developed secondary to new onset occipital lobe epilepsy. We then discuss the possible underlying neurologic mechanisms responsible for the symptomatology.

The interaction of converging fires often leads to significant changes in fire behavior, including increased flame length, angle, and intensity. In this paper, the fluid mechanics of two adjacent line fires are studied both theoretically and experimentally. A simple potential flow model is used to explain the tilting of interacting flames towards each other, which results from a momentum imbalance triggered by fire geometry. The model was validated by measuring the velocity field surrounding stationary alcohol pool fires. The flow field was seeded with high-contrast colored smoke, and the motion of smoke structures was analyzed using a cross-correlation optical flow technique. The measured velocities and flame angles are found to compare reasonably with the predicted values, and an analogy between merging fires and wind-blown flames is proposed.

This Campbell systematic review examines the effect of interventions on school attendance to inform policy, practice and research. The review summarise findings from 28 studies conducted in the US, Canada, UK and Australia. Overall, truancy intervention programs are effective. There is a significant overall positive and moderate mean effect of intervention on attendance, which increases attendance by 4.7 days per student by the end of the intervention. Studies did not measure longer‐term outcomes, so we do not know if these gains in attendance continue after the intervention ends. There was no significant difference in the effectiveness of different delivery channels (e.g. school, court or community‐based), different modalities (e.g., individual, family, group, or multimodal), or different lengths of time (e.g., one day versus a school year). Contrary to popular belief and recommendations for best practices in truancy reduction found in the existing literature, collaborative programs and multimodal interventions do not produce greater effects on attendance than other types of programs. However, small sample sizes and substantial variation between studies suggest caution is needed in interpreting and applying these findings. There are shortcomings in the literature, notably the lack of inclusion of minority students. Executive summary/Abstract BACKGROUND Truancy is a significant problem in the U.S. and in other countries around the world. Truancy has been linked to serious immediate and far‐reaching consequences for youth, families, and schools and communities, leading researchers, practitioners, and policy makers to try to understand and to address the problem. Although numerous and significant steps have been taken at the local, state, and national levels to reduce truancy, the rates of truancy have at best remained stable or at worst been on the rise, depending on the indicator utilized to assess truancy rates. The costs and impact of chronic truancy are significant, with both short‐ and long‐term implications for the truant youth as well as for the family, school, and community. Although several narrative reviews and one meta‐analysis of attendance and truancy interventions have attempted to summarize the extant research, there are a number of limitations to these reviews. It is imperative that we systematically synthesize and examine the evidence base to provide a comprehensive picture of interventions that are being utilized to intervene with chronic truants, to identify interventions that are effective and ineffective, and to identify gaps and areas in which more research needs to be conducted to better inform practice and policy. OBJECTIVES The main objective of this systematic review was to examine the effects of interventions on school attendance to inform policy, practice, and research. The questions guiding this study were: 1) Do truancy programs with a goal of increasing student attendance for truant youth affect school attendance behaviors of elementary and secondary students with chronic attendance problems? 2) Are there differences in the effects of school‐based, clinic/community‐based, and court‐based programs? 3) Are some modalities (i.e., family, group, multimodal) more effective than others in increasing student attendance? SEARCH STRATEGY A systematic and comprehensive search process was employed to locate all possible studies between 1990 and 2009, with every effort made to include both published and unpublished studies to minimize publication bias. A wide range of electronic bibliographic databases and research registers was searched, websites of relevant research centers and groups were mined for possible reports, over 200 e‐mails and letters were sent to programs listed in large databases of truancy programs compiled by the National Center for School Engagement and the National Dropout Prevention Center, and contact with researchers in the field of truancy and absenteeism was attempted. In addition, we examined reference lists of all previous reviews as well as citations in research reports for potential studies. SELECTION CRITERIA Studies eligible for this review were required to meet several eligibility criteria. Studies must have utilized a randomized, quasi‐experimental, or single‐group pre‐posttest design with the aim of evaluating the effectiveness of interventions with a stated primary goal of increasing student attendance (or decreasing absenteeism) among chronic truant students. Studies must have measured an attendance outcome and reported sufficient data to calculate an effect size. Finally, studies must have been published between 1990 and 2009 in the United States, United Kingdom, Australia, or Canada. DATA COLLECTION AND ANALYSIS A total of 28 studies, reported in 26 reports, met final eligibility criteria and were included in this review and meta‐analysis. Of the studies that were included, 5 utilized a randomized design (RCT), 11 utilized a quasi‐experimental design (QED), and 12 utilized a single group pre‐posttest design (SGPP). All eligible studies were coded using a structured coding instrument, with 20% of studies coded by a second coder. Descriptive analysis was conducted to examine and describe data related to the characteristics of the included studies. Analysis of the mean effect size, the heterogeneity of effect sizes, and the relationship between effect size and methodological and substantive characteristics of the interventions was also conducted separately for the RCT/QED studies and the SGPP studies. The effect sizes were calculated using the standardized mean difference effect size statistic, correcting for small sample size using Hedges' g (Hedges, 1992). Assuming a mixed effects model, the analog to the ANOVA and bivariate meta‐regression frameworks were used to examine potential moderating variables related to study, participant, and intervention characteristics. RESULTS The meta‐analytic findings demonstrated a significant overall positive and moderate mean effect of interventions on attendance outcomes. The mean effect size for interventions examined in the included RCT studies was .57 and the mean effect size for the QED studies was .43. No significant differences were observed between the RCT and QED studies in the magnitude of the treatment effect (Qb= .28, p >.05). The mean effect size of interventions examined using an SGPP design was .95. A moderate effect on attendance outcomes is encouraging; however, the overall mean effect size is masked by a large amount of heterogeneity, indicating significant variance in effect sizes between studies. Moderator analyses found no significant differences in mean effects between studies on any moderating variable tested. No differences were found between school‐, court‐, or community‐based programs or between different modalities of programs. The duration of the intervention also did not demonstrate any association with effect size. Collaborative programs and multimodal interventions produced statistically similar effects on attendance as non‐collaborative and single‐modality programs, which runs counter to the prevailing beliefs and recommendations for best practices in truancy reduction found in the literature. Other significant findings from this study relate to methodological shortcomings, the absence of important variables as well as gaps in the evidence base. These findings include the lack of inclusion of minority students and a lack of reporting and statistical analysis of demographic variables, particularly race/ethnicity and socioeconomic status (SES). Given that race and SES have been linked to absenteeism, the absence of this data was surprising. The majority of studies also lacked adequate descriptions of the interventions, making replication of the intervention difficult, and failed to measure and report long‐term outcomes. AUTHORS' CONCLUSIONS Overall, the findings from this study suggest that chronic truant students benefit from interventions targeting attendance behaviors; thus it is important and worthwhile to intervene with chronic truant youth. Given the minimal differences in effects across program types and modalities, no one program type or modality stands out as being more effective than any other. Although no statistically significant differences in effects were found between types and modalities of interventions included in this review, there was a lack of available evidence to support the general belief (and popular “best‐practice” recommendations) that collaborative and multimodal interventions are more effective than programs that are not collaborative and single modal interventions. Due to the small sample size and large heterogeneity between studies and within groups of studies, caution must be used when interpreting and applying the findings from this meta‐analysis. Overall, the studies included in the review improved attendance by an average of 4.69 days, almost a full school week. However, although the interventions included in this study were, overall, found to be effective, the mean rates of absenteeism at posttest in most studies remained above acceptable levels. This finding indicates the need for additional work and research. Developing more effective interventions and policies as well as studying outcomes of interventions, particularly with vulnerable and at‐risk populations, is crucial to combating absenteeism. The gaps and deficiencies identified in this study also affirm the need for increasing and strengthening the evidence base on which current policies and practices rest. Although additional outcome research is necessary, more of the same is not sufficient. Significant improvements in the quality of truancy intervention research are required and identified gaps need to be addressed. Recommendations to improve the quality and fill gaps in truancy intervention research are discussed here. In addition, given the significant and pervasive deficiencies in the extant research, a critical analysis of the practices, assumptions, and sociopolitical contexts underlying truancy intervention research seems warranted.

Background. The purpose of this study was to explore healthcare providers’ perspectives on antiretroviral (ART) adherence in two ART clinics in southern Malawi. Nonadherence to ART is a significant hindrance to the success of HIV/AIDS treatment. Methods. A one-on-one semistructured interview was conducted with eight healthcare providers in two ART clinics in rural and urban southern Malawi. The interviews were focused on factors facilitating or hindering ART adherence and strategies to improve adherence. Interviews were audio-recorded, transcribed, and content-analyzed with the use of the constant comparison approach. Results. Of the eight participants, 63% were between the ages of 20 and 30 years and 37% were HIV counselors. Factors facilitating adherence include patients’ belief and knowledge, HIV/AIDS education, and a supportive network. Barriers to adherence include discrimination, nondisclosure of HIV status, food insecurity, medication side effects, religion, misinformation, and staff and drug shortages. Strategies to improve adherence were identified by participants to include nutritional/food supplementation for malnourished or undernourished patients and patient counseling. Conclusions. There is a need for collaborative efforts between healthcare providers, patients, and faith-based organizations to identify and address hindrances and facilitators to patients’ adherence. Further research is needed to develop strategies addressing religion, staff, and drug shortages.

Background It is unclear how to geographically distribute percutaneous coronary intervention (PCI) programs to optimize patient outcomes. The Washington State Certificate of Need program seeks to balance hospital volume and patient access through regulation of elective PCI. Methods and Results We performed a retrospective cohort study of all non‐Veterans Affairs hospitals with PCI programs in Washington State from 2009 to 2018. Hospitals were classified as having (1) full PCI services and surgical backup (legacy hospitals, n=17); (2) full services without surgical backup (new certificate of need [CON] hospitals, n=9); or (3) only nonelective PCI without surgical backup (myocardial infarction [MI] access hospitals, n=9). Annual median hospital‐level volumes were highest at legacy hospitals (605, interquartile range, 466–780), followed by new CON, (243, interquartile range, 146–287) and MI access, (61, interquartile range, 23–145). Compared with MI access hospitals, risk‐adjusted mortality for nonelective patients was lower for legacy (odds ratio [OR], 0.59 [95% CI, 0.48–0.72]) and new‐CON hospitals (OR, 0.55 [95% CI, 0.45–0.65]). Legacy hospitals provided access within 60 minutes for 90% of the population; addition of new CON and MI access hospitals resulted in only an additional 1.5% of the population having access within 60 minutes. Conclusions Many PCI programs in Washington State do not meet minimum volume standards despite regulation designed to consolidate elective PCI procedures. This CON strategy has resulted in a tiered system that includes low‐volume centers treating high‐risk patients with poor outcomes, without significant increase in geographic access. CON policies should re‐evaluate the number and distribution of PCI programs.

Abstract Climate change is a mounting global issue, but its consequences will be variable across regions. Tropical species are hypothesized to have reduced climatic adaptability and plasticity. Yet, relative to temperate species, less is understood about how they will respond to climate change. Rising temperature and atmospheric CO2 could impact plant–herbivore systems directly by altering species traits or abundances, or the effects could be indirect by altering the strength and direction of the relationships that govern organismal strategies and interactions. Using open‐top chambers in a Neotropical wet forest, we applied a full‐factorial combination of active warming and CO2 fertilization to investigate the above‐ground, short‐term effects of climate change on plant–herbivore interactions in a common Neotropical shrub, Piper generalense. We aimed to answer two main questions: (1) Could climate change alter plant–herbivore systems through direct effects on plant growth rate, chemical defense, and/or insect herbivore damage rate? and (2) Could climate change affect plant–herbivore systems indirectly by altering (a) the strength of plant resource allocation trade‐offs between growth and defense or (b) the effectiveness of plant chemical defense against herbivory? None of the microclimate treatments had direct effects on plant growth, chemical defense, or herbivore damage. However, we did observe a positive relationship between growth and chemical defense in treatments mimicking climate‐change conditions, which partially supports the growth–differentiation balance hypothesis. We did not detect any effects of treatments on the effectiveness of plant chemical defense against herbivory. It appears that, in this system, increased CO2 concentration and temperature may cause indirect, cascading consequences, even where direct effects are not observable. We recommend more climate‐change experiments addressing multi‐trophic interactions that focus not only on the direct responses of organisms but also on the ways in which climate change can restructure the relationships that govern complex biotic systems.

Abstract Background Challenging classroom behaviors can interfere with student social and academic functioning and may be harmful to everyone in schools. Self‐management interventions within schools can address these concerns by helping students develop necessary social, emotional, and behavioral skills. Thus, the current systematic review synthesized and analyzed school‐based self‐management interventions used to address challenging classroom behaviors. Objectives The current study aimed to inform practice and policy by (a) evaluating the effectiveness of self‐management interventions at improving classroom behaviors and academic outcomes and (b) examining the state of research for self‐management interventions based on existing literature. Search Methods Comprehensive search procedures included electronically searching online databases (e.g., EBSCO Academic Search Premier, MEDLINE, ERIC, PsycINFO), hand‐searching 19 relevant journals (e.g., School Mental Health, Journal of School Psychology), reference‐list searching 21 relevant reviews, and searching gray literature (e.g., contacting authors, searching online dissertation/theses databases and national government clearinghouses/websites). Searches were completed through December of 2020. Selection Criteria Included studies employed either a multiple group‐design (i.e., experimental or quasi‐experimental) or single‐case experimental research design and met the following criteria: (a) utilized a self‐management intervention, (b) conducted in a school setting, (c) included school‐aged students, and (d) assessed classroom behaviors. Data Collection and Analysis Standard data collection procedures expected by the Campbell Collaboration were used in the current study. Analyses for single‐case design studies incorporated three‐level hierarchical models to synthesize main effects, and meta‐regression for moderation. Further, robust variance estimation was applied to both single‐case design and group‐design studies to account for dependency issues. Main Results Our final single‐case design sample included 75 studies, 236 participants, and 456 effects (i.e., 351 behavioral outcomes and 105 academic outcomes). Our final group‐design sample included 4 studies, 422 participants, and 11 total behavioral effects. Most studies occurred in the United States, in urban communities, in public schools, and in elementary settings. Single‐case design results indicated that self‐management interventions significantly and positively impacted both student classroom behaviors (LRRi = 0.69, 95% confidence interval [CI] [0.59, 0.78]) and academic outcomes (LRRi = 0.58, 95% CI [0.41, 0.76]). Single‐case results were found to be moderated by student race and special education status, whereas intervention effects were more pronounced for African American students (F = 5.56, p = 0.02) and students receiving special education services (F = 6.87, p = 0.01). Single‐case results were not found to be moderated by intervention characteristics (i.e., intervention duration, fidelity assessment, fidelity method, or training). Despite positive findings for single‐case design studies, risk of bias assessment indicated methodological shortcomings that should be considered when interpreting findings. A significant main effect of self‐management interventions for improving classroom behaviors was also revealed for group‐design studies (g = 0.63, 95% CI [0.08, 1.17]). However, these results should be interpreted with caution given the small number of included group‐design studies. Implications for Policy, Practice, and Research The current study, conducted using comprehensive search/screening procedures and advanced meta‐analytic techniques, adds to the large amount of evidence indicating that self‐management interventions can be successfully used to address student behaviors and academic outcomes. In particular, the use specific self‐management elements (i.e., self‐determining a performance goal, self‐observing and recording progress, reflecting on a target behavior, and administering primary reinforcers) should be considered within current interventions as well as in the development of future interventions. Future research should aim to assess the implementation and effects of self‐management at the group or classroom‐level within randomized controlled trials.

Abstract Background There is growing recognition that people need stronger financial capability to avoid and recover from financial difficulties and poverty. Researchers are testing financial capability interventions with adults, children, immigrant populations and other groups, but little is known about the effectiveness of financial capability interventions on financial behaviour and financial outcomes. Objectives The purpose of this review is to inform practice and policy by examining and synthesizing evidence of the effects of interventions designed to improve financial capability. Financial capability interventions combine financial education and financial products and/or services. The research questions are: (a) What are the effects of interventions designed to improve financial capability on financial behaviour and financial outcomes? and (b) Does study(design), intervention (dosage, duration, type) or sample (age) characteristics relate to the magnitude of effect size? Methods We conducted two identical rounds of electronic searches for two different time periods. In Round 1 searched for studies through May, 2017 and Round 2 searched from May, 2017 through May, 2020. For both rounds, we identified and retrieved both published and unpublished studies, including conference proceedings, through a comprehensive search that included multiple electronic databases, grey literature sources, organizational websites, government websites and reference lists of reviews and relevant studies. We also conducted forward citation searching using Google Scholar to search for studies citing the included studies. We also conducted a search on Google using key terms. We hand searched the table of contents of selected journals to identify potentially eligible reports not properly indexed. Finally, experts who were study or sub‐study authors of prior studies were contacted in an attempt to obtain unpublished studies, studies in process and published studies missed in the database search. Selection Criteria To be eligible for this review, the intervention must have included a financial education component and a financial product or service. Studies must have also been conducted in any of the 35‐member countries of the OECD, and included a financial behaviour or financial outcome. To meet the criteria for delivering financial education, interventions must have delivered information about: (1) a variety of general financial concepts and behaviours, or advice about financial behaviours); (2) a specific financial topic; (3) a specific product; and/or (4) a specific service. To meet the criteria for access to a financial product or service, interventions must have facilitated access to one or more of the following: (1) a child development account; (2) a retirement account through an employer; (3) a ‘second chance’ checking account; (4) a matched savings account; (5) a financial service, such as financial counselling or coaching; (6) a bank account; (7) an investment vehicle; or (8) a home mortgage loan product. Data Collection and Analysis Electronic searches of bibliographic databases and searches of other sources identified a total of 35,484 hits. Titles and abstracts were screened for relevance and 35,071 were excluded as duplicates or deemed inappropriate. The full text of the remaining 416 potential studies was reviewed and screened for eligibility by two independent coders. We excluded 353 reports that were deemed ineligible and included 63 reports that met inclusion criteria. Of the 63, 15 reports were deemed duplicates or summary reports. Of the remaining 48 reports, 24 were unique studies (using unique samples) that were included in this review. Six of those 24 studies were large longitudinal studies that presented unique analyses (using different time points, subsamples, and/or outcomes). Thus, we extracted data from 48 reports, reporting data and analyses from 24 unique studies. At least two review authors who were not study authors independently assessed risk of bias in all included studies using the Cochrane Collaboration's risk of bias tool. Results The review summarizes evidence from 63 reports from 24 unique studies, which included 17 randomized controlled trials and 7 quasi‐experimental designs. In addition, 17 duplicate or summary reports were also located. This review identified several different types of previously evaluated financial capability interventions. Unfortunately, few interventions that were evaluated by more than one study measured the same or similar outcomes, thus there were not a sufficient number of studies of any of the included intervention types that could be pooled to conduct a meta‐analysis. Therefore, evidence is sparse about whether participants’ financial behaviours and/or financial outcomes are improved. While the majority of the studies used random assignment (72%), many of the studies had some important methodological weakness. Authors’ Conclusions There is a lack of strong evidence about the effectiveness of financial capability intervention. Better evidence is needed about the effectiveness of financial capability interventions to guide practitioners.

Abstract Aims Despite advances in coronary reperfusion and percutaneous mechanical circulatory support, mortality among patients presenting with cardiogenic shock (CS) remains unacceptably high. Clinical trials and risk stratification tools have largely focused on acute CS, particularly secondary to acute coronary syndrome. Considerably less is understood about CS in the setting of acute decompensation in patients with chronic heart failure (HF). We sought to compare outcomes between patients with acute CS and patients with acute on chronic decompensated HF presenting with laboratory and haemodynamic features consistent with CS. Methods and results Sequential patients admitted with CS at a single quaternary centre between January 2014 and August 2017 were identified. Acute on chronic CS was defined by having a prior diagnosis of HF. Initial haemodynamic and laboratory data were collected for analysis. The primary outcome was in‐hospital mortality. Secondary outcomes were use of temporary mechanical circulatory support, durable ventricular assist device implantation, total artificial heart implantation, or heart transplantation. Comparison of continuous variables was performed using Student's t‐test. For categorical variables, the χ2 statistic was used. A total of 235 patients were identified: 51 patients (32.8%) had acute CS, and 184 patients (64.3%) had acute decompensation of chronic HF with no differences in age (52 ± 22 vs. 55 ± 14 years, P = 0.28) or gender (26% vs. 23%, P = 0.75) between the two groups. Patients with acute CS were more likely to suffer in‐hospital death (31.4% vs. 9.8%, P

Abstract Given the importance of Kentucky bluegrass (Poa pratensis L.) seed production in the inland Pacific Northwest, USA, and the difficulty to predict and maintain seed yields as production fields age, greater knowledge of the impact of reduced or nonthermal practices on seed yield and stand longevity is necessary. Longer‐term studies (>3 yr) are needed to maintain high bluegrass seed yields, reduce soil erosion, and amortize the expense of stand establishment. The purpose of this study was to measure the impact of residue management practice on seed production throughout the expected 7‐yr life of a bluegrass field. Four residue management treatments—full load burn (FLB), bale then burn (BB), bale then mow then harrow (MEC), and rotation system (SYS) (MEC in Year 1, BB in Year 2, and FLB in Year 3)—were evaluated from 2002–2007. Average seed yields over the entire study period were 774 kg ha–1 in FLB, 742 kg ha–1 in BB, 525 kg ha–1 in MEC, and 600 kg ha–1 in SYS. Nonstanding residue removal was difficult to accomplish using MEC compared with FLB. Reduced‐burn methods (BB and SYS), however, were able to keep this residue level lower than MEC, and therefore yielded more than MEC. Across‐treatment regression suggest that seed yield was negatively influenced by the amount of nonstanding residue in the previous fall (r2 = .64), yet positively influenced by the nitrogen content of standing biomass in the previous fall (r2 = .78). Profitability was highest in BB and FLB. Overall, understanding the factors that relate to stand decline may help growers prolong stand life and increase profitability, while mitigating air quality issues.

Abstract Most modern threats to biodiversity are due to human actions. Conservation psychology models provide tools to strategically change human behaviors to reduce these threats; however, behavior change theories have yet to be fully incorporated into conservation strategic planning techniques. The public that may be interested in a conservation issue are often untapped resources to expand a conservation organization's limited reach. Increased public participation could fill a gap between an organization's objectives and the scope of what is feasible for limited staff or budget. This study presents an expanded framework for biodiversity conservation strategic planning using conservation behaviors. Some conservation organizations, such as zoos and aquariums, have access to extensive audiences that could be mobilized to take‐action to directly reduce threats to biodiversity or indirectly support others' efforts. To test our expanded planning framework, we evaluated the current status of conservation behavior change techniques used by zoos, which are increasingly identifying as conservation organizations. We used the framework to measure whether zoos are providing conservation behavior opportunities to their audiences of millions. The framework consisting of 12 behaviors nested within five categories includes behaviors in the public and private spheres. We tested the framework using content analyses of 211 zoo's websites across North America, sampled from the Association of Zoos and Aquariums. The methods elicited 2,187 conservation projects for the sample, only 32% of which provided any form of conservation behavior change opportunities to the zoo audiences. We present the range and frequency of conservation behavior strategies in zoos, revealing their current strengths as conservation organizations and opportunities for improved audience activation. The results demonstrate the value of integrating the conservation behavior change framework into biodiversity conservation strategic planning for conservation organizations. The framework can be used to facilitate expanded conservation activities, a valuable opportunity to reduce threats to biodiversity.

Background Patient selection and outcomes for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) have changed over the past decade. However, there is limited information on outcomes for both revascularization strategies in the same population. The study evaluated temporal changes in risk profile, procedural characteristics, and clinical outcomes for PCI‐ and CABG‐treated patients. Methods and Results We analyzed all PCI and isolated CABG between 2005 and 2017 in nonfederal hospitals in Washington State. Descriptive analysis was performed to evaluate temporal changes in risk profile and, risk‐adjusted in‐hospital mortality. Over the study period, 178 474 PCI and 36 592 CABG procedures were performed. PCI and CABG volume decreased by 2.9% and 22.6%, respectively. Compared with 2005–2009, patients receiving either form of revascularization between 2014 and 2017 had a higher prevalence of comorbidities including diabetes mellitus and hypertension and dialysis. Presentation with ST‐segment–elevation myocardial infarction (17% versus 20%) and cardiogenic shock (2.4% versus 3.4%) increased for patients with PCI compared with CABG. Conversely, clinical acuity decreased for patients receiving CABG over the study period. From 2005 to 2017, mean National Cardiovascular Data Registry CathPCI mortality score increased for patients treated with PCI (20.1 versus 22.4, P