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Field experiments were conducted over 2 yr (2019 to 2020) at two locations in Iowa to evaluate multi-tactic strategies for managing multiple herbicide–resistant (MHR) waterhemp [Amaranthus tuberculatus (Moq.) Sauer] in a corn (Zea mays L.)–soybean [Glycine max (L.) Merr.] rotation. The effect of three herbicide programs on A. tuberculatus control was tested in corn (2019). The effects of the prior year’s corn weed control, a cereal rye (Secale cereale L.) cover crop, and soybean row spacing (38-cm vs. 76-cm wide) on A. tuberculatus density, biomass, and seed production were tested in soybean (2020). A herbicide program used in corn with two sites of action provided only 35% control of MHR A. tuberculatus compared with ≥97% control by a herbicide program with three sites of action. In soybean, adequate control of A. tuberculatus (≥90%) in the prior year’s corn crop and use of a cover crop or narrow rows reduced A. tuberculatus density by more than 60% at 3 and 9 wk after planting (WAP) compared with inadequate control (30%) in the prior year’s corn and no cover crop. Cover crop and narrow-row soybean reduced A. tuberculatus density by 44% at 3 WAP compared with no cover crop and wide-row soybean. Inclusion of a single control tactic, adequate control (≥90%) with multiple herbicides in the prior year’s corn, use of a cover crop, or narrow-row soybean reduced A. tuberculatus biomass and seed production at soybean harvest by at least 24% compared with inadequate control (30%) in the prior year’s corn, no cover crop, and wide-row soybean. The combination of all three control tactics reduced A. tuberculatus biomass and seed production at soybean harvest by at least 80%. In conclusion, diverse control tactics targeting A. tuberculatus at multiple life-cycle stages can make substantial contributions to the management of MHR populations.

Development of integrated weed management strategies requires knowledge of weed emergence timing and patterns, which are regulated primarily by water and thermal requirements for seed germination. Laboratory experiments were conducted in fall 2017 to fall 2018 to quantify the effect of osmotic potential and temperature on germination of 44 kochia [Bassia scoparia (L.) A.J. Scott] populations under controlled conditions. Bassia scoparia populations were collected in fall 2016 from northern (near Huntley, MT, and Powell, WY) and southern (near Lingle, WY, and Scottsbluff, NE) regions of the U.S. Great Plains. Ten osmotic potentials from 0 to −2.1 MPa and eight constant temperatures from 4 to 26 C were evaluated. Response of B. scoparia populations to osmotic potential did not differ between the northern and southern regions. At an osmotic potential of 0 MPa, all B. scoparia populations had greater than 98% germination, and the time to achieve 50% germination (t50) was less than 1 d. At −1.6 MPa, 25% of seeds of all B. scoparia populations germinated. Osmotic potentials of −0.85 and −1.9 MPa reduced B. scoparia germination by 10% and 90%, respectively. Regardless of temperature regime, all populations exhibited greater than 88% germination. The germination rate was highest at temperatures between 15 to 26 C and did not differ between populations from northern versus southern regions. At this temperature range, all populations had a t50 of less than 1 d. However, at 4 C, B. scoparia populations from the northern region had a higher germination rate (5 h) and cumulative germination (7%) than populations from the southern region. Overall, these results indicate a wide range of optimum temperatures and osmotic potential requirements for B. scoparia germination.

The herbicides that inhibit 4-hydroxyphenylpyruvate dioxygenase (HPPD) are primarily used for weed control in corn, barley, oat, rice, sorghum, sugarcane, and wheat production fields in the United States. The objectives of this review were to summarize 1) the history of HPPD-inhibitor herbicides and their use in the United States; 2) HPPD-inhibitor resistant weeds, their mechanism of resistance, and management; 3) interaction of HPPD-inhibitor herbicides with other herbicides; and 4) the future of HPPD-inhibitor-resistant crops. As of 2022, three broadleaf weeds (Palmer amaranth, waterhemp, and wild radish) have evolved resistance to the HPPD inhibitor. The predominance of metabolic resistance to HPPD inhibitor was found in aforementioned three weed species. Management of HPPD-inhibitor-resistant weeds can be accomplished using alternate herbicides such as glyphosate, glufosinate, 2,4-D, or dicamba; however, metabolic resistance poses a serious challenge, because the weeds may be cross-resistant to other herbicide sites of action, leading to limited herbicide options. An HPPD-inhibitor herbicide is commonly applied with a photosystem II (PS II) inhibitor to increase efficacy and weed control spectrum. The synergism with an HPPD inhibitor arises from depletion of plastoquinones, which allows increased binding of a PS II inhibitor to the D1 protein. New HPPD inhibitors from the azole carboxamides class are in development and expected to be available in the near future. HPPD-inhibitor-resistant crops have been developed through overexpression of a resistant bacterial HPPD enzyme in plants and the overexpression of transgenes for HPPD and a microbial gene that enhances the production of the HPPD substrate. Isoxaflutole-resistant soybean is commercially available, and it is expected that soybean resistant to other HPPD inhibitor herbicides such as mesotrione, stacked with resistance to other herbicides, will be available in the near future.

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.

Evolution of multiple herbicide–resistant Palmer amaranth warrants the development of integrated strategies for its control in the southcentral Great Plains (SGP). To develop effective control strategies, a better understanding of the emergence biology of Palmer amaranth populations from the SGP region is needed. A common garden study was conducted in a no-till (NT) fallow field at the Kansas State University Agricultural Research Center near Hays, KS, during the 2018 and 2019 growing seasons, to determine the emergence pattern and periodicity of Palmer amaranth populations collected from the SGP region. Nine Palmer amaranth populations collected from five states were included: Colorado (CO1, CO2), Oklahoma (OK), Kansas (KS1, KS2), Texas (TX), and Nebraska (NE1, NE2, NE3). During the 2018 growing season, the CO1 and KS1 populations displayed more rapid emergence rates, with greater parameter b values (−5.4, and −5.3, respectively), whereas the TX and NE3 populations had the highest emergence rates (b = −12.2) in the 2019 growing season. The cumulative growing degree days (cGDD) required to achieve 10%, 50%, and 90% cumulative emergence ranged from 125 to 144, 190 to 254, and 285 to 445 in 2018; and 54 to 74, 88 to 160, and 105 to 420 in the 2019 growing season across all tested populations, respectively. The OK population exhibited the longest emergence duration (301 and 359 cGDD) in both growing seasons. All tested Palmer amaranth populations had a peak emergence period between May 11 and June 8 in 2018, and April 30 and June 1 in the 2019 growing season. Altogether, these results indicate the existence of differential emergence pattern and peak emergence periods of geographically distant Palmer amaranth populations from the SGP region. This information will help in developing prediction models for decision-making tools to manage Palmer amaranth in the region.

Late-season control of Palmer amaranth in postharvest wheat stubble is important for reducing the seedbank. Our objectives were to evaluate the efficacy of late-season postemergence herbicides for Palmer amaranth control, shoot dry biomass, and seed production in postharvest wheat stubble. Field experiments were conducted at Kansas State University Agricultural Research Center near Hays, KS, during 2019 and 2020 growing seasons. The study site had a natural seedbank of Palmer amaranth. Herbicide treatments were applied 3 wk after wheat harvest when Palmer amaranth plants had reached the inflorescence initiation stage. Palmer amaranth was controlled by 96% to 98% 8 wk after treatment and shoot biomass as well as seed production was prevented when paraquat was applied alone or when mixed with atrazine, metribuzin, flumioxazin, 2,4-D, sulfentrazone, pyroxasulfone + sulfentrazone, or flumioxazin + metribuzin, and with glyphosate + dicamba, glyphosate + 2,4-D, saflufenacil + 2,4-D, glufosinate + dicamba + glyphosate, and glufosinate + 2,4-D + glyphosate. Palmer amaranth was controlled by 89% to 93% with application of glyphosate, glufosinate, dicamba + 2,4-D, saflufenacil + atrazine, and saflufenacil + metribuzin resulting in Palmer amaranth shoot biomass of 15 to 56 g m−2 and production of 1,080 to 7,040 seeds m−2. Palmer amaranth control was less than 86% with application of dicamba, 2,4-D, dicamba + atrazine, and saflufenacil resulting in Palmer amaranth shoot biomass of 38 to 47 g m−2 and production of 3,110 to 6,190 seeds m−2. Palmer amaranth was controlled 63% and 72%, shoot biomass was 178 and 161 g m−2, and seed production was 35,180 and 39,510 seeds m−2, respectively, with application of 2,4-D + bromoxynil + fluroxypyr, and bromoxynil + pyrasulfotole + atrazine. Growers should use these effective postemergence herbicide mixes for Palmer amaranth control to prevent seed prevention postharvest in wheat stubble.

Glyphosate-resistant (GR) Palmer amaranth is one of the most difficult to control weeds in soybean production fields in Nebraska and the United States. An integrated approach is required for effective management of GR Palmer amaranth. Cultural practices such as narrow row spacing might augment herbicide efficacy for management of GR Palmer amaranth. The objectives of this study were to evaluate the effect of row spacing and herbicide programs for management of GR Palmer amaranth in dicamba/glyphosate-resistant (DGR) soybean. Field experiments were conducted in a grower’s field with a uniform population of GR Palmer amaranth near Carleton, Nebraska, in 2018 and 2019. Year-by-herbicide program-by-row spacing interactions were significant for all variables; therefore, data were analyzed by year. Herbicides applied PRE controlled GR Palmer amaranth ≥95% in both years 14 d after PRE (DAPRE). Across soybean row-spacing, most PRE followed by (fb) early-POST (EPOST) herbicide programs provided 84% to 97% control of Palmer amaranth compared with most EPOST fb late-post (LPOST) programs, excluding dicamba in single and sequential applications (82% to 95% control). Mixing microencapsulated acetochlor with a POST herbicide in PRE fb EPOST herbicide programs controlled Palmer amaranth ≥93% 14 d after EPOST and ≥96% 21 d after LPOST with no effect on Palmer amaranth density. Interaction of herbicide program-by-row spacing on Palmer amaranth control was not significant; however, biomass reduction was significant at soybean harvest in 2019. The herbicide programs evaluated in this study caused no soybean injury. Due to drought conditions during a majority of the 2018 growing season, soybean yield in 2018 was reduced compared with 2019.

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].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.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, p0.001, 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, p0.001). 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.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.

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.

Kochia accessions (designated as KS-4A and KS-4H) collected from a corn field near Garden City, KS, have previously shown multiple resistance to glyphosate, dicamba, and fluroxypyr. These accessions were also suspected as being resistant to photosystem II (PS II) inhibitors. The main objectives of this research were to 1) confirm the coexistence of cross-resistance to PS II inhibitors (atrazine and metribuzin) applied PRE and POST, 2) investigate the underlying mechanism of PS II-inhibitor resistance, and 3) determine the effectiveness of alternative POST herbicides for control of these multiple herbicide–resistant (MHR) kochia accessions. Results from dose-response experiments revealed that the KS-4A and KS-4H kochia accessions were 23-fold to 48-fold resistant to PRE- and POST-applied atrazine and 13-fold to 18-fold resistant to POST-applied metribuzin compared to a known susceptible kochia accession (KS-SUS). Both accessions also showed putative resistance to PRE-applied metribuzin that needs to be confirmed. Sequence analyses of the psbA gene further revealed that all samples from the KS-4A and KS-4H kochia accessions had a Ser264Gly point mutation. A pretreatment with malathion followed by a POST application of atrazine at 1,120 g ha−1 or metribuzin at 630 g ha−1 did not reverse the resistance phenotypes of these MHR accessions. In a separate greenhouse study, alternative POST herbicides, including bicyclopyrone + bromoxynil; bromoxynil + pyrasulfotole; paraquat alone or in combination with atrazine, metribuzin, 2,4-D, or saflufenacil; and saflufenacil alone or in combination with 2,4-D effectively controlled the KS-4H accession (≥97% injury). To our knowledge, this research reports the first case of kochia accessions with cross-resistance to PRE-applied atrazine and POST-applied metribuzin. Growers should adopt diversified weed control strategies, including the use of competitive crops, cover crops, targeted tillage, and harvest weed seed control along with effective alternative PRE and POST herbicides with multiple sites of action to control MHR kochia seedbanks on their production fields.

Isolated chylopericardium is an exceedingly rare complication in any age group. Review of the limited published case series shows the most common cause of isolated chylopericardium to be cardiac surgery. We present a case of isolated chylopericardium after a bidirectional Glenn procedure in an infant with hypoplastic left heart syndrome. (Level of Difficulty: Intermediate.), Graphical abstract

The growth response of annual sowthistle (Sonchus oleraceusL.) to anticipated future climate conditions is currently unknown, and thus two parallel studies were conducted dealing with glyphosate-resistant (GR) and glyphosate-susceptible (GS) biotypes ofS. oleraceus. The glyphosate efficacy study was conducted using different doses of glyphosate (0 [control], 180, 360, 720 [recommended dose], and 1,440 g ae ha−1) at two different moisture levels (well-watered and water-stressed conditions). In the second study, the growth and seed production of these biotypes were studied under different atmospheric carbon dioxide (CO2) concentrations (450 and 750 ppm) and under well-watered (100% field capacity) and water-stressed (50% field capacity) conditions. Results showed that the GR biotype survived (>68%) at 1,440 g ha−1, but for the GS biotype, no plant survived, and both biotypes were slightly (2condition, the GS biotype plants were >38% taller and produced >44%, >18%, and >21% more leaves, buds, and seeds, respectively, compared with the ambient CO2concentration under both moisture regimes. The biomass also increased by 27% in comparison with the ambient CO2concentration. For the GR biotype, plants at the elevated CO2level, while they also grew 38% taller in comparison with the ambient CO2concentration, the numbers of leaves, buds, and seeds and biomass were not affected by this increase in CO2. Results showed that there were minimal changes in response to glyphosate for GR and GS biotypes ofS. oleraceuswith or without moisture stress. Our study suggests that future climate change with elevated CO2levels can affect the response ofS. oleraceusto glyphosate, and such knowledge will be helpful for weed management in the future.

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.

The widespread evolution of herbicide resistance in weed populations has become an increasing concern for no-tillage (NT) growers in semiarid regions of the U.S. Great Plains. Lack of cost-effective and alternative new herbicide sites of action further exacerbates the problem of herbicide-resistant (HR) weeds and threatens the long-term sustainability of prevailing cropping systems in the region. A recent decline in commodity prices and increasing herbicide costs to manage HR weeds has spurred research efforts to build a strong rationale for developing ecologically based integrated weed management (IWM) strategies in the U.S. Great Plains. Integration of cover crops (CCs) in NT dryland production systems potentially offers several ecosystem services, including weed control, soil health improvement, decline in selective pest pressure, and overall reduction in pest management inputs. This review article aims to document the role of CCs for IWM, with emphasis on exploring emerging weed issues; ecological, economic, and agronomic benefits of growing CCs; and constraints preventing adoption of CCs in NT cropping systems in the semiarid Great Plains. We attempt to focus on changes in weed management practices, their long-term impacts on weed seedbanks, weed shifts, and herbicide-resistance evolution in the most common weed species in the region. We also highlight current knowledge gaps and propose new research priorities based on an improved understanding of CC management strategies that will ultimately aid in achieving sustainable weed management goals and preserving natural resources in water-limited environments.

Understanding the effects of crop management practices on weed survival and seed production is imperative in improving long-term weed management strategies, especially for herbicide-resistant weed populations. Kochia [Bassia scoparia (L.) A.J. Scott] is an economically important weed in western North American cropping systems for many reasons, including prolific seed production and evolved resistance to numerous herbicide sites of action. Field studies were conducted in 2014 in a total of four field sites in Wyoming, Montana, and Nebraska to quantify the impact of different crop canopies and herbicide applications on B. scoparia density and seed production. Crops used in this study were spring wheat (Triticum aestivum L.), dry bean (Phaseolus vulgaris L.), sugar beet (Beta vulgaris L.), and corn (Zea mays L.). Herbicide treatments included either acetolactate synthase (ALS) inhibitors effective on non-resistant B. scoparia or a non–ALS inhibiting herbicide effective for both ALS-resistant and ALS-susceptible B. scoparia. Bassia scoparia density midseason was affected more by herbicide choice than by crop canopy, whereas B. scoparia seed production per plant was affected more by crop canopy compared with herbicide treatment. Our results suggest that crop canopy and herbicide treatments were both influential on B. scoparia seed production per unit area, which is likely a key indicator of long-term management success for this annual weed species. The lowest germinable seed production per unit area was observed in spring wheat treated with non–ALS inhibiting herbicides, and the greatest germinable seed production was observed in sugar beet treated with ALS-inhibiting herbicides. The combined effects of crop canopy and herbicide treatment can minimize B. scoparia establishment and seed production.

Kochia [Bassia scoparia (L.) A. J. Scott] represents one the most troublesome weeds in crop production systems in the North American Great Plains. The development of herbicide-resistant B. scoparia populations further exacerbated this problem. More ecologically driven approaches to its control are necessary. This study examined the competitive effects of four crops (sugar beet, soybean, barley, and corn) in combination with B. scoparia densities (3, 13, 24, 47, 94, and 188 plants m-2) on B. scoparia development and seed production across 2 years. Corn and barley had the greatest impact on B. scoparia growth and fecundity. B. scoparia biomass was 87 and 82% lower and seed production was 98 and 96% lower (pB. scoparia biomass and seed production. Barley had greatest effect in delaying B. scoparia flowering which occurred 113 days after B. scoparia emergence (pB. scoparia biomass by 70 and 65% and seed production by 84 and 80% (pB. scoparia densities resulted in reductions in B. scoparia width, number of primary branches, biomass plant-1, and seeds plant-1 but increased B. scoparia height, biomass m-2, and seeds m-2 (pB. scoparia through reduced fecundity and delayed flowering, with the latter providing a window of opportunity for post-harvest control. The effects observed here were isolated from differences in herbicide practices that are associated with each of these crops, differences that have a dramatic effect on B. scoparia in their own right.

We are presenting a case of 4-years-old previously healthy male with coma, severe acute hepatitis and multiorgan failure in presence of Influenza infection. Literature review highlighted an immune-mediated pathophysiology for such presentations so the child underwent a trial of plasmapheresis which resulted in a rapid clinical improvement and child was discharge in his baseline neurologic status by day 14.

Evolution of kochia resistance to glyphosate and dicamba is a concern for growers in the US Great Plains. An increasing use of glyphosate and dicamba with the widespread adoption of glyphosate/dicamba-resistant (GDR) soybean in recent years may warrant greater attention. Long-term stewardship of this new stacked-trait technology will require the implementation of diverse weed control strategies, such as the use of soil-residual herbicides (PRE) aimed at effective control of GDR kochia. Field experiments were conducted in Huntley, MT, in 2017 and 2018, and Hays, KS, in 2018 to determine the effectiveness of various PRE herbicides applied alone or followed by (fb) a POST treatment of glyphosate plus dicamba for controlling GDR kochia in GDR soybean. Among PRE herbicides tested, sulfentrazone provided complete (100%), season-long control of GDR kochia at both sites. In addition, PRE fb POST programs tested in this study brought 71% to 100% control of GDR kochia throughout the season at both sites. Pyroxasulfone applied PRE resulted in 57% to 70% control across sites at 9 to 10 wk after PRE (WAPRE). However, mixing dicamba with pyroxasulfone improved control up to 25% at both sites. Kochia plants surviving pyroxasulfone applied PRE alone produced 2,530 seeds m−2 compared with pyroxasulfone + dicamba (230 seeds m−2) at the Montana site. No differences in soybean grain yields were observed with PRE alone or PRE fb POST treatments at the Montana site; however, dicamba, pyroxasulfone, and pendimethalin + dimethenamid-P applied PRE brought lower grain yield (1,150 kg ha−1) compared to all other tested programs at the Kansas site. In conclusion, effective PRE or PRE fb POST (two-pass) programs tested in this research should be proactively utilized by the growers to manage GDR kochia in GDR soybean.

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.

Glyphosate-resistant junglerice [Echinochloa colona (L.) Link] is a problematic weed in mungbean [Vigna radiata (L.) R. Wilczek] crops in Australia. Due to limited herbicide options in mungbean, there is an increased interest in developing integrated management strategies for the sustainable control of E. colona. Pot experiments were conducted in a screenhouse in 2017 and 2018 by growing E. colona plants (glyphosate-resistant [GR] and glyphosate-susceptible [GS] biotypes) alone (1 plant pot−1) and in competition with 4 and 8 mungbean plants pot−1. Both biotypes were developed from a single population using the clone method. The growth and seed production of both GR and GS biotypes were similar in response to mungbean competition. Averaged over biotypes, there was a reduction in the growth and seed production of E. colona as crop plants increased. Compared with the weed plants grown alone, crop interference reduced E. colona height by 17% to 19%, tiller numbers by 69% to 82%, total shoot biomass by 85% to 91%, and inflorescence numbers by 74% to 91%. When E. colona was grown with 8 mungbean plants pot−1, leaf weight ratio increased by 42% compared with plants grown alone. Compared with weed plants grown alone, mungbean interference (4 and 8 plants pot−1) reduced weed seed production by 85% to 95%. These reductions were similar for both biotypes (GR and GS), suggesting that there was no fitness penalty associated with resistance. The results of this study suggest that mungbean interference can reduce E. colona growth and seed production, but it should not be considered as a stand-alone strategy to manage E. colona and similar species in mungbean. These results also highlight the need for integrating crop competition with other management strategies to achieve complete and sustainable management of this weed.

Dicamba-resistant (DR) kochia is an increasing concern for growers in the US Great Plains, including Kansas. Greenhouse and field experiments (Garden City and Tribune, KS, in the 2014 to 2015 growing season) were conducted to characterize the dicamba resistance levels in two recently evolved DR kochia accessions collected from fallow fields (wheat–sorghum–fallow rotation) near Hays, KS, and to determine the effectiveness of various PRE herbicide tank mixtures applied in fall or spring prior to the fallow year. Dicamba dose–response studies indicated that the KS-110 and KS-113 accessions had 5- to 8-fold resistance to dicamba, respectively, relative to a dicamba-susceptible (DS) accession. In separate field studies, atrazine-based PRE herbicide tank mixtures, dicamba + pendimethalin + sulfentrazone, and metribuzin + sulfentrazone when applied in the spring had excellent kochia control (85% to 95%) for 3 to 4 mo at the Garden City and Tribune sites. In contrast, kochia control with those PRE herbicide tank mixtures when applied in the fall did not exceed 79% at the later evaluation dates. In conclusion, the tested kochia accessions from western Kansas had evolved moderate to high levels of resistance to dicamba. Growers should utilize these effective PRE herbicide tank mixtures (multiple sites of action) in early spring to manage kochia seed bank during the summer fallow phase of this 3-yr crop rotation (wheat–corn/sorghum–fallow) in the Central Great Plains.

Evolution and rapid spread of herbicide-resistant (HR) kochia has become a significant challenge for growers in the U.S. Great Plains. The main objectives of this research were to confirm and characterize the response of putative auxinic HR (Aux-HR) kochia accessions (designated as KS-4A, KS-4D, KS-4H, KS-10A, KS-10-G, and KS-10H) collected from two different corn fields near Garden City, KS, to dicamba and fluroxypyr and to determine the EPSPS gene copy number to detect whether those accessions were also resistant to glyphosate. Single-dose experiments indicated that putative Aux-HR kochia accessions had 78% to 100% and 85% to 100% survivors when treated with dicamba (560 g ae ha−1) and fluroxypyr (235 g ae ha−1), respectively. Whole-plant dicamba dose–response studies revealed that the selected Aux-HR accessions had 2.9- to 15.1- and 3.1- to 9.4-fold resistance to dicamba relative to two susceptible accessions (MT-SUS and KS-SUS). In a separate fluroxypyr dose–response experiment, the selected Aux-HR accessions also exhibited 3.8- to 7.3- and 3.0- to 8.6-fold resistance to fluroxypyr on the basis of shoot fresh and dry weight responses, respectively. The confirmed Aux-HR kochia accessions also had 3 to 13 EPSPS gene copies relative to MT-SUS and KS-SUS accessions (each with 1 EPSPS gene copy). These results suggest that the putative Aux-HR kochia accessions from Kansas had developed moderate to high levels of cross-resistance to dicamba and fluroxypyr and low to high levels of resistance to glyphosate. This is the first confirmation of kochia accessions with cross-resistance to dicamba and fluroxypyr in Kansas. Growers should use diverse kochia control programs, including the proper use of dicamba and fluroxypyr stewardship, use of cover crops, occasional tillage, diversified crop rotations, and alternative effective herbicides to prevent further evolution and spread of Aux-HR kochia on their fields.

Sonchus oleraceus is becoming a hard-to-control weed in Australian cropping systems, especially in glyphosate-tolerant cotton and during summer fallows. Several biotypes of this weed have developed resistance to glyphosate as a result of common management practices under conservation agriculture systems in the country. A series of pot experiments were conducted to evaluate the effect of temperature on glyphosate efficacy and performance of several post-emergence and pre-emergence herbicides on a glyphosate-resistant (GR) and a glyphosate-susceptible (GS) biotype of S. oleraceus. At low temperatures (19&ndash, 24 &deg, C), no plants of the GS biotype survived glyphosate application at 570 g/ha, however, in the high-temperature regime (28&ndash, 30 &deg, C), 83% of the plants survived this rate of glyphosate. Similarly, for the GR biotype, up to 58% of the plants survived at 2280 g/ha of glyphosate when applied during the high-temperature regime and no plants survived this rate during the low-temperature regime. A number of post-emergence herbicides were found to be effective for S. oleraceus control. However, herbicide application delayed to the six-leaf stage compared with the four-leaf stage reduced control, especially for bromoxynil and saflufenacil herbicides. Glufosinate and paraquat were the most effective herbicides for S. oleraceus control, resulting in no seedling survival for both biotypes. Isoxaflutole, pendimethalin or s-metolachlor efficacy was not reduced by the presence of crop residue, suggesting that these herbicides could be used to control S. oleraceus in conservation agriculture systems. The results of this study suggest that growers will need to reduce over-reliance on glyphosate for weed control in summer fallows and use alternative post-emergence herbicides.

A COVID-19 disease threatens the population and the economies of the countries significantly. Till now, this pandemic has affected 215 counties or territories. Unavailability of vaccine is the primary concern for the society. To avoid the spread of this disease, social isolation must be preserved and the inter and intra-population movement must be minimized. To reduce the possibility of transmission, the categorization of regions based on susceptibility to COVID-19 infection is a must.Due to the unavailability of a large amount of paper collection for this novel COVID-19 diseases, we used current literature available on a COVID-19 susceptibility of the diabetic patient, human reproductivity, hemodialysis patient’s, pregnant women and meteorological factors and geographical location. Countries in the cold region are more susceptible to the risk of COVID-19 transmission. There was no evidence of the spread of this disease from non-respiratory bodies. Diabetic patients and pregnant women were found to be more susceptible to COVID-19 infection. Anosmia was observed in the majority of the COVID-19 infected cases in European countries. No evidence indicates COVID-19's impact on the human reproductive system explicitly. No cases of vertical transmission of this disease have been observed until now. All the studies available till now is the small scale study. Correlation with something always does not mean causation. There are certain factor like pollution level, temperature Diurnal temperature range, geographical factor, humidity, pollution level, wind speed, population density, medical healthcare facilities social and political factor plays a critical role in transmitting the SARS-COV-2 virus. Besides the adverse effects, it has taught us to shed our selfish goals and to promote the welfare of all.

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.

We are in the middle of the COVID-19 pandemic and our healthcare systems have never looked so vulnerable and fragile. Humanity has put a brave face, and healthcare providers are our new warriors. From clapping for carers to lighting a diya (lights made of clay) or showering flowers on hospitals, we have given the token of appreciation to our front-line workers. But this sense of gratitude has been marred by the disturbing reports of lack of personal protective equipment at the front line. COVID-19 has just put a magnifying glass at the fault-lines within our health supplies and delivery systems, and our misplaced priorities. Innovation often optimises costs by reducing redundancies. The most glaring pitfall of this approach was the mad rush for ventilators in early 2020. ABCDs (Ambu bag compression …

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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.

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.