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Atypical hemolytic uremic syndrome (aHUS) is a rare, possibly life-threatening disease characterized by platelet activation, hemolysis and thrombotic microangiopathy (TMA) leading to renal and other end-organ damage. We originally conducted two phase 2 studies (26 weeks and 1 year) evaluating eculizumab, a terminal complement inhibitor, in patients with progressing TMA (trial 1) and those with long duration of aHUS and chronic kidney disease (trial 2). The current analysis assessed outcomes after 2 years (median eculizumab exposure 100 and 114 weeks, respectively). At all scheduled time points, eculizumab inhibited terminal complement activity. In trial 1 with 17 patients, the platelet count was significantly improved from baseline, and hematologic normalization was achieved in 13 patients at week 26, and in 15 patients at both 1 and 2 years. The estimated glomerular filtration rate (eGFR) was significantly improved compared with baseline and year 1. In trial 2 with 20 patients, TMA event-free status was achieved by 16 patients at week 26, 17 patients at year 1, and 19 patients at year 2. Criteria for hematologic normalization were met by 18 patients at each time point. Improvement of 15 ml/min per 1.73 m2 or more in eGFR was achieved by 1 patient at week 26, 3 patients at 1 year, and 8 patients at 2 years. The mean change in eGFR was not significant compared with baseline, week 26, or year 1. Eculizumab was well tolerated, with no new safety concerns or meningococcal infections. Thus, a 2-year analysis found that the earlier clinical benefits achieved by eculizumab treatment of aHUS were maintained at 2 years of follow-up.

Purpose To investigate the contralateral effect of extended release steroid implants on cystoid macular edema (CME). Methods Retrospective study of patients with bilateral CME receiving intravitreal injections of long-acting intravitreal corticosteroid implants in one eye. Changes in CME and central subfield thickness (CST) in the contralateral eye on optical coherence tomography (OCT) were compared to an untreated control group. The main outcome measures were the change in central subfield thickness (CST) and the change in the macular volume. Results Thirteen study patients and 14 controls were included in the study. There was no difference in the baseline LogMAR visual acuity (0.32 ± 0.35 vs 0.43 ± 0.26, p  = 0.37) or the baseline central subfield thickness (341.4 ± 76.6 vs 296.5 ± 65.0 µm, p  = 0.12) between groups. In the treatment group CST remained stable in 92.3% of the patients. Of the controls, CST worsened in 21.4% and remained stable in 78.6%. The mean change in CST (6.3 ± 30.3 vs. 27.5 ± 66.1 µm, p  = 0.2) and the mean change in macular volume (0.08 ± 0.34 vs. -0.05 ± 0.21 mm 3 , P  = 0.8) were not statistically different between the treatment group and control group. In the post-hoc analysis restricting the treatment group to patients who had not received intravitreal injections in the study eye within 6 months, CST decrement was not statistically significant ( p  = 0.11). Conclusion In this study there was no statistically significant effect on CME of contralateral intravitreal corticosteroid implants.

The 2016 election was one of the most dramatic upsets in US history. Explaining the surprising Trump victory, the leading scholars trace the entire gamut of the election. Illustrated with over 100 meticulous full-color maps, the atlas will be an essential reference and a fascinating resource for pundits, voters, campaign staffs, and political junkies.

Background Youth with HIV disproportionately experience psychological trauma, but implementation methods for trauma-informed care are lacking. Methods To identify potential processes and determinants of trauma-informed care implementation, we conducted process mapping and qualitative interviews and thematically applied the organizational trauma resilience framework to elicit perceived safety, stability, and nurturance in a pediatric HIV clinic. Results Forty-three personnel and 8 patient representatives engaged in process mapping; 20 completed qualitative interviews. Clinic culture was described as supportive, cohesive, and equity-focused, but requiring workflow improvements for patient autonomy. Trauma screening, assessment, and interventions were limited/inconsistently applied, with duplicative risk assessments. Support for professional quality of life was limited, despite burnout/attrition reports. Some personnel had trauma-focused training, but ongoing education and culturally responsive policies were needed. Conclusions Process mapping presented as a low-burden tool for unveiling gaps and care standards; alongside qualitative interviews, these methods provided practical insights for trauma-informed HIV care. Plain Language Summary Pre-implementation stage research to guide Trauma-Informed Care for Youth with HIV in the Southern US: A Multi-Method Study Youth with HIV disproportionately experience psychological trauma, but implementation methods for trauma-informed care (TIC) are lacking. To identify factors that might influence the implementation of TIC, we conducted process mapping (PM) and qualitative interviews in a pediatric HIV clinic and thematically applied the organizational trauma resilience (OTR) framework. Forty-three personnel and 8 patient representatives completed PM, and 20 personnel completed interviews. Clinic culture was described as supportive, cohesive, and equity-focused, but workflow improvements were suggested to elevate patient choice. Trauma screening, assessment, and interventions were limited/inconsistently applied, and risk assessments were duplicative. Support for professional quality of life was limited, despite burnout and attrition. Some personnel had trauma-focused training, but ongoing TIC education was requested as were culturally responsive policies. PM presented as a low-burden tool for unveiling gaps and established care standards. Findings were enriched by qualitative interviews, together providing practical insights for TIC pre-implementation in HIV care.

Memphis, Tennessee is second in the nation for HIV incidence, with one in three diagnoses among youth. Psychological trauma disproportionately impacts youth with HIV, compared with HIV-negative counterparts, requiring community-led and trauma-informed solutions to address mental wellness among youth with HIV. However, a dearth of research concentrates on trauma-informed care (TIC) for this population, with little exploration among youth-centered HIV care settings or into strategies for mobilizing communities to develop solutions. Research co-production, an approach in which research beneficiaries engage in research as cooperative partners, aligns with the TIC focus on collaborative decision-making and could be an effective strategy for facilitating collaborative TIC adoption, but formative research is needed to explore this potential. We sought to explore TIC implementation determinants and contextual factors that might influence research co-production as a strategy for implementation, including appetite for evidence-based approaches, support for co-production, and resources for capacity building. We applied an exploratory sequential mixed methods design to identify potential barriers and facilitators to TIC implementation in a youth-focused clinic and contextual factors relative to co-production. All clinic personnel were purposively invited to complete semistructured interviews. Thematic analysis, via four cycles of coding, was applied using the Consolidated Framework for Implementation Research 2.0 to qualitative data. Subsequently, a steering committee of clinic personnel was invited to complete surveys, applying the Research Quality Plus for Co-Production framework to explore co-production factors. A deliberative dialog approach was applied to analyze these findings and synthesize them with Consolidated Framework for Implementation Research. A total of 20 personnel completed interviews, and 9 completed surveys. Potential facilitators included perceived clinic cohesiveness, equity focus, and prioritization or compatibility of TIC. Potential barriers included perceived disconnect between the clinic and larger hospital (in which youth with HIV were seen as stigmatized in other areas of the hospital), sustainability concerns related to a perceived lack of championing by leaders, insufficient mental health protocols, a lack of formal patient feedback procedures, and a lack of protected time for personnel activity engagement. Survey responses suggested that the clinic is likely supportive of evidence-based approaches (mean 3.6, SD 0.70) and collaborative research (mean 3.1, SD 0.31) and empowers personnel to participate (mean 3.1, SD 0.22). Conducive to co-production, the environment was seen as learning-centered, where evidence and standardized or validated approaches are prioritized, and there is an openness for innovation, with a focus on health disparities and quality improvement. Potential barriers included change-resistant staff, role silos, and underutilization of staff skills, coupled with a lack of formal research training and time constraints. Findings suggested that TIC implementation is likely to be embraced in the clinic, with co-production perceived as useful and fitting. However, greater effort is needed to integrate patient experiences and test co-production as a TIC implementation strategy.

Guidelines for Reporting Health Research is a practical guide to choosing and correctly applying the appropriate guidelines when reporting health research to ensure clear, transparent, and useful reports. This new title begins with an introduction to reporting guidelines and an overview of the importance of transparent reporting, the characteristics of good guidelines, and how to use reporting guidelines effectively in reporting health research. This hands-on manual also describes over a dozen internationally recognised published guidelines such as CONSORT, STROBE, PRISMA and STARD in a clear and easy to understand format. It aims to help researchers choose and use the correct guidelines for reporting their research, and to produce more completely and transparently reported papers which will help to ensure reports are more useful and are not misleading. Written by the authors of health research reporting guidelines, in association with the EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Network, Guidelines for Reporting Health Research is a helpful guide to producing publishable research. It will be a valuable resource for researchers in their role as authors and also an important reference for editors and peer reviewers.

Bermudagrass (Cynodon dactylon) may be a problematic weed within zoysiagrass (Zoysia spp.) swards across its entire range. The objective of this study was to determine the efficacy of the herbicide safener metcamifen + trifloxysulfuron-sodium, in conjunction with fluazifop-P-butyl, at removing bermudagrass from zoysiagrass and how varying levels of treatment affected bermudagrass control and zoysiagrass tolerance. Field studies tested rates of metcamifen + trifloxysulfuron-sodium applied with fluazifop-P-butyl compared to treatments of fluazifop alone and fenoxaprop with triclopyr. All treatments controlled bermudagrass, and treatments with the herbicide safener remained under the 20% injury threshold for zoysiagrass for ≤ to 15 days compared to ≥ 46 days across the study for the remaining treatments. This is the first report of complete suppression of bermudagrass without unacceptable injury to zoysiagrass.Listronotus maculicollis is an economically important pest of turfgrass that has historically been confined to the Northeastern USA. In recent years, this pest has been found causing damage to golf courses outside of its traditional range. In Kentucky, damage from L. maculicollis was first reported in 2018. Although the presence of the weevil has been confirmed, little was known about the distribution and abundance of L. maculicollis within the state. The objective of this study was to conduct a statewide survey of golf courses superintendents in Kentucky and develop a map of the known distribution of L. maculicollis in the state. The results of the survey showed that the current distribution of L. maculicollis is limited to the physiographic Bluegrass region of the state which contains the most populous cities and the highest number of golf courses.

We provide evidence on the sticky-information model of Mankiw and Reis (2002) by examining how often individual professional forecasters revise their forecasts. We draw interest rate and unemployment rate forecasts from the monthly Wall Street Journal surveys. We find evidence that forecasters frequently leave forecasts unchanged but revise more often the larger the changes in the information set; additionally, the information sensitivity of revision frequencies increased after 2007. We also find that, on average, forecasters in our sample revise more frequently than found in previous research but that revised forecasts are not consistently more accurate.