Explore the vast range of titles available.

New surgical procedures can expose patients to harm and should be carefully evaluated before widespread use. The InSpace balloon (Stryker, USA) is an innovative surgical device used to treat people with rotator cuff tears that cannot be repaired. We aimed to determine the effectiveness of the InSpace balloon for people with irreparable rotator cuff tears. We conducted a double-blind, group-sequential, adaptive randomised controlled trial in 24 hospitals in the UK, comparing arthroscopic debridement of the subacromial space with biceps tenotomy (debridement only group) with the same procedure but including insertion of the InSpace balloon (debridement with device group). Participants had an irreparable rotator cuff tear, which had not resolved with conservative treatment, and they had symptoms warranting surgery. Eligibility was confirmed intraoperatively before randomly assigning (1:1) participants to a treatment group using a remote computer system. Participants and assessors were masked to group assignment. Masking was achieved by using identical incisions for both procedures, blinding the operation note, and a consistent rehabilitation programme was offered regardless of group allocation. The primary outcome was the Oxford Shoulder Score at 12 months. Pre-trial simulations using data from early and late timepoints informed stopping boundaries for two interim analyses. The primary analysis was on a modified intention-to-treat basis, adjusted for the planned interim analysis. The trial was registered with ISRCTN, ISRCTN17825590. Between June 1, 2018, and July 30, 2020, we assessed 385 people for eligibility, of which 317 were eligible. 249 (79%) people consented for inclusion in the study. 117 participants were randomly allocated to a treatment group, 61 participants to the debridement only group and 56 to the debridement with device group. A predefined stopping boundary was met at the first interim analysis and recruitment stopped with 117 participants randomised. 43% of participants were female, 57% were male. We obtained primary outcome data for 114 (97%) participants. The mean Oxford Shoulder Score at 12 months was 34·3 (SD 11·1) in the debridement only group and 30·3 (10·9) in the debridement with device group (mean difference adjusted for adaptive design –4·2 [95% CI –8·2 to –0·26];p=0·037) favouring control. There was no difference in adverse events between the two groups. In an efficient, adaptive trial design, our results favoured the debridement only group. We do not recommend the InSpace balloon for the treatment of irreparable rotator cuff tears. Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health and Care Research partnership

Cotton, rye, and vegetables are planted on over 567, 23, and 46 thousand ha of land in Georgia, respectively, and collectively account for a farm gate value of over $1.9 billion. These crops are not only critical for the success of local agriculture but for the nation. To maximize yields and preserve crop quality, weeds must be controlled in each of these crops.Cotton engineered to resist dicamba provides an effective option to control Georgia’s most problematic pest, glyphosate-resistant Palmer amaranth. However, overuse of dicamba postemergence in cotton is a concern and sustainable weed management programs must be implemented to delay resistance development. A study, conducted at 4 locations, demonstrated that adding 1) a rye cover crop, 2) preemergence herbicides, or 3) both the cover crop and preemergence herbicides reduced Palmer amaranth exposure to dicamba in a standard program by 65, 98, and 99%, respectively. These results are critical helping farmers implement sound diversified weed management systems.In multi-cropped plasticulture vegetable production, plastic mulch is often used over 18 months thereby facilitating dense weed infestations. With formulation improvements and effective broadleaf weed control, 2,4-D and dicamba may serve as new tools to manage weeds between crops but only if they can be removed from the mulch. A study, conducted 8 times, used HPLC analysis and bioassay plantings of squash, watermelon, cantaloupe, broccoli, and collard to determine if 0.6 cm of overhead irrigation could remove these herbicides from the mulch. Irrigation effectively removed 2,4-D from the mulch to levels that were non-lethal for all crops. In contrast, irrigation did not successfully remove dicamba from the mulch.Herbicide options in cereal rye are lacking, particularly for Italian ryegrass control. Cereal rye tolerance to 8 wheat herbicides was evaluated at 5 locations to potentially pursue registrations for cereal rye. Thifensulfuron-methyl + tribenuron-methyl, pyroxsulam, and halauxifen-methyl + florasulam resulted in minimal injury (≤15%) and growth reductions at the 2X rate and are candidates for potential labeling. In contrast, unacceptable injury was noted with pyroxasulfone, pyroxasulfone + flumioxazin, mesosulfuron-methyl, pinoxaden, and pinoxaden + fenoxaprop-p-ethyl.

Field studies were conducted the spring of 2016 and 2017 at the Old Agronomy Farm (OAF) in Auburn, Alabama, and the Plant Breeding Unit (PBU) in Tallassee, Alabama to evaluate the effect of preemergence herbicide applications pre- and post-crimp in a cereal rye cover crop for control of escape weeds in watermelons. The trial consisted of an augmented factorial treatment arrangement of 3 levels of preemergence herbicides, two levels of application timing, and a nontreated control. Application timings were pre-crimp (herbicide applied prior to crimping and rolling of the cover crop) and post-crimp (herbicide applied after crimping and rolling of the cover crop). Preemergence herbicide options were ethalfluralin (1,470 g ai∙ha-1), fomesafen (180 g ai∙ha-1), and halosulfuron (39 g ai∙ha-1). A nontreated cover crop only treatment was also included yielding a total of seven treatments. Treatments were arranged in a randomized complete block design with four replications.There were no interactions among application timing and herbicide, therefore data was pooled by location. Results at the OAF location indicate application timing did not influence total weed coverage, nutsedge density, or watermelon yield. Broadleaf weed density was lower in post-crimp applied treatments 6 weeks after treatment (WAT) while grass density was lower in pre-crimp applied treatments 4 WAT. Differences were not observed at any other rating dates. Comparing individual treatments at OAF revealed yield was greatest in treatments containing fomesafen. Results at the PBU location indicated application timing did not influence nutsedge density or watermelon yield. Total weed coverage was lowest in pre-crimp applied treatments at 2, 4 and 6 WAT. Broadleaf weed density and grass density was lowest in post-crimp applied treatments 8 WAT. Comparing individual treatments revealed no significant differences among herbicides at PBU; however, all herbicides increased yield compared to the nontreated plots.

Background and objective CT perfusion (CTP) is rapid and accessible for emergency ischaemic stroke diagnosis. The feasibility of introducing CTP and diagnostic accuracy versus non-contrast CT (NCCT) in a tertiary hospital were assessed. Methods All patients presenting <9 h from stroke onset or with wake-up stroke were eligible for CTP (Siemens 16-slice scanner, 2×24 mm slabs) unless they had estimated glomerular filtration rate (eGFR)<50 ml/min or diabetes with unknown eGFR. NCCT was assessed by a radiologist and stroke neurologist for early ischaemic change and hyperdense arteries. CTP was assessed for prolonged time to peak and reduced cerebral blood flow. Technical adequacy was defined as 2 CTP slabs of sufficient quality to diagnose stroke. Results Between January 2009 and September 2011, 1152 ischaemic stroke patients were admitted, 475 (41%) were <9 h/wake-up onset. Of these, 276 (58%) had CTP. Reasons for not performing CTP were diabetes with unknown eGFR (48 (10%)), known kidney disease (36 (8%)), established infarct on NCCT (27 (6%)), posterior circulation syndrome (25 (5%)) and patient motion/instability (16 (3%)). Clinician discretion excluded a further 47 (10%). CTP was more frequently diagnostic than NCCT (80% vs 50%, p<0.001). Non-diagnostic CTP was due to lacunar infarction (28 (10%)), infarct outside slab coverage (21 (8%)), technical failure (4 (1%)) and reperfusion (2 (0.7%)). Normal CTP in 86/87 patients with stroke mimics supported withholding tissue plasminogen activator. CTP technical adequacy improved from 56% to 86% (p<0.001) after the first 6 months. Median time for NCCT/CTP/arch-vertex CT angiogram (including processing and interpretation) was 12 min. No clinically significant contrast nephropathy occurred. Conclusions CTP in suspected stroke is widely applicable, rapid and increases diagnostic confidence.

The central nucleus of the amygdala (CeA) is a key hub of the neural circuitry regulating alcohol and stress interactions. However, the exact neuronal populations that govern this interaction are not well defined. Here we examined the role of the neuropeptide cocaine and amphetamine regulated transcript (CART) within the CeA in stress-induced alcohol seeking. We found that CART-containing neurons are predominantly expressed in the capsular/lateral division of the CeA and are a subpopulation of protein kinase Cδ (PKCδ) cells, distinct from corticotrophin releasing factor (CRF)-expressing cells. Both stress (yohimbine) and stress-induced alcohol seeking activated CART cells within the CeA, while neutralisation of endogenous CeA CART signalling (via antibody administration) attenuated stress-induced alcohol, but not sucrose seeking. Further, blocking CART signalling within the CeA did not alter the motivation to obtain and consume alcohol but did attenuate stressor-induced anxiety-like behaviour during abstinence from alcohol. Together, these data identify CeA CART cells as a subpopulation of PKCδ cells that influence stress × alcohol interactions and mediate stress-induced alcohol seeking behaviours.

Background. Tenofovir disoproxil fumarate (TDF) has been linked to renal impairment, but the extent to which this impairment is reversible is unclear. We aimed to investigate the reversibility of renal decline during TDF therapy. Methods. Cox proportional hazards models assessed factors associated with discontinuing TDF in those with an exposure duration of >6 months. In those who discontinued TDF therapy, linear piecewise regression models estimated glomerular filtration rate (eGFR) slopes before initiation of, during, and after discontinuation of TDF therapy. Factors associated with not achieving eGFR recovery 6 months after discontinuing TDF were assessed using multivariable logistic regression. Results. We observed declines in the eGFR during TDF exposure (mean slopes, -15.7 mL/minute/1.73 m²/year [95% confidence interval {CI}, -20.5 to -10.9] during the first 3 months and -3.1 mL/minute/1.73 m²/year [95% CI, -4.6 to -1.7] thereafter) and evidence of eGFR increases following discontinuation of TDF therapy (mean slopes, 12.5 mL/minute/1.73 m²/year [95% CI, 8.9-16.1] during the first 3 months and 0.8 mL/minute/1.73 m²/year [95% CI, .1-1.5] thereafter). Following TDF discontinuation, 38.6% of patients with a decline in the eGFR did not experience recovery. A higher eGFR at baseline, a lower eGFR after discontinuation of TDF therapy, and more-prolonged exposure to TDF were associated with an increased risk of incomplete recovery 6 months after discontinuation of TDF therapy. Conclusions. This study shows that a decline in the eGFR during TDF therapy was not fully reversible in one third of patients and suggests that prolonged TDF exposure at a low eGFR should be avoided.

Effective population size (Ne) is among the most important metrics in evolutionary biology. In natural populations, it is often difficult to collect adequate demographic data to calculate Ne directly. Consequently, genetic methods to estimate Ne have been developed. Two Ne estimators based on sibship reconstruction using multilocus genotype data have been developed in recent years: sibship assignment and parentage analysis without parents. In this study, we evaluated the accuracy of sibship reconstruction using a large empirical dataset from five hatchery steelhead populations with known pedigrees and using 95 single nucleotide polymorphism (SNP) markers. We challenged the software COLONY with 2,599,961 known relationships and demonstrated that reconstruction of full‐sib and unrelated pairs was greater than 95% and 99% accurate, respectively. However, reconstruction of half‐sib pairs was poor (<5% accurate). Despite poor half‐sib reconstruction, both estimators provided accurate estimates of the effective number of breeders (Nb) when sample sizes were near or greater than the true Nb and when assuming a monogamous mating system. We further demonstrated that both methods provide roughly equivalent estimates of Nb. Our results indicate that sibship reconstruction and current SNP panels provide promise for estimating Nb in steelhead populations in the region.

Bystanders to bullying perpetration are considered an extremely important group to engage in bullying prevention and intervention. It is important to understand the key differences between students who are proactive bystanders, who try to stop the bullying and those bystanders who observe but take no action to help the student being bullied. Of 1,231 secondary students (aged 11 to 15 years) surveyed in 12 Australian schools, only 26.9% (509) reported they had not witnessed any bullying. The actions taken by student witnesses were grouped into proactive bystanding (786, 41.5%) and passive bystanding (445, 23.5%) responses. Age, gender, victimisation, being connected to school, perceived peer support and moral engagement were examined. The strongest predictor for proactive bystander responses was previous experience of bullying victimisation. Feeling connected to school, having higher levels of peer support and being morally engaged also predicted proactive bystander behaviour. Age and gender were not associated with being a proactive bystander or a passive bystander. Implications for school policy and practices to prevent and reduce peer bullying behaviour are discussed.

Background: Smoking is a major public health issue, estimated as causing 120 000 deaths in the UK per year. Smoking cessation is an important aspect of the treatment of many diseases. Nicotine replacement therapy (NRT) has been shown to increase cessation rates among healthy volunteers and in general practice, but it is not clear whether it has an effect in hospital patients. Methods: Patients referred by their hospital doctor to the smoking cessation counsellor and who agreed to participate in the study were randomised to receive either NRT given as a nicotine patch daily and a nicotine inhalator on an as needed basis plus advice and support (AS+NRT), or to receive just advice and support (AS). Claims of smoking cessation were validated at 1 week, 3 months, 6 months, and 1 year by carbon monoxide (CO) breath testing. Results: A total of 245 patients were randomised, 136 AS+NRT and 109 AS. There were no significant demographic differences between the two groups at baseline. At 1 year 35 (14%) had sustained cessation confirmed by a CO breath test, 20/136 (15%) AS+NRT and 15/109 (14%) AS, p=0.857. One hundred and ten patients gave up smoking for at least 1 week, 54% AS+NRT and 33% AS (p<0.001). By 6 months there was no significant difference between the two groups (22/136 (16%) AS+NRT and 15/109 (14%) AS). Conclusion: In hospital patients NRT, given as regular daily patches plus an inhalator to be used as needed, did not add to the smoking cessation rate achieved at 1 year by regular advice and support, despite significantly increasing the cessation rate at 1 week.

To evaluate the impact of the QuinteT Recruitment Intervention (QRI) on recruitment in challenging randomized controlled trials (RCTs) that have applied the intervention. The QRI aims to understand recruitment difficulties and then implements “QRI actions” to address these as recruitment proceeds. A mixed-methods study, comprising (1) before-and-after comparisons of recruitment rates and the numbers of patients approached and (2) qualitative case studies, including documentary analysis and interviews with RCT investigators. Five UK-based publicly funded RCTs were included in the evaluation. All recruited to target. Randomized controlled trial 2 and RCT 5 both received up-front prerecruitment training before the intervention was applied. Randomized controlled trial 2 did not encounter recruitment issues and recruited above target from its outset. Recruitment difficulties, particularly communication issues, were identified and addressed through QRI actions in RCTs 1, 3, 4, and 5. Randomization rates significantly improved after QRI action in RCTs 1, 3, and 4. Quintet Recruitment Intervention actions addressed issues with approaching eligible patients in RCTs 3 and 5, which both saw significant increases in the number of patients approached. Trial investigators reported that the QRI had unearthed issues they had been unaware of and reportedly changed their practices after QRI action. There is promising evidence to suggest that the QRI can support recruitment to difficult RCTs. This needs to be substantiated with future controlled evaluations.