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In many developed economies, the struggle to survive finds many small farms disappearing. Diversification is recognized as an important strategy for sustaining farms of this scale, addressing food security issues and creating a more resilient food system. This study aims to analyze farmers’ intentions to diversify into new business opportunities and how opportunity alertness and risk-taking propensity affect their intentions. These relationships are examined using data collected from 166 small and medium-sized farmers in five regions within Florida. The results indicate that for small and medium-sized farmers, opportunity alertness and risk-taking propensity have a positive effect on diversification intentions across seven different types of activities. Implications are drawn for theory and practice.

HighlightsThe RASE pedagogical model for integrating technology into an upper-division structures course proved effective.A retrospective pre-test/post-test was used to measure changes in students’ perceived competencies.Students indicated increases in perceived knowledge, skills, and attitudes following several course modifications.Students felt technology, experiential learning, and formative and summative assessment improved their learning.Abstract. In early 2019, instructors in the Agricultural Operations Management (AOM) program in the Department of Agricultural and Biological Engineering at the University of Florida developed a retrospective pre-test/post-test survey instrument to measure changes in perceived knowledge, skills, and attitudes (KSA) for students enrolled in AOM4642: Environmental Systems for Agricultural Structures during the fall 2019 semester. The course trains students to understand the components of the environment, the impact of those components on building usage, and how to control the environmental variables of buildings used to house agricultural products (e.g., livestock and horticultural) for more efficient production, processing, and storage. The course stresses a hands-on approach through experiential learning opportunities, and it challenges students to solve problems using critical thinking and application of conceptual principles. The course recently underwent significant revisions following the RASE pedagogical model to create student-centered curricular experiences and link learning objectives with assessments, outcomes, and evaluation. Thirty-one AOM students enrolled in the 16-week course completed the survey. After the course, the students retroactively (i.e., “before and after” instruction) rated their perceived learning. Changes in pre- and post-instruction responses were compared using measures of central tendency and correlations, and statistical significance (p-values) was reported. Constructs measuring KSA items were created using collapsed variables and tested for internal consistency and scale reliability against a threshold reliability coefficient of 0.70. The goal of this study was to assess the effectiveness of the RASE pedagogical model on student-perceived learning with respect to changes in knowledge, skills, and attitudes in an agricultural structures course. The specific objectives of this study were to: (1) measure changes in students’ perceived knowledge, skills, and attitudes, (2) evaluate student sentiment toward the course materials and activities, and (3) solicit feedback from the students on ways to improve the course. Results of the survey indicated significant increases in students’ perceived learning with respect to KSA. In addition, students commented on the effectiveness of several instructional activities (e.g., labs, field trips), indicating that those activities enhanced their experiences, but they also noted that shorter, more frequent homework would help with retention. Keywords: Assessment and evaluation, Construct reliability analysis, Instructional improvement, Perceived learning, RASE pedagogical model, Retrospective pre-test and post-test design, Student perceptions.

PURPOSECoronavirus-2019 (COVID-19) mortality is higher in patients with cancer than in the general population, yet the cancer-associated risk factors for COVID-19 adverse outcomes are not fully characterized.PATIENTS AND METHODSWe reviewed clinical characteristics and outcomes from patients with cancer and concurrent COVID-19 at Memorial Sloan Kettering Cancer Center until March 31, 2020 (n = 309), and observed clinical end points until April 13, 2020. We hypothesized that cytotoxic chemotherapy administered within 35 days of a COVID-19 diagnosis is associated with an increased hazard ratio (HR) of severe or critical COVID-19. In secondary analyses, we estimated associations between specific clinical and laboratory variables and the incidence of a severe or critical COVID-19 event.RESULTSCytotoxic chemotherapy administration was not significantly associated with a severe or critical COVID-19 event (HR, 1.10; 95% CI, 0.73 to 1.60). Hematologic malignancy was associated with increased COVID-19 severity (HR, 1.90; 95% CI, 1.30 to 2.80). Patients with lung cancer also demonstrated higher rates of severe or critical COVID-19 events (HR, 2.0; 95% CI, 1.20 to 3.30). Lymphopenia at COVID-19 diagnosis was associated with higher rates of severe or critical illness (HR, 2.10; 95% CI, 1.50 to 3.10). Patients with baseline neutropenia 14-90 days before COVID-19 diagnosis had worse outcomes (HR, 4.20; 95% CI, 1.70 to 11.00). Findings from these analyses remained consistent in a multivariable model and in multiple sensitivity analyses. The rate of adverse events was lower in a time-matched population of patients with cancer without COVID-19.CONCLUSIONRecent cytotoxic chemotherapy treatment was not associated with adverse COVID-19 outcomes. Patients with active hematologic or lung malignancies, peri–COVID-19 lymphopenia, or baseline neutropenia had worse COVID-19 outcomes. Interactions among antineoplastic therapy, cancer type, and COVID-19 are complex and warrant further investigation.

BACKGROUND Cleft repair requires multiple operations from infancy through adolescence, with repeated exposure to opioids and their associated risks. The authors implemented a quality improvement project to reduce perioperative opioid exposure in their cleft lip/palate population. METHODS After identifying key drivers of perioperative opioid administration, quality improvement interventions were developed to address these key drivers and reduce postoperative opioid administration from 0.30 mg/kg of morphine equivalents to 0.20 mg/kg of morphine equivalents. Data were retrospectively collected from January 1, 2015, until initiation of the quality improvement project (May 1, 2017), tracked over the 6-month quality improvement study period, and the subsequent 14 months. Metrics included morphine equivalents of opioids received during admission, administration of intraoperative nerve blocks, adherence to revised electronic medical record order sets, length of stay, and pain scores. RESULTS The final sample included 624 patients. Before implementation (n =354), children received an average of 0.30 mg/kg of morphine equivalents postoperatively. After implementation (n = 270), children received an average of 0.14 mg/kg of morphine equivalents postoperatively (p < 0.001) without increased length of stay (28.3 versus 28.7 hours; p = 0.719) or pain at less than 6 hours (1.78 versus 1.74; p = 0.626) or more than 6 hours postoperatively (1.50 versus 1.49; p = 0.924). CONCLUSIONS Perioperative opioid administration after cleft repair can be reduced in a relatively short period by identifying key drivers and addressing perioperative education, standardization of intraoperative pain control, and postoperative prioritization of nonopioid medications and nonpharmacologic pain control. The authors' quality improvement framework has promise for adaptation in future efforts to reduce opioid use in other surgical patient populations. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.

Background Uncertainty in patients' COVID-19 status contributes to treatment delays, nosocomial transmission, and operational pressures in hospitals. However, the typical turnaround time for laboratory PCR remains 12–24 h and lateral flow devices (LFDs) have limited sensitivity. Previously, we have shown that artificial intelligence-driven triage (CURIAL-1.0) can provide rapid COVID-19 screening using clinical data routinely available within 1 h of arrival to hospital. Here, we aimed to improve the time from arrival to the emergency department to the availability of a result, do external and prospective validation, and deploy a novel laboratory-free screening tool in a UK emergency department. Methods We optimised our previous model, removing less informative predictors to improve generalisability and speed, developing the CURIAL-Lab model with vital signs and readily available blood tests (full blood count [FBC]; urea, creatinine, and electrolytes; liver function tests; and C-reactive protein) and the CURIAL-Rapide model with vital signs and FBC alone. Models were validated externally for emergency admissions to University Hospitals Birmingham, Bedfordshire Hospitals, and Portsmouth Hospitals University National Health Service (NHS) trusts, and prospectively at Oxford University Hospitals, by comparison with PCR testing. Next, we compared model performance directly against LFDs and evaluated a combined pathway that triaged patients who had either a positive CURIAL model result or a positive LFD to a COVID-19-suspected clinical area. Lastly, we deployed CURIAL-Rapide alongside an approved point-of-care FBC analyser to provide laboratory-free COVID-19 screening at the John Radcliffe Hospital (Oxford, UK). Our primary improvement outcome was time-to-result, and our performance measures were sensitivity, specificity, positive and negative predictive values, and area under receiver operating characteristic curve (AUROC). Findings 72 223 patients met eligibility criteria across the four validating hospital groups, in a total validation period spanning Dec 1, 2019, to March 31, 2021. CURIAL-Lab and CURIAL-Rapide performed consistently across trusts (AUROC range 0·858–0·881, 95% CI 0·838–0·912, for CURIAL-Lab and 0·836–0·854, 0·814–0·889, for CURIAL-Rapide), achieving highest sensitivity at Portsmouth Hospitals (84·1%, Wilson's 95% CI 82·5–85·7, for CURIAL-Lab and 83·5%, 81·8–85·1, for CURIAL-Rapide) at specificities of 71·3% (70·9–71·8) for CURIAL-Lab and 63·6% (63·1–64·1) for CURIAL-Rapide. When combined with LFDs, model predictions improved triage sensitivity from 56·9% (51·7–62·0) for LFDs alone to 85·6% with CURIAL-Lab (81·6–88·9; AUROC 0·925) and 88·2% with CURIAL-Rapide (84·4–91·1; AUROC 0·919), thereby reducing missed COVID-19 cases by 65% with CURIAL-Lab and 72% with CURIAL-Rapide. For the prospective deployment of CURIAL-Rapide, 520 patients were enrolled for point-of-care FBC analysis between Feb 18 and May 10, 2021, of whom 436 received confirmatory PCR testing and ten (2·3%) tested positive. Median time from arrival to a CURIAL-Rapide result was 45 min (IQR 32–64), 16 min (26·3%) sooner than with LFDs (61 min, 37–99; log-rank p Interpretation Our findings show the generalisability, performance, and real-world operational benefits of artificial intelligence-driven screening for COVID-19 over standard-of-care in emergency departments. CURIAL-Rapide provided rapid, laboratory-free screening when used with near-patient FBC analysis, and was able to reduce the number of patients who tested negative for COVID-19 but were triaged to COVID-19-suspected areas.

Plain language summaries of peer-reviewed medical journal publications are a means of sharing research with a broad range of audiences and may improve the transparency, accountability, accessibility, discoverability, and inclusivity of medical research. There is currently an ongoing, industry-wide effort to establish consensus on plain language summaries, and initiatives are already in place that provide detailed guidance on plain language best practice, co-creation methods, patient-focused content, graphic and digital considerations, and publisher-specific guidelines. However, there remains a need for a foundational set of recommendations that complement existing initiatives to outline the minimum steps needed to develop discoverable, plain language summaries that are trustworthy, credible, and of high quality. Here, we present the Open Pharma recommendations for plain language summaries of peer-reviewed medical journal publications. These recommendations were initially developed by the Open Pharma Accessibility workstream and were extensively reviewed and refined during an expert roundtable and a focused, public consultation. Open Pharma is a multi-sponsor collaboration of pharmaceutical companies, non-pharmaceutical funders, publishers, patients, academics, regulators, editors, and societies seeking to identify and drive positive changes in the publishing of pharmaceutical company-funded research. We recommend that plain language summaries should be in the style of an abstract, free of technical jargon, unbiased, non-promotional, peer reviewed, and easily accessed. Plain language summaries should also meet the technical requirements to be indexed in directories such as PubMed. Ultimately, these recommendations are intended to be a concise outline of a minimum standard that provides top-line guidance on plain language summaries for authors, medical writers, publishers, and research funders. Articles published in peer-reviewed medical journals are written using technical language. Plain language summaries are short summaries of these articles, written in everyday language that is easy to understand by anyone interested in medical research. This can include patients, patient advocates, caregivers, healthcare professionals, and policymakers. Sharing research through plain language summaries makes medical information more accessible and inclusive. However, few medical research articles include plain language summaries. The pharmaceutical industry has an opportunity to improve everyone’s understanding of medical research by regularly developing plain language summaries of their articles. Plain language summaries can come in many different formats such as infographics and videos. However, text-only summaries are the easiest to find on internet search engines and research websites such as PubMed. Currently, there is limited guidance available to help researchers and medical journal publishers develop plain language summaries for their articles. In this article, ‘Open Pharma recommendations for plain language summaries of peer-reviewed medical journal publications’, we suggest a set of simple rules to help authors make and share text-only plain language summaries that we believe are possible for all articles reporting medical research. Once these have been met, we encourage researchers to consider making and sharing infographics and video summaries as well, to help people to understand their research even more. Watch the video on Vimeo © 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

Extension of the interval between vaccine doses for the BNT162b2 mRNA vaccine was introduced in the UK to accelerate population coverage with a single dose. At this time, trial data was lacking, and we addressed this in a study of UK healthcare workers. The first vaccine dose induced protection from infection from the circulating alpha (B.1.1.7) variant over several weeks. In a sub-study of 589 individuals, we show that this single dose induces SARS-CoV-2 neutralizing antibody (NAb) responses and a sustained B and T cell response to spike protein. NAb levels were higher after the extended dosing interval (6-14 weeks) compared to the conventional 3-4 week regimen, accompanied by enrichment of CD4+ T cells expressing IL2. Prior SARS-CoV-2 infection amplified and accelerated the response. These data on dynamic cellular and humoral responses indicate that extension of the dosing interval is an effective, immunogenic protocol., After giving a primary dose, delaying administration of a second dose of BNT162b2 COVID-19 vaccine up to 6-14 weeks continues to provide strong protection and contributes to favorable antibody, B cell, and T cell responses.

In the Spring of 2021, a survey of college students’ perceptions and behaviors regarding grocery shopping methods, including online purchases of fresh produce, in the post-response to COVID-19 was conducted. The purpose of this research was to analyze the perceptions of online grocery shopping and identify specific factors that significantly influenced the grocery shopping experience. A sample of 203 responses was collected from undergraduate and graduate students within the College of Agricultural & Life Sciences (CALS) at the University of Florida. Participants perceived in-store grocery shopping as superior in terms of product quality, shopping experience, store loyalty, and hygiene while convenience was perceived as an advantage with online grocery shopping. Participants identified product quality and greater transparency regarding food handling as important concerns and factors when purchasing fresh produce online. Although COVID-19 pandemic caused students to explore various online grocery services, it had limited effect on their purchasing of fresh produce. The implications for this study are far reaching, applicable to industry retailers interested in consumer willingness to pay for online grocery options and in identifying value-adding services that would increase consumer participation. This study also provides baseline data useful to researchers interested in consumer behavior, acceptance, and food marketing.

PURPOSE: The aim of this study was to evaluate the psychometric properties of the Keratoconus Outcomes Research Questionnaire (KORQ) in patients enrolled in the Save Sight Keratoconus Registry. METHODS: A cross-sectional study was conducted utilizing prospectively collected web-based registry data. The psychometric properties of the KORQ were assessed using both classical test theory and Rasch analysis. Andrich group rating scale variant of the Rasch analysis was conducted using Winsteps software, Version 3.92.1. RESULTS: The KORQ was completed by 189 patients with keratoconus (men, 67.7%; white, 69.8%; median age 29 years; better eye median values: visual acuity, 75 LogMAR letters; Kmax, 51.3 D; K2, 46.5 D; thinnest pachymetry, 485 μm). Cronbach's α for the "Activity Limitation" and "Symptoms" scales were 0.95 and 0.91, respectively, with both scales free from floor or ceiling effects. On Rasch analysis, the category thresholds were ordered and well-spaced for both scales. The Activity Limitation scale had excellent psychometric properties including person separation index (3.6), unidimensionality (variance explained, 65.4%), fit statistics (

Electroreduction of CO2 represents a promising solution for addressing the global challenges in energy and sustainability. This reaction is highly sensitive to the surface structure of electrocatalysts and the local electrochemical environment. We have investigated the effect of Cu nanoparticle shape on the electrocatalysis of CO2 reduction by using gas-diffusion electrodes (GDEs) and flowing alkaline catholytes. Cu nanocubes of ∼70 nm in edge length are synthesized with {100} facets preferentially exposed on the surface. They are demonstrated to possess substantially enhanced catalytic activity and selectivity for CO2 reduction, compared to Cu nanospheres of similar particle sizes. The electrocatalytic performance was further found to be dependent on the concentration of electrolyte (KOH). The Cu nanocubes reach a Faradaic efficiency of 60% and a partial current density of 144 mA/cm2 toward ethylene (C2H4) production, with the catalytic enhancement being attributable to a combination of surface structure and electrolyte alkalinity effects.

There is a paucity of evidence regarding mid- to long-term clinical outcomes of arthroscopic repair of humeral avulsion of the glenohumeral ligament (HAGL). This study investigated clinical outcomes, return to sport and the frequency of associated shoulder lesions. Eighteen patients underwent arthroscopic repair of a HAGL lesion between 2008 and 2015. Clinical outcome was evaluated using the Rowe Score, the Quick DASH Score (Q-DASH), the Oxford Shoulder Instability Score (OSIS), the ASES Score and Range of Motion (ROM). Return to sports and associated shoulder lesions were documented. Sixteen patients agreed to complete the shoulder scores and nine patients were available for clinical examination. Median time to follow-up was 59 months (range 16–104). The median Rowe Score and Q-DASH Score improved significantly from 33 to 85 points and 61 to 7 points, respectively (p = 0.001, p = 0.001). The median OSIS and ASES Score were 20 and 91 points. External rotation was significantly reduced compared to the contralateral side (p = 0.011). One recurrent dislocation was reported. No neurologic or vascular complications after surgery were reported. Five out of the nine patients did not return to sports at the same level. Associated shoulder lesions were found in 89% of the cases. Arthroscopic repair of a HAGL lesion is a reliable method to restore shoulder stability with good clinical results. However, limitations in external rotation and a reduction in sporting ability may persist at 59 months follow-up. Concomitant lesions are common. Case series, level IV.

BackgroundMedical Student First Responder (MSFR) schemes provide a Community First Responder (CFR) resource to their local ambulance Trust and experience for students. We aimed to investigate the contribution of these schemes and perceptions of students taking part in them.MethodsIn this convergent mixed methods study, we analysed dispatch data from two regional ambulance services and used propensity score matching to adjust for rurality and timing of attendance. MSFR attendances were compared with CFR and ambulance attendances. Multinomial logistic regression identified predictors of MSFR attendance compared with CFR and ambulance staff whilst accounting for confounders. We combined this with semistructured interviews of MSFRs from five schemes across the two regions. Interviews were transcribed verbatim and analysed using the Framework approach supported by NVivo. Final themes and categories were agreed through consensus.ResultsWe included MSFR attendances from 2019 (n = 5817). MSFRs were more likely to attend urgent category 1 and 2 calls (vs ambulance category 3: RRR 4.67, 95%CI 3.08 - 7.07 or category 4: RRR 8.85, 95%CI 1.09 - 71.75) and cardiorespiratory (vs ambulance RRR 0.44, 95%CI 0.35 - 0.56) or neurological/endocrine calls (vs ambulance RRR 0.55, 95%CI 0.41 - 0.74). MSFRs were more likely, compared to CFRs and ambulance staff, to be dispatched to younger patients, those from ethnic minorities and deprived areas.We interviewed 16 MSFRs from 5 medical schools. Participants described routes, requirements and challenges to recruitment. Training, mentorship, shadowing and debriefing were helpful to the role. Despite the risks and stress, most MSFRs enjoyed and valued their experience for enhancing clinical knowledge and skills in emergency care and understanding the wider context of care delivery. MSFRs’ experience also helped prepare for a future career involving emergency care.ConclusionsMSFR schemes provide a valuable contribution to prehospital care and beneficial experiences for medical students.

Background:. An entrustable professional activity (EPA) is defined as a core task of a specialty that is entrusted to a trainee once sufficient competence has been reached. A group of EPAs reflects the activities that clinicians commonly do on a day-to-day basis. Lists of EPAs have been created for most medical subspecialties, but not orthopaedic surgery. The aim of this study was to create a peer-reviewed list of essential EPAs that a resident must perform independently before completing orthopaedic residency training. Methods:. A focus group of 7 orthopaedic surgeons from the University of Toronto developed a comprehensive list of 285 EPAs. For each subspecialty group, the opinions of at least 15 academic and nonacademic surgeons, as well as subspecialty-trained and non–subspecialty-trained surgeons, were used. The modified Delphi method was used to rank EPAs on a five-point scale from not important to mandatory for a resident to competent before exiting training. Two Delphi rounds were used, using a threshold of >50% of surgeons considering the EPA as mandatory before being considered for the next round. A final list of EPAs was ratified using the focus group of academic surgeons involved in the study. Results:. Seventy-five (75) of 107 (70%) surgeons invited responded to the survey. Nearly half (129) of the 285 EPAs were discarded after the first round of Delphi. A further 118 EPAs were discarded after the second Delphi round, leaving 49 final EPAs, across 9 subspecialties in orthopaedic surgery. Conclusions:. Expert consensus was used to create a list of EPAs considered mandatory for completion of resident training in orthopaedics in our province. The final 49 peer-reviewed EPAs will be a valuable benchmark in curriculum design and assessment in orthopaedic surgery in the competency-based era for other programs.

Florida’s K–12 schools provide a potential opportunity to increase market channel options for small- and mid-sized diversified farms, but processing, storage, and distribution resources are extremely limited for smaller producers. This 9-page document serves as a model and case study with steps for producers and other stakeholders to conduct a feasibility study before forming a cooperative to sell local fruits and vegetables to schools and other institutional food-service outlets. Written by Jonathan Adam Watson, Danielle D. Treadwell, Catherine Campbell, and Ray Bucklin, and published by the UF/IFAS Department of Agricultural and Biological Engineering, March 2021.

Background:. Childhood opioid consumption is potentially deleterious to cognitive development and may predispose children to later addiction. Opioids are frequently prescribed for outpatient surgery but may not be necessary for adequate pain control. We aimed to reduce opioid prescriptions for outpatient pediatric skin and soft tissue lesion excisions using quality improvement (QI) methods. Methods:. A multidisciplinary team identified drivers for opioid prescriptions. Interventions were provider education, improving computer order set defaults, and promoting non-narcotic pain control strategies and patient-family education. Outcomes included percentage of patients receiving opioid prescriptions and patient-satisfaction scores. Data were retrospectively collected for 3 years before the QI project and prospectively tracked over the 8-month QI period and the following 18 months. Results:. The percentage of patients receiving an opioid prescription after outpatient skin or soft tissue excision dropped significantly from 18% before intervention to 6% at the end of the intervention period. Patient-reported satisfaction with pain control improved following the QI intervention. Satisfaction with postoperative pain control was independent of closure size or receipt of a postoperative opioid prescription. Intraoperative use of lidocaine or bupivacaine significantly decreased the incidence of postoperative opioid prescription in both bivariate and multivariate analyses. Results were maintained at 18 months after the conclusion of the QI project. Conclusion:. Raising provider awareness, educating patients on expected postoperative pain management options, and prioritizing non-narcotic medications postoperatively successfully reduced opioid prescription rates in children undergoing skin and soft tissue lesion excisions and simultaneously improved patient-satisfaction scores.

Aims/Objectives/BackgroundMedical Student First Responders (MSFRs) are volunteer Community First Responders, who respond to emergency calls and can provide life-saving interventions before the arrival of an ambulance. There is no data on diurnal trends in ambulance service demand for MSFRs, who do not typically work fixed shift patterns and therefore at present do not know when the most beneficial time of day to volunteer is. Thus, the aim of this service evaluation was to asses when demand for MSFRs is highest in central Oxfordshire and assess if MSFRs were available to respond at those times.Methods/DesignAll MSFRs shifts on a single Dynamic Response Vehicle between 1 October to 31 December 2020 were included. The MSFRs operated exclusively in central Oxfordshire (post codes OX1 – OX4) on behalf of South Central Ambulance Service. MSFR dispatch probability was calculated by comparing total time on duty (for each hour between 9 am – 1 am) with the respective number of incidents attended within that hour, and then plotted as a 3-point moving average against time. No patient data was collected.Results/Conclusions163 ‘on duty’ hours and 58 incidents (44% ‘Category 1’ responses, 88% MSFR first on scene) were included. There were clear diurnal trends in MSFR availability and demand (Abstract 797 figure 1). The probability of MSFR dispatch was highest at 56.3% between 6–7 pm; however, MSFRs were most likely to be available later in the day between 9–10 pm.These findings suggest that the majority of MSFRs shifts occur at times when demand is relatively low. MSFRs are a highly flexible resource and should be encouraged to volunteer earlier in the day, as this would significantly improve coverage during the late afternoon when demand is greatest.Abstract 797 Figure 1

BackgroundWe aimed to assess the validity of magnetic resonance imaging (MRI) in assessing the subcorocoid space and determine the validity of novel sagittal plane subcorocoid space measurements.MethodsWe assessed 33 arthroscopically proven subscapularis tears with MRIs compared to 33 (instability) controls with normal subscapularis tendons. Three examiners analyzed MRIs for seven static indices of corocoid morphology, in axial and sagittal planes. We explored reviewer variation using intraclass correlation coefficients (ICC) and differences between the two groups was explored using t-tests.ResultsGroups were similar in characteristics but different in age (cases = 53, controls = 23). ICC showed good (2/7) or excellent (5/7) reliability. Small differences(ConclusionsAcute inferior angulation of the corocoid in the sagittal plane may be associated with subscapularis tears. Static indices are measured within the scapula and not affected by arm position. MRI reliably provided a platform to assess the coracoid. Based on this, we currently consider corocoplasty in patients with subscapularis tears and a sagittal coroco–glenoid angle oto reduce potential impingement.

Here we present our twenty‐third annual report on the survival of Scottish snow patches.

Sleep disturbances and hyperactivity are prevalent in several neurodevelopmental disorders, including autism spectrum disorders (ASDs) and attention deficit-hyperactivity disorder (ADHD). Evidence from genome-wide association studies indicates that chromosomal copy number variations (CNVs) are associated with increased prevalence of these neurodevelopmental disorders. In particular, CNVs in chromosomal region 16p11.2 profoundly increase the risk for ASD and ADHD, disorders that are more common in males than females. We hypothesized that mice hemizygous for the 16p11.2 deletion (16p11.2 del/+) would exhibit sex-specific sleep and activity alterations. To test this hypothesis, we recorded activity patterns using infrared beam breaks in the home-cage of adult male and female 16p11.2 del/+ and wildtype (WT) littermates. In comparison to controls, we found that both male and female 16p11.2 del/+ mice exhibited robust home-cage hyperactivity. In additional experiments, sleep was assessed by polysomnography over a 24-hr period. 16p11.2 del/+ male, but not female mice, exhibited significantly more time awake and significantly less time in non-rapid-eye-movement (NREM) sleep during the 24-hr period than wildtype littermates. Analysis of bouts of sleep and wakefulness revealed that 16p11.2 del/+ males, but not females, spent a significantly greater proportion of wake time in long bouts of consolidated wakefulness (greater than 42 min in duration) compared to controls. These changes in hyperactivity, wake time, and wake time distribution in the males resemble sleep disturbances observed in human ASD and ADHD patients, suggesting that the 16p11.2 del/+ mouse model may be a useful genetic model for studying sleep and activity problems in human neurodevelopmental disorders. Autism Res 2016. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. Autism Res 2017, 10: 572-584. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Introduction: The need to rapidly collect, integrate, and share data on COVID-19 patients with cancer at scale has given rise to multiple internal and cross-institutional research registries. These registries support use cases that require data at different levels of granularity and are built using mixed standards. Ensuring semantic interoperability and quality of this data is critical for generating reliable and reproducible evidence. At MSK, we created a framework that enabled the rapid development of semantically compatible COVID and cancer registries and data exchange. Background: Handling and harmonizing real-world data for COVID and cancer research presented with typical challenges: maintenance of complex patient cohorts; reconciling different levels of temporal and semantic granularity; supporting crosswalks between different representations without information loss; and sharing it internally and with research consortia. Solving these challenges for COVID and cancer studies necessitated advanced infrastructure and harmonization solutions. Methods: We used MSK Extract, our research platform, to create an integrated COVID and cancer data research framework. It included a library of reusable standardized REDCap used in multiple RedCap instances supporting individual research studies; PostgreSQL database containing patient cohorts and data from Electronic Health Records (EHR) standardized to OMOP; and ETL pipelines. Our approach to the REDCap design and data management allowed for combined sets of detailed, atomic, and aggregate-level data through a combination of abstraction, curation, and extraction of data from different sources. We developed reconciliation methodology between initial curation, available raw data, and the subsequent abstraction. We enforced consistent temporal constraints on data extraction and curation. We used the OMOP vocabulary for semantic harmonization, mapping metadata from internal and external registries to OMOP concepts. We linked procedure and medication codes to high-level treatment groups leveraging classifications available in the OMOP vocabulary. Results: Our approach to the REDCap design supported various analytical use cases and enabled data sharing between different investigators and registries. Reuse of the data that was previously abstracted complemented with the data extracted from EHR allowed investigators and their teams to quickly review, validate, and update the prior curation. Explicit temporal constraints supported alignment between different registries. Using the OMOP standards and high-level treatment classifications supported data conversion between various registries and integration of the data collected via REDCap and sourced from EHR. Conclusion: Using real-world data for observational COVID and cancer research presented us with opportunities to improve and mature our evolving research infrastructure and better support internal and distributed research, and highlighted the need for uniform data standards in the cancer domain. Citation Format: Rimma Belenkaya, Adam Watson, Shantha Bethusamy, Meera Patel, Tatyana Sandler, Julian Schwartz, James Park, Maggie Dobbins, Molly Maloy, Michael Lam, Nadia Bahadur, John Philip. Data harmonization for COVID-19 and cancer research registries [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-061.

Farm to school (F2S) programs aim to educate people about food and farming, to increase the availability of fresh, nutritious foods, and to improve health outcomes among children. Nationally, all states have school districts that self-identify as farm-to-school program participants. National and regional food procurement systems account for the majority of food purchased by National School Lunch Program participants, but school foodservice authorities (SFA) who purchase food from farmers often do so in the context of strengthening their farm-to-school program (U.S. Department of Agriculture [USDA], n.d.-b). A greater number of local supply chain participants benefit when food is sourced in state (locally) rather than out-of-state because more money ends up in the pockets of local producers and distribu­tors. Local fruit and vegetable producers and SFAs interested in developing business partnerships for local procurement would benefit from recommen­dations on menu-appropriate fresh market prod­ucts, volume, and purchase prices. However, detailed data sets from SFAs are uncommon, limiting opportunities to advance procurement efforts. The objective for this project was to begin developing local procurement recommendations for other Florida school districts based on the purchasing history and experiences of the Sarasota County School District (SCSD). In 2014, Sarasota County, Florida, received a USDA F2S implementation grant, affording it the opportunity to develop its local procurement efforts. One deliverable from that project was a robust data set of school food purchases over a two-year period. With permission SCSD, we analyzed seasonal purchase variations and market prices of local and out-of-state fresh fruits, vege­tables, and egg purchases for 38 public schools in the SCSD. In this paper, we present an approach to estimate the potential of local procurement viability in the context of an emerging districtwide F2S program and recommend system changes based on the success of procurement efforts in SCSD and surrounding school districts in Southwest Florida.

Background National guidelines for the prevention of surgical site infections (SSI) recommend against antibiotic prophylaxis following wound closure for clean and clean-contaminated surgical procedures. Prolonged antibiotic prophylaxis can lead to antibiotic resistance and adverse drug events without reducing SSI rates. The objective was to reduce the rate of antibiotic prophylaxis following surgical incision closure for specified procedures in the Divisions of Neurosurgery (NRS), Otolaryngology (OTO), and General Surgery (GS) at Children’s Hospital of Philadelphia (CHOP). Methods We identified all NRS, OTO, and GS procedures conducted at CHOP from July 1, 2016 to June 20, 2017. Collaborative meetings between surgical quality improvement team leads and the antimicrobial stewardship program (ASP) were convened to identify procedures most suitable for the intervention, including Chiari decompressions and tethered cord repair (NRS); tympanoplasty and tracheostomy (OTO); and laparoscopic and thoracoscopic procedures (GS). The intervention, started in March 2018, included (1) education of surgeons on perioperative prescribing guidelines, (2) order set modification, and (3) individualized monthly audit with feedback reports of inappropriate postoperative prescribing (via email copying all surgeons within the division). We monitored rates utilizing SPC charts of postoperative antibiotic use (defined as administration within 24 hours of procedure end) and evaluated SSI rates pre and post-intervention with a Poisson regression. Results Following the intervention, postoperative antibiotic use reached special cause resulting in a mean decline for laparoscopy (19.6% to 11.7%), thoracoscopy (35.6% to 17.9%), tympanoplasty (90.5% to 11.4%), tethered cord repair (95% to 25.5%), and Chiari decompression (97% to 45.9%). There was no mean shift in postoperative antibiotic use for tracheostomy (25.5%). 30-day SSI rates did not change pre- and post-intervention (P = 0.36). Conclusion A quality improvement initiative conducted to implement national guidelines recommending against postoperative antibiotic prophylaxis showed a significant reduction in postoperative antibiotic prophylaxis without a concomitant rise in SSI rates. Disclosures All authors: No reported disclosures.

Twentieth annual report on the survival of Scottish snow patches.

The 21st annual report on the survival of Scottish snow patches.

ABSTRACT INTRODUCTIONMeasles is a highly contagious disease caused by the rubeola virus. It can result in ocular complications such as conjunctivitis and keratitis, which will be encountered in general practice. Cases usually resolve without sequelae, but may progress to corneal perforation if left untreated. AIMWe present two cases of rubeola keratitis secondary to measles infection. METHODSThis report is about a retrospective review of data from two patients who presented to the eye department with rubeola keratitis in the midst of the recent measles outbreak in New Zealand. RESULTSBoth patients presented with decreased visual acuity approximately 2 weeks after being diagnosed with measles. One of them was unvaccinated, whereas the other had no documentation of previous vaccination. Both were healthy and immunocompetent individuals. There was no evidence of corneal perforation or retinopathy on examination. Both patients regained their baseline visual acuity after treatment with fluorometholone eye drops. DISCUSSIONDespite the existence of a safe and effective vaccine, there were more than 2000 cases of measles in the recent outbreak in New Zealand. The lack of vaccination is one of the primary causes of rubeola keratitis. These cases highlight the effects of measles infection from an ophthalmology perspective and reinforce the paramount importance of getting vaccinated.