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Abstract Background New patient-centered models of care are needed to individualize care and reduce high-cost care, including emergency department (ED) visits and hospitalizations for low- and intermediate-acuity conditions that could be managed outside the hospital setting. Community paramedics (CPs) have advanced training in low- and high-acuity care and are equipped to manage a wide range of health conditions, deliver patient education, and address social determinants of health in the home setting. The objective of this trial is to evaluate the effectiveness and implementation of the Care Anywhere with Community Paramedics (CACP) program with respect to shortening and preventing acute care utilization. Methods This is a pragmatic, hybrid type 1, two-group, parallel-arm, 1:1 randomized clinical trial of CACP versus usual care that includes formative evaluation methods and assessment of implementation outcomes. It is being conducted in two sites in the US Midwest, which include small metropolitan areas and rural areas. Eligible patients are ≥ 18 years old; referred from an outpatient, ED, or hospital setting; clinically appropriate for ambulatory care with CP support; and residing within CP service areas of the referral sites. Aim 1 uses formative data collection with key clinical stakeholders and rapid qualitative analysis to identify potential facilitators/barriers to implementation and refine workflows in the 3-month period before trial enrollment commences (i.e., pre-implementation). Aim 2 uses mixed methods to evaluate CACP effectiveness, compared to usual care, by the number of days spent alive outside of the ED or hospital during the first 30 days following randomization (primary outcome), as well as self-reported quality of life and treatment burden, emergency medical services use, ED visits, hospitalizations, skilled nursing facility utilization, and adverse events (secondary outcomes). Implementation outcomes will be measured using the RE-AIM framework and include an assessment of perceived sustainability and metrics on equity in implementation. Aim 3 uses qualitative methods to understand patient, CP, and health care team perceptions of the intervention and recommendations for further refinement. In an effort to conduct a rigorous evaluation but also speed translation to practice, the planned duration of the trial is 15 months from the study launch to the end of enrollment. Discussion This study will provide robust and timely evidence for the effectiveness of the CACP program, which may pave the way for large-scale implementation. Implementation outcomes will inform any needed refinements and best practices for scale-up and sustainability. Trial registration ClinicalTrials.gov NCT05232799. Registered on 10 February 2022.

The present research examined the distributional properties of construct reliability indices and model fit metrics, explored relationships between and among the indices and metrics, and investigated variables influencing the relative magnitudes of the indices and metrics in structural equation measurement models. A broad-based meta-analysis of reported construct reliability indices and selected model fit metrics revealed modest relationships among reliability indices, minimal relationships among model fit metrics, and a virtual absence of relationships between reliability indices and model fit metrics. Differences in magnitudes of selected reliability indices and model fit metrics were found to primarily be a function of the (total) number of items employed in a measurement model. The implications of the findings suggest that the current practice of indiscriminately computing and reporting of reliability indices and model fit metrics based only on arbitrary heuristics should be abolished and replaced by theoretically justified indices and metrics.

Loss of crop protection products when agricultural spray applications drift has economic and ecological consequences. Modification of the spray solution through tank additives and product formulation is an important drift reduction strategy that could mitigate these effects, but has been studied less than most other strategies. Therefore, an experimental field study was conducted to evaluate spray drift resulting from agricultural ground applications of an insecticide formulated as a suspension concentrate (SC) and as a wettable powder (WP), with and without two adjuvants. Droplet sizes were also measured in a wind tunnel to determine if indirect methods could be substituted for field experimentation to quantify spray drift from these technologies. Results suggest that spray drift was reduced by 37% when comparing the SC to the WP formulation. As much as 63% drift reduction was achieved by incorporating certain spray adjuvants, but this depended on the formulation/adjuvant combination. The wind tunnel data for droplet spectra showed strong agreement with field deposition trends, suggesting that droplet statistics could be used to estimate drift reduction of spray solutions. These findings can be used to develop a classification scheme for formulated products and tank additives based on their potential for reducing spray drift.

Plant resistance against insect herbivory has greatly focused on antibiosis, whereby the plant has a deleterious effect on the herbivore, and antixenosis, whereby the plant is able to direct the herbivore away from it. Although these two types of resistance may reduce injury and yield loss, they can produce selection pressures on insect herbivores that lead to pest resistance. Tolerance, on the other hand, is a more sustainable pest management strategy because it involves only a plant response and therefore does not cause evolution of resistance in target pest populations. Despite its attractive attributes, tolerance has been poorly studied and understood. In this critical, interpretive review, we discuss tolerance to insect herbivory and the biological and socioeconomic factors that have limited its use in plant resistance and integrated pest management. First, tolerance is difficult to identify, and the mechanisms conferring it are poorly understood. Second, the genetics of tolerance are mostly unknown. Third, several obstacles hinder the establishment of high-throughput phenotyping methods for large-scale screening of tolerance. Fourth, tolerance has received little attention from entomologists because, for most, their primary interest, research training, and funding opportunities are in mechanisms which affect pest biology, not plant biology. Fifth, the efforts of plant resistance are directed at controlling pest populations rather than managing plant stress. We conclude this paper by discussing future research and development activities.

There are relatively few experimental studies and risk assessments of the effects on non-target insects from ultra-low volume (ULV) insecticides used for management of adult mosquitoes. Therefore, we evaluated factors that may influence the ability of an insect to intercept the insecticide at the time of application by using Hippodamia convergens (Coleoptera: Coccinellidae) in field bioassay experiments in 2011 and 2015. Treatment factors included different distances, two cage heights (ground-level and 1.5 m above ground) to the point of the application, and covered vs. uncovered cage faces (2015 only). Insecticides used included a water-based formulation (Aqua-Reslin®) and an oil-based formulation (Permanone® 30-30) of permethrin. Cage height was highly significant both years, with much less acute (i.e., short-term exposure) mortality at ground-level compared with 1.5 m. In 2011, acute mortality was less at ground-level (mean = 3.2%, median = 0%) compared to 1.5 m (mean = 85.2%, median = 100%). Cage type also was highly significant, with less mortality in covered cages compared to uncovered cages. Mortality by cage height and cage type was as follows: ground level, covered cage (mean = 2.8%, median = 0.1%); ground level, uncovered cage (mean = 41.9%, median = 9.6%); 1.5 m, covered cage (mean = 6.8%, median = 0%); 1.5 m, uncovered cage (mean = 83.7%, median = 100%). Results suggest that acute mortality to non-target insects may vary considerably based on their height and their ability to directly intercept the insecticide as the aerosol passes through the area being sprayed.

In 2005, an outbreak of West Nile virus (WNV) disease occurred in Sacramento County, California; 163 human cases were reported. In response to WNV surveillance indicating increased WNV activity, the Sacramento-Yolo Mosquito and Vector Control District conducted an emergency aerial spray. We determined the economic impact of the outbreak, including the vector control event and the medical cost to treat WNV disease. WNV disease in Sacramento County cost ≈$2.28 million for medical treatment and patients’ productivity loss for both West Nile fever and West Nile neuroinvasive disease. Vector control cost ≈$701,790, including spray procedures and overtime hours. The total economic impact of WNV was $2.98 million. A cost-benefit analysis indicated that only 15 cases of West Nile neuroinvasive disease would need to be prevented to make the emergency spray cost-effective.

Decision analysis often considers multiple lines of evidence during the decision making process. Researchers and government agencies have advocated for quantitative weight-of-evidence approaches in which multiple lines of evidence can be considered when estimating risk. Therefore, we utilized Bayesian Markov Chain Monte Carlo to integrate several human-health risk assessment, biomonitoring, and epidemiology studies that have been conducted for two common insecticides (malathion and permethrin) used for adult mosquito management to generate an overall estimate of risk quotient (RQ). The utility of the Bayesian inference for risk management is that the estimated risk represents a probability distribution from which the probability of exceeding a threshold can be estimated. The mean RQs after all studies were incorporated were 0.4386, with a variance of 0.0163 for malathion and 0.3281 with a variance of 0.0083 for permethrin. After taking into account all of the evidence available on the risks of ULV insecticides, the probability that malathion or permethrin would exceed a level of concern was less than 0.0001. Bayesian estimates can substantially improve decisions by allowing decision makers to estimate the probability that a risk will exceed a level of concern by considering seemingly disparate lines of evidence.

Comparing risks among pesticides has substantial utility for decision makers. However, if rating schemes to compare risks are to be used, they must be conceptually and mathematically sound. We address limitations with pesticide risk rating schemes by examining in particular the Environmental Impact Quotient (EIQ) using, for the first time, a probabilistic analytic technique. To demonstrate the consequences of mapping discrete risk ratings to probabilities, adjusted EIQs were calculated for a group of 20 insecticides in four chemical classes. Using Monte Carlo simulation, adjusted EIQs were determined under different hypothetical scenarios by incorporating probability ranges. The analysis revealed that pesticides that have different EIQs, and therefore different putative environmental effects, actually may be no different when incorporating uncertainty. The EIQ equation cannot take into account uncertainty the way that it is structured and provide reliable quotients of pesticide impact. The EIQ also is inconsistent with the accepted notion of risk as a joint probability of toxicity and exposure. Therefore, our results suggest that the EIQ and other similar schemes be discontinued in favor of conceptually sound schemes to estimate risk that rely on proper integration of toxicity and exposure information.

Florida is riddled with sinkholes due to its karst topography. Sometimes these sinkholes can cause extensive damage to infrastructure and homes. It has been suggested that agricultural practices, such as sprinkler irrigation methods used to protect crops, can increase the development of sinkholes, particularly when temperatures drop below freezing, causing groundwater levels to drop quickly during groundwater pumping. In the strawberry growing region, Dover/Plant City, Florida, the effects have caused water shortages resulting in dry-wells and ground subsidence through the development of sinkholes that can be costly to maintain and repair. In this study, we look at how frost-freeze events have affected West Central Florida over the past 25 years with detailed comparisons made between two cold-years (with severe frost-freeze events) and a warm year (no frost-freeze events). We analyzed the spatial and temporal correlation between strawberry farming freeze protection practices and the development of sinkholes/dry well complaints, and assessed the economic impact of such events from a water management perspective by evaluating the cost of repairing and drilling new wells and how these compared with using alternative crop-protection methods. We found that the spatial distribution of sinkholes was non-random during both frost-freeze events. A strong correlation between sinkhole occurrence and water extraction and minimum temperatures was found. Furthermore as temperatures fall below 41°F and water levels decrease by more than 20 ft, the number of sinkholes increase greatly (N >10). At this time alternative protection methods such as freeze-cloth are cost prohibitive in comparison to repairing dry wells. In conclusion, the findings from this study are applicable in other agricultural areas and can be used to develop comprehensive water management plans in areas where the abstraction of large quantities of water occur.

Thin-layer chromatography of phospholipids and cerebrosides was performed on Silica Gel G plates using a mixture of chloroform-methanol-acetic acid-water as development solvent. Two types of chromatoplates were used: “neutral” plates, prepared from Silica Gel G slurry made in water, and “basic” plates, prepared from Silica Gel G slurry made in 0.01 m sodium acetate or sodium carbonate solutions. Only chromatograms run on “basic” plates showed good and reproducible separations of phosphatidyl serine from other phospholipids, independent of the amount of phosphatidyl serine present in the sample. However, “neutral” plates gave better separation of cerebrosides from phospholipids. A practical method of applying these systems for separation of phospholipids extracted from rat liver and human serum is presented.

Yellowstone National Park thermal features regularly discharge various heavy metals and metalloids. These metals are taken up by microorganisms that often form mats in thermal springs. These microbial mats also serve as food sources for invertebrate assemblages. To examine how heavy metals move through insect food webs associated with hot springs, two sites were selected for this study. Dragon-Beowulf Hot Springs, acid-sulfate chloride springs, have a pH of 2.9, water temperatures above 70 °C, and populations of thermophilic bacterial, archaeal, and algal mats. Rabbit Creek Hot Springs, alkaline springs, have a pH of up to 9, some water temperatures in excess of 60 °C, and are populated with thermophilic and phototrophic bacterial mats. Mats in both hydrothermal systems form the trophic base and support active metal transfer to terrestrial food chains. In both types of springs, invertebrates bioaccumulated heavy metals including chromium, manganese, cobalt, nickel, copper, cadmium, mercury, tin and lead, and the metalloids arsenic, selenium, and antimony resulting from consuming the algal and bacterial mat biomass. At least two orders of magnitude increase in concentrations were observed in the ephydrid shore fly Paracoenia turbida, as compared to the mats for all metals except antimony, mercury, and lead. The highest bioaccumulation factor (BAF) of 729 was observed for chromium. At the other end of the food web, the invertebrate apex predator, Cicindelidia haemorrhagica, had at least a 10-fold BAF for all metals at some location-year combinations, except with antimony. Of other taxa, high BAFs were observed with zinc for Nebria sp. (2180) and for Salda littoralis (1080). This accumulation, occurring between primary producer and primary consumer trophic levels at both springs, is biomagnified through the trophic web. These observations suggest trace metals enter the geothermal food web through the microbial mat community and are then transferred through the food chain. Also, while bioaccumulation of arsenic is uncommon, we observed five instances of increases near or exceeding 10-fold: Odontomyia sp. larvae (13.6), P. turbida (34.8), C. haemorrhagica (9.7), Rhagovelia distincta (16.3), and Ambrysus mormon (42.8).