A new invasive species in South America: Pinus oocarpa Schiede ex Schltdl.

Conifers have a long history of introductions into many parts of the world and are among the most notorious plant invaders. At least 20 species of the genus Pinus are now considered to be invasive in at least one region of the southern hemisphere. Here, we present a quantitative report of invasion by Pinus oocarpa in a relatively undisturbed vegetation of the Cerrado region of Brazil. The invasion front of P. oocarpa was 458 m distant from the area of introduction, which represents a mean rate of spread of 12.72 m year-1. The average density of invasive plants was 561 ind ha-1, with a maximum density of 1,212 ind ha-1. It is currently unknown if the studied invasive population has produced negative impacts on the invaded ecosystem. However, it would be safe to assume that with the observed densities and rate of spread, P. oocarpa could affect the native community that it invaded. An early response targeting the eradication of the invasive population could prevent these ecological costs

Innovative Technologies for Human Exploration: Opportunities for Partnerships and Leveraging Novel Technologies External to NASA

Human spaceflight organizations have ambitious goals for expanding human presence throughout the solar system. To meet these goals, spaceflight organizations have to overcome complex technical challenges for human missions to Mars, Near Earth Asteroids, and other distant celestial bodies. Resolving these challenges requires considerable resources and technological innovations, such as advancements in human health and countermeasures for space environments; self-sustaining habitats; advanced power and propulsion systems; and information technologies. Today, government space agencies seek cooperative endeavors to reduce cost burdens, improve human exploration capabilities, and foster knowledge sharing among human spaceflight organizations. This paper looks at potential opportunities for partnerships and spin-ins from economic sectors outside the space industry. It highlights innovative technologies and breakthrough concepts that could have significant impacts on space exploration and identifies organizations throughout the broader economy that specialize in these technologies

Innovative Technologies for Global Space Exploration

Under the direction of NASA's Exploration Systems Mission Directorate (ESMD), Directorate Integration Office (DIO), The Tauri Group with NASA's Technology Assessment and Integration Team (TAIT) completed several studies and white papers that identify novel technologies for human exploration. These studies provide technical inputs to space exploration roadmaps, identify potential organizations for exploration partnerships, and detail crosscutting technologies that may meet some of NASA's critical needs. These studies are supported by a relational database of more than 400 externally funded technologies relevant to current exploration challenges. The identified technologies can be integrated into existing and developing roadmaps to leverage external resources, thereby reducing the cost of space exploration. This approach to identifying potential spin-in technologies and partnerships could apply to other national space programs, as well as international and multi-government activities. This paper highlights innovative technologies and potential partnerships from economic sectors that historically are less connected to space exploration. It includes breakthrough concepts that could have a significant impact on space exploration and discusses the role of breakthrough concepts in technology planning. Technologies and partnerships are from NASA's Technology Horizons and Technology Frontiers game-changing and breakthrough technology reports as well as the External Government Technology Dataset, briefly described in the paper. The paper highlights example novel technologies that could be spun-in from government and commercial sources, including virtual worlds, synthetic biology, and human augmentation. It will consider how these technologies can impact space exploration and will discuss ongoing activities for planning and preparing them

Is the NICE traffic light system fit-for-purpose for children presenting with undifferentiated acute illness in primary care?

Background The National Institute of Clinical Excellence (NICE) traffic light system uses children’s symptoms and signs to categorise acute infections into red, amber and green. To our knowledge, no study has described the proportion of children with acute undifferentiated illness who fall into these categories in primary care, which is important since red and amber children are considered at higher risk of serious illness requiring urgent secondary care assessment. Aim To estimate the proportion of acutely unwell children presenting to primary care classified by the NICE traffic light system as red, amber or green, and to describe their initial management. Design and setting Secondary analysis of the Diagnosis of Urinary Tract infection in Young children prospective cohort study. Method 6797 children under 5 years presenting to 225 general practices with acute undifferentiated illness were retrospectively mapped to the NICE traffic light system by a panel of general practitioners. Results 6406 (94%) children were classified as NICE red (32%) or amber (62%) with 1.6% red and 0.3%, respectively, referred the same day for hospital assessment; and 46% and 31%, respectively, treated with antibiotics. The remaining 385 (6%) were classified green, with none referred and 27% treated with antibiotics. Results were robust to sensitivity analyses. Conclusion The majority of children presenting to UK primary care with acute undifferentiated illness meet red or amber NICE traffic light criteria,with only 6% classified as low risk, making it unfit for use in general practice. Research is urgently needed to establish as triage system suitable for general practice

A Synthetic Gene Drive System for Local, Reversible Modification and Suppression of Insect Populations

Replacement of wild insect populations with genetically modified individuals unable to transmit disease provides a self-perpetuating method of disease prevention but requires a gene drive mechanism to spread these traits to high frequency. Drive mechanisms requiring that transgenes exceed a threshold frequency in order to spread are attractive because they bring about local but not global replacement, and transgenes can be eliminated through dilution of the population with wild-type individuals and 6]. These features are likely to be important in many social and regulatory contexts. Here we describe the first creation of a synthetic threshold-dependent gene drive system, designated maternal-effect lethal underdominance (UD^(MEL)), in which two maternally expressed toxins, located on separate chromosomes, are each linked with a zygotic antidote able to rescue maternal-effect lethality of the other toxin. We demonstrate threshold-dependent replacement in single- and two-locus configurations in Drosophila. Models suggest that transgene spread can often be limited to local environments. They also show that in a population in which single-locus UDMEL has been carried out, repeated release of wild-type males can result in population suppression, a novel method of genetic population manipulation

802-6 The Cost-Effectiveness of Pravastatin in Secondary Prevention of Coronary Heart Disease

To determine the cost-effectiveness of pravastatin therapy in patients with coronary heart disease, a projected risk model was developed that used the results of the three-year, double blind, placebo controlled clinical trials: Pravastatin Limitation ofAtherosclerosis in the Coronary Arteries (PLAC I) and Pravastatin, Upids and Atherosclerosis in the Carotid Arteries (PLAC II). In addition to measuring atherosclerotic progression, the PLAC studies evaluated four outcome variables: coronary heart disease death, non-coronary heart disease death, fatal myocardial infarction, and non-fatal myocardial infarction in a patient population (mean age 60 years) with established coronary heart disease and moderate low-density-lipoprotein cholesterol levels, Pooled PLAC data analysis (n=559) revealed a statistically significant (p<0.05) difference in male non-fatal myocardial infarctions between the pravastatin and placebo groups. The projected risk model utilized Framingham data to project the risk of mortality 10 years post myocardial infarction. Markov Process was used to estimate the life-years saved and cost. All costs and benefits were discounted by 5%, Results are presented in the table below:Patient Risk ProfileCost per Life-Year SavedMale with CHD + 1Additional Risk Factor$19,082Male with CHD + 2 Additional Risk Factors$14,022Male with CHD + 3 Additional Risk Factors$10,630Based on this model, pravastatin monotherapy in secondary prevention of coronary heart disease has a cost-effectiveness ratio comparable to some of the widely accepted medical interventions such as breast cancer screening,$21,700, hydrochlorothiazide in the treatment of hypertension, $16,400, and pneumococcal vaccine,$12,000

The community paediatric respiratory infection surveillance study protocol:a feasibility, prospective inception cohort study

INTRODUCTION: Paediatric respiratory tract infections (RTIs) are common reasons for primary care consultations and antibiotic prescribing. Locally relevant syndromic and microbiological surveillance information has the potential to improve the care of children with RTIs by normalising illness (parents) and reducing uncertainty (clinicians). Currently, most RTI studies are conducted at the point of healthcare service consultation, leaving the community burden, microbiology, symptom duration and proportion consulting largely unknown. This study seeks to establish the feasibility of (mainly online) participant recruitment and retention, and the acceptability/comparability of parent versus nurse-collected microbiological sampling, to inform the design of a future surveillance intervention study. Evidence regarding consultation rates and symptom duration is also sought. METHODS AND ANALYSIS: A community-based, feasibility prospective inception cohort study, recruiting children aged ≥3 months and <16 years and their parents via general practitioner surgery invitation letter, aiming to collect data on 300 incident RTIs by July 2016. Following informed consent, parents provide baseline (demographic) data online, and respond to weekly emails to confirm the absence/presence of new RTI symptoms. Once symptomatic, parents provide daily data online (RTI symptoms, school/day-care attendance, time off work, health service use, medication), and a research nurse visits to collect clinical examination data and microbiological (nasal and saliva) swabs. Parents are invited to provide symptomatic (at nurse visit, but without nurse assistance) and asymptomatic (alone) swabs on recovery. A review of primary care medical notes will gather medical history, health service utilisation, referral and antibiotic prescribing rates. Feasibility will be assessed using recruitment and retention rates, data completeness; and acceptability by quantitative survey and qualitative interviews. Symptomatic parent and nurse swab pairs will be compared for microbe isolation

Outcome measures for use in trials of paediatric otorrhoea:A systematic review

Introduction:Paediatric otorrhoea (PO) describes a middle ear infection that results in a perforation of the tympanic membrane and ear discharge, in children and young people (CYP). Prolonged infection may be associated with hearing loss and developmental delay. The current management of paediatric otorrhoea is variable, including non-invasive treatments (conservative, oral antibiotics, topical antibiotics) and surgery, reflecting the lack of a sufficiently strong evidence base. Outcome reporting is fundamental to producing reliable and meaningful evidence to inform best practice.Objectives:Primary objective: to determine which outcome measures are currently used to evaluate treatment success in studies of non-surgical treatments for paediatric otorrhoea. Secondary objectives: to identify outcome measurement instruments used in the literature and assess their applicability for use in clinical trials of PO.Methods:This systematic review was registered with PROSPERO (CRD42023407976). Database searches of EMBASE, MEDLINE and Cochrane was performed on June 6, 2023, covering from Jan 1995 to May 2023. Randomised controlled trials or study protocols involving CYP with PO were included following PRISMA guidelines. Risk of bias was assessed with Cochrane's tool.Results:Of the 377 papers identified, six were included in the systematic review. The primary outcome of five of the studies related to otorrhoea cessation; both time to cessation and proportion recovered at various time points were used as measures. Two measurement instruments were identified: Otitis Media-6 Questionnaire and the Institute for Medical Technology Assessment Productivity Cost Questionnaire. Both were shown to be applicable measurement instruments when used in clinical trials of PO.Conclusions:To promote homogeneity and facilitate meaningful comparison and combination of studies, we propose that time to cessation of otorrhoea from onset of otorrhoea should be used as the primary outcome in future studies. Further research is needed to establish if this is the most important outcome to children and their caregivers

Reply to Dr. Lai regarding Allopurinol Hypersensitivity Syndrome in patients of Asian ancestry

We thank Dr Lai for their interest in our study (1). While we did not show a statistically significant link between the use of allopurinol and mortality in people with gout, we agree that Allopurinol Hypersensitivity Syndrome (AHS) is the most serious side-effect of allopurinol, particularly in populations with South East Asian ancestry, leading to the recommendation to screen people of South East Asian descent for the HLA-B*5801 allele prior to starting treatment with allopurinol (2,3)