‘Sunglow’ American Witchhazel

Witchhazel (Hamamelis sp.) cultivars are now available in an array of forms and flower colors, including several native, pollinator-friendly cultivars. However, little is known about response of witchhazel cultivars to powdery mildew (Podosphaera biuncinata) or the growth and flowering characteristics of witchhazel cultivars in a nursery field production setting. To provide growth, flowering, and disease incidence data to nursery growers, a cultivar trial including 23 cultivars of witchhazel representing five species was planted Apr. 2016 in McMinnville, TN. Plant growth, flowering density, length of bloom, and foliar disease incidence were evaluated over three growing seasons between May 2016 and Oct. 2018. ‘Zuccariniana’ japanese witchhazel (H. japonica) and ‘Sunglow’ common witchhazel (H. virginiana) showed the greatest height increase during the trial, and ‘Sunglow’ also added the most width during the trial. Cultivars with negative height or width growth included Sweet Sunshine chinese witchhazel (H. mollis) and hybrid witchhazels (H. ×intermedia) Aphrodite, Twilight, and Barmstedt Gold. Ten of the 23 cultivars experienced winter injury in the form of stem necrosis. Root crown sprouts were observed for all cultivars at least once during the trial. ‘Wisely Supreme’ chinese witchhazel had the longest bloom period, followed by ‘Westerstede’ and ‘Twilight’ hybrid witchhazels, whereas ‘Quasimodo’ vernal witchhazel (H. vernalis) had the greatest density of flowers. The hybrid witchhazel cultivars Aphrodite, Nina, and Arnold Promise and the common witchhazel cultivars Green Thumb and Sunglow were resistant to powdery mildew under trial conditions in all 3 years. ‘Twilight’ and ‘Barmstedt Gold’ hybrid witchhazel, ‘Little Suzie’ common witchhazel, ‘Wisley Supreme’ chinese witchhazel, and ‘Shibamichi Red’ japanese witchhazel were moderately resistant to powdery mildew

Sleep Hygiene and Problem Behaviors in Snoring and Non- Snoring School-Age Children

Objectives—The effects of sleep-disordered breathing, sleep restriction, dyssomnias, and parasomnias on daytime behavior in children have been previously assessed. However, the potential relationship(s) between sleep hygiene and children’s daytime behavior remain to be explored. The primary goal of this study was to investigate the relationship between sleep hygiene and problematic behaviors in non-snoring and habitually snoring children. Methods—Parents of 100 5- to 8-year-old children who were reported to snore “frequently” to “almost always,” and of 71 age-, gender-, and ethnicity-matched children who were reported to never snore participated in this study. As part of a larger, ongoing study, children underwent nocturnal polysomnography and parents were asked to complete the Children’s Sleep Hygiene Scale (CSHS) and the Conners’ Parent Rating Scales-Revised (CPRS-R:L). Results—In the snoring group, strong negative correlations (r = −.39, p Conclusions—Parental reports of behavioral patterns in snoring children indicate that poorer sleep hygiene is more likely to be associated with behavior problems, including hyperactivity, impulsivity, and oppositional behavior. In contrast, no significant relationships between slee

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomised, sham-controlled, blinded, phase 3 trial

Background High blood pressure is common in acute stroke and is a predictor of poor outcome; however, large trials of lowering blood pressure have given variable results, and the management of high blood pressure in ultra-acute stroke remains unclear. We investigated whether transdermal glyceryl trinitrate (GTN; also known as nitroglycerin), a nitric oxide donor, might improve outcome when administered very early after stroke onset. Methods We did a multicentre, paramedic-delivered, ambulance-based, prospective, randomised, sham-controlled, blinded-endpoint, phase 3 trial in adults with presumed stroke within 4 h of onset, face-arm-speech-time score of 2 or 3, and systolic blood pressure 120 mm Hg or higher. Participants were randomly assigned (1:1) to receive transdermal GTN (5 mg once daily for 4 days; the GTN group) or a similar sham dressing (the sham group) in UK based ambulances by paramedics, with treatment continued in hospital. Paramedics were unmasked to treatment, whereas participants were masked. The primary outcome was the 7-level modified Rankin Scale (mRS; a measure of functional outcome) at 90 days, assessed by central telephone follow-up with masking to treatment. Analysis was hierarchical, first in participants with a confirmed stroke or transient ischaemic attack (cohort 1), and then in all participants who were randomly assigned (intention to treat, cohort 2) according to the statistical analysis plan. This trial is registered with ISRCTN, number ISRCTN26986053. Findings Between Oct 22, 2015, and May 23, 2018, 516 paramedics from eight UK ambulance services recruited 1149 participants (n=568 in the GTN group, n=581 in the sham group). The median time to randomisation was 71 min (IQR 45–116). 597 (52%) patients had ischaemic stroke, 145 (13%) had intracerebral haemorrhage, 109 (9%) had transient ischaemic attack, and 297 (26%) had a non-stroke mimic at the final diagnosis of the index event. In the GTN group, participants’ systolic blood pressure was lowered by 5·8 mm Hg compared with the sham group (p<0·0001), and diastolic blood pressure was lowered by 2·6 mm Hg (p=0·0026) at hospital admission. We found no difference in mRS between the groups in participants with a final diagnosis of stroke or transient ischaemic stroke (cohort 1): 3 (IQR 2–5; n=420) in the GTN group versus 3 (2–5; n=408) in the sham group, adjusted common odds ratio for poor outcome 1·25 (95% CI 0·97–1·60; p=0·083); we also found no difference in mRS between all patients (cohort 2: 3 [2–5]; n=544, in the GTN group vs 3 [2–5]; n=558, in the sham group; 1·04 [0·84–1·29]; p=0·69). We found no difference in secondary outcomes, death (treatment-related deaths: 36 in the GTN group vs 23 in the sham group [p=0·091]), or serious adverse events (188 in the GTN group vs 170 in the sham group [p=0·16]) between treatment groups. Interpretation Prehospital treatment with transdermal GTN does not seem to improve functional outcome in patients with presumed stroke. It is feasible for UK paramedics to obtain consent and treat patients with stroke in the ultraacute prehospital setting. Funding British Heart Foundation

C-reactive Protein, Obstructive Sleep Apnea, and Cognitive Dysfunction in School-aged Children

Rationale: Obstructive sleep apnea (OSA) in children is associated with substantial neurobehavioral and cognitive dysfunction. However, not all children with OSA exhibit altered cognitive performance