Headlands Center for the Arts

BackgroundIn previous treat-to-target trials, adjustments to the dose of basal insulin have been made at least weekly, according to fasting blood glucose levels. A fixed-dose regimen of insulin efsitora alfa (efsitora), a once-weekly basal insulin, may provide a benefit in adults with type 2 diabetes who have not received previous insulin therapy.MethodsWe conducted a 52-week, phase 3, open-label, treat-to-target trial involving adults with type 2 diabetes who had not previously received insulin therapy. Participants were randomly assigned in a 1:1 ratio to receive once-weekly efsitora or once-daily insulin glargine U100 (glargine). Treatment with efsitora was initiated as a single dose of 100 U administered once weekly, with dose adjustments made every 4 weeks, as needed, at fixed doses of 150, 250, and 400 U to achieve fasting blood glucose levels of 80 to 130 mg per deciliter. Doses of glargine were adjusted weekly or more often according to a standard algorithm to reach the same glycemic goals. The primary end point, tested for noninferiority (noninferiority margin, 0.4 percentage points), was the change from baseline in the glycated hemoglobin level at 52 weeks.ResultsA total of 795 participants underwent randomization. The mean glycated hemoglobin level decreased from 8.20% at baseline to 7.05% at week 52 with efsitora (least-squares mean change, −1.19 percentage points) and from 8.28% to 7.08% with glargine (least-squares mean change, −1.16 percentage points); the estimated between-group difference of −0.03 percentage points (95% confidence interval [CI], −0.18 to 0.12) confirmed the noninferiority of efsitora to glargine. Superiority was not shown (P=0.68). The rate of combined clinically significant hypoglycemia (glucose level, <54 mg per deciliter) or severe hypoglycemia (level 3; requiring assistance for treatment) was lower with efsitora than with glargine (0.50 events per participant-year of exposure with efsitora vs. 0.88 with glargine; estimated rate ratio, 0.57 [95% CI, 0.39 to 0.84]). At week 52, the mean total weekly insulin dose was 289.1 U per week with efsitora and 332.8 U per week with glargine (estimated between-group difference, −43.7 U per week; 95% CI, −62.4 to −25.0); the median number of dose adjustments needed was 2 with efsitora and 8 with glargine.ConclusionsIn adults with type 2 diabetes who had not previously received insulin, once-weekly efsitora, administered in a fixed-dose regimen, was noninferior to once-daily glargine in reducing glycated hemoglobin levels. (Funded by Eli Lilly; ClinicalTrials.gov number, NCT05662332.)

A 2-yr grazing trial was conducted to evaluate the use of conserved forage type, stockpiled Tifton 85 bermudagrass ( L.; T85) or T85 hay, and supplement type for stocker cattle during the fall forage deficit in the southeastern United States. The study site consisted of six 0.75-ha paddocks of stockpiled T85 for grazing and six 0.20-ha drylot paddocks for feeding T85 hay. Steers ( = 5 per paddock; mean initial BW for both yr, 263 ± 30 kg) were randomly assigned to paddocks on November 11, 2014 and October 28, 2015 in yr 1 and yr 2, respectively. Treatments included T85 hay or stockpile (control), T85 hay or stockpile plus 0.2 kg cottonseed meal and 0.7 kg soybean hulls∙steer∙d (SUPPL1), or 0.45 kg cottonseed meal and 0.45 kg soybean hulls∙steer∙d (SUPPL2). Polytape fencing was used for frontal grazing stockpiled T85 paddocks to allocate a 3- to 4-d allotment of forage DM for the animals based on available forage mass and steer DMI requirements. There were no differences among treatments ( > 0.10) in mean pregrazing forage mass across sampling dates (5,099 kg DM/ha and 7,998 kg DM/ha in yr 1 and yr 2, respectively), forage allowance (1.9 kg DM/kg steer BW and 3.0 kg DM/kg steer BW in yr 1 and yr 2, respectively) and forage utilization (84% and 88% in yr 1 and yr 2, respectively). No differences ( > 0.10) were detected for nutritive value parameters CP, ADF, NDF, and TDN among stockpiled T85 treatments in both yr. However, there were differences across sampling dates ( < 0.0001) for stockpiled T85 such that forage quality generally declined as the grazing season progressed in both yr. Steers fed T85 hay had greater final BW and ADG ( = 0.018) than those grazing stockpiled T85. Mean final BW and ADG of steers grazing T85 stockpile or fed hay with no supplementation was less ( = 0.020) than those receiving supplementation. Steers grazing stockpiled T85 had decreased ADG in the second half of the grazing season in both yr of the study, which is a result of declining forage nutritive value as the stockpiling season progressed. Results indicate that stockpiled T85 supplemented with CP and energy can support stocker cattle at a maintenance level, but to achieve a target gain of 0.9 kg/day would require a greater level of supplementation to overcome decreasing forage nutritive value dynamics.

Increasing the peanut (Arachis hypogea L.) digger efficiency by accurate placement over the target rows could minimize damaged pods and yield losses. Producers have traditionally relied solely on tractor operator skills to harvest peanuts. However, as peanut production has shifted to new growing regions in the Southeast US, producers face difficulties digging peanuts under conventional and new management schemes. The present study aimed to: (i) determine the effect of row deviations (RD) of the digger from the target row on peanut yield and quality, and (ii) determine the economic value of using RTK auto-steer guidance systems to avoid tractor deviations during peanut harvest. The study consisted of a randomized complete block design of tillage [conventional (CT) and strip tillage (ST)], row patterns [single (SR) and twin (TWR)] and row deviation (RD0 mm, RD90 mm, and RD180 mm). The RD90 mm and RD180 mm treatments exemplify manual driving deviations compared to using an RTK auto-steer guidance system (RD0 mm). Higher yields and higher net returns resulted from using the RTK auto-steer guidance system. Data showed that for every 20 mm row deviation, an average of 186 kg ha−1 yield loss can be expected. Overall, yield was higher for the conventional tillage and twin row pattern treatments compared to the other treatments. Yield losses for the SR-CT treatment were higher as the row deviation increased compared with the TWR-CT treatment. In contrast, higher yield losses for TWR-ST compared to SR-ST were observed when deviations of 180 mm occurred instead of digging using the RTK auto-steer guidance system. While a farmer using an RTK auto-steer guidance system with an accuracy within 25 mm (RD0 mm treatment) could potentially expect additional net returns of between 94 and 404 $ ha−1 compared to those from row deviations of 90 mm, higher net returns of between 323 and 695 $ ha−1 could be perceived if the guidance system is used instead of having row deviations of 180 mm. Therefore, the use of RTK auto-steer guidance system will allow growers to capitalize on the increases in yield potential by implementing changes in tillage and row patterns as those evaluated in this study.

Purpose Highly stressed employees are subject to greater health risks, costs, and productivity losses than those with normal stress levels. To address this issue, work-site stress management programs must be able to engage individuals as well as capture data on stress, health indices, work productivity, and healthcare costs. In this randomized controlled pilot, our primary objective was to evaluate the viability and proof of concept for two innovative mind-body workplace stress reduction programs, setting the stage for larger cost-effectiveness trials. A second objective was to evaluate two delivery venues of the mindfulness intervention (online versus in-person). Methods