QuitSMART Utah: an implementation study protocol for a cluster-randomized, multi-level Sequential Multiple Assignment Randomized Trial to increase Reach and Impact of tobacco cessation treatment in Community Health Centers.

BACKGROUND: Tobacco use remains the leading cause of death and disability in the USA and is disproportionately concentrated among low socioeconomic status (SES) populations. Community Health Centers (CHCs) are a key venue for reaching low SES populations with evidence-based tobacco cessation treatment such as Quitlines. Electronic health record (EHR)-based interventions at the point-of-care, text messaging (TM), and phone counseling have the potential to increase Quitline reach and are feasible to implement within CHCs. However, there is a lack of data to inform how, when, and in what combination these strategies should be implemented. The aims of this cluster-randomized trial are to evaluate multi-level implementation strategies to increase the Reach (i.e., proportion of tobacco-using patients who enroll in the Quitline) and Impact (i.e., Reach × Efficacy [efficacy is defined as the proportion of tobacco-using patients who enroll in Quitline treatment that successfully quit]) and to evaluate characteristics of healthcare system, providers, and patients that may influence tobacco-use outcomes. METHODS: This study is a multilevel, three-phase, Sequential Multiple Assignment Randomized Trial (SMART), conducted in CHCs (N = 33 clinics; N = 6000 patients). In the first phase, clinics will be randomized to two different EHR conditions. The second and third phases are patient-level randomizations based on prior treatment response. Patients who enroll in the Quitline receive no further interventions. In phase two, patients who are non-responders (i.e., patients who do not enroll in Quitline) will be randomized to receive either TM or continued-EHR. In phase three, patients in the TM condition who are non-responders will be randomized to receive either continued-TM or TM + phone coaching. DISCUSSION: This project will evaluate scalable, multi-level interventions to directly address strategic national priorities for reducing tobacco use and related disparities by increasing the Reach and Impact of evidence-based tobacco cessation interventions in low SES populations. TRIAL REGISTRATION: This trial was registered at ClinicalTrials.gov (NCT03900767) on April 4th, 2019.

Healing efficacy of sea buckthorn (Hippophae rhamnoides L.) seed oil in an ovine burn wound model.

To investigate the efficacy of sea buckthorn (SBT) seed oil - a rich source of substances known to have anti-atherogenic and cardioprotective activity, and to promote skin and mucosa epithelization - on burn wound healing, five adult sheep were subjected to 3rd degree flame burns. Two burn sites were made on the dorsum of the sheep and the eschar was excised down to the fascia. Split-thickness skin grafts were harvested, meshed, and fitted to the wounds. The autograft was placed on the fascia and SBT seed oil was topically applied to one recipient and one donor site, respectively, with the remaining sites treated with vehicle. The wound blood flow (LASER Doppler), and epithelization (ultrasound) were determined at 6, 14, and 21 days after injury. 14 days after grafting, the percentage of epithelization in the treated sites was greater (95 ± 2.2% vs. 83 ± 2.9%, p<0.05) than in the untreated sites. Complete epithelization time was shorter in both treated recipient and donor sites (14.20 ± 0.48 vs. 19.60 ± 0.40 days, p<0.05 and 13.40 ± 1.02 vs. 19.60 ± 0.50 days, p<0.05, respectively) than in the untreated sites, confirmed by ultrasound. In conclusion, SBT seed oil has significant wound healing activity in full-thickness burns and split-thickness harvested wounds.

Rice (Oryza sativa) response to drift rates of glyphosate.

Greenhouse and field studies were conducted to investigate response of two rice varieties, Priscilla and Cocodrie, to sub-lethal rates of glyphosate in terms of injury, shikimate accumulation and yield. In the greenhouse, more shikimate accumulated in Cocodrie than Priscilla at comparable glyphosate rates applied to plants at the three-leaf stage. In field studies, glyphosate was applied to both varieties when they were 74-cm tall and in the internode separation growth stage. Visual injury, plant height, and leaf-tissue samples for shikimate analysis were collected at 3, 7, 14, 21 and 28 days after treatment (DAT). Rice yield was also determined. Noticeable visual injury and height reduction to both varieties was observed as early as 7 and 3 DAT in Cocodrie and Priscilla, respectively. Shikimate levels in leaves began to increase in both varieties by 3 DAT in a dose-dependent manner and reached a peak between 7 and 14 DAT. Elevated shikimate levels were still detectable by 28 DAT. Similar levels of shikimate accumulated in both varieties at comparable glyphosate rates. However, glyphosate treatment at comparable rates reduced rice yields more in Cocodrie than in Priscilla. The highest rate of glyphosate reduced yield in Cocodrie by 92% whereas there was only a 60% yield reduction in Priscilla. Shikimate levels in glyphosate-treated rice were strongly correlated to yield reductions across both varieties and appeared to be a better predictor of yield reduction than was visual injury. Visual injury coupled with measured shikimate levels can be used collaboratively to identify glyphosate exposure and estimate subsequent rice yield reductions.