bluuebunny/crossref_metadata_2025 huggingface dataset:
Control of Phoma Leaf Spot and Root Decay of Table Beet in New York
Authors: Pethybridge Sarah J. , Murphy Sean , Hay Frank , Branch Eric , Sharma Pratibha , Kikkert Julie R.
Published: January 2022

Disease caused by Neocamarosporium betae (syn. Phoma betae, Pleospora betae) results in reductions in plant populations, foliar disease (Phoma leaf spot [PLS]), and root disease and decay in table beet. Disease caused by N. betae has reemerged as prevalent in organic table beet production in New York. The disease can also cause substantial issues in conventional table beet production. To evaluate in-field control options for conventional and organic table beet production, small-plot, replicated trials were conducted in each of two years (2019 and 2021). The fungicides, propiconazole and difenoconazole, and premixtures, pydiflumetofen + fludioxonil or pydiflumetofen + difenoconazole, provided excellent PLS and root decay control. Azoxystrobin provided excellent (69.9%) control of PLS in 2019 and lesser (40%) control in 2021. Field trial results complemented in vitro sensitivity testing of 30 New York N. betae isolates that were all highly sensitive to azoxystrobin (mean effective concentration to reduce mycelial growth by 50%, EC50= 0.0205 µg/ml) and propiconazole (mean EC50= 0.0638 µg/ml). Copper octanoate and microbial biopesticides containing either Bacillus amyloliquefaciens D747 or B. mycoides strain J provided moderate (68.5 to 74.6%) PLS control as reflected in epidemic progress. The Gompertz model provided the best fit to PLS epidemics reflecting a polycyclic epidemic. Reductions in PLS severity were associated with significant decreases in Phoma root decay and increases in canopy health and the time-to-death of leaves compared with nontreated control plots. Prolonging leaf survival is critical for mechanical harvest of roots. These findings underpin the design of programs for foliar disease control in conventional and organic table beet production. Assessment of PLS severity in the field will better inform postharvest management decisions.
Plasmodiophora brassicae in Mexico: From Anecdote to Fact
Authors: Padrón-Rodríguez Legnara , Cerdán Cabrera Carlos Roberto , Sánchez Coello Nadia Guadalupe , Luna-Rodríguez Mauricio , Pérez-López Edel
Published: January 2022

For years, the presence of clubroot disease and its causal agent, Plasmodiophora brassicae, in Mexico has been stated as a fact. However, an intensive search of the scientific literature in English and Spanish, as well as gray literature including theses and government reports, did not reveal any information about the actual detection of the pathogen, affected hosts, or areas with clubroot presence, or any information about clubroot (hernia de la col in Mexico). We followed a multistep process to confirm whether P. brassicae was indeed in Mexico. First, we identified agricultural communities with a history of cruciferous crop cultivation. Second, we asked growers if they had seen clubroot on their crops, using pictures of the characteristic root galls. Third, we collected soil from the locations where clubroot was reported and looked for clubroot/P. brassicae in the soil using several cruciferous bait plants. For the first time we confirm the presence of the clubroot pathogen P. brassicae in Mexico, through a bioassay, the presence of resting spores, and a P. brassicae-specific PCR assay. The identification of P. brassicae in Mexico will contribute to our understanding of the genetic diversity of this elusive and devastating plant pathogen in future studies.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Intra-operative hypertension and myocardial injury and/or mortality and acute kidney injury after noncardiac surgery
Authors: Shimada Tetsuya , Mascha Edward J. , Yang Dongsheng , Bravo Mauro , Rivas Eva , Ince Ilker , Turan Alparslan , Sessler Daniel I.
Published: January 2022

BACKGROUND

Whether intra-operative hypertension causes postoperative complications remains unclear.

OBJECTIVE

We sought to assess whether there is an absolute systolic hypertensive threshold associated with increased odds of a composite of postoperative myocardial injury and mortality, and acute kidney injury.

DESIGN

A retrospective cohort analysis using an electronic medical record registry.

SETTING

The Cleveland Clinic Main Campus, Cleveland, Ohio, USA, between January 2005 and December 2018.

PATIENTS

A total of 76 042 adults who had inpatient noncardiac surgery lasting at least an hour, creatinine recorded preoperatively and postoperatively, and had an available clinic blood pressure within 6 months before surgery.

MAIN OUTCOME MEASURES

Univariable smoothing and multivariable logistic regression were used to estimate the probability of each outcome as a function of the highest intra-operative pressure for a cumulative 5, 10, or 30 min. We further assessed whether the relationships between intra-operative hypertension and each outcome depended on baseline systolic blood pressure.

RESULTS

The composite of myocardial injury and mortality was observed in 1.9%, and acute kidney injury in 4.5% of patients. After adjustment for confounders, there was little or no relationship between systolic pressure and either outcome over the range from 120 to 200 mmHg. There were also no obvious change points or thresholds above which odds of each outcome increased. And finally, there was no interaction with preoperative clinic blood pressure.

CONCLUSIONS

There was no clinically meaningful relationship between intra-operative systolic pressure and the composite of myocardial injury and mortality, or acute kidney injury, over the range from 120 and 200 mmHg.
The Effect of Oestrogen Supplementation on Antioxidant Enzymes and Mitochondrial Respiratory Function After Myocardial Infarction of Ovariectomized Rats
Authors: Čižmárová Beáta , Evinová Andrea , Račay Peter , Birková Anna , Hubková Beáta , Mareková Mária , Toporcer Tomáš , Grendel Tomáš , Toporcerová Silva , Vašková Janka
Published: January 2022

Acute myocardial infarction (MI) is the leading cause of mortality worldwide with premenopausal women showing a lower incidence of cardiovascular disease compared with men of the same age. After menopause, this advantage disappears, suggesting that sex hormones play a cardioprotective role. This study was aimed to assess on the activity of antioxidant enzymes in plasma and the respiratory function of isolated heart mitochondria after the induction of MI in rats after ovariectomy and estradiol benzoate supplementation. Sprague–Dawley female rats were ovariectomized 3 months before the induction of MI and supplemented/not supplemented with oestrogen 3 months before/7 days after the induction of MI. No significant differences in glutathione peroxidase activities were found in any group. Differences between values were only significant in the ovariectomized not supplemented group (P < 0.01) for the glutathione reductase activity and glutathione concentrations. In isolated mitochondria (7 days after MI), the decline in respiration was observed comparing the ovariectomized and nonovariectomized group. Respiratory functions did not show significant differences between animals supplemented with oestrogen before MI or treated with oestrogen after MI. Ovariectomy worsened mitochondrial dysfunction after MI, and oestrogen supplementation before or after the induction of MI did not improve mitochondrial function.
Inosine Triphosphate Pyrophosphatase and NUDT15 are Good Predictors of Clinical Outcomes in Thiopurine-Treated Chinese Patients with Inflammatory Bowel Disease
Authors: Luo Xuemei , Yan Simin , Jin Lu , Zhu Huaijun , Zhang Xiaoqi , Ge Weihong
Published: January 2022

Background:

Although the relationship between NUDT15 and thiopurine-induced leukopenia has been proven in previous studies, no prominent factors explaining interindividual variations in its active metabolite, 6-thioguanine nucleotide (6-TGN), and clinical efficacy have been identified. In this study, the correlation between genotypes (thiopurine S-methyltransferase, NUDT15, and ITPA polymorphisms), 6-TGN concentrations, and clinical outcomes (efficacy and side effects) in patients with inflammatory bowel disease were investigated.

Methods:

In total, 160 patients with inflammatory bowel disease were included, and the 3 genotyped genes and 6-TGN levels were measured by high-performance liquid chromatography. Statistical analyses and calculations were performed to determine their relationships.

Results:

ITPA genotypes and 6-TGN concentration were both associated with the clinical effectiveness of azathioprine (P = 0.036 and P = 4.6 × 10−7), with a significant correlation also detected between them (P = 0.042). Patients with ITPA variant alleles exhibited higher 6-TGN levels than those with the wild-type allele. In addition, the relationship between NUDT15 and leukopenia and neutropenia was confirmed (P = 1.79 × 10−7 and 0.002).

Conclusions:

In summary, it is recommended that both ITPA and NUDT15 genotyping should be performed before azathioprine initiation. Moreover, the 6-TGN concentration should be routinely monitored during the later period of treatment.
Outpatient Nonmelanoma Skin Cancer Excision and Reconstruction: A Clinical, Economical, and Patient Perception Analysis
Authors: Lisa Andrea Vittorio Emanuele , Vinci Valeriano , Galtelli Leonardo , Battistini Andrea , Murolo Matteo , Vanni Elena , Azzolini Elena , Klinger Marco
Published: January 2022

Background:

Nonmelanoma skin cancers constitute more than 15% of all types of cancer. To obtain the best cosmetic outcome, local flaps represent the ideal surgical choice.

Methods:

We conducted a retrospective review of patients treated from 2016 to 2019. The day-surgery group included 73 patients, and the outpatient group included 70 patients. We analyzed medical records regarding age of diagnosis, waiting time, site of lesion, reconstructive technique, histologic diagnosis, radicality of excision, and complications. We administered a survey based on quality items and carried out an economic evaluation.

Results:

Outpatient removals were radical 92.6% of the time against the 78% of those performed in the operating room (P = 0.14). We observed two cases of wound dehiscence and two cases of hematoma in the day-surgery group. Economic analysis showed reduced costs in the outpatient setting.

Conclusion:

Skin excision and local flap reconstruction are safe procedures in an outpatient setting under a clinical, economical, and patient perception point of view.
Optimal Irrigant in High Pressure Paint Injection Injuries of the Hand
Authors: Bascone Corey M. , Sheber Benjamin , Dave Dattesh , Firriolo Joseph M. , Pereira Clifford
Published: January 2022

Background:

High pressure injection injury to the hand with paint leads to amputation rates near 48%. Historically, authors utilized saline irrigation alone, but have high reoperation rates. We conducted a cadaveric study to determine the ideal detergent for effective paint removal from the soft tissue.

Methods:

Two cadaveric hands were amputated from the same cadaver. The left and right hand digits were injected with flat white latex-based paint and flat white oil-based paint, respectively. Each digit received a longitudinal incision and was scrubbed for 120 seconds with 50 mL of a randomly assigned detergent and no detergent (saline) as the control. After achieving a lather, each finger was cleansed with 50 mL saline before being evaluated by two blinded hand surgery faculty. Reviewers assessed the washouts as adequate or inadequate, in order to generate a Kappa statistic and measure inter-rater reliability prior to ranking each digit (1 through 5) (ie, 1 = most paint-free soft tissue).

Results:

The two hand faculty had an inter-rater reliability of 0.70. Both reviewers ranked povidone-iodine 10% or Johnson & Johnson shampoo as the best irrigant for latex-based paint. In oil-based paint, povidone-iodine 10%, Johnson & Johnson, & Techni-care were ranked as top three. All reviewers reported detergents were better than saline alone.

Conclusions:

The addition of detergent created an irrigant that removed both latex- and oil-based paint better than normal saline alone. Based on these results, surgeons treating high-pressure injection injury should consider using Povidone-Iodine 10% or Johnson & Johnson baby shampoo for latex- or oil-based paint.
Neuropsychological Performance and Functional Capacity Following Mild Traumatic Brain Injury in Veterans
Authors: Clark Jillian M. R. , Mahmood Zanjbeel , Jak Amy J. , Huckans Marilyn , O'Neil Maya E. , Roost Mai S. , Williams Rhonda M. , Turner Aaron P. , Pagulayan Kathleen F. , Storzbach Daniel , Twamley Elizabeth W.
Published: January 2022

Objective:

To examine the relationship between neuropsychological functioning and performance-based functional capacity in veterans with a history of mild traumatic brain injury (mTBI), as well as the moderating effects of age and psychiatric symptoms on this relationship.

Setting:

Three Veterans Affairs medical centers.

Participants:

One hundred nineteen Iraq/Afghanistan veterans with a history of mTBI and self-reported cognitive difficulties.

Design:

Cross-sectional, secondary data analysis of baseline measures in a randomized controlled trial.

Main Measures:

The main outcome measure, functional capacity, was assessed using the objective and performance-based University of California San Diego Performance-based Skills Assessment-Brief. A global deficit score (GDS) was created as a composite score for performance on a battery of neuropsychological measures assessing domains of attention, processing speed, executive functioning, and verbal memory performance. Posttraumatic stress disorder (PTSD) symptom severity was assessed using the PTSD Checklist-Military Version, and depressive symptom severity was assessed using the Beck Depression Inventory, Second Edition.

Results:

Bivariate analyses indicated that worse neuropsychological performance (ie, higher GDS) and greater PTSD symptom severity were associated with worse communication abilities and worse overall functional capacity. Multiple linear regressions demonstrated that GDS and PTSD symptom severity explained 9% of the variance in communication and 10% of the variance in overall functional capacity; however, GDS emerged as the only significant predictor in both regressions. Age, PTSD, and depressive symptom severity did not moderate the relationship between GDS and overall functional capacity. Performance in the verbal learning and memory domain emerged as the strongest neuropsychological predictor of communication and overall functional capacity.

Conclusions:

Worse neuropsychological functioning was moderately associated with worse performance-based functional capacity, even when accounting for PTSD symptom severity. Verbal learning and memory was the primary neuropsychological domain driving the relationship with functional capacity; improvement in verbal learning and memory may translate into improved functional capacity.
Exploring Vestibular Ocular Motor Screening in Adults With Persistent Complaints After Mild Traumatic Brain Injury
Authors: Parrington Lucy , King Laurie A. , Hoppes Carrie W. , Klaiman Maxwell J. , Michielutti Patrick , Fino Peter C. , Dibble Leland E. , Lester Mark E. , Weightman Margaret M.
Published: January 2022

Objective:

The purpose of this study was to (1) explore differences in vestibular ocular motor screening (VOMS) symptoms between healthy adults and adults with persistent symptoms after mild traumatic brain injury (mTBI), and (2) explore the relationships between VOMS symptoms and other measures (self-reported vestibular symptoms, clinical measures of balance and gait, and higher-level motor ability tasks).

Setting:

Research laboratory setting.

Participants:

Fifty-three persons with persistent symptoms (>3 weeks) following mTBI and 57 healthy controls were recruited. Eligibility for participation included being 18 to 50 years of age and free of medical conditions that may affect balance, with the exception of recent mTBI for the mTBI group.

Design:

Cross-sectional.

Main Measures:

The primary outcomes were the VOMS symptom scores and near point of convergence (NPC) distance. Secondary outcomes included the Dizziness Handicap Inventory (DHI) total and subdomain scores, sway area, Functional Gait Analysis total score, gait speed, and modified Illinois Agility Task completion time, and Revised High-Level Mobility Assessment Tool total score.

Results:

The mTBI group reported more VOMS symptoms (z range, −7.28 to −7.89) and a further NPC (t = −4.16) than healthy controls (all Ps < .001). DHI self-reported symptoms (total and all subdomain scores) were strongly associated with the VOMS symptom scores (rho range, 0.53-0.68; all Ps < .001). No significant relationships existed between VOMS symptoms and other measures.

Conclusion:

Significant group differences support the relevance of the VOMS for mTBI in an age-diverse sample with persistent symptoms. Furthermore, strong association with DHI symptoms supports the ability of the VOMS to capture vestibular complaints in this population.
CLINICAL PRESENTATIONS, MICROBIOLOGY, AND FACTORS AFFECTING MANAGEMENT OUTCOMES IN LENS ABSCESS WITH CONCURRENT ENDOPHTHALMITIS
Authors: Dave Vivek Pravin , Ramamurthy Srishti , Das Anthony Vipin , Joseph Joveeta , Pathengay Avinash
Published: January 2022

Purpose:

To describe the clinical presentations, microbiology, and factors affecting management outcomes in lens abscess with concurrent endophthalmitis.

Materials:

A retrospective, consecutive, noncomparative series including cases of endophthalmitis with concurrent lens abscess from January 2017 to May 2021.

Results:

This study included 102 eyes, predominantly male (71.6%). All cases were posttrauma. The mean age noted was 30.47 ± 19.51 years. Presenting vision was logMAR 3.02 ± 0.74 (median 3.5, Snellen 20/63245). A favorable anatomical outcome was seen in 63 eyes (61.8%), while a final favorable functional outcome was seen in 51 eyes (50%). The mean follow-up duration was 10.04 ± 10.87 months (median 4.5). Final vision was logMAR 2.13 ± 1.32 (median 2.7, Snellen 20/10023) (P < 0.0001). The mean follow-up duration was 10.04 ± 10.87 months (median 4.5). Increasing age (OR 1.04, P = 0.02), female sex (OR 7.91, P = 0.007), initial intervention of vitrectomy instead of limited vitreous biopsy (OR 11.72, P = 0.009), and a negative vitreous culture (OR 14.28, P = 0.0004) predicted a favorable anatomical outcome. Absence of a corneal infiltrate (OR 11.11, P = 0.003) and initial intervention of vitrectomy instead of a limited vitreous biopsy (OR 21.96, P < 0.0001) predicted a favorable functional outcome. Culture positivity was seen in 56.9% of the cases. Gram-positive organisms were predominant (n = 41) followed by Gram-negative organisms (n = 12) and fungi (n = 10).

Conclusion:

Lens abscess can present concurrently with traumatic endophthalmitis. Management should involve the complete removal of the crystalline lens along with a pars plana vitrectomy for optimal outcomes.
Efficacy of Acitretin Monotherapy on Basal Cell Carcinoma: A Case Report
Authors: Chen Ping-Jiao , Liang Jing-Yao , Tian Xin , Li Chang-Xing , Zhang Xi-Bao
Published: January 2022

Introduction:

Basal cell carcinoma (BCC) is the most common skin cancer which mainly affects the population over 50 years of age. In addition to surgical treatment, nonsurgical treatment is also an attractive option for some patients.

We herein report a case of an 82-year-old man with BCC successfully treated with acitretin.

Case presentation:

An 82-year-old man presented with BCC on his left nose wing more than 2 years ago. Due to his unwillingness to accept treatment that may lead to pain, discomfort, or trauma, the patient was prescribed oral acitretin 25 mg twice daily [0.8 mg/(kg·d)] and was instructed to apply 2% fusidic acid cream topically once daily for trauma protection. The lesion progressively shrank in size after 4 weeks of treatment, and was almost completely resolved after 28 weeks of follow-up. The patient reported mild adverse effects, such as mild skin fragility and cheilitis, and apparent scaling skin, which caused minor discomfort but did not affect the continuation of treatment.

Discussion:

The pathogenesis of BCC is still unclear, but it has been demonstrated to be linked to overactive hedgehog signaling and its crosstalk with other pathways such as phosphoinositide 3-kinase and mammalian target of rapamycin. Acitretin could obviously inhibit cell growth and proliferation and down-regulate AMP-dependent protein kinases that plays critical role in the blocking of malignant progression of several tumors including BCC.

Conclusion:

We provide an effective alternative for the patients with BCC who are unwilling to receive surgical therapy.
An Exploration into the Physician Assistant Entry-Level Doctoral Degree: Lessons Learned From Across Health Professions
Authors: Gordes Karen L. , Fleming Shani , Kulo Violet , Cawley James F. , Kibe Lucy , Kayingo Gerald
Published: January 2022

This article explores current trends in the ongoing debate about transitioning to an entry-level doctoral degree for the physician assistant (PA) profession and identifies lessons learned from the disciplines of nursing, pharmacy, and physical therapy, which have already transitioned to an entry-level doctoral credential. We conducted a mixed-method study that involved an interprofessional systematic literature review and an examination of publicly available databases. Based on lessons learned from other health professions, a model for implementation of an entry-level doctoral degree for the PA profession is presented here. Recommendations for the profession include establishing a clear objective for doctoral degree transition, providing flexibility for options in program delivery, and transitioning through a phased approach. Further studies are warranted to explore risks and benefits in detail and to establish PA doctorate essentials, competencies, and an accreditation plan before the profession transitions to an entry-level doctoral credential.
Wet Mount Microscopy of the Vaginal Milieu Does Not Predict the Outcome of Fertility Treatments: A Cross-sectional Study
Authors: Vieira-Baptista Pedro , Silva-Soares Sandra , Lyra Joana , Falcão Vera , Póvoa Ana Margarida , Calejo Lucinda , Sousa Sónia
Published: January 2022

Objective

The aim of the study was to evaluate whether vaginal dysbiosis (bacterial vaginosis [BV] or moderate/severe aerobic vaginitis [AV]/desquamative inflammatory vaginitis) in women subjected to intrauterine insemination (IUI) or in vitro fertilization/intracytoplasmic sperm injection influences the rates of pregnancy.

Materials and Methods

This is a cross-sectional study involving 392 women who underwent IUI or in vitro fertilization/intracytoplasmic sperm injection at a fertility clinic. All had a slide collected for phase contrast wet mount microscopy (WMM), which was classified according to the International Society for the Study of Vulvovaginal Disease recommendations. Correlation between flora patterns and the rate of pregnancy were evaluated.

Results

There were no differences in any of the groups in terms of pregnancy rate (biochemical, clinical, at first trimester ultrasound, or live birth) after stratifying for the presence of BV, moderate or severe (ms) AV, BV and/or moderate or severe AV, cytolysis, or abnormal vaginal flora (lactobacillary grade ≥ IIb). The presence of Candida species, cocci, or bacilli morphotypes other than lactobacilli also showed no differences.

Conclusions

The vaginal flora assessment by WMM at the time of IUI or oocyte retrieval was not predictive of the success of fertility treatments.

The absence of differences may be due to intrinsic limitations of WMM (i.e., identifying only bacterial morphotypes), a positive impact of the treatments in the vaginal flora or because the sperm and embryo transfer is made directly into the uterine cavity, thus overcoming any cervical or vaginal dysbiosis disadvantage. Future studies should focus on the endometrial milieu, rather than in the vaginal and/or cervical one.
Calcitonin gene-related peptide and pituitary adenylate cyclase-activating polypeptide in migraine treatment
Authors: Dominguez-Moreno Rogelio , Do Thien Phu , Ashina Messoud
Published: January 2022

Purpose of review

To review the latest advances in migraine management with a focus on medications specifically developed for the treatment of migraine.

Recent findings

Randomized clinical trials demonstrated the efficacy of calcitonin gene-related peptide (CGRP) mAbs for the preventive treatment of migraine and the small molecule CGRP receptor antagonist gepants for acute abortion and prevention of migraine attacks. Pituitary adenylate cyclase-activating polypeptide (PACAP) is another signaling molecule of interest and represents a potential new drug class of mechanism-based migraine medications. Drugs targeting PACAP are currently undergoing clinical trials, and the coming years will reveal whether this class of drugs will expand our therapeutic armamentarium.

Here, we summarize the role of CGRP and PACAP in migraine pathophysiology and discuss novel therapies targeting the CGRP and PACAP signaling pathways.
Empowering Nurses Through Peer-Led Instruction to Increase Specialty Certification Rates
Authors: Fox Naomi M. , Richter Stephanie M. , Gerardo Floresca Lucia Russini
Published: January 2022

Nursing specialty certification is an organizational, nursing, and professional goal for many stakeholders. Several types of review courses are available to support nurses. A peer-led certification review course was designed and implemented for medical/surgical and telemetry nurses. The peer-led instruction was the crux of empowering nurses to achieve certification. Assessment of the intervention was measured by quantitative data on pass rates. Evaluative information was gathered from the participants. Certification rates increased for applicable units.
Quick Response (QR) Code Electronic Competencies
Authors: Coughlin Vincenza
Published: January 2022

Documentation of competency as validation of nursing skill and knowledge is essential for safe patient care. In efforts to leverage technology and maximize mobile resources, a process for electronic competency validation was developed. Utilization of quick response (QR) codes allows for easy application and efficient tracking. Results include cost savings, improved time spent on filing, and overall satisfaction. This is a simple and sustainable process for competency documentation that can translate across diverse professional development settings.
Preparing New Graduate Nurses for Patient Rescue
Authors: Norris Heather , New Keri , Miller Bethany , Kramer Margaret , Fultz Julia , Arthur Charity , Smoot Brittany , Rogers Allison
Published: January 2022

A patient deterioration educational program was offered to new graduate nurses. Pre and post self-confidence scores were compared, and competency performance was evaluated during a simulation. The results indicate that most of the participants successfully demonstrated simulation competencies, and there was a statistically significant improvement in self-confidence scores. Based on these findings, education on identifying and managing patient deterioration that includes a simulation experience may be beneficial.
Addressing Challenges in Recruiting Diverse Populations for Research
Authors: Wright Fay , Malone Susan Kohl , Wong Agnes , D'Eramo Melkus Gail , Dickson Victoria Vaughan
Published: January 2022

Background

Improving the recruitment and retention of underrepresented groups in all research areas is essential for health equity. However, achieving and retaining diverse samples is challenging. Barriers to recruitment and retention of diverse participants include socioeconomic and cultural factors and practical challenges (e.g., time and travel commitments).

Objectives

The purpose of this article is to describe the successful recruitment and retention strategies used by two related studies within a P20 center funded by the National Institute of Nursing Research focused on precision health research in diverse populations with multiple chronic conditions, including metabolic syndrome.

Methods

To address the complexity, biodiversity, and effect of metabolic syndrome and multiple chronic conditions, we developed culturally appropriate, multipronged recruitment and retention strategies for a pilot intervention study and a longitudinal observational pilot study within our P20 center. The following are the underlying principles that guided the recruitment and retention strategies: (a) flexibility, (b) active listening and bidirectional conversations, and (c) innovative problem solving.

Results

The intervention study (Pilot 1) enrolled 49 participants. The longitudinal observational study (Pilot 2) enrolled 45 participants. Women and racial/ethnic minorities were significantly represented in both. In Pilot 1, most of the participants completed the intervention and all phases of data collection. In Pilot 2, most participants completed all phases of data collection and chose to provide biorepository specimens.

Discussion

We developed a recruitment and retention plan building on standard strategies for a general medical population. Our real-world experiences informed the adaption of these strategies to facilitate the participation of individuals who often do not participate in research—specifically, women and racial/ethnic populations. Our experience across two pilot studies suggests that recruiting diverse populations should build flexibility in the research plan at the outset.
Composite Classic Hodgkin Lymphoma and Follicular Lymphoma
Authors: Huang Yuhua , Hu Shimin , Larson Daniel P. , Shi Min , He Rong , Dave Bhavana J. , Greiner Timothy C. , Fu Kai , McPhail Ellen D. , Ketterling Rhett P. , Medeiros L. Jeffrey , Yuan Ji
Published: January 2022

Composite classic Hodgkin lymphoma and follicular lymphoma (CHLFL) is a rare and poorly characterized entity. Herein, we report the clinicopathologic features of 22 cases of CHLFL from 3 institutions and we assess 27 additional cases reported in the literature. In our cohort (n=22), patients with CHLFL had a median age of 61 years and an equal male to female incidence. Most cases (95%) arose de novo with the remaining patients having a history of non-Hodgkin lymphoma. CHLFL always involved lymph nodes (100%) and most cases (95%) revealed 2 distinct areas separately diagnostic for CHL and FL. The CHL component represented a variable proportion of the overall neoplasm (5% to 90%) and was either mixed cellularity (82%) or nodular sclerosis (18%) type. The Hodgkin/Reed-Sternberg cells expressed CD30 (100%), PAX5 (100%), CD15 (62%), BCL6 (47%), BCL2 (29%), and EBER (25%), in a polymorphous inflammatory background typical of CHL. The FL component was low-grade in 55%, grade 3A in 36%, and grade 3B in 9% of cases. All 3 cases investigated by cytogenetic methods for a clonal relationship between the CHL and FL components were clonally related. These clinicopathologic features of our cohort are similar to those of cases reported in the literature. The 5-year overall survival in combined patients with CHLFL (n=49) was 48%, comparable to CHL but worse than FL in the elderly. In summary, CHLFL is a rare entity that most often occurs in older adults, involves lymph nodes, and most commonly presents de novo. In the small number of cases assessed, the CHL and FL components are usually clonally related suggesting that the CHL and FL components may share a common progenitor B-cell, likely a mutated germinal center B-cell.
Intravenous Fluid Bolus Volume and Resolution of Acute Kidney Injury in Children With Diabetic Ketoacidosis
Authors: Bergmann Kelly R. , Boes Morgan , Velden Heidi Vander , Abuzzahab M. Jennifer , Watson David
Published: January 2022

Objectives

To describe trends in creatinine and acute kidney injury (AKI) in children who present with diabetic ketoacidosis (DKA) and receive low versus high intravenous (IV) fluid bolus volumes. Further, to determine whether resolution of AKI is hastened by low versus high bolus volumes.

Methods

We conducted an observational retrospective cohort study between January 2012 and March 2020 among children ≤21 years presenting with DKA. Acute kidney injury was defined by the Kidney Disease/Improving Global Outcomes creatinine criteria, using the Schwartz estimating equation to calculate an expected baseline creatinine. Bolus volume was categorized as low (<15 mL/kg) or high (≥15 mL/kg). Generalized additive mixed models were used to model trends of creatinine ratios. Estimated mean creatinine ratios and differences by bolus volumes were assessed at the time of bolus, and 12, 24, 36, 48 hours. Cox proportional hazard models were used to estimate the association between resolution of AKI and bolus volume after adjustment for confounders.

Results

We identified 708 eligible encounters with DKA, of which 169 (23.9%) had AKI at presentation and 10 (1.4%) developed AKI after hospitalization. Comparing patients who received low versus high bolus volumes, the proportion of encounters with AKI on presentation was similar (P = 0.364) as was the mean difference in creatinine ratios over time. In adjusted analysis, treatment with high IV fluid bolus volume was only associated with a 6.2% faster resolution of AKI (hazard ratio, 1.062; 95% confidence interval, 0.61–1.87).

Conclusions

Intravenous fluid bolus volume was not associated with resolution of AKI in our cohort of children with DKA.
Musculoskeletal and Neurological Pain Symptoms Among Hospitalized COVID-19 Patients
Authors: Jena Debasish , Sahoo Jagannatha , Barman Apurba , Gupta Anil , Patel Vikas
Published: January 2022

Objective

As the coronavirus disease 2019 pandemic continues to grow, its clinical manifestations are still emerging and are being widely investigated. However, the pain symptoms, including neurological and musculoskeletal pain symptoms, are still poorly understood.

Design

In this cross-sectional study, we investigated the prevalence of musculoskeletal and neurological pain symptoms among hospitalized coronavirus disease 2019 patients. Furthermore, the association of clinical and demographic factors with the prevalence of pain symptoms was also investigated.

Result

We included 182 hospitalized coronavirus disease 2019 patients with a mean age of 48.86 ± 13.98 yrs. Pain symptoms were reported by 61.54% patients (n = 112). Most common symptoms reported were generalized myalgia (n = 60, 32.96%), headache (n = 50, 27.47%), and low back pain (n = 41, 22.53%). Interestingly, neuropathic pain was present in 14 participants (7.69%). Logistic regression analysis revealed an association of pain symptoms with coronavirus disease 2019 severity, male sex, higher body mass index, and a history of addiction.

Conclusions

Pain symptoms are common manifestation of coronavirus disease 2019. Generalized myalgia, headache, and low back pain are the three most common new-onset pain symptoms in hospitalized coronavirus disease 2019 patients. Further investigation of pain symptoms and their predictive factors are recommended, which may guide healthcare workers and policymakers to plan in this direction.

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CME Objectives

Upon completion of this article, the reader should be able to: (1) Understand common musculoskeletal and neurological pain symptoms among hospitalized COVID-19 patients; (2) Understand the basic etiopathogenesis of COVID-19 associated pain; and (3) Identify factors associated with presence of COVID-19 pain symptoms.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Central nervous system monoaminergic activity in hip osteoarthritis patients with disabling pain: associations with pain severity and central sensitization
Authors: Bjurström Martin F. , Blennow Kaj , Zetterberg Henrik , Bodelsson Mikael , Waldén Markus , Dietz Nicholas , Hall Sara , Hansson Oskar , Irwin Michael R. , Mattsson-Carlgren Niklas
Published: January 2022

Introduction:

Monoaminergic activity modulates nociceptive transmission in the central nervous system (CNS). Although pain is the most disabling symptom of osteoarthritis (OA), limited knowledge exists regarding the CNS mechanisms that amplify pain and drive sensitization processes in humans.

Objectives:

The main objective of this study was to evaluate associations between cerebrospinal fluid (CSF) monoamine metabolites, pain severity, and central sensitization in patients with OA undergoing total hip arthroplasty (THA).

Methods:

Patients with OA (n = 52) and pain-free controls (n = 30) provided CSF samples for measurement of serotonin (5-hydroxyindoleacetic acid [5-HIAA]), noradrenaline (3-methoxy-4-hydroxyphenylglycol [HMPG]), and dopamine (homovanillic acid [HVA]) monoamine metabolites. Patients with OA completed longitudinal evaluation of pain using clinical measures and quantitative sensory testing.

Results:

Patients with OA had higher HMPG levels when compared with controls (P = 0.036). Within patients with OA undergoing THA, higher 5-HIAA and HVA levels were consistently associated with higher preoperative pain severity. Higher concentrations of 5-HIAA and HVA were also associated with lower conditioned pain modulation levels, whereas higher HMPG levels were linked to more efficient conditioned pain modulation. Patients with higher levels of CSF HVA exhibited increased pressure pain sensitivity (arm pressure pain detection threshold < 250 kPa vs ≥ 250 kPa, P = 0.042). Higher preoperative levels of CSF 5-HIAA predicted poorer pain control 6 months postoperatively (brief pain inventory pain severity; adjusted β = 0.010, 95% CI 0.001–0.019).

Conclusions:

In OA patients with disabling pain, higher CSF levels of serotonin and dopamine metabolites are associated with increased pain severity and central sensitization. Increased noradrenergic activity may be associated with more efficient pain inhibitory capacity.
Sleep and Daily Social Experiences as Potential Mechanisms Linking Social Integration to Nocturnal Blood Pressure Dipping
Authors: Chin Brian N. , Dickman Kristina D. , Koffer Rachel E. , Cohen Sheldon , Hall Martica H. , Kamarck Thomas W.
Published: January 2022

Objective

Socially integrated individuals are at lower risk of cardiovascular disease morbidity and mortality compared with their more isolated counterparts. This association may be due, in part, to the effect of social integration on nocturnal blood pressure (BP) decline or “dipping,” a physiological process associated with decreased disease risk. However, the pathways linking social integration with nocturnal BP dipping are unknown. We sought to replicate the association between social integration and BP dipping, and to test whether sleep characteristics (duration, regularity, continuity) and/or daily social interactions (frequency, valence) helped to explain the association.

Methods

A total of 391 healthy midlife adults completed an actigraphy assessment protocol that measured sleep. During four actigraphy assessment days, participants also completed ambulatory BP monitoring and ecological momentary assessment protocols that measured BP and social interactions at regular intervals throughout the day. Social integration was assessed via a questionnaire.

Results

Linear regression controlling for age, sex, race, education, and body mass index indicated that higher levels of social integration were associated with greater nocturnal BP dipping, as indicated by a smaller ratio of night/day mean arterial pressure (β = −0.11, p = .031). Analyses of indirect effects suggested that this association was explained, in part, by greater sleep regularity among more integrated individuals. We did not find evidence for other hypothesized indirect effects.

Conclusions

This was the first study to investigate sleep and social mechanisms underlying the link between social integration and nocturnal BP dipping. Because sleep regularity is modifiable, this pathway represents a potential intervention target to promote nocturnal BP dipping.
Effects of Early Life Adversity on Pubertal Timing and Tempo in Black and White Girls: The National Growth and Health Study
Authors: Hamlat Elissa June , Laraia Barbara , Bleil Maria E. , Deardorff Julianna , Tomiyama A. Janet , Mujahid Mahasin , Shields Grant S. , Brownell Kristy , Slavich George M. , Epel Elissa S.
Published: January 2022

Objective

Although exposure to abuse in early life predicts earlier pubertal timing, especially for girls, it is unclear if this association generalizes to nonabuse stressors. In addition, the impact of race on the stress-maturation association remains unknown. To address these issues, we examined whether race moderates the effects of early adversity on pubertal timing and tempo using a longitudinal study design.

Methods

In a cohort of 9- and 10-year-old Black and White girls, pubertal (areolar and pubic hair) maturation was assessed annually for 7 years. In adulthood, 368 participants (186 Black, 182 White) reported on abuse and nonabuse stressors they experienced from ages 0 to 12 years.

Results

Early life abuse was associated with earlier pubertal timing, as indexed by younger age at menarche (b = −0.22, p = .005, 95% confidence interval [CI] = −0.39 to −0.06) and greater pubic hair development (b = 0.11, p = .003, 95% CI = 0.04 to 0.18), in addition to slower pubertal tempo, as indexed by slower rate of pubic hair (b = −0.03, p < .001, 95% CI = −0.05 to −0.01) and areolar (b = −0.02, p = .02, 95% CI = −0.03 to −0.003) development. These associations were not found for nonabuse adversity. Black girls with early life abuse had greater pubic hair development (b = 0.23, p < .001, 95% CI = 0.12 to 0.35) and were slower in pubic hair tempo (b = −0.07, p < .001, 95% CI = −0.09 to −0.04) than their White counterparts.

Conclusions

Screening for early life abuse may help address health disparities related to earlier pubertal timing.
Associations Between Maternal Distress, Cortisol Levels, and Perinatal Outcomes
Authors: Lundholm Cecilia , Rejnö Gustaf , Brew Bronwyn , Smew Awad I. , Saltvedt Sissel , Almqvist Catarina
Published: January 2022

Objective

Stress during pregnancy may decrease gestational age at birth and birth size. We aimed to investigate the associations between maternal subjective stress measures, salivary cortisol, and perinatal outcomes.

Methods

A cohort of pregnant women (n = 1693) was recruited from eight antenatal care clinics in Stockholm, Sweden. Questionnaires on subjective distress (perceived stress, worry, depression symptoms, sleep quality) and saliva samples for cortisol measurement (morning and evening) were collected in early and late pregnancy. Perinatal outcomes were birth weight, birth length, gestational age, and birth weight for gestational age. We used linear regression to estimate associations adjusted for maternal characteristics.

Results

All associations between subjective distress and cortisol levels were close to null and nonsignificant, for example, exp(β) = 1.001 (95% confidence interval = 0.995 to 1.006) for the morning cortisol level and perceived stress in early pregnancy. Likewise, most associations between distress (subjective and cortisol) and perinatal outcomes were weak and not statistically significant, for example, β = 1.95 (95% confidence interval = −4.16 to 8.06) for perceived stress in early pregnancy and birth weight. An exception was a statistically significant association between birth weight for gestational age and depression symptoms in early pregnancy, with somewhat higher weight with more symptoms (β = 0.08; 95% CI = 0.04 to 0.13). The results were similar for stress in early and late pregnancy.

Conclusions

We found no association between subjective distress and cortisol measures irrespective of when in pregnancy the measures were taken. Furthermore, we found no evidence for a longitudinal association between psychological measures of stress or cortisol with lower birth weight, birth weight for gestational age, or gestational age.
Developing Methods to Support Collaborative Learning and Co-creation of Resilient Healthcare—Tips for Success and Lessons Learned From a Norwegian Hospital Cancer Care Study
Authors: Bergerød Inger Johanne , Clay-Williams Robyn , Wiig Siri
Published: January 2022

Background

There is a growing attention on the role of patients and stakeholders in resilience, but there is lack of knowledge and methods on how to support collaborative learning between stakeholders and co-creation of resilient healthcare. The aim of this article was to demonstrate how the methodological process of a consensus process for exploring aspects of next of kin involvement in hospital cancer care can be replicated as an effort to promote resilient healthcare through co-creation with multiple stakeholders in hospitals.

Methods

The study applied a modified nominal group technique process developed by synthesizing research findings across 4 phases of a research project with a mixed-methods approach. The process culminated in a 1-day meeting with 20 stakeholder participants (5 next of kin representatives, 10 oncology nurses, and 5 physicians) from 2 Norwegian university hospitals.

Results

The consensus method established reflexive spaces with collective sharing of experiences between the 2 hospitals and between the next of kin and healthcare professionals. The method promoted collaborative learning processes including identification and reflection upon new ideas for involvement, and reduction of the gap between healthcare professionals’ and next of kin experiences and expectations for involvement. Next of kin were considered as important resources for resilient performance, if involved with a proactive approach. The consensus process identified both successful and unsuccessful collaborative practices and resulted in a co-designed guide for healthcare professionals to support next of kin involvement in hospital cancer care.

Conclusions

This study expands the body of knowledge on methods development that is relevant for collaborative learning and co-creation of resilient healthcare. This study demonstrated that the consensus methods process can be used for creating reflexive spaces to support collaborative learning and co-creation of resilience in cancer care. Future research within the field of collaborative learning should explore interventions that include a larger number of stakeholders.