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Natural transformation is the process by which bacteria actively take up and integrate extracellular DNA into their genomes. In cyanobacteria, natural transformation has only been experimentally demonstrated in a few species. Although cyanobacteria are important model systems for studying photosynthesis and circadian cycling, natural transformation in cyanobacteria has not been characterized to the degree that the process has been studied in other Gram-negative bacteria. Two cyanobacterial species that are 99.8% genetically identical provide a unique opportunity to better understand the nuances of natural transformation in cyanobacteria: Synechococcus elongatus PCC 7942 and Synechococcus elongatus UTEX 2973 (hereafter called Synechococcus 7942 and Synechococcus 2973, respectively). Synechococcus 7942 is a naturally transformable model system, while Synechococcus 2973 is a recently discovered species that is not naturally competent. Taking only 1.5 h to replicate, Synechococcus 2973 is the fastest-growing cyanobacterial species known and thus is a strong candidate for serving as a model organism. However, its inability to undergo natural transformation has prevented it from becoming a widely used model system. By substituting polymorphic alleles from Synechococcus 7942 for native Synechococcus 2973 alleles, natural transformation was introduced into Synechococcus 2973. Two genetic loci were found to be involved in differential natural competence between the two organisms: transformation pilus component pilN and circadian transcriptional master regulator rpaA. By using targeted genome editing and enrichment outgrowth, a strain that was both naturally transformable and fast-growing was created. This new Synechococcus 2973-T strain will serve as a valuable resource to the cyanobacterial research community. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolic (VTE) complications appear common in hospitalised COVID‐19 patients, particularly among critically ill patients in intensive care units. However, there is significant heterogeneity in the reported use of thromboprophylaxis. Aims: The primary objective was to determine rates of symptomatic VTE in hospitalised COVID‐19 patients. Secondary objectives were to assess adherence to an institutional risk‐adapted thromboprophylaxis guideline, and rates of bleeding complications. Methods: A retrospective, single‐centre, cohort study was performed in consecutive hospitalised COVID‐19 patients over a 6‐month period (March to August 2020). Enoxaparin was used as thromboprophylaxis in all patients without a contraindication, with dose adjusted according to disease severity, weight and renal function. Results: Among 86 hospitalised COVID‐19 patients, no VTE were identified. Eighty‐one (94%) patients received anticoagulation, with 90% adherence to institutional thromboprophylaxis guidelines. Four bleeding events occurred, with one clinically relevant non‐major bleeding event and three minor bleeding events. Conclusion: Low rates of VTE were identified in hospitalised COVID‐19 patients using a risk‐adapted thromboprophylaxis protocol. [ABSTRACT FROM AUTHOR]

• In the United States (US), COVID-19 vaccination rates among non-US-born individuals are variable, but understanding them is critical to identifying disparities. • Among over 1.5 million patients eligible for COVID-19 vaccination at 4 health systems across the US, completion of the primary vaccination series was lower in patients with a language preference other than English (62.7 %) compared with English preferring patients (63.6 %). • Though completion of the primary series was higher for non-US-born persons compared with US born persons, completion of a booster dose was lower for non-US-born persons, refugees, and patients with language preference other than English compared with their counterparts. • Requirements for COVID-19 primary vaccination for entry into the US may have played a role in the higher completion of primary COVID-19 series vaccines among refugee, immigrant and migrant populations. • The lower rate of booster uptake among newcomer populations is worthy of further attention. In the United States (US), COVID-19 vaccination rates among non-US-born individuals (i.e., refugees, immigrants, and migrants [RIM]) are variable. Understanding baseline COVID-19 vaccine coverage among these populations and determining if disparities exist is essential for quality improvement initiatives and public health interventions. Baseline COVID-19 vaccination rates for both primary series and booster doses were calculated at four health systems located in Minnesota, Colorado, and Pennsylvania participating in the Minnesota Department of Health's Center of Excellence in Newcomer Health. Patients aged ≥5 years as of 1/1/22, seen for ≥1 primary care visit during 7/1/2019–6/30/22 were included. Descriptive statistics were calculated for three measures of COVID-19 vaccine coverage during 12/14/2020–6/30/2022: 1) initiation of primary series; 2) completion of primary series; 3) completion of first booster. We calculated vaccine coverage rates for the entire population and stratified by subgroup including country of origin, refugee status, and primary language preference. We included 1,624,573 patients eligible for COVID-19 primary series vaccine and 907,749 eligible for COVID-19 booster vaccination. The percent of eligible patients who completed a COVID-19 primary series (63.4 %) and booster dose (66.2 %) were similar. Completion of the primary series was higher for non-US-born persons (72.7 %) compared with US born persons (65.4 %), similar among refugees (63.5 %) and non-refugees (63.4 %), and lower in patients with language preference other than English (62.7 %) compared with English preferring patients (63.6 %). Booster completion was lower for non-US-born persons (61.8 %), refugees (46.7 %), and patients with language preference other than English (55.3 %) compared with US-born (70 %), non-refugees (66.3 %), and English preferring patients (67.3 %) respectively. This evaluation identified disparities in COVID-19 vaccination rates among non-US-born persons and persons with a language preference other than English living in the US. Targeted outreach efforts may be beneficial in reaching these populations. [ABSTRACT FROM AUTHOR]

Novel models that improve generalist-level palliative care for cystic fibrosis (CF) are needed to address the burden of this illness. A screening-and-triage model has the potential to identify clinical problems requiring immediate follow-up by CF professionals. This study describes such a model and its immediate impact on care delivery for CF patients during a two-year period. Eligible adults completed monthly online screening for sources of distress. If results revealed one or more "indicators of concern" on two consecutive screenings, this triggered an attempted triage by a social worker. Completed triages led to prompt follow-up by CF professionals for clinical problems, if indicated. Process data were summarized and generalized linear mixed models were used to evaluate baseline patient characteristics (symptom distress, quality of life, and sociodemographics) associated with the need for prompt follow-up. A total of 1,015 monthly surveys were completed by 74 patients; 634 (66 patients) had > 1 indicators of concern; and 164 surveys (46 patients) had > 1 indicators for two consecutive surveys (e.g., global distress, pain, dyspnea, and psychological symptoms). The 164 attempted triages yielded 84 completed triages (51.2%), of which 39 (46.4%) required prompt follow-up. In multivariable analyses, older patients and those with higher symptom distress at baseline were more likely to require prompt follow-up (p <.05). Web-based screening that assesses varied domains of distress or burden can identify a subset of CF patients whose clinical problems may benefit from immediate medical or psychological attention. Additional investigations should improve screening efficiency. [ABSTRACT FROM AUTHOR]

BACKGROUND ATX-101 is approved for submental fat reduction. OBJECTIVE To characterize the histological effect of ATX-101 injection into subcutaneous fat. METHODS This Phase 1 open-label study enrolled 14 adults to receive injections of ATX-101 into abdominal fat at varying concentrations (0.5%, 1.0%, 2.0%, or 4.0%), volumes (0.2 or 0.4 mL), spacing (0.7, 1.0, or 1.5 cm), and time points before scheduled abdominoplasty (1, 3, 7, or 28 days). During abdominoplasty, tissue was excised and preserved for histology. RESULTS All injection paradigms resulted in histological changes confined to the subcutaneous layer, which were more prominent at higher concentrations and independent of volume and spacing. Key features at Day 1 after injection were adipocytolysis, blood vessel injury, neutrophilic inflammation, and lysis of locally present neutrophils. At Day 3, inflammation was reduced versus Day 1, and hemorrhage and lipid lake formation (at higher concentrations) were observed. Day 7 samples exhibited prominent adipocytolysis, mild inflammation, lipid-laden macrophages in the septae, and repair of vascular injury. At Day 28, inflammation was largely resolved and prominent features were septal thickening, neovascularization, and atrophy of fat lobules. CONCLUSION Subcutaneous injection of ATX-101 induces adipocytolysis and local inflammation with septal thickening and resolution of inflammation by 28 days after injection. [ABSTRACT FROM AUTHOR]

A case report of two patients with NPM1-mutated donor-derived acute myeloid leukemia (AML) Among these 9 patients, 4 patients had AML, of which 3 received a 2nd transplant and 1 patient only received intensive chemotherapy; the remaining 5 patients either had chronic myeloid or lymphocytic leukemia or MDS. The impact of therapy-related acute myeloid leukemia (AML) on outcome in 2853 adult patients with newly diagnosed AML. [Extracted from the article]

Current published estimates of the prevalence of hyperhidrosis in the United States are outdated and underestimate the true prevalence of the condition. The objectives of this study are to provide an updated estimate of the prevalence of hyperhidrosis in the US population and to further assess the severity and impact of sweating on those affected by the condition. For the purposes of obtaining prevalence, a nationally representative sample of 8160 individuals were selected using an online panel, and information as to whether or not they experience hyperhidrosis was obtained. The 393 individuals (210 female, 244 non-Hispanic white, 27 black, mean age 40.3, SE 0.64) who indicated that they have hyperhidrosis were asked further questions, including body areas impacted, severity of symptoms, age of onset, and socioemotional impact of the condition. Current results estimate the prevalence of hyperhidrosis at 4.8 %, which represents approximately 15.3 million people in the United States. Of these, 70 % report severe excessive sweating in at least one body area. In spite of this, only 51 % have discussed their excessive sweating with a healthcare professional. The main reasons are a belief that hyperhidrosis is not a medical condition and that no treatment options exist. The current study's findings with regard to age of onset and prevalence by body area generally align with the previous research. However, current findings suggest that the severity and prevalence are both higher than previously thought, indicating a need for greater awareness of the condition and its associated treatment options among medical professionals. [ABSTRACT FROM AUTHOR]

Background ATX-101 (deoxycholic acid injection, Kythera Biopharmaceuticals, Inc.) is a proprietary formulation of pure synthetic deoxycholic acid ( DCA). It is undergoing clinical investigation as an injectable drug for contouring the submental area by reducing submental fat ( SMF). When injected into subcutaneous fat, ATX-101 causes focal adipocytolysis, the targeted destruction of fat cells. Objectives This phase 1 study evaluated the safety, pharmacokinetics ( PK), and pharmacodynamic effects of ATX-101 (100-mg total dose). Methods Following PK evaluation of baseline endogenous DCA, lipids, and adipokines in the initial stage of the study (samples collected at hours 0.25, 0.5, 1, 1.5, 2, 4, 6, 12, 15.5, and 24.5), 10 subjects received subcutaneous injections of ATX-101 into abdominal fat. PK evaluation of DCA, lipids, and adipokines was repeated in the second phase of the study. Results After ATX-101 injections, plasma concentration of DCA increased transiently, reached a maximum plasma concentration rapidly, and returned to endogenous concentrations within 12 h postdose. ATX-101 injection was not associated with any clinically meaningful changes in systemic concentrations of total cholesterol, total triglycerides, free fatty acids, C-reactive protein, or interleukin-6. Adverse events were mild in severity, transient, and showed a temporal relationship to dosing. Conclusions This study demonstrated favorable safety and PK profiles, and no clinically meaningful changes in DCA, lipids, and proinflammatory cytokines following subcutaneous injection of ATX-101. Our results support continued clinical investigation of ATX-101 as an injectable drug to reduce SMF. [ABSTRACT FROM AUTHOR]

The internationalization of tertiary education has given rise to student mobility of industrial proportions and affects and is affected by, national economies. Currently British universities are host to the second highest number of international students in the world; the proportionality of international students in the student body in UK higher education (HE) is also the second highest globally.Over the decades the British government has declined to link policy and practice on international student issues, rather, has taken a stance which presented a view of the country’s role in overseas student affairs that reflected imperialist, postcolonial, international, and global perspectives, invariably mirroring the political complexion of the day. The article highlights a number of ways in which policies designed to control international student numbers has had the effect of creating conditions in which the domestic students have in turn been privileged and disadvantaged. Using a historical perspective to interrogate former policy initiatives, it concludes by reflecting on what the impact of present policies are likely to be for future developments of the sector. [ABSTRACT FROM AUTHOR]

The article focuses on the emergence of the Technology Informatics Guiding Education Reform (TIGER) initiative to respond to the health information technology (HIT) changes in health care in the U.S. It notes that the initiative is centered on informatics tools and practices to enable nurses to make health care safer, patient centered, and efficient. It stresses the need for nursing executives to see nursing informatics and technology as core support to nursing functions and decision making.

The uniquely Japanese institution of the tanki daigaku (two-year university) known as 'junior college' in English was seen as Japan's answer to increasing participation in higher education. Initially established on a provisional basis in 1950, becoming permanent in 1965, they were the higher education institution (HEI) of choice of almost 500,000 students a year at their peak in 1995. Demographic changes after 1992 brought about a buyers' market for higher education with institutions in aggressive competition for students, a battle in which the tanki daigaku seems destined to be defeated. This paper examines the options available to junior colleges in crisis and in so doing identifies a number of features of a virtually universal system of higher education which raise issues for other advanced societies grappling with massification and commodification in their own higher education systems. The paper reviews the literature in this area, as well as drawing on a year of participant observation as an associate professor from 2000-2001. [ABSTRACT FROM AUTHOR]

Although collaboration is not a new idea, new opportunities for collaboration exist in this 21st century global-knowledge and information-driven economy. Technology has reduced time and space while enhancing communication, thereby opening the possibilities of exploring new boundaries in the area of interdisciplinary collaboration. The goal of this article is to assist leaders in changing the language of organizations so that new technologies can enhance collaboration. A systematic approach for leaders to use in assisting assist persons, groups, and organizations in integrating new technologies into their organizations locally and globally is offered, along with a summary of new, and several established, collaboration techniques. [ABSTRACT FROM AUTHOR]

Smoking cessation among African Americans is a primary health objective for the nation. African American women are more likely than their counterparts to have a high dependency upon nicotine. Studies with African American women report lower quit rates than those for whites. A culturally sensitive pilot project was designed for African American women to investigate smoking, perception of family environment (FES-R, Life Events Scale, family survey), feasibility of family-focused followup sessions, and an exercise program. Baseline cigarettes were negatively correlated with the FES-R subscales for cohesion, active-recreational orientation, and moral/ religious emphasis; they were positively correlated with negativity in an important relationship. Predictors of ending cigarettes were scores for life events internal to the family and the FES-R subscale for independence. Interview and survey data identified potential sources of social support and perceived relational injustices. Future studies will explore expressed emotion, relational ethics, and interventions that improve relationships. [ABSTRACT FROM AUTHOR]

Background: Unmethylated CpG sequences in bacterial DNA act as adjuvants selectively inducing Th1 predominant immune responses during genetic vaccination or when used in conjunction with protein Ag. The precise mechanism of this adjuvant effect is unknown. Because dendritic cells (DC) are thought to be crucially involved in T cell priming and Th1/Th2 education during vaccination via skin, we characterized the effects of bacterial DNA and CpG–containing oligodeoxynucleotides (CpG ODN) on cutaneous DC. Methods and Results: Stimulation with CpG ODN 1826 (6 μg/ml) induced activation of immature Langerhans cell (LC)–like DC as determined by an increased expression of MHC class II and costimulatory molecules, loss of E–cadherin–mediated adhesion and increased ability to stimulate allogeneic T cells. Composition–matched control ODN 1911 lacking CpG sequences at equal concentrations was without effect. In comparison to LPS and ODN 1911, CpG ODN 1826 selectively stimulated DC to release large amounts of IL–12 (p40) and little IL–6 or TNF–α within 18 h and detectable levels of IL–12 p70 within 72 h. Stimulation with Escherichia coli DNA, but not calf thymus DNA, similarly induced DC maturation and IL–12 p40 production. Injection of CpG ODN into murine dermis induced enhanced expression of MHC class II and CD86 by LC in the overlying epidermis and intracytoplasmic IL–12 p40 accumulation in a subpopulation of activated LC. Conclusion: Bacterial DNA and CpG ODN stimulate DC in vitro and in vivo and may preferentially elicit Th1–predominant immune responses because they can activate and mobilize DC, inducing them to produce IL–12. [ABSTRACT FROM AUTHOR]

Suggests the application of theory-guided, evidence-based reflective practice at the core of nursing education and practice. Definition of evidence-based medicine; Components of reflective practice; Types of practice inquiry foci developed to address future issues in nursing and healthcare.

Presents information on a study that determined the protection provided by the immunostimulatory CpG-containing oligodeoxynucleotides, known for promoting T helper 1 immune response, from Leishmania infection coinjected in a BALB/c mice. Materials and methods; Results; Discussion.

Investigates the quality issues in international student contracting arrangements in Great Britain. Aspects of international partnerships requiring vigilance on universities; Decrease in enrollments from overseas; Impact of standards of degree courses on international entrants.

There is an increasing emphasis and interest in the economic evaluation of health care. There is a great deal of confusion about the labels i.e. cost-effectiveness analysis or cost-benefit analysis and sometimes the methodologies used to evaluate programs or treatment alternatives from an economic perspective. Cost-effectiveness analysis is the form of economic evaluation presented in this article and the particular methodological approach used is decision analysis. Insurers and health policy decision makers should view a birth center as an economical model of health care delivery.

Methodological characteristics and substantive findings of investigations of essential and reactive alcoholics were reviewed. The data base was comprised of approximately 12 studies published between 1951–1992, most of which employed small samples of hospitalized male alcoholics. Psychometric properties of the Essential-Reactive Alcoholism Questionnaire, the instrument generally used to assess the essential-reactive dimensions, rarely were examined. The weight of the evidence suggests that essential alcoholics have earlier onset and greater severity of alcoholism, lower levels of occupational and educational achievement, more interpersonal conflict, fewer long-term friendships, more antisocial attitudes and conduct, greater density of familial alcoholism, more impaired neuropsychological functioning, and lower resting blood pressure than do reactive alcoholics. Research is needed to assess the prognostic utility of the essential-reactive typology and the degree to which the distinction may facilitate patient-treatment matching. [ABSTRACT FROM AUTHOR]

The author reflects on the significance of pre-travel medical consultations for Hepatitis B virus (HBV) to prevent infection and complications in HBV patients. She cites a study which measured the level of acquisition of HBV in those who travel to countries endemic of the virus. She says that the identification of carriers enables awareness and interventions to lessen the risk of transmission.

Comments on the resurgence in the use of herbal and natural remedies. Reported adverse reactions to herb-derived flavenoids; Potential interactions between components of herbal remedies and conventional drugs; Percentage of the human population which depend on traditional medicines for primary health needs.

Examines the experience of the University of Rochester in managed care. Information about The School-Based Health Center (SBHC); Criteria for membership; Services provided; Evaluation of the program; Problems faced in implementing the program; Status of the program; Future plans.

Introduction: For patients on renal replacement therapy (RRT), "travel" and "independence" are rated as 2 of the top 5 factors that inform their choice of treatment modality. While home dialysis modalities offer patients a high degree of independence, the most common RRT in the United States is in‐center hemodialysis (IHD). The limits imposed by IHD treatment can present a variety of challenges for patients who wish to travel. This study explored how IHD patients managed their travel and the role of dialysis social workers in executing travel arrangements for patients. Methods: We performed a qualitative descriptive investigation using semi‐structured interviews with adults receiving IHD (n = 16) and renal social workers (n = 8) from Iowa, Minnesota, North Dakota, South Dakota, and Wisconsin. Data were analyzed using a constant comparative method. Findings: Three themes emerged from the interviews: travel process, travel‐related barriers, and travel‐related facilitators. The travel process entailed transient dialysis unit challenges and the need for multiple preparations and precautions. Barriers included comorbidities and not having a relationship with transient dialysis unit staff. Facilitators focused on the importance of travel and staff professionalism at transient dialysis units. Overall, there was lack of uniform protocols to guide the travel process at the patient and the dialysis unit levels. Discussion: This study identified multiple perspectives regarding travel arrangements in chronic IHD patients. There is limited research on travel issues for IHD patients and this investigation is among the first to articulate barriers and facilitators associated with travel from the perspective of patients and social workers. Supporting travel for IHD patients can increase their sense of autonomy and provide opportunities to improve their quality of life. [ABSTRACT FROM AUTHOR]

Summary: KappaMab (KM; formerly MDX‐1097) is a monoclonal antibody specific for the kappa myeloma antigen (KMA), a cell‐surface antigen expressed on malignant plasma cells in kappa‐restricted multiple myeloma (κMM), some lymphomas, occasional tonsillar B cells and in vitro activated B cells, but not on normal B cells in bone marrow. Phase I/IIa studies of single‐agent KM confirmed a favourable toxicity profile and evidence of anti‐myeloma activity. Ex‐vivo studies demonstrating upregulation of KMA by lenalidomide, and enhanced effector‐cell cytotoxicity provided the rationale for this phase IIb study where KM or KM in combination with lenalidomide and dexamethasone (KM‐Rd) was administered in relapsed, refractory κMM patients. In addition, outcomes for a real‐world matched case–control cohort from the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR) who received Rd were compared to the KM‐Rd cohort. KM‐Rd demonstrated an overall response rate of 82.5% which compared favourably to the Rd‐MRDR cohort of 45.1%. Both single‐agent KM and KM‐Rd regimens were well tolerated, with the KM‐Rd safety profile similar to patients given only Rd in other clinical settings. Based on the excellent safety profile and significant efficacy, further clinical trials escalating the KM dose and pairing KM with other standard‐of‐care treatments are planned. [ABSTRACT FROM AUTHOR]

• Clinical trial participation is not equitable across people with cystic fibrosis (CF). • Self-study is a valuable tool for reducing disparities in CF clinical trial participation. • Tailored approaches to recruitment and referrals can increase diversity in CF clinical trials. Clinical trials are a necessary tool for evaluating the effectiveness of newly developed treatments and interventions for cystic fibrosis (CF). Prior work demonstrated a proportional underrepresentation of people with CF (pwCF) identifying as part of a minoritized racial or ethnic group in clinical trials. In order to establish a baseline for improvement efforts, we undertook a center-level self-study to evaluate if the racial and ethnic backgrounds of pwCF participating in clinical trials at our CF Center in New York City reflect our overall patient diversity (N = 200; 55 pwCF identifying as part of a minoritized racial or ethnic group and 145 pwCF identifying as non-Hispanic White). A smaller proportion of pwCF identifying as part of a minoritized racial or ethnic group participated in a clinical trial as compared to pwCF identifying as non-Hispanic White (21.8% vs. 35.9%, P = 0.06). A similar trend was present for pharmaceutical clinical trials (9.1% vs. 16.6%, P = 0.3). When limiting the study population to the pwCF most likely to be eligible for a CF pharmaceutical clinical trial, a larger proportion of pwCF identifying as part of a minoritized racial or ethnic group participated in a pharmaceutical clinical trial as compared to pwCF identifying as non-Hispanic White (36.4% vs. 19.6%, P = 0.2). No pwCF identifying as part of a minoritized racial or ethnic group participated in an offsite clinical trial. Efforts to improve the racial and ethnic diversity of pwCF in clinical trials, both onsite and offsite, will require a shift in how recruitment opportunities are identified and communicated to pwCF. [ABSTRACT FROM AUTHOR]

An estimated 257 million persons worldwide have chronic hepatitis B virus (HBV) infection (1). CDC recommends HBV testing for persons from countries with intermediate to high HBV prevalence (≥2%), including newly arriving refugees (2). Complications of chronic HBV infection include liver cirrhosis and hepatocellular carcinoma, which develop in 15%-25% of untreated adults infected in infancy or childhood (3). HBV-infected patients require regular monitoring for both infection and sequelae. Several studies have evaluated initial linkage to HBV care for both refugee and nonrefugee immigrant populations (4-9), but none contained standardized definitions for either linkage to or long-term retention in care for chronic HBV-infected refugees. To assess chronic HBV care, three urban sites that perform refugee domestic medical examinations and provide primary care collaborated in a quality improvement evaluation. Sites performed chart reviews and prospective outreach to refugees with positive test results for presumed HBV infection during domestic medical examinations. Linkage to care (29%-53%), retention in care (11%-21%), and outreach efforts (22%-71% could not be located) demonstrated poor access to initial and ongoing HBV care. Retrospective outreach was low-yield. Interventions that focus on prospective outreach and addressing issues related to access to care might improve linkage to and retention in care. [ABSTRACT FROM AUTHOR]

Background: Foreign‐born kidney transplant recipients (FBKTRs) are at increased risk for reactivation of latent infections that may impact outcomes. We aimed to compare the etiology of infections and outcomes between FBKTR and United States KTRs (USKTR). Methods: We performed a retrospective study of patients who underwent kidney transplantation between January 1, 2014 and December 31, 2018 at two transplant centers in Minnesota. Frequency and etiology of infections as well as outcomes (graft function, rejection, and patient survival) at 1‐year post‐transplant between FBKTR and USKTR were compared. Results: Of the 573 transplant recipients, 124 (21.6%) were foreign‐born and 449 (78.4%) US‐born. At least one infection occurred in 411 (71.7%) patients (38.2% bacterial, 55% viral, 9.4% fungal). Viral infections were more frequent in FBKTR, particularly BK viremia (38.7% vs. 21.2%, p <.001). No statistical differences were found for bacterial or fungal infections; no parasitic infections were identified in either group. No geographically‐restricted infections were noted aside from a single case of Madura foot in a FBKTR. Rejection episodes were more common in USKTR (p =.037), but stable/improving graft function (p =.976) and mortality (p =.451) at 1‐year posttransplantation were similar in both groups. After adjusting for covariates, previous transplantation was associated with a higher number of infections (IRR 1.35, 95% confidence intervals 1.05–1.73, p =.020). Conclusion: Although viral infections were more frequent in FBKTR, overall frequency and etiology of most infections and outcomes were similar between FBKTR and USKTR suggesting that comprehensive transplant care is providing timely prevention, diagnosis, and treatment of latent infections in FBKTR. [ABSTRACT FROM AUTHOR]

The author discusses the use of virtual networks and guidelines in migration medicine. She states that the immigrant-specific, evidence-based clinical guidelines were lacking and the Clinical Preventive Care Recommendations for Newly Arriving Immigrants and Refugees to Canada are significant to the world literature on migration medicine. She relates that the refugee camp disease surveys and outbreaks of disease prevalence could be used to guide real-time recommendations for empiric treatment.

The article offers a guide to understanding and addressing health care disparities. It looks at the tension that exists between integration and segregation in caring for diverse ethnic and racial populations. Three factors are explored to explain how to address health care disparities between minority and majority patients. The role of health system leaders in recognition of health care disparities is also addressed.

A letter to the editor is presented in response to the article about the attention and care that should be directed to refugee camps and vulnerable population to stop the transmission of infectious disease like eosinophilia among refugees.

Examines the incidence of metabolic alkalosis in patients with cystic fibrosis. Low molar urinary chloride/creatinine ratio in children with metabolic alkalosis and cystic fibrosis but normal or elevated in adult patients; Inability to conserve chloride in the urine during metabolic alkalosis associated with hyperaldosteronism.

BTK inhibitor exposure increases significantly when coadministered with CYP3A inhibitors, which may lead to dose-related toxicities. This study explored the pharmacokinetics, efficacy, and safety of zanubrutinib when coadministered with moderate or strong CYP3A inhibitors in 26 patients with relapsed or refractory B-cell malignancies. Coadministration of zanubrutinib (80 mg BID) with moderate CYP3A inhibitors fluconazole and diltiazem or zanubrutinib (80 mg QD) with strong CYP3A inhibitor voriconazole resulted in comparable exposures to zanubrutinib (320 mg QD) with AUC0-24h geometric least squares mean ratios approaching 1 (0.94, 0.81, and 0.83, for fluconazole, diltiazem, and voriconazole, respectively). The most common treatment-emergent adverse events were contusion (26.9%), back pain (19.2%), constipation and neutropenia (15.4% each), and rash, diarrhea, and fall (11.5% each). This study supports current United States Prescribing Information dose recommendations for the coadministration of reduced-dose zanubrutinib with moderate or strong CYP3A inhibitors and confirms the favorable efficacy and safety profile of zanubrutinib. [ABSTRACT FROM AUTHOR]

Discusses the development of bone marrow transplantation as a possible treatment for leukemia. Demands placed by the procedure upon nursing staff; Characteristics of transplant candidates; Infusion procedure; Precautions designed to counteract the toxic effects of the chemotherapeutic agent Cytoxan.

The article reviews the book "Maternal and Infant Nutrition and Nurture: Controversies and Challenges" edited by Victoria Hall Moran.

The present study examined costs of two residential substance abuse treatment programs designed for urban American Indians and Alaska Natives (AI/ANs). Costs for one agency were well within national norms, while costs at the other program were less than expected from nationwide data. Economies of scale accounted for much of the difference between observed and expected costs. Culturally specific residential substance abuse treatment services can be provided to urban AI/ANs within budgets typically found at mainstream programs. [ABSTRACT FROM AUTHOR]

Although residential substance abuse treatment is utilized extensively by urban American Indians and Alaska Natives (AI/ANs), there are few detailed descriptions of this care. This study delineated services provided by and interviewed staff working at residential programs designed for chemically dependent urban AI/ANs. Study agencies were compared to national data from residential programs serving general population clients. Study agencies delivered arrays of services substantially broader than those provided by general population programs. As well as culturally specific programs tailored for AI/ANs plus so-called "mainstream" substance abuse treatments, study facilities provided numerous ancillary services, such as care for clients' children. [ABSTRACT FROM AUTHOR]

Summary: The frequency and causes of early mortality in patients with newly diagnosed multiple myeloma (NDMM) have not been well described in the era of novel agents. We investigated early mortality in a prospective cohort study of all patients with NDMM registered on the Australian and New Zealand Myeloma and Related Diseases Registry (MRDR) at 36 institutions between July 2011 and March 2020. Early mortality was defined as death from any cause within the first 12 months after diagnosis. A total of 2377 patients with NDMM were included in the analysis, with a median (interquartile range) age of 67.4 (58.9–74.60 years, and 60% were male. Overall, 216 (9.1%) patients died within 12 months, with 119 (4.5%) having died within 6 months. Variables that were independent predictors of early mortality after adjustment in multivariable regression included age (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.05–1.08; p < 0.001), Eastern Cooperative Oncology Group performance status (OR 1.50, 95% CI 1.26–1.79; p < 0.001), serum albumin (OR 0.95, 95% CI 0.93–0.98; p < 0.001), cardiac disease (OR 1.96, 95% CI 1.35–2.86; p < 0.001) and International Staging System (OR 1.40, 95% CI 1.07–1.82; p = 0.01). For those with a primary cause of death available, it was reported as disease‐related in 151 (78%), infection 13 (7%), other 29 (15%). Infection was listed as a contributing factor for death in 38% of patients. [ABSTRACT FROM AUTHOR]

Background: Zanubrutinib is a next-generation, selective Bruton tyrosine kinase inhibitor with efficacy in relapsed chronic lymphocytic leukemia (CLL) and small lymphocytic lymphoma (SLL). We compared zanubrutinib with bendamustine-rituximab to determine its effectiveness as frontline therapy in patients with CLL or SLL.Methods: We conducted an open-label, multicentre, phase 3 study at 153 academic or community hospitals in 14 countries and regions. Eligible patients had untreated CLL or SLL requiring treatment as per International Workshop on CLL criteria; were aged 65 years or older, or 18 years or older and had comorbidities; and had an Eastern Cooperative Oncology Group performance status score of 0-2. A central interactive web response system randomly assigned patients without del(17)(p13·1) to zanubrutinib (group A) or bendamustine-rituximab (group B) by sequential block method (permutated blocks with a random block size of four). Patients with del(17)(p13·1) were enrolled in group C and received zanubrutinib. Zanubrutinib was administered orally at 160 mg twice per day (28-day cycles); bendamustine at 90 mg/m2 of body surface area on days 1 and 2 for six cycles plus rituximab at 375 mg/m2 of body surface area the day before or on day 1 of cycle 1, and 500 mg/m2 of body surface area on day 1 of cycles 2-6, were administered intravenously. The primary endpoint was progression-free survival per independent review committee in the intention-to-treat population in groups A and B, with minimum two-sided α of 0·05 for superiority. Safety was analysed in all patients who received at least one dose of study treatment. The study is registered with ClinicalTrials.gov, NCT03336333, and is closed to recruitment.Findings: Between Oct 31, 2017, and July 22, 2019, 590 patients were enrolled; patients without del(17)(p13·1) were randomly assigned to zanubrutinib (group A; n=241) or bendamustine-rituximab (group B; n=238). At median follow-up of 26·2 months (IQR 23·7-29·6), median progression-free survival per independent review committee was not reached in either group (group A 95% CI not estimable [NE] to NE; group B 28·1 months to NE). Progression-free survival was significantly improved in group A versus group B (HR 0·42 [95% CI 0·28 to 0·63]; two-sided p<0·0001). The most common grade 3 or worse adverse event was neutropenia (27 [11%] of 240 patients in group A, 116 [51%] of 227 in group B, and 17 [15%] of 111 patients in group C). Serious adverse events occurred in 88 (37%) of 240 patients in group A, 113 (50%) of 227 patients in group B, and 45 (41%) of 111 patients in group C. Adverse events leading to death occurred in 11 (5%) of 240 patients in group A, 12 (5%) of 227 patients in group B, and three (3%) of 111 patients in group C, most commonly due to COVID-19 (four [2%] of 240 patients in group A), diarrhoea, and aspiration pneumonia (two each [1%] of 227 patients in group B).Interpretation: Zanubrutinib significantly improved progression-free survival versus bendamustine-rituximab, with an acceptable safety profile consistent with previous studies. These data support zanubrutinib as a potential new treatment option for untreated CLL and SLL.Funding: BeiGene. [ABSTRACT FROM AUTHOR]

The role of upfront non‐myeloablative allogeneic stem cell transplantation (NMA alloSCT) in high‐risk multiple myeloma (HR‐MM) is unclear. We evaluated outcomes of NMA alloSCT following autologous stem cell transplant (ASCT) compared with ASCT alone for newly diagnosed HR‐MM. Two‐year progression‐free survival was improved in the ASCT‐NMA alloSCT group (44% vs 16%; P = 0.035), with a trend for improved overall survival (P = 0.118). These results suggest that ASCT‐NMA alloSCT can be considered as upfront therapy in HR‐MM. [ABSTRACT FROM AUTHOR]

Enumerates questions relevant to the discipline of nursing, addressed during the `Journal of Advanced Nursing' forum in January 2000. Components of evidence in evidence-based practice; Foundations in the discipline evident in nursing practices and research; Interface between discipline and profession; Link between scientific and clinical knowledge.

The article discusses study on use of primary antifungal prophylaxis (PAP) in adult patients with acute lymphoblastic leukemia (ALL). It mentions the investigation of the prescribing practices of primary antifungal prophylaxis (PAP) and incidence of invasive fungal disease (IFD) in adult patients with ALL receiving induction-consolidation chemotherapy. It reveals association of PAP with a reduced IFD risk.

Background Cystic fibrosis (CF) causes high illness burden. Screening may identify patients who could potentially benefit from interventions for symptoms or other sources of distress. We evaluated the feasibility of a web-based system for routine monitoring. Methods Adult CF patients enrolled in a study of palliative care service delivery completed web-based assessments every 30 days on global distress, physical and psychological symptom distress, and the perceived benefits of discussing advance care planning (ACP) with CF clinicians. Feasibility was assessed by the rate of survey completion, survey reminders, and missed surveys during a 9-month rolling enrollment period. Results Of 74 participants (47.3% women, 94.4% white), 36.7% had comorbid diabetes, and 56.9% had an FEV1% predicted score of 40–69. In total, patients completed 456 (80.6%) of 566surveys every 30 days over the assessment period. Sixty-five (87.8%) completed 405 (79.7%) of 508 surveys online and 9 (12.2%) completed 51 (88.0%) of 58 surveys using a combination of online, telephone, and mail-based methods. Many surveys were completed without reminders (online: 261 [64.4%] of 405; combined methods: 29 [56.9%] of 51), with 166 (36.4%) surveys requiring 1 or more reminders. Further, 23.0% (17) of patients noted elevated global distress; 20.3% (15) endorsed physical symptom distress, 12.2% (9) had psychological distress, and 58.1% (43) reported that discussing ACP would be beneficial. Conclusions Repeated web-based screening for symptom distress and ACP preferences is feasible in adult CF patients. Future studies should assess the system's generalizability and staff resources when implementing reminders and non-web methods of completion. [ABSTRACT FROM AUTHOR]

LEOPARD was a single arm, phase II study of lenalidomide (LEN) and alternate day prednisolone maintenance in patients with newly diagnosed multiple myeloma (MM) following autologous stem cell transplantation (ASCT). Sixty patients were enrolled. Estimated median potential follow-up was 44 m, median PFS was 38.3 m, median OS was not reached (landmark 36 m OS: 71.4%). Correlative immunohistochemistry performed on pre-ASCT trephines demonstrated high MM tumor cereblon (total/cytoplasmic) was associated with superior OS (p =.045, p =.031, respectively), whereas high c-Myc was associated with inferior PFS (p =.04). Patients with high cereblon (total/nuclear) were more likely to improve depth of response, whereas patients with high c-Myc were less likely, suggesting alternative/more effective post-ASCT strategies for patients with high c-Myc need identification. Peripheral blood immune profiling (mass cytometry) informed a more sustained response to LEN maintenance, demonstrating enrichment of activated/cytotoxic NK cells and cytotoxic T cells in patients with durable responses, contrasting with enrichment of B-regs in early relapsers. [ABSTRACT FROM AUTHOR]

Anticipating widespread global use of dexamethasone for COVID-19 in the wake of RECOVERY trial findings, this Viewpoint summarizes the theoretical risk of triggering Strongyloides hyperinfection/dissemination syndrome in people with asymptomatic strongyloidiasis, and proposes an algorithm to for assessing and managing the risk in outpatient and hospital settings. [ABSTRACT FROM AUTHOR]

Objective: To determine the pharmacokinetic and pharmacodynamic interaction between oral tazarotene and an oral contraceptive containing norethindrone I mg and ethinylestradiol 0.035mg (Ortho-Novum® 1/35). Design: Two separate open-label, parallel-group, single-centre, pharmacokinetic and pharmacodynamic interaction studies. Participants and methods: Twenty-seven healthy women (age 20-55 years) completed Study I, with a duration of 64 days during three consecutive menstrual cycles. Ortho-Novum® 1/35 was taken once daily from study day 0 (first cycle day 1) to day 61 (third cycle day 6), and oral tazarotene 1.1 mg was co administered daily from study day 34 (second cycle day 7) to day 61. Twenty-nine healthy women (age 20-44 years) completed Study II, with a duration of 75 days during three consecutive menstrual cycles. Ortho-Novum® 1/35 was taken once daily from study day 0 (first cycle day 1) to day 74 (third cycle day 19), and oral tazarotene 6mg was coadministered daily from study day 48 (second cycle day 21) to day 74. In both studies, the pharmacokinetics of tazarotenic acid on study day 61 (third cycle day 6) were evaluated from plasma tazarotenic acid concentrations. Pharmacokinetic parameters of plasma norethindrone and ethinylestradiol were compared before and after tazarotene administration (cycle day 6 of the second and third cycles, respectively). Serum luteinising hormone (LH) and follicle-stimulating hormone (FSH) concentrations were compared before and after tazarotene administration (cycle days 2, 4 and 6 of the second and third cycles, respectively). In Study II, serum progesterone concentrations were also determined on cycle days 18 and 20 of the second and third cycles. Tazarotenic acid was determined by liquid chromatography-tandem mass spectrometry. Ethinylestradiol and norethindrone were determined by gas chromatography-mass spectrometry. LH and FSH were assayed by microp article enzyme immunoas say in Study I and by double-antibody radioimmunoassay in Study IT. Progesterone was determined by solid-phase radioimmunoassay. Results: In Study I (tazarotene 1.1 mg), the area under the plasma concentration-time curve from zero to 24 hours (AUC24) and the peak concentration in plasma (Cmax) for tazarotenic acid were 121 ± 27 μg • h/L and 28.9 ± 9.4 μg/L (mean ± SD), respectively. In Study II (tazarotene 6mg), AUC24 and Cmax for tazarotenic acid were 379 ± 78 μg • h/L and 111 ± 37 μg/L (mean ± SD), respectively. In both studies, for both norethindrone and ethinylestradiol, the 90% CIs of AUC24 and Cmax on cycle day 6 before and after tazarotene administration were within the 80-125% boundary. In Study I, the 90% CIs of serum FSH and LH concentrations on cycle day 4 were within the 80-125% boundary. FSH and LH concentrations on cycle day 6 were marginally/partially outside the 80-125% boundary as a result of high variability. However, the mean FSH and LH serum concentrations on cycle day 6 of the third cycle were lower than those of the second cycle. In Study II, the 90% CIs of serum FSH, LH and progesterone concentrations were all within the 80-125% boundary, except for LH on cycle day 2. LH concentrations on cycle day 2 were marginally/partially outside the 80-125% boundary as a result of high variability. However, the mean serum LH concentration on cycle day 2 of the third cycle was lower than that of the second cycle. Conclusions: Oral tazarotene up to 6mg once daily does not affect the pharmacokinetics and efficacy of Ortho-Novum® 1/35. [ABSTRACT FROM AUTHOR]

Background: Biliary liver flukes are extremely common parasites in some regions of the world where consumption of raw fresh-water fish is a cultural practice. Clonorchis sinensis and Opisthorchis spp. are the major biliary liver flukes associated with human disease. Some of these parasites are highly associated with cholangiocarcinoma. It was noted that several cases presenting at our center had been in the US for prolonged periods. This prompted us to retrospectively review cases of liver fluke infection diagnosed at our facility. Methods: All cases of biliary liver fluke infection over a 6-year period were retrospectively investigated at a clinic serving international patients, to determine the prevalence and risk factors for infection in a nonendemic area. Cases were identified through review of stool ova and parasite (O&P) records maintained at Regions Hospital/HealthPartners microbiology laboratory. All O&P samples positive for Opisthorchis spp. or Clonorchis sinensis were included in the review. Results: Seventeen cases were identified during the study period. Our center performed approximately 1,800 stool O&P examinations per year on approximately 1,100 individuals per year during the study period. Biliary liver flukes were uncommon, accounting for 1.3% of individuals infected with organisms considered to be potentially pathogenic. Infections were predominantly found in migrants from Laos, Cambodia and Thailand. Cases were also identified in migrants from the former Soviet Union and South America. It is of note that 25% of patients were detected after 5 years of residence in the US. Often, the only clinical clue to infection was a mild absolute eosinophilia (500 to 1000 µL). Conclusions: Although biliary liver fluke is an infrequent cause of infection in immigrants to the US, because of the potential long-term consequences of chronic infection, educational information highlighting routes of infection and the fact that asymptomatic infec... [ABSTRACT FROM AUTHOR]

A quality improvement collaborative evaluated Hepatitis B virus (HBV) care for resettled refugees and identified strategies to enhance care. 682 of the 12,934 refugees from five refugee health clinics in Colorado, Minnesota, and Pennsylvania had chronic HBV. Timely care was defined relative to a HBsAg + result: staging (HBV DNA, hepatitis Be antigen, hepatitis Be antibody, alanine transaminase testing) within 14 days, comorbid infection screening (hepatitis C virus and HIV) within 14 days, and linkage to care (HBV specialist referral within 30 days and visit within 6 months). Completed labs included: HBV DNA (93%), hepatitis Be antigen (94%), hepatitis Be antibody (92%), alanine transaminase (92%), hepatitis C screening (86%), HIV screening (97%). 20% had HBV specialist referrals within 30 days; 36% were seen within 6 months. Standardized reflex HBV testing and specialist referral should be prioritized at the initial screening due to the association with timely care. [ABSTRACT FROM AUTHOR]