Introduction
The transformation of our food system towards a more resilient agroecological framework is one of the most pressing needs faced by our global community. Understanding the use of multiple ...conservation practices is important in the development of research, education, and policy to accelerate their more widespread integration of into farming systems.
Methods
The aim of this study was to conduct a preliminary investigation of the trends regarding multiple practice adoption of conservation farming practices by conventional and organic farmers engaging with sustainable farming methods. Forty farmers were interviewed regarding their use of conservation practices, as well as their motivations, barriers, and future plans for new implementation and expansion of current practices.
Results
Farmers spontaneously identified cover crops and vegetation strips as the most frequently used conservation practices; however, upon more specific inquiry, we found that more than 50% of farmers used additional agroecological conservation practices including local crop varieties, intercropping, managed grazing, crop rotations, and no-till, with many farmers using multiple practices. Overall, we found no correlation of organic certification with the number of conservation practices implemented by farmers. The major motivations towards the adoption of practices included improved soil quality and profitability. Main identified barriers included financial means and risk, lack of knowledge, and access to resources. Farmers showed interest in further implementation of additional conservation practices, including expanded use of cover crops, tree plantings, and no-till practices.
Discussion
Further understanding complementarities, as well as differences in barriers and motivations, can contribute to the design of effective education strategies and financial incentives to promote the simultaneous implementation of agroecological conservation practices.
The purpose of this study was to learn from mothers with physical (MWPD) and sensory disabilit(ies) (MWSD) about their experiences of parenthood, in a society that is not well suited to support them. ...This was two-part study employing quantitative and qualitative methodology. Participants who self-identified MWPD or MWSD, were recruited via disability and parenting-related online groups. In Part 1, participants (n = 34) completed a Qualtrics survey, which consisted of a screening questionnaire, demographic questions, an Experience of Stigma scale, and the Adverse Childhood Experiences scale (ACE). In Part 2, participants (n = 14) of the 34 survey respondents participated in a follow-up semi-structured interview to gain a deeper understanding of their experiences as mothers with disabilt(ies) (MWD). Results of Part 1 were analyzed using a Mann-Whitney U test, multiple linear regression, and a Chi-square test. Part 2 was analyzed using Interpretative Phenomenological Analysis. Key findings of Part 1 were that MWPD endorsed significantly more experiences of stigma from others relative to MWSD. Demographic variables (age, race, income, education level) did not significantly affect the total score on the Experiences of Stigma scale reported by MWPD or MWSD in the sample. MWD, as a whole, reported significantly more ACE and a higher incidence of interaction with child protective services (CPS), relative to a sample of the general population in the U.S. Key findings of Part 2 were that all of the mothers within this sample acknowledged that they experience stigma around parenting with a disability, whether internalized, or via negative messages from individuals within their sociocultural environments. Mothers from both groups reported shared experiences regarding the positive and negative aspects of being MWD. The five main sources of stigma were self, family, medical professionals, their children’s schools, other parents, and total strangers. Results emphasize the need to continue increasing knowledge about the unique challenges presented to parents with disabilities via increasing education, training, affirmative support, and accessibility in social services and the child welfare systems.
Thin basement membrane nephropathy (TBMN) often is diagnosed clinically when there is persistent dysmorphic or glomerular hematuria, but minimal proteinuria, normal kidney function, and no other ...obvious cause. This study investigated hematuria in patients with TBMN. A total of 112 patients with biopsy examination-proven TBMN were studied. All had hematuria at the time of presentation, with a mean urinary red blood cell (RBC) count of 256 +/- 250 x 10 3 /mL. Seventy-five (67%) patients attended for review over a median of 48 months (range, 3-120 mo) and provided a total of 485 urine specimens. Twenty-one patients (28%) had no hematuria by phase-contrast microscopy on at least 1 occasion. These corresponded to 32 urine specimens (7% of total). Of the 21 patients, the most recent urinary RBC counts were within the normal range in 11 (52%), but hematuria had recurred in the other 10 (48%). Hematuria is persistent in most patients with TBMN, but occasionally it resolves or is intermittent.
Cold agglutinin disease (CAD) is a rare autoimmune hemolytic anemia mediated by IgM autoantibodies that trigger hemolysis via classical complement pathway. Increased incidence of thrombotic events ...(TEs) has been reported in patients with other forms of hemolysis. The incidence of TEs in patients with CAD is unknown.
Evaluate TE risk in patients with CAD.
This is a matched cohort comparison study evaluating the risk of TEs in patients with CAD and without CAD over a 10‐year period. A total of 608 patients with CAD were identified in the Optum Claims–Clinical data set by reviewing clinical notes for CAD terms and matched with up to 10 patients without CAD (N = 5873). TEs were defined as the first medical claim for a TE using International Classification of Diseases, Ninth and Tenth Revision codes. Cox regression models were used to estimate time to first TE. Sensitivity analyses were conducted to estimate TE risk among patients with primary CAD.
At least 1 TE occurred in 29.6% of patients with CAD and 17.6% of patients without CAD. The proportion of patients experiencing venous, arterial, and cerebral TEs were each higher among CAD patients. The overall risk of having TEs was higher in patients with CAD (adjusted hazard ratio aHR, 1.94; 95% confidence interval CI, 1.64‐2.30). Patients with presumed primary CAD also demonstrated an increased risk of TEs (aHR, 1.80; 95% CI, 1.46‐2.22). Patients with CAD with the fewest comorbidities had 2.44‐fold higher risk of having a TE (95% CI, 1.70‐3.52).
Patients with CAD have an increased risk of TEs when compared with a matched non‐CAD population.
Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian ...emergency medical services (EMS) systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality.
This was a prospective analysis of ARC bundle administration between 2021 and 2023 in an urban EMS system with 70,000 annual responses. The ARC bundle consisted of calcium, tranexamic acid, and packed red blood cells via a rapid infuser. Advanced resuscitative care patients were compared with trauma registry controls from 2016 to 2019. Included were patients with a penetrating injury and systolic blood pressure ≤90 mm Hg. Excluded were isolated head trauma or prehospital cardiac arrest. In-hospital mortality was the primary outcome of interest.
A total of 210 patients (ARC, 61; controls, 149) met the criteria. The median age was 32 years, with no difference in demographics, initial systolic blood pressure or heart rate recorded by EMS, or New Injury Severity Score between groups. At hospital arrival, ARC patients had lower median heart rate and shock index than controls ( p ≤ 0.03). Fewer patients in the ARC group required prehospital advanced airway placement ( p < 0.001). Twenty-four-hour and total in-hospital mortality were lower in the ARC group ( p ≤ 0.04). Multivariable regression revealed an independent reduction in in-hospital mortality with ARC (odds ratio, 0.19; 95% confidence interval, 0.05-0.68; p = 0.01).
Early ARC in a fast-paced urban EMS system is achievable and may improve physiologic derangements while decreasing patient mortality. Advanced resuscitative care closer to the point of injury warrants consideration.
Therapeutic/Care Management; Level IV.
Objective
To evaluate the influence of osteoarthritis on the measurement of patella tendon angle (PTA) and determine intraobserver and interobserver variability.
Study design
Retrospective clinical ...study.
Sample population
Eighty‐seven mediolateral radiographs that were obtained prior to tibial tuberosity advancement.
Methods
Radiographic osteoarthritis was scored by 2 observers using guidelines derived from the International Elbow Working Group Protocol. Patella tendon angle was measured by 3 observers on 3 occasions, with at least 7 days between measurements. The data were statistically analyzed via weighted κ and Kruskal‐Wallis testing.
Results
A fair strength of agreement was found among observers scoring osteoarthritis, with the same grades in 48% of radiographs. The intraobserver average bias between PTA measurements 1 and 3 ranged from −0.38° to −0.94°. Interobserver bias in angle measurement ranged from −0.92° to −2.00°. Observer 1 had the narrowest range of PTA differences (12.1°), and observer 3 had the highest range of PTA differences (23.5°). Observer 2 had the lowest mean bias (−0.38°). The mean bias was lowest between observers 1 and 2 (−0.92°) and highest between observers 1 and 3 (−2.0°). The mean intraobserver standard deviation of the PTA measurement differences was 2.90°, and interobserver standard deviation of the PTA measurement differences was 2.26°. The degree of osteoarthritis did not influence PTA measurements or their variability.
Conclusion
The current study did not find evidence of an influence of osteoarthritis on PTA or on the repeatability of measurements.
Clinical significance
Our findings suggest that osteoarthritis should not affect the radiographic planning for tibial tuberosity advancement surgery. The high variances in PTA measurement in less experienced observers may influence the clinical outcome of surgery.
A 4‐year‐old Border collie was presented with one episode of collapse, altered mentation, and a suspected pharyngeal stick injury. Magnetic resonance imaging (MRI) and computed tomography showed a ...linear foreign body penetrating the right oropharynx, through the foramen ovale and the brain parenchyma. The foreign body was surgically removed and medical treatment initiated. Complete resolution of clinical signs was noted at recheck 8 weeks later. Repeat MRI showed chronic secondary changes in the brain parenchyma. To the authors' knowledge, this is the first report of the advanced imaging findings and successful treatment of a penetrating oropharyngeal intracranial foreign body in a dog.
There is limited data comparing the performance of Afirma Genomic Sequencing Classifier (GSC) in thyroid nodules carrying an initial versus a repeat diagnosis of atypia of undetermined significance ...(AUS). This study reported an institutional experience in this regard.
This retrospective study included consecutive thyroid nodules that had an initial or a repeat AUS diagnosis and had a subsequent GSC diagnostic result (benign or suspicious) from 2017 to 2021. All nodules were followed by surgical intervention or by clinical and/or ultrasound monitoring. GSC's benign call rate (BCR), rate of histology-proven malignancy associated with a suspicious GSC result, and diagnostic parameters of GSC were calculated and compared between the two cohorts (initial versus repeat AUS). Statistical significance was defined with a p-value of <.05 for all analysis.
A total of 202 cases fulfilled inclusion criteria, including 67 and 135 thyroid nodules with an initial and a repeat AUS diagnosis, respectively. BCR was 67% and 66% in initial and repeat AUS cohorts, respectively. Rate of histology-proven malignancy associated with a suspicious GSC result were 22% and 24% in initial and repeat AUS cohorts, respectively. Compared with the repeat AUS cohort, the initial AUS cohort showed slightly lower sensitivity (83% vs. 100%), specificity (70% vs. 73%), PPV (23% vs. 24%), NPV (98% vs. 100%), and diagnostic accuracy (72% vs. 75%). Nevertheless, these differences did not reach statistical significance.
GSC demonstrated comparable performance in thyroid nodules with a repeat AUS diagnosis versus nodules with an initial AUS diagnosis.
In 2005, the National Institutes of Health (NIH) chronic graft-versus-host disease (cGVHD) consensus project provided diagnosis and staging criteria, based mostly on clinical experience and expert ...opinion. These criteria were revised in 2014, aiming to provide enhanced specificity and clarity. However, the impact of 2014 changes to the original NIH cGVHD severity scoring criteria has not been reported. In this study, 284 patients, prospectively enrolled on the National Cancer Institute's cross-sectional cGVHD natural history study, were scored using the 2005 NIH cGVHD criteria and then rescored according to the 2014 modifications. In comparing the two criteria, 2014 cGVHD global severity scoring resulted in a tendency toward being categorized as milder scores (75 vs. 72% of severe score per 2014, p = 0.0009), with a statistically significant shift in NIH liver and lung scores toward milder categories (p < 0.0001). 2005 and 2014 NIH global severity scores showed a significant association with reduced grip strength (p < 0.0001), reduced joint range of motion (p = 0.0003), and the subspecialist evaluation score (p < 0.0001). Poor survival prediction of the severe NIH lung score is also retained in the new criteria (p = 0.0012). These findings support the use of 2014 cGVHD scoring criteria in continuous efforts to develop better classification systems.
Introduction: Cold agglutinin disease (CAD) is a rare form of autoimmune hemolytic anemia (AIHA) with a prevalence of approximately 16 patients per million. CAD accounts for less than 20% of all AIHA ...and is characterized by immunoglobulin M (IgM) mediated agglutination of erythrocytes and subsequent activation of the classical complement pathway. In addition to hemolysis, which can vary from mild to severe, clinical manifestations of CAD have been reported to include livedo reticularis, acrocyanosis, circulatory symptoms and cutaneous necrosis (Swiecicki, P Et al Blood 2013). The rarity of this disease has resulted in a lack of data regarding its natural history. Thromboembolic events (TEs) are a known complication of other hemolytic disorders, however, little is known about its incidence and severity in CAD. We evaluated the largest cohort of CAD patients to date and compared them to a matched non-CAD cohort to evaluate clinical characteristics and occurrence rate of TEs.
Methods: Patients were identified from the Optum-Humedica database, containing de-identified information on claims, medications, lab results, diagnoses, procedures and clinical notes for individuals from all 50 states. The presence of “cold agglutinin disease” must have appeared in their medical record on at least 3 separate dates from 2006-2016. Patients with “cold agglutinin disease” documented on 1 or 2 dates were included only after an independent review and agreement by 2 hematologists. A comparison cohort was identified from the database and matched on gender, race, region, overall follow-up time, age, and entry date into the health plan. Patient characteristics, TEs, treatment with rituximab, and lab parameters hemoglobin (Hgb), bilirubin, lactate dehydrogenase (LDH) were evaluated. LDH and bilirubin were included as they represent hemolysis and indirect measures of complement activity in CAD. TEs in both cohorts were identified from claims submitted.
Results: 814 patients with CAD and 7,960 comparisons were identified. Median follow-up time for CAD patients was 75.6 months (0-125 months). Seventy percent of CAD patients were over 65 years of age, 62% were women and 84% were Caucasian. Forty-four percent of CAD patients reside in the midwest, 13% in the northeast, 29% in the south, 12% in the west, with 2% unknown.
Thirty-one percent of CAD patients had a medical claim for any form of TE compared to 20% in the matched comparisons (p < 0.0001). Eighteen percent of CAD patients had 1 TE compared to 14% of the matched comparisons (p < 0.001). Thirteen percent of CAD patients had 2 or more types of TEs compared to 6% of matched comparisons (p < 0.001). Nearly 10% of all CAD patients had a venous TE compared to 3% of matched comparisons (p < 0.0001). Twenty five percent of all CAD patients had a cerebral TE compared to 16% of matched comparisons (p < 0.0001). Eight percent of all CAD patients had an arterial TE compared to 5% of matched comparisons (p < 0.0001).
Of the 94 CAD patients that had available Hgb within a month prior to a medical claim for a TE, 47% had mild anemia (Hgb > 10 g/dL), 29% had moderate anemia (Hgb 8.1-10 g/dL) and 24% had severe anemia (Hgb < 8 g/dL). Forty-one of the 94 patients had LDH and bilirubin values documented within one month of a medical claim for TE. Ninety percent of these CAD patients had evidence of ongoing hemolysis, represented by an abnormal bilirubin or LDH.
Seventy-nine percent of CAD patients treated with a rituximab-containing regimen had an abnormal bilirubin or LDH within 12 months of completion of therapy.
Conclusion: Thromboembolic events have been an under-appreciated complication of CAD. Patients with CAD had a significantly higher overall incidence of TEs compared to matched comparisons including venous, arterial, and cerebral events. Furthermore, patients with CAD also had a higher incidence of more than one type of TE. The severity of anemia does not appear to predict TE risk, whereas markers of hemolysis (LDH/bilirubin) do. Standard therapy with rituximab did not result in sustained control of hemolysis, as demonstrated by abnormal bilirubin and LDH values in a majority of patients within 12 months of last dose. Therapeutic modalities that can quickly and completely inhibit complement activity in CAD may offer clinical benefits beyond correcting hemolysis and anemia, such as decreasing TE risk.
Disclosures: This study was funded by True North Therapeutics, Inc., a Bioverativ Inc. company
Broome:TrueNorth Therapuetics: Honoraria; Alexion Pharmaceuticals: Honoraria. Cunningham:TrueNorth therapeutics: Honoraria. Rosenthal:Bioverativ Inc: Employment.
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