Mobile Mindfulness for Psychological Distress and Burnout among Frontline COVID-19 Nurses: A Pilot Randomized Trial.

Rationale: The coronavirus disease (COVID-19) pandemic exacerbated psychological distress and burnout in frontline healthcare workers. Interventions addressing psychological distress and burnout among these workers are lacking. Objectives: To determine the feasibility and explore the impact of mobile mindfulness to treat psychological distress and burnout among nurses in frontline COVID-19 units. Methods: We conducted a pilot randomized trial of 102 nurses working in COVID-19 units at a single hospital between May 2021 and January 2022. Participants were randomized to mobile mindfulness (intervention) or waiting list (control). The primary outcome was feasibility, assessed by comparing rates of randomization, retention, and intervention completion to predefined targets. Secondary outcomes were changes in psychological distress (Patient Health Questionnaire-9, General Anxiety Disorder-7, Perceived Stress Scale-4) and burnout symptoms (Maslach Burnout Inventory) after 1 month. Results: We randomized 102 of 113 consented individuals (90%, target 80%), and 88 completed follow-up (86%, target 80%). Among 69 intervention participants, 19 completed ⩾1 mindfulness session per week (28%, target 60%), and 13 completed ⩾75% of mindfulness sessions (19%, target 50%). Intervention participants had greater decreases in Patient Health Questionnaire-9 scores than control subjects (difference in differences, -2.21; 95% confidence interval, -3.99, -0.42; P = 0.016), but the Maslach Burnout Inventory depersonalization scores decreased more in the control arm than in the intervention arm (difference in differences, 1.60; 95% confidence interval, 0.18, 3.02; P = 0.027). There were no other changes in emotional distress or burnout symptoms. Conclusions: This trial of mobile mindfulness in frontline nurses met feasibility targets for randomization and retention, but participants had modest intervention use. Intervention participants had a reduction in depression symptoms, but not in burnout. Clinical trial registered with www.clinicaltrials.gov (NCT04816708).

Occurrence of Volutella Blight Caused by Pseudonectria foliicola on Boxwood in Tennessee.

Boxwood (Buxus sp. L.) is a very popular evergreen shrub in the United States which is widely used as landscape plant and fresh greenery. Boxwood 'Green velvet' (B. sinica var. insularis x B. sempervirens) plants grown in field condition exhibiting Volutella blight symptoms were found in a commercial nursery in Warren Co., Tennessee in May 2019. Leaves appeared red, brown or tan color on affected plants. Waxy, salmon pink colored fruiting bodies (sporodochia) were observed underneath the affected leaves using a hand lens (Figure 1). Leaf drop was also observed on plants. Black lesions under the bark were observed in some of the plants. The disease severity (percentage leaf area diseased) was nearly 40% and the disease incidence was nearly 30% of 1,000 plants. Infected leaf and stem tissues collected from four symptomatic plants were surface sterilized with 70% ethanol and washed with sterile distilled water. Culturing the infected leaf and stem pieces, 5-mm in size, on potato dextrose agar (PDA) consistently yielded white fluffy aerial mycelium growth with scattered salmon-color slimy masses of conidia forming from sporodochia after 10 days incubation at 25°C in a 12-h fluorescent light and dark cycle. A total of two isolates (FBG2020_396 and FBG2020_405) were hyphal tip purified on PDA. The conidia (n = 50) were hyaline, aseptate, fusiform to ellipsoidal measuring average of 7.8 × 3.3 µm (range: 4.84 to 13.2 µm × 2.2 to 4.64 µm). To confirm the pathogen identity, total DNA was extracted using UltraClean Microbial DNA Isolation Kit (MO BIO Laboratories, Inc., Carlsbad, CA) directly from a 5-day old culture of isolates (FBG2020_396 and FBG2020_405) on PDA. The ribosomal DNA internal transcribed spacer region (ITS), ß-tubulin (tub2) and part of 28S large ribosomal subunit (LSU) regions were amplified by PCR using the primer pairs ITS 5/ITS 4, T1/BTb2 and LR0R/LR5, respectively (Glass and Donaldson 1995; O'Donnell and Cigelnik 1997; Rehner and Samuels 1994; Vilgalys and Hester 1990; White et al. 1990). Newly generated sequences - GenBank/NCBI acc. nos. MW459251, MW465902 (ITS), MW464656, MW464657 (tub2) and MW459255, MW465903 (LSU) were 100% identical to Pseudonectria foliicola L. Lombard & Crous ex-type (CBS 123190) sequences KM231776, KM232035 and NG_058095, respectively. To complete Koch's postulates, six boxwood 'Green velvet' plants grown in 10 cm square pots (containing 40% coarse sand and 60% ground pine bark) were inoculated by spraying conidial suspension of P. foliicola [FBG2020_396 (1 × 105 conidia/mL)] obtained from 2-wk-old PDA cultures. Plants were covered with clear plastic humidity domes for 3 days and then they were maintained in a growth chamber at 25°C and 60% RH in a 12-h fluorescent light and dark cycle. Six control boxwood plants were maintained in the same environment without pathogen introduction. Pathogenicity test was conducted twice. After 10 days, typical symptoms of Volutella blight developed on the inoculated plants and microscopic examination revealed the same pathogen morphology as the original isolate. Pseudonectria foliicola was consistently re-isolated from leaves and stems. All control boxwood plants remained symptom-free and P. foliicola was not isolated from the leaves or stems. Pseudonectria foliicola causing Volutella blight has been reported on B. sempervirens in Czech Republic (Spetik et al. 2020), New Zealand (Lombard et al. 2015); Buxus sp. in Illinois, Maryland, Massachusetts, North Carolina and Washington (Salgado-Salazar et al. 2019). To our knowledge, this is the first report of Volutella blight of boxwood caused by P. foliicola in Tennessee. Pseudonectria foliicola is an opportunistic pathogen and infects weak, stressed, and injured boxwood plants/cuttings (Rivera et al. 2018). This pathogen could cause a serious economic loss to boxwood nursery growers, as it can significantly affect the ornamental value of boxwood plants and fresh greenery. Integration of sanitation practices with other disease management strategies such as biorational products and reduced-risk fungicides will be necessary for limiting the spread of pathogen and successful management of P. foliicola on boxwood in both field and postharvest conditions.

First Report of Powdery Mildew on Physocarpus opulifolius Caused by Podosphaera physocarpi in Tennessee.

Eastern ninebark (Physocarpus opulifolius (L.) Maxim.) is a popular native perennial plant used in landscapes because of its colorful foliage and spring flower display. Powdery mildew symptoms were observed on container-grown eastern ninebark 'Mindia' Coppertina® plants in a commercial nursery in DeKalb County, TN in May 2016. The disease severity was nearly 40% and the disease incidence was nearly 60% of 1,000 plants. Affected plants displayed witches'-brooms with cream to white colored, thickened shoots with stunted, curly leaves as well as patches of white powdery fungal growth on the surface of young and old leaves, inflorescences, infructescences and stems (Figures 1 and 2). Microscopic observation revealed masses of conidia and mycelium covering symptomatic tissues. Conidiophore foot cells measured 19.2 to 66.7 µm (mean = 38.3 µm) × 5.4 to 15.1 µm (mean = 9.7 µm) (n = 30). Conidia were ovoid and measured 11.4 to 28.5 µm (mean = 20.9 µm) (n = 30) in length and 8.2 to 14.8 µm (mean = 11.7 µm) (n = 30) in width. Conidiophores produced two to six conidia in chains. Fibrosin bodies were observed after treating conidia with a 3% KOH solution. Chasmothecia were numerous, 60.0 to 85.0 µm (mean = 74.2 µm) (n = 30) in size and contained one ascus [60.0 to 82.0 × 52.0 to 69.0 µm; mean = 73.4 × 59.4 µm (n = 30)] with 8 ascospores [25.2 to 28.0 × 14.8 to 16.0 µm; mean = 26.5 × 15.5 µm (n = 30)]. To confirm pathogen identity, total DNA was extracted directly from plant tissue with the UltraClean Microbial DNA Isolation Kit (MO BIO Laboratories, Inc., Carlsbad, CA) following the manufacturer's instructions. The ITS region of the ribosomal DNA was amplified by PCR using primer pair ITS1 and ITS4 (White et al. 1990). The sequence (GenBank acc. no. MT605142) of the amplicon had 100% coverage and 100% identity to that of Podosphaera physocarpi (U. Braun) U. Braun (= Podosphaera aphanis var. physocarpi (U. Braun) U. Braun & S. Takam.) (GenBank acc. no. MT106654). Pathogenicity was confirmed three times by inoculating leaf surfaces of five eastern ninebark 'Mindia' Coppertina® plants by tapping fungal spores from infected eastern ninebark leaves onto the surfaces of healthy leaves. Inoculated plants were maintained in a greenhouse (21 to 23°C) using drip irrigation system until symptoms developed. Five non-inoculated control plants were maintained in the same greenhouse. After two weeks, typical symptoms of powdery mildew developed on the inoculated plants and microscopic examination revealed the same pathogen morphology as the original isolate. All non-inoculated control plants remained disease-free. To our knowledge, this is the first report of powdery mildew caused by P. physocarpi on P. opulifolius in Tennessee. Powdery mildew is known to be a disease problem on eastern ninebark grown in its native range in landscape plantings. Lubell et al. (2011) reported varying levels of powdery mildew resistance among eastern ninebark cultivars. Timely application of fungicides with no phytotoxic effect will be necessary to manage this disease on susceptible eastern ninebark cultivars in affected nurseries.