Interactions between Bacillus thuringiensis and selected plant extracts for sustainable management of Phthorimaea absoluta.

Phthorimaea absoluta is a global constraint to tomato production and can cause up to 100% yield loss. Farmers heavily rely on synthetic pesticides to manage this pest. However, these pesticides are detrimental to human, animal, and environmental health. Therefore, exploring eco-friendly, sustainable Integrated Pest Management approaches, including biopesticides as potential alternatives, is of paramount importance. In this context, the present study (i) evaluated the efficacy of 10 Bacillus thuringiensis isolates, neem, garlic, and fenugreek; (ii) assessed the interactions between the most potent plant extracts and B. thuringiensis isolates, and (iii) evaluated the gut microbial diversity due to the treatments for the development of novel formulations against P. absoluta. Neem recorded the highest mortality of 93.79 ± 3.12% with an LT50 value of 1.21 ± 0.24 days, Bt HD263 induced 91.3 ± 3.68% mortality with LT50 of 2.63 ± 0.11 days, compared to both Bt 43 and fenugreek that caused < 50% mortality. Larval mortality was further enhanced to 99 ± 1.04% when Bt HD263 and neem were combined. Furthermore, the microbiome analyses showed that Klebsiella, Escherichia and Enterobacter had the highest abundance in all treatments with Klebsiella being the most abundant. In addition, a shift in the abundance of the bacterial genera due to the treatments was observed. Our findings showed that neem, garlic, and Bt HD263 could effectively control P. absoluta and be integrated into IPM programs after validation by field efficacy trials.

Conceptualizing the Biopsychosocial-Spiritual Health Influences of Adverse Childhood Experiences and the Application of Primary Care Behavioral Health for Their Treatment.

Adverse Childhood Experiences (ACEs) are common and affect the overall functioning of adults, but there is a need to understand how to better address the health impact of ACEs on adults in primary healthcare settings. A narrative review was utilized to extract data from seminal articles to (1) operationalize the influence of ACEs on health outcomes, (2) assess the primary care behavioral health (PCBH) model as a mechanism to address the influence of ACEs, and (3) identify mechanisms to expand the PCBH model to explicitly address spiritual determinants of health. The extracted data revealed that ACEs influence the biological, psychological, social, and spiritual health of patients providing a rationale for integrating psychosocial and spiritual treatment within primary healthcare settings. Simultaneously, the PCBH model integrates psychosocial interventions into existing primary care services but does not explicitly address spiritual determinants. Recommendations for expansion include (1) training for clinicians on evidence-based interventions to address spirituality, (2) spiritual screening tools in PCBH settings, and (3) consultation with chaplains as needed.

Loneliness, Spirituality, and Health-Related Quality of Life in Hispanic English-Speaking Cancer Caregivers: A Qualitative Approach.

Hispanic caregivers experiencing higher caregiving burden than their non-Hispanic cohorts, due in part to contextual factors, such as barriers to accessing health care, challenging employment environments, low education and income, immigration issues, and minority stress. Spirituality may serve as a coping strategy for Hispanic caregivers that influences health-related quality of life (HRQoL), possibly by modifying loneliness associated with caregiving. We explored these concepts using semi-structured interviews (N = 10 Hispanic caregivers). Participants shared perceptions of loneliness, spirituality, and how these factors related to HRQoL. Five themes emerged: caregiver experience, coping strategies, loneliness, religion and spirituality to gain strength. Findings suggested that spirituality and religion improved HRQoL partially by reducing loneliness. Future programs to improve HRQoL in Hispanic English-speaking cancer caregivers should address spirituality.

Exploring the relationship between loneliness, spirituality, and health-related quality of life in Hispanic cancer caregivers.

Caregivers of cancer patients find it challenging to perform their roles and to meet the demands of caregiving. Spirituality has been investigated as a potential coping strategy employed by caregivers, yet spirituality and related practices vary among cultural groups. In this study, we investigated the relationship between spirituality and health-related quality of life (HRQOL) and evaluated mediation effects of loneliness on this relationship. The sample was 234 lower socioeconomic status (SES) Hispanic caregivers of breast cancer survivors using existing data from the Support for Latinas with Breast Cancer and Their Intimate and Family Partners study, funded by the American Cancer Society (Badger, PI). A cross-sectional analysis was conducted at baseline, using self-reported spirituality, loneliness, and HRQOL data collected from 2012 to 2017. The exposures and outcomes were assessed using the Spiritual Well-Being Scale, the Social Isolation-Short Form 8a PROMIS Item Bank v2.0 scale, and the Global Health Scale PROMIS v.1.0/1.1 scale. Descriptive and mediation analyses using the Preacher and Hayes' approach were conducted to estimate the direct effect of spirituality on HRQOL and the indirect effect of spirituality through mediation of loneliness in relation to HRQOL. A positive association between spirituality and HRQOL was found, whereas loneliness was inversely associated with HRQOL (b = - .18, SE = .03, p < .0001). Age did not function as a moderator of the spirituality-HRQOL association in any of the models tested, but in the model testing mediation, loneliness was shown to mediate the association between spirituality and HRQOL (b = - .17, p < .0001). These results suggest that spirituality may be beneficial to HRQOL in caregivers of Hispanic breast cancer survivors, due in part to reduced loneliness among more spiritual caregivers.

Implementation of Un Abrazo Para La FamiliaTM in southern Arizona with extension to survivors and assessment of effects on distress.

Introduction: Un Abrazo Para La FamiliaTM [Embracing the Family] (Abrazo) is a 3-hr psychoeducational intervention designed for low-income informal caregivers who are cosurvivors of cancer. A rehabilitation-informed preventive intervention, Abrazo reflects the importance of family, culture, and socioeconomic background. A pilot study was conducted to inform a larger geographic implementation of Abrazo. The aims were to determine if previous outcomes of increased cancer knowledge and self-efficacy could be replicated and to investigate intervention effects on distress. Method: A pretest-posttest design was used to assess changes in cancer knowledge, self-efficacy, and distress for Abrazo participants. Distress was measured with the American Medical Association's Caregiver Assessment (Epstein-Lubow et al., 2010) and the National Comprehensive Cancer Network Distress Thermometer (Donovan et al., 2014; Forsythe et al., 2013; Fulcher & Gosselin-Acomb, 2007). The Patient Health Questionnaire-4 (PHQ-4) (Kroenke et al., 2009) measured symptoms of anxiety and depression. Results: Both survivors (n = 37) and cosurvivors (n = 103) increased in cancer knowledge and self-efficacy after completing Abrazo. Mean levels of distress and symptoms decreased for cosurvivors, but not for survivors. At study entry, 19% of cosurvivors and 12% of survivors scored ≥6/12 on the PHQ-4, the standard cutoff for clinically significant symptoms. Only 13% of cosurvivors, but 30% of survivors exceeded this threshold at three-month follow-up. Elevated symptoms persisted in 12% of survivors from baseline to follow-up; in 18% of survivors, symptoms rose between baseline and follow-up. Discussion: Increased cancer knowledge and self-efficacy in participants replicates evidence of Abrazo's effectiveness. The result of decreased distress in cosurvivors extends our understanding of Abrazo's effectiveness with this population. The increase in distress in cancer survivors warrants further attention to their intervention needs. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Rehabilitation for unilateral deafness - Narrative review comparing a novel bone conduction solution with existing options.

Patients with single sided deafness (SSD) struggle with sound localization and speech in noise. Existing treatment options include contralateral routing of signal (CROS) systems, percutaneous bone conduction hearing devices (BCHDs), passive transcutaneous BCHDs, active BCHDs, and cochlear implants. Implanted devices provide benefits in speech in noise compared to CROS devices. Percutaneous BCHDs transmit sound efficiently but have aesthetic drawbacks and skin complications. Scalp attenuation impacts passive transcutaneous BCHD performance. Active BCHDs overcome these issues and provide benefits for speech in noise. Cochlear implantation is the only existing option that restores binaural input but introduces electrical rather than acoustic stimuli to the deaf ear. Active BCHDs have been designed to maintain efficient sound transmission and avoid chronic skin irritation and cosmetic concerns that may occur with percutaneous BCHDs. Cochlear implantation may be a superior option for recently deafened SSD patients, though this requires further study. The duration of deafness, patient age and comorbidities, and a shared decision-making model among patients, surgeons, and audiologists should be considered in device selection. The aim of this manuscript is to review available devices, discuss surgical considerations for implantable devices, review available published results for speech in noise and sound quality with each device, and provide an overview to guide shared decision making for patients and providers. This review consolidates available literature and reviews experience with a newer active transcutaneous active BCHD available for use in the SSD population.

A nonproteinaceous Fusarium cell wall extract triggers receptor-like protein-dependent immune responses in Arabidopsis and cotton.

Fusarium wilt caused by the ascomycete fungus Fusarium oxysporum is a devastating disease of many economically important crops. The mechanisms underlying plant responses to F. oxysporum infections remain largely unknown. We demonstrate here that a water-soluble, heat-resistant and nonproteinaceous F. oxysporum cell wall extract (FoCWE) component from multiple F. oxysporum isolates functions as a race-nonspecific elicitor, also termed pathogen-associated molecular pattern (PAMP). FoCWE triggers several demonstrated immune responses, including mitogen-activated protein (MAP) kinase phosphorylation, reactive oxygen species (ROS) burst, ethylene production, and stomatal closure, in cotton and Arabidopsis. Pretreated FoCWE protects cotton seeds against infections by virulent F. oxysporum f. sp. vasinfectum (Fov), and Arabidopsis plants against the virulent bacterium, Pseudomonas syringae, suggesting the potential application of FoCWEs in crop protection. Host-mediated responses to FoCWE do not appear to require LYKs/CERK1, BAK1 or SOBIR1, which are commonly involved in PAMP perception and/or signalling. However, FoCWE responses and Fusarium resistance in cotton partially require two receptor-like proteins, GhRLP20 and GhRLP31. Transcriptome analysis suggests that FoCWE preferentially activates cell wall-mediated defence, and Fov has evolved virulence mechanisms to suppress FoCWE-induced defence. These findings suggest that FoCWE is a classical PAMP that is potentially recognised by a novel pattern-recognition receptor to regulate cotton resistance to Fusarium infections.

Effects of supplementing docosahexaenoic acid-rich microalgae and antioxidants on beef longissimus lumborum steak color stability and sensory characteristics.

The objective of this study was to determine the effects of four microalgae and antioxidant feeding regimens on beef longissimus lumborum color stability and palatability. Steers were blocked by weight and randomly assigned to one of four dietary treatments fed during a 45-d feeding period. Treatments (n = 10 per treatment) consisted of a control diet (CON) and control diet plus 100 g∙steer-1∙d-1 microalgae (ALGAE), ALGAE plus antioxidants (103 IU/d vitamin E and Sel-Plex) fed throughout feeding (AOX), and AOX fed for the final 10 d of finishing (LATE). The longissimus lumborum muscle was removed, aged for 14 d, and fabricated into steaks for objective and subjective color and palatability analyses. There were treatment × day of display interactions for a* value and steak surface metmyoglobin percentage (P < 0.01). There were no treatment differences through day 4 of display for a* value (P > 0.16) and day 5 of display for surface metmyoglobin (P > 0.10). By day 10 of display, ALGAE steaks had a smaller a* value than all other treatments (P < 0.01). Steaks from AOX steers had a greater (P < 0.01) a* value than CON steaks, whereas both a* values did not differ from LATE steaks (P > 0.19). By the end of display, ALGAE steaks had more metmyoglobin than the other treatments (P < 0.01). Steaks from AOX steers had less metmyoglobin than CON and LATE steaks (P < 0.04), which did not differ (P > 0.25). Treatment did not affect trained panel ratings (P > 0.15); however, treatment did affect (P < 0.01) off-flavor intensity. Steaks from ALGAE and AOX steers had greater off-flavor ratings than CON steaks (P < 0.03), but did not differ (P = 0.10). Steaks from LATE steers did not differ in off-flavor ratings from the other treatments (P > 0.07). Use of antioxidants improved color stability of steaks from microalgae fed steers; however, panelists still detected off-flavors.

Amino acids effects on heterocyclic amines formation and physicochemical properties in pan-fried beef patties.

The effects of surface application of amino acids on the formation of heterocyclic amines (HCAs) and meat quality properties were evaluated in pan-fried beef patties (230 °C/15 min). Tryptophan, lysine, leucine, and proline at three concentrations, 0.05%, 0.20%, and 0.50% (w/w), were tested. The meat crusts were analyzed for HCA content using liquid chromatography-tandem mass spectrometry. Results showed that surface application of all tested amino acids significantly reduced total HCA content (P < 0.05), and the interaction of amino acid type and concentration significantly affected (P < 0.05) both individual and total HCA formation. Tryptophan at 0.50% reduced total HCAs the most (0.92 ng/g, 93% inhibition), followed by 0.50% lysine (1.94 ng/g, 84% inhibition), while leucine (3.95 ng/g, 64% inhibition) and proline (4.71 ng/g, 56% inhibition) were less effective at 0.50%. In addition, applying amino acids to meat surface significantly influenced (P < 0.05) pH and surface color change of beef crusts; particularly, lysine at 0.20% and 0.50% increased pH and a* (redness) but reduced b* (yellowness), while tryptophan and leucine at 0.50% increased L* (whiteness). No significant effect was observed on cooking loss. Adding amino acids at 0.50% affected (P < 0.05) formation of aldehydes and pyrazines (as the key flavor compounds of fried beef). Overall, the results of this study suggested that adding amino acids to ground beef patties could effectively mitigate mutagenic HCA formation during cooking.

JCL roundtable: Omega-3 fatty acids and cardiovascular outcomes.

The Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT) in 2018 demonstrated the value of an omega-3 fatty acid formulation, icosapent ethyl (eicosapentaenoic acid ethyl ester) for preventive treatment of atherosclerotic cardiovascular disease (ASCVD). This JCL Roundtable discussion brings together three experts to explore the origins and implications of REDUCE-IT and more broadly omega-3 fatty acids for mitigation of ASCVD risk. REDUCE-IT achieved a highly significant 25% reduction of major adverse cardiovascular events. It is the first trial of a triglyceride-lowering drug to gain unequivocal success in high-risk patients treated intensively with statins. It corroborates positive results from an earlier major trial using eicosapentaenoic acid (EPA) ethyl ester, the Japan EPA Lipid Intervention Study (JELIS), which included hypercholesterolemic subjects treated with low-dose statin mostly in primary prevention. Together these studies mark a new avenue for preventive treatment of ASCVD. Omega-3 fatty acids also show some promise, though less decisively, for reducing inflammation and cardiovascular mortality in a broader context.

Gene Expression Signatures Identify Novel Therapeutics for Metastatic Pancreatic Neuroendocrine Tumors.

PURPOSE: Pancreatic neuroendocrine tumors (pNETs) are uncommon malignancies noted for their propensity to metastasize and comparatively favorable prognosis. Although both the treatment options and clinical outcomes have improved in the past decades, most patients will die of metastatic disease. New systemic therapies are needed. EXPERIMENTAL DESIGN: Tissues were obtained from 43 patients with well-differentiated pNETs undergoing surgery. Gene expression was compared between primary tumors versus liver and lymph node metastases using RNA-Seq. Genes that were selectively elevated at only one metastatic site were filtered out to reduce tissue-specific effects. Ingenuity pathway analysis (IPA) and the Connectivity Map (CMap) identified drugs likely to antagonize metastasis-specific targets. The biological activity of top identified agents was tested in vitro using two pNET cell lines (BON-1 and QGP-1). RESULTS: A total of 902 genes were differentially expressed in pNET metastases compared with primary tumors, 626 of which remained in the common metastatic profile after filtering. Analysis with IPA and CMap revealed altered activity of factors involved in survival and proliferation, and identified drugs targeting those pathways, including inhibitors of mTOR, PI3K, MEK, TOP2A, protein kinase C, NF-kB, cyclin-dependent kinase, and histone deacetylase. Inhibitors of MEK and TOP2A were consistently the most active compounds. CONCLUSIONS: We employed a complementary bioinformatics approach to identify novel therapeutics for pNETs by analyzing gene expression in metastatic tumors. The potential utility of these drugs was confirmed by in vitro cytotoxicity assays, suggesting drugs targeting MEK and TOP2A may be highly efficacious against metastatic pNETs. This is a promising strategy for discovering more effective treatments for patients with pNETs.

National Lipid Association Scientific Statement on the use of icosapent ethyl in statin-treated patients with elevated triglycerides and high or very-high ASCVD risk.

Representatives from the National Lipid Association (NLA) participated in the development of the 2018 American Heart Association/American College of Cardiology/Multisociety Guideline on the Management of Blood Cholesterol, which reaffirmed that lifestyle changes and statin treatment are therapeutic cornerstones for atherosclerotic cardiovascular disease (ASCVD) risk reduction. It also updated prior recommendations to incorporate newer data demonstrating ASCVD risk reduction with ezetimibe and proprotein convertase subtilisin kexin type 9 inhibitors as adjuncts to statin therapy for patients at high and very-high ASCVD risk. The 2018 Guideline was finalized shortly before full results were available from a randomized, placebo-controlled cardiovascular outcomes trial [Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial (REDUCE-IT)] that examined the effects of icosapent ethyl (IPE) 4 g/d on major adverse cardiovascular events in selected high- or very high-risk, statin-treated patients with elevated triglycerides. The primary outcome variable of first major adverse cardiovascular event (cardiovascular death, myocardial infarction, stroke, coronary revascularization and hospitalization for unstable angina) was reduced by 25% (95% confidence interval 17%-32%, P < .001). REDUCE-IT served as the primary basis for the NLA's review of evidence for the use of IPE for ASCVD risk reduction. Based on this review, the NLA position is that for patients aged ≥45 years with clinical ASCVD, or aged ≥50 years with diabetes mellitus requiring medication plus ≥1 additional risk factor, with fasting triglycerides 135 to 499 mg/dL on high-intensity or maximally tolerated statin therapy (±ezetimibe), treatment with IPE is recommended for ASCVD risk reduction (evidence rating: class I; evidence level: B-R).

Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association.

Hypertriglyceridemia (triglycerides 200-499 mg/dL) is relatively common in the United States, whereas more severe triglyceride elevations (very high triglycerides, ≥500 mg/dL) are far less frequently observed. Both are becoming increasingly prevalent in the United States and elsewhere, likely driven in large part by growing rates of obesity and diabetes mellitus. In a 2002 American Heart Association scientific statement, the omega-3 fatty acids (n-3 FAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) were recommended (at a dose of 2-4 g/d) for reducing triglycerides in patients with elevated triglycerides. Since 2002, prescription agents containing EPA+DHA or EPA alone have been approved by the US Food and Drug Administration for treating very high triglycerides; these agents are also widely used for hypertriglyceridemia. The purpose of this advisory is to summarize the lipid and lipoprotein effects resulting from pharmacological doses of n-3 FAs (>3 g/d total EPA+DHA) on the basis of new scientific data and availability of n-3 FA agents. In treatment of very high triglycerides with 4 g/d, EPA+DHA agents reduce triglycerides by ≥30% with concurrent increases in low-density lipoprotein cholesterol, whereas EPA-only did not raise low-density lipoprotein cholesterol in very high triglycerides. When used to treat hypertriglyceridemia, n-3 FAs with EPA+DHA or with EPA-only appear roughly comparable for triglyceride lowering and do not increase low-density lipoprotein cholesterol when used as monotherapy or in combination with a statin. In the largest trials of 4 g/d prescription n-3 FA, non-high-density lipoprotein cholesterol and apolipoprotein B were modestly decreased, indicating reductions in total atherogenic lipoproteins. The use of n-3 FA (4 g/d) for improving atherosclerotic cardiovascular disease risk in patients with hypertriglyceridemia is supported by a 25% reduction in major adverse cardiovascular events in REDUCE-IT (Reduction of Cardiovascular Events With EPA Intervention Trial), a randomized placebo-controlled trial of EPA-only in high-risk patients treated with a statin. The results of a trial of 4 g/d prescription EPA+DHA in hypertriglyceridemia are anticipated in 2020. We conclude that prescription n-3 FAs (EPA+DHA or EPA-only) at a dose of 4 g/d (>3 g/d total EPA+DHA) are an effective and safe option for reducing triglycerides as monotherapy or as an adjunct to other lipid-lowering agents.

Evaluation of antitrypanosomal activity of Pterocarpus santalinoides L'H'erit ex DC hydroethanol leaf extract in rats experimentally infected with Trypanosoma brucei.

ETHNOPHARMACOLOGICAL RELEVANCE: The leaves of Pterocarpus santalinoides are used alone or with other plants by traditional healers in some Southern Nigerian and Ivorian rural villages to treat blood parasitic infections including trypanosomiasis and malaria. However, their efficacy and safety remains doubtful. AIM: To evaluate the antitrypanosomal activity of Pterocarpus santalinoides hydroethanol leaf extract (PSELE) in vitro and in vivo. MATERIALS AND METHODS: The phytochemical and acute toxicity studies of PSELE were performed using standard methods. Eleven different concentrations of the extract were screened for in vitro antitrypanosomal activity. For the in vivo study, twenty-five female albino rats were randomly assigned into five groups of five rats each. Group A was the uninfected and untreated group while groups B - E were infected intraperitoneally with 106 trypanosomes. Group C rats were treated once on day 11 post infection (PI) with 7 mg/kg diminazene aceturate while groups D and E rats were also treated on same day with 200 mg/kg and 400 mg/kg PSELE respectively for seven days. The level of parasitaemia (LOP), survivability, packed cell volume (PCV), total leucocyte count (TLC), total erythrocyte count (TEC), body weight and rectal temperature were used to assess the antitrypanosomal effect of PSELE. RESULTS: Phytochemical analysis revealed the presence of flavonoids, tannins, carbohydrates and reducing sugar. No sign of toxicity or mortality was observed following acute toxicity study at a single dose of 2000 mg/kg. The LC50 of PSELE was 0.0625 mg/ml. Parasitaemia was first detected on day 8 and all infected rats became parasitaemic on day 10 (PI). PSELE significantly reduced (p < 0.05) LOP, improved PCV, TEC and prolonged survival time of the rats compared with the infected untreated group B. CONCLUSION: It was therefore concluded that PSELE is safe, possesses some antitrypanosomal activity and may serve as a lead for the development of an effective alternative antitrypanosomal drug.

Cognitively-Based Compassion Training versus cancer health education to improve health-related quality of life in survivors of solid tumor cancers and their informal caregivers: study protocol for a randomized controlled pilot trial.

BACKGROUND: Cancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers. METHODS: Forty dyads consisting of solid tumor survivors who have completed primary treatments (chemotherapy, radiation, surgery) and their informal caregivers, with at least one dyad member with ≥ mild depressive symptoms or anxiety, will be recruited from Tucson, Arizona, USA. Survivor-caregiver dyads will be randomized together to complete either CBCT or CHE. CBCT is a manualized, 8-week, group meditation-based intervention that starts with attention and mindfulness and builds to contemplative practices aimed at cultivating compassion to the self and others. The goal of CBCT is to challenge unexamined assumptions about feelings and behaviors, with a focus on generating spontaneous self-compassion and increased empathic responsiveness and compassion for others. CHE is an 8-week, manualized group intervention that provides cancer-specific education on various topics (e.g., cancer advocacy, survivorship wellness). Patient-reported HRQOL outcomes will be assessed before, immediately after (week 9), and 1 month after CBCT or CHE (week 13). At the same time points, stress-related biomarkers of inflammation (e.g., plasma interleukin-6) and saliva cortisol relevant for survivor and informal caregiver wellness and healthcare utilization will be measured. DISCUSSION: If CBCT shows acceptability, a larger trial will be warranted and appropriately powered to formally test the efficacy of this dyadic intervention. Interventions such as CBCT directed toward both survivors and caregivers may eventually fill a gap in supportive oncology care programs to improve HRQOL and healthcare utilization in both dyad members. TRIAL REGISTRATION: Clinicaltrials.gov, NCT03459781 . Prospectively registered on 9 March 2018.

Interventions in occupational health psychology.

The set of studies in this issue focus on applied interventions in occupational health psychology (OHP), that is, interventions that are intended to treat employee health and well-being problems or prevent these problems from occurring in the first place. An issue regarding many past evaluations of the effectiveness of these treatments was the relatively weak research methods, especially in regard to obtaining comparable groups to study so that internal validity is enhanced. Many of the studies presented here used the classically recommended approach of random assignment to alleviate this potential problem. We can see that there are a variety of types of potential treatments in OHP, including interventions focusing on changing the employee, other people in the employee's workplace (supervisors or coworkers), the employee's job characteristics, or the organization's climate. Although the ultimate criterion variables in OHP are indicators of employee wellness, some studies focused on improving what might theoretically be mediating variables between the interventions and employees' actual health or well-being. These outcomes include reductions of work-nonwork conflict and stigma of mental illness potentially present in the organization, its supervisors, or employees' coworkers. We note that there are probably moderators of the effectiveness of the interventions, so that a treatment may work better in some people, some situations, and some times than others. Finally, it is interesting to note that the interventions and their studies may be geographically concentrated rather than distributed equally around the globe. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Effects of lespedeza condensed tannins alone or with monensin, soybean oil, and coconut oil on feed intake, growth, digestion, ruminal methane emission, and heat energy by yearling Alpine doelings.

Fifty-four Alpine doelings (initial BW and age of 31.7 ± 0.38 kg and 306 ± 1.9 d, respectively) were allocated to nine treatments individually fed for ad libitum intake of 25% concentrate and 75% forage diets (DM basis). Alfalfa was the forage in the control diet. Other diets contained Sericea lespedeza as the forage, with 1.25% DM of quebracho extract included in the concentrate fraction for a dietary condensed tannin level of 8.4%. Lespedeza treatments were no additive (L) and inclusion of monensin (I) at 22 mg/kg DM (L-I), soybean oil at 3% (L-S), coconut oil at 3% (L-N), I and 3% soybean oil (L-I-S), I and 3% coconut oil (L-I-N), 1.5% soybean oil and 1.5% coconut oil (L-S-N), and I, 1.5% soybean oil, and 1.5% coconut oil (L-I-S-N). The experiment was 12 wk with two 6-wk periods. Gas exchange was determined in weeks 6 and 12, and other measures occurred in weeks 5 and 11. The control diet offered averaged 2.67% nitrogen, 43.8% neutral detergent fiber, and 8.8% acid detergent lignin, and the L diet offered averaged 2.03% nitrogen, 42.8% neutral detergent fiber, and 13.2% acid detergent lignin. There were no treatment × period interactions for digestibilities (P ≥ 0.770) or methane emission (P ≥ 0.324). There were differences (P < 0.001) between the control treatment and diets with lespedeza in intake of DM (1.46, 1.23, 1.30, 1.18, 1.32, 1.10, 1.02, 1.20, and 1.01 kg/d; SEM = 0.059), digestibility of OM (57.4%, 50.9%, 51.8%, 52.7%, 50.3%, 52.1%, 52.1%, 51.9%, and 49.8%; SEM = 1.42), and digestibility of nitrogen (59.1%, 31.2%, 32.5%, 37.1%, 31.6%, 38.3%, 30.4%, 38.4%, and 34.1% for control, L, L-I, L-S, L-N, L-I-S, L-I-N, L-S-N, and L-I-S-N, respectively; SEM = 2.21). Ruminal methane emission was less (P < 0.001) for diets with lespedeza than for the control in MJ/d (1.36, 0.76, 0.84, 0.71, 0.71, 0.66, 0.65, 0.68, and 0.68; SEM = 0.048) and relative to intake of gross energy (5.92%, 3.27%, 3.49%, 3.19%, 2.84%, 2.91%, 3.20%, 3.20%, and 3.27%; SEM = 0.165) and digestible energy (11.19%, 6.98%, 7.40%, 6.38%, 5.90%, 5.69%, 6.37%, 6.38%, and 6.70% for control, L, L-I, L-S, L-N, L-I-S, L-I-N, L-S-N, and L-I-S-N, respectively; SEM = 0.400). In conclusion, the magnitude of effect of condensed tannins from lespedeza and quebracho extract on ruminal methane emission by Alpine doelings did not diminish over time and was not markedly influenced by dietary inclusion of monensin, soybean oil, or coconut oil.

The effect of food and liquid pH on the integrity of enteric-coated beads from cysteamine bitartrate delayed-release capsules.

BACKGROUND: Cysteamine bitartrate delayed-release (DR) capsule (Procysbi®) is approved for treatment of nephropathic cystinosis in the USA, Canada, and the EU. The capsules contain cysteamine bitartrate beads that are enteric coated with acid-resistant Eudragit L 30 D-55, preventing drug release in the acidic stomach environment while allowing dissolution of the beads in the more alkaline environment of the small intestine. Patients who have difficulty swallowing capsules can open capsules, sprinkle beads onto 4 ounces of a suitable food or liquid, gently mix, and consume the entire content within 30 minutes. Foods found to be suitable for administration, and described in the Procysbi US labeling, include fruit juices (except grapefruit juice), applesauce, and berry jelly; there are minor variations in the foods and liquids recommended by regulatory authorities in other countries. This study aimed to assess the stability of enteric-coated beads exposed to additional foods at different conditions to expand the list of suitable foods for drug administration. METHODS: For each test condition, beads from eight opened 75 mg cysteamine bitartrate DR capsules were gently mixed with test food and maintained at a prespecified temperature and duration; remaining undissolved beads were then recovered from the food. The recovered beads were split into two portions: one assayed for remaining drug content and the other subjected to dissolution testing to assess the effect on the drug-release profile. RESULTS: The results show that bead integrity was maintained when mixed with foods at pH values <5.5 at all time points when refrigerated (2°C-8°C) and at room (20°C-22°C) and lukewarm (37°C-41°C) temperatures. Bead integrity was not maintained when mixed with foods at pH values of ≥5.5 at room temperature. CONCLUSION: The results from this in vitro dissolution study help in identifying additional foods that may be used for the administration of cysteamine bitartrate DR beads from opened capsules using the sprinkle method.

Multimodal Clinical Pathway With Adductor Canal Block Decreases Hospital Length of Stay, Improves Pain Control, and Reduces Opioid Consumption in Total Knee Arthroplasty Patients: A Retrospective Review.

BACKGROUND: Total knee arthroplasty volume is increasing significantly in the United States. Reducing hospital length of stay may represent the best method for accommodating expanding volume and reducing costs. We hypothesized that tailoring a clinical pathway to facilitate early ambulation would decrease costs and resource utilization. METHODS: We conducted a sequential before-and-after study of total knee arthroplasty patients after a phased implementation of a clinical pathway that includes multimodal oral analgesic protocols, adductor canal nerve block, and standardized day of surgery ambulation protocols. Primary outcomes measured were hospital length of stay, total opioid consumption, total antiemetic use, and perioperative pain scores. RESULTS: Two hundred ninety-five patients were divided into 3 sequential cohorts. Cohort 1 received spinal anesthesia, femoral nerve block, and was not placed into postop day 0 ambulation therapy. Cohort 2 received spinal anesthesia, adductor canal block, and postop day 0 ambulation therapy. Cohort 3 received spinal anesthesia, adductor canal block, postop day 0 ambulation therapy, and standardized oral multimodal analgesic protocol. Cohort 3 had significantly reduced hospital length of stay. Cohorts 2 and 3 had significantly less opioid consumption. Cohort 3 had significantly less total ondansetron consumption compared with cohort 1. Cohort 3 had significantly reduced average pain scores compared with cohort 1. CONCLUSION: The data demonstrate that tailored clinical pathways designed to facilitate early ambulation can reduce hospital length of stay, reduce opioid consumption, reduce antiemetic use, and improve pain control. The results establish that refined clinical pathways can assist in improving care while increasing value to patients, providers, and systems.

Provider recommendations for patient-reported muscle symptoms on statin therapy: Insights from the Understanding Statin Use in America and Gaps in Patient Education survey.

BACKGROUND: Statin-associated muscle symptoms are reported by 10% to 29% of patients in clinical practice and are a major determinant of statin nonadherence, discontinuation, and switching. Little is known about what advice patients receive from their providers when dealing with these symptoms. OBJECTIVE: The objective of the study was to assess patient's reports of provider advice when experiencing new or worsened muscle symptoms while taking a statin. METHODS: Data were analyzed from the Understanding Statin Use in America and Gaps in Education survey, a self-administered internet-based survey of 10,138 adults with a reported history of high cholesterol and statin use. RESULTS: Of the respondents, 60% of former statin users (n = 1220) reported ever experiencing new or worsened muscle pain on a statin, in contrast to 25% of current users (n = 8918; P < .001). Former statin users reported stopping more statins because of muscle symptoms (mean ± standard deviation, 2.2 ± 1.7) compared with current users (mean 1.6 ± 1.5, P < .0001). For those with muscle-related symptoms while on a statin, participants reported that providers most often suggested switching to another statin (33.8%), stopping the statin (15.9%), continuing the statin with further monitoring of muscle symptoms (12.2%), reducing the statin dose (9.8%), or getting a blood test for signs of muscle damage (9.2%). A lower percentage were advised to add either vitamin D (7.0%) or coenzyme Q10 (5.8%), or to switch to nonstatin therapy (6.1%) or red yeast rice (2.6%). CONCLUSIONS: This study highlights patient experience with statin-associated muscle symptoms and the strategies recommended by providers in managing these symptoms. More research is needed to develop patient-centric and evidence-based approaches to managing statin-associated muscle symptoms, which is especially important in light of recent data showing increased cardiovascular risk among those who discontinue statin therapy.