Fracking pond restoration in the western Rio Grande Plains, Texas: Stockpiled topsoils may not be necessary, but seeding helps.

Soil disturbances that accompany energy development can damage local habitats. Prior to oil and gas extraction, it is commonly recommended that topsoil stockpiles be created to aid future restoration. Our study area, a retired fracking pond in the western Rio Grande Plains, Texas, was restored in 2017 with stockpiled topsoil that was collected in 2013. We segregated the existing stockpile into three layers that were ∼1.5 m in thickness and distributed these layers, along with a non-amended control surface (consisting of former subsoil that made up the perimeter of the fracking pond), in strips over the restoration area. Each of the four surfaces was seeded with a mixture of (1) 13 native grasses, (2) 13 native grasses plus an annual warm-season grass cover crop, or (3) non-seeded. We monitored plant density and species composition two through five years post-restoration. The non-amended control surface had higher seeded grass density during the final 2 sampling periods; stockpiled surfaces seldom differed from each other. Previous year's competing plant density had little effect on restoration success. Providing supplemental seed initially increased seeded plant density but benefits diminished over time; adding a cover crop was not advantageous. Changes in community composition over time were similar on stockpile surfaces but more variable than observed on the control surface. Results suggest that stockpiling topsoil may not be necessary, but that supplemental seeding was beneficial, to restoration success.

Pain associated with pressure injury: A qualitative study of community-based, home-dwelling individuals.

AIMS: The aim of this study was to provide deep insights into the pain associated with pressure injuries in home-dwelling individuals using narrative accounts. BACKGROUND: Pressure injuries or pressure ulcers are burdensome and costly. Prevalence data, surveys and systematic reviews demonstrate that pain associated with pressure injury is widespread, but voices of home-dwelling patients have remained largely unheard. DESIGN: Concurrent mixed methods case study of a UK community of approximately 50,000 adults. METHODS: Qualitative interviews, conducted in 2016, of 12 home-dwelling adult participants with a current pressure injury (n = 10), or a recently healed pressure injury (n = 2). FINDINGS: Pain had an adverse impact on activities of daily living, mobility and sleep. Participants described days that were clouded in pain; a pain they felt was poorly understood and often out of control. Thematic content analysis revealed two major themes; these are: Poorly controlled pain: "I just want the pain to go away"; and, Uncertainty for the future: "it almost seems insurmountable." CONCLUSION: Findings of our study support the need to develop an appropriate assessment tool for pressure injury patients in the community to enable healthcare professionals and patients to recognize and manage pressure injury-related pain effectively.

Engineered Immunomodulatory Nanoparticles Inhibit Root Resorption and Ankylosis.

INTRODUCTION: External root resorption following avulsion injury is a complex process wherein differentiation of macrophages (Mϕ) to multinucleated osteoclasts is temporally regulated by resident periodontal fibroblasts (PDLF). The current study aims to assess the effect of engineered bioactive chitosan nanoparticles (CSNP), sustained released dexamethasone conjugated CSNP (CS-DEX) and CSNP functionalized with photosensitizer Rose Bengal (CSRB) for application in root resorption using an in-vitro PDLF-Mϕ direct coculture model and in-vivo delayed reimplantation model. METHODS: PDLF-Mϕ direct coculture system was exposed to lipopolysaccharide (LPS), macrophage colony stimulating factor, receptor activator of nuclear factor kappa ß ligand with or without CSNP/CS-DEX for 7 days. Clastic differentiation was assessed by tartrate resistant acid phosphatase (TRAP) staining on day 7. On day 2 and 7, immunofluorescence analysis was conducted to assess the expression of Mϕ polarization markers (CD80, CD206), multinucleation markers (NFATc1, STAT6) in Mϕ and matricellular protein periostin in PDLF and cytokine profiling in cell culture supernatants. Delayed replantation model with extraoral air dry/LPS exposure for 1h followed by root surface treatment with CS-DEX/CSRB was used in Wistar rats. After 21 days, rats were euthanized for histologic and immunofluorescence analysis. Statistical analysis one-way ANOVA with Tukey's multiple comparisons was used to analyze the data (P < .05). RESULTS: CS-DEX significantly reduced TRAP+ multinucleated cells and CSNP treatment showed no TRAP+ cells. Immunofluorescence analysis showed that CSNP/CS-DEX reduced CD80, NFATc1 and STAT6 expression and increased periostin as expressed by fluorescence intensity. CSNP/CS-DEX significantly reduced TNFα, MMP9 and increased IL10, TGFß1. Osteoprotegerin was upregulated only by CSNP. Root surface treatment in delayed replantation model showed that CS-DEX and CSRB substantially reduced the degree of resorption and ankylosis. Further, CD80, CD206, and MMP2 expression in groups with root surface treatment with CS-DEX and CSRB was lower than airdry/LPS group and similar to healthy control and NFATc1, STAT6, and MMP9 expressions were lower than healthy control. CONCLUSION: The engineered nanosized immunomodulatory bioactive materials chitosan nanoparticles functionalized with photosensitizer and dexamethasone effectively reduced the clastic differentiation of Mϕ in in-vitro coculture and minimized the resorption and ankylosis in a delayed reimplantation model. These biomaterials have the potential to serve as root modification agents, promoting favorable healing outcomes in cases of dental avulsion.

Deciphering 3D periodontal fibroblast-macrophage crosstalk in bioactive nanoparticle-guided immunomodulation for treating traumatic dental avulsion.

Prolonged extra-oral period in dental avulsion is often associated with loss of viability of Periodontal fibroblasts (PDLF) and increased risk of ankylosis. Root surface treatment with bioactive agents to reduce the risk of ankylosis can be a potential strategy. The objective of the study was to investigate the impact of an engineered chitosan nanoparticles (CSNP), photosensitizer Rose Bengal (RB) functionalized CSNP (CSRB) and sustained dexamethasone (CSDEX) releasing CSNP for application in management of delayed replantation of avulsed teeth. The 3D PDLF-macrophage (Mϕ) collagen model was developed and exposed to LPS, MCSF, RANKL with and without CSDEX/CSNP. Immunofluorescence and cytokine analysis was done at 2 and 7 days to assess cellular interactions. Maxillary right incisors in male Wistar rats were extracted, exposed to extraoral dry or LPS for 1 h and treated with or without CSDEX/CSRB for 1 min before replantation. Rats were euthanized after 21 days for micro-CT, TRAP, and immunofluorescence analysis. CSDEX/CSNP treatment in 3D model significantly reduced CD80, NFATc1, STAT6 and increased CD206 and periostin expression (p < 0.05). TNFα, MMP9 was downregulated and IL10, TGFß1, MMP2 upregulated with CSDEX/CSNP (p < 0.05). CSDEX/CSRB in animal study significantly reduced resorption, ankylosis, TRAP activity and osteocalcin expression and increased periostin (p<0.05). CSDEX demonstrated higher anti-inflammatory activity by downregulating TNFα, while CSNP upregulated TGFß1, periostin, and downregulated MMP9. The combination of matrix stabilization with CSRB with periostin upregulation and sustained releasing CSDEX showed potential for hampering root resorption and ankylosis in dental avulsion.

Harnessing the power of patient engagement in evaluating a novel brace for knee osteoarthritis: a co-produced commentary.

INTRODUCTION: Patient oriented research (POR) invites patients to partner with researchers, clinicians, and other stakeholders, incorporating diverse perspectives to generate scientific evidence meaningful to all parties involved. We adopted a POR approach for this study evaluating the feasibility of conducting a randomized control trial of a novel tri-compartment offloader brace for knee osteoarthritis. We involved patients as partners to enhance study design, implementation and interpretation of key outcomes. APPROACH: Patient involvement consisted of two patient leaders and five patient advisors. Patients participated in 2 virtual focus groups to discuss study outcomes, protocol, results and knowledge translation. Patients were involved in all aspects of the research cycle. OUTCOMES: Patient feedback resulted in changes to study design, documentation, participant recruitment, data collection, results interpretation and knowledge dissemination, improving the participant experience and aligning study outcomes with patient priorities. Study participants showed a high level of protocol adherence and follow-up rates were excellent. We experienced several unexpected benefits including genuine friendships, a deeper understanding of the patient experience, a more pragmatic approach to clinical research, and leadership opportunities for patients. RECOMMENDATIONS: We agreed on POR "non-negotiables" to ensure a positive experience for everyone, including creating a safe and comfortable environment, being genuinely receptive to patient feedback, and providing appropriate supports for patients. We strongly recommend that researchers (1) involve patients as early as possible, (2) provide ample and equal opportunities for all patients to be involved, and (3) address system hierarchy by involving patients as equals and fully considering all patient ideas from the beginning of the project. CONCLUSIONS: While POR is a learning process that is often more challenging than the traditional clinical research approach, the benefits are well worth the additional time and effort required to do it well. Over time, our team experienced a cultural shift and evolution from a top-down research approach to a more inclusive approach considering patient voices as equal to those of researchers. Patient involvement in all aspects of the research process, from question development to results interpretation and dissemination is integral to clinical research advancing equitably.

Involving patients as partners in research can be challenging. However, the benefits are well worth the additional time and effort required to do it well. Patients improve the relevance, success and impact of clinical research, and are central to clinical research advancing. We partnered with seven patients from the community to conduct a research study assessing the effectiveness of a new knee brace for people with knee osteoarthritis. Patients participated in 2 virtual Zoom discussions and were involved in all aspects of the research process. The feedback received from patients led to many helpful changes to the study design, documents, recruitment strategies, data collection, and how to understand and share our results. These changes made the study more aligned with patient priorities and improved participants' experience. Study participants followed study instructions and the majority completed the study. Our team also experienced many unexpected benefits of involving patients in research including genuine friendships, a deeper understanding of the patient experience, a more practical approach to clinical research, and more leadership opportunities for patients. We agreed that for everyone on the team to have a good experience, it's important to create a safe and comfortable environment, really listen to and consider patient input, and provide patients the tools and trainings they need to fully participate. We recommend that researchers involve patients in their studies as early as possible, give patients lots of opportunities to be involved, and involve patients as equals, considering their ideas from start to finish.

Tricompartment offloader knee brace reduces sagittal plane knee moments, quadriceps muscle activity, and pain during chair rise and lower in individuals with knee osteoarthritis.

The Levitation tricompartment offloader (TCO) knee brace provides an assistive knee extension moment with the goal of unloading all three compartments of the knee and reducing pain for individuals with multicompartment knee osteoarthritis (OA). This study aimed to determine the effect of the TCO brace on sagittal plane knee moments, quadriceps muscle activity, and pain in individuals with multicompartment knee OA. Lower limb kinematics, kinetics, and electromyography data were collected during a chair rise and lower to determine differences between bracing conditions. TCO brace use significantly decreased the peak net knee external flexion moment in high power mode, providing extension assistance during chair rise [p<0.001; mean difference (MD) (98.75% CI) -0.8 (-1.0, -0.6)%BWxH] and bodyweight support during chair lower [p<0.001; -1.1 (-1.6, -0.7)%BWxH]. Quadriceps activation intensity was significantly reduced with brace use by up to 67% for the vastus medialis [Z = -2.55, p = 0.008] and up to 39% for the vastus lateralis [Z = -2.67, p = 0.004]. Participants reported significantly reduced knee pain with the TCO brace worn in high power mode compared to the no brace condition [p = 0.014; MD (97.5% CI) -18.8 (-32.22, -2.34) mm]. These results support the intended mechanism of joint unloading via extension assistance with the TCO brace. The observed biomechanical changes were accompanied by immediate reductions in user reported pain levels, and support the use of the TCO for conservative management to reduce knee pain in patients with multicompartment knee OA.

Marsh migration and beyond: A scalable framework to assess tidal wetland resilience and support strategic management.

Tidal wetlands are critical but highly threatened ecosystems that provide vital services. Efficient stewardship of tidal wetlands requires robust comparative assessments of different marshes to understand their resilience to stressors, particularly in the face of relative sea level rise. Existing assessment frameworks aim to address tidal marsh resilience, but many are either too localized or too general, and few directly translate resilience evaluations to recommendations for management strategies. In response to the deficiencies in existing frameworks, we identified a set of metrics that influence overall marsh resilience that can be assessed at any spatial scale. We then developed a new comprehensive assessment framework to rank relative marsh resilience using these metrics, which are nested within three categories. We represent resilience as the sum of results across the three metric categories: current condition, adaptive capacity, and vulnerability. Users of this framework can add scores from each category to generate a total resilience score to compare across marshes or take the score from each category and refer to recommended management actions we developed based on expert elicitation for each combination of category results. We then applied the framework across the contiguous United States using publicly available data, and summarized results at multiple spatial scales, from regions to coastal states to National Estuarine Research Reserves to finer scale marsh units, to demonstrate the framework's value across these scales. Our national analysis allowed for comparison of tidal marsh resilience across geographies, which is valuable for determining where to prioritize management actions for desired future marsh conditions. In combination, the assessment framework and recommended management actions function as a broadly applicable decision-support tool that will enable resource managers to evaluate tidal marshes and select appropriate strategies for conservation, restoration, and other stewardship goals.

Tricompartment offloader knee brace reduces contact forces in adults with multicompartment knee osteoarthritis.

The levitation tricompartment offloader (TCO) brace is designed to unload all three knee compartments by reducing compressive forces caused by muscle contraction. This study aimed to determine the effect of the TCO on knee contact forces and quadriceps muscle activity in individuals with knee osteoarthritis. Lower limb kinematics, kinetics, and electromyography data were collected during a chair rise-and-lower task. A three-dimensional inverse dynamics model of the lower leg and foot was used with a sagittal plane knee model to compute knee joint forces. TCO brace use significantly decreased forces in the tibiofemoral [p = 0.001; mean difference, MD (97.5% confidence interval, CI) -0.62 (-0.91, -0.33) body weight (BW)] and patellofemoral [p = 0.001; MD (97.5% CI) -0.88 (-1.36, -0.39) BW] compartments in high-power mode. Significant reductions in quadriceps tendon force [p = 0.002; MD (97.5% CI) -0.53 (-0.83, -0.23) BW] and electromyography intensity of the vastus medialis [p = 0.018, MD (97.5% CI) -30.7 (-59.1, -2.3)] and vastus lateralis [p = 0.012, MD (97.5% CI) -26.2 (-48.5, -3.9)] were also observed. The TCO significantly reduced tibiofemoral and patellofemoral contact forces throughout chair lower, and when knee flexion was greater than 50° during chair rise in high power. These results demonstrate that the TCO reduces contact forces in the tibiofemoral and patellofemoral joint compartments and confirms that the TCO unloads the joint by reducing compressive forces caused by the quadriceps. Clinical significance: The magnitude of knee joint unloading provided by the TCO is similar to that achieved by clinically recommended levels of bodyweight loss and is therefore expected to result in clinical benefits for knee osteoarthritis patients.

Genome sequence and annotation of the B3 mycobacteriophage Phayeta.

Mycobacteriophage Phayeta was extracted from soil near Myrtle Beach, South Carolina using Mycobacterium smegmatis as a host. Annotation of the 68,700 base-pair circularly permuted genome identified 104 predicted protein-encoding genes, 34 of which have functional assignments.

Genome Sequences of 14 Siphophages That Infect Serratia marcescens.

We announce the complete genome sequences of 14 Serratia bacteriophages isolated from wastewater treatment plants. These phages define two previously undescribed types which we call the Carrot-like phage cluster (phages Carrot, BigDog, LittleDog, Niamh, Opt-148, Opt-169, PhooPhighters, Rovert, Serratianator, Stoker, Swain, and Ulliraptor) and Tlacuache-like phage cluster (Tlacuache and Opt-155).

Ethical reflections: examining reflexivity through the narrative paradigm.

Being reflexive and providing these reflections for public scrutiny is often considered a key element of ethical, rigorous qualitative research. Prevalent conceptualizations of reflexivity, however, need interrogating and sharpening. We aim to contribute to this by examining reflexive practice, and in particular researchers' reflexive accounts, through the lens of the narrative paradigm. Our aim is to demonstrate that acknowledging the role of narrative reconstruction in reflexivity creates more ethical research, and that it is therefore crucial for researchers to more explicitly recognize this. Both authors present an analysis of one particular exchange between interviewer and participant. This analysis highlights that despite our best efforts at "doing reflexivity," both immediately following and when reflecting back on an interview, there are influential factors that escape our gaze. Reflections of the past are particularly imperfect. Without fully recognizing this, we are not utilizing all the tools available for ensuring honest, ethical research.

Preliminary Evaluation of a New Orthotic for Patellofemoral and Multicompartment Knee Osteoarthritis.

PURPOSE: Traditional knee osteoarthritis (OA) braces are usually indicated for a minority of patients with knee OA, as they are only suitable for those with unicompartmental disease affecting the tibiofemoral joint. A new assistive brace design is intended for use in a wider range of knee OA patients with heterogeneous symptoms characteristic of patellofemoral, tibiofemoral, or multicompartmental knee OA. The purpose of this case series was to explore whether the use of this novel "tricompartment offloader" (TCO) brace was associated with clinically relevant improvements in pain and function. MATERIALS AND METHODS: A retrospective analysis of individuals with knee OA (n = 40) was conducted to assess pain, function, physical activity, and use of medication and other treatments before and after brace use. Validated outcome measures including the Visual Analog Scale (VAS) and Lower Extremity Functional Scale (LEFS) were used to assess pain and physical function (primary outcome measures). Exploratory measures were used to quantify physical activity levels and use of medication and other treatments (secondary outcome measures). RESULTS: Average total pain (VAS) scores decreased by 36.6 mm and physical function (LEFS) scores increased by 16.0 points following the use of the TCO brace. Overall, 70% of the participants indicated increased weekly physical activity and 60% reported a decrease in their use of at least one other treatment. CONCLUSIONS: Results from this case series suggest that the TCO brace shows strong potential to fill a conservative treatment gap for patients with heterogeneous symptoms of knee OA that are characteristic of patellofemoral or multicompartment disease. Further investigation is warranted.

Characterizing healthy knee symmetry using the finite helical axis and muscle power during open and closed chain tasks.

Understanding healthy joint movement and muscle control, and injurious alterations, is important to determine musculoskeletal contributions to post-injury joint instabilities or altered dynamic joint function. The contralateral limb is often used as a point of reference to determine the effects of knee joint injury. However, it is currently difficult to interpret within subject variability between limbs as this is not well established in the healthy population. There is a continuing need to characterize healthy knee joint mechanics and neuromuscular control to determine the degree of symmetry within healthy individuals. The current study quantified limb symmetry in healthy individuals using the finite helical axis with a unique reference position (rFHA) and electromyography (EMG) approaches, for a closed-chain single leg squat (SLS) and an open-chain seated leg swing. Muscle power and FHA translation, orientation and dispersion were similar between limbs. However, the FHA was located significantly more anterior in the dominant limb relative to the contralateral during both tasks. These between-limb differences in FHA location could be attributed to differences in joint geometry and strength between limbs. This finding provides evidence that healthy knees have asymmetries which have implications for selection of control limbs in studies comparing conditions within and between individuals. Differences identified in dynamic joint function between tasks suggest that the SLS is useful for revealing joint asymmetries due to altered muscular control strategies, while the swing task is expected to highlight asymmetries in joint motion due to altered knee structures following injury.

Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis.

Objective: Off-loader knee braces have traditionally focused on redistributing loads away from either the medial or lateral tibiofemoral (TF) compartments. In this article, we study the potential of a novel "tricompartment unloader" (TCU) knee brace intended to simultaneously unload both the patellofemoral (PF) and TF joints during knee flexion. Three different models of the TCU brace are evaluated for their potential to unload the knee joint. Methods: A sagittal plane model of the knee was used to compute PF and TF contact forces, patellar and quadriceps tendon forces, and forces in the anterior and posterior cruciate ligaments during a deep knee bend (DKB) test using motion analysis data from eight participants. Forces were computed for the observed (no brace) and simulated braced conditions. A sensitivity and validity analysis was conducted to determine the valid output range for the model, and Statistical Parameter Mapping was used to quantify the effectual region of the different TCU brace models. Results: PF and TF joint force calculations were valid between ~0 and 100 degrees of flexion. All three simulated brace models significantly (p < 0.001) reduced predicted knee joint loads (by 30-50%) across all structures, at knee flexion angles >~30 degrees during DKB. Conclusions: The TCU brace is predicted to reduce PF and TF knee joint contact loads during weight-bearing activity requiring knee flexion angles between 30 and 100 degrees; this effect may be clinically beneficial for pain reduction or rehabilitation from common knee injuries or joint disorders. Future work is needed to assess the range of possible clinical and prophylactic benefits of the TCU brace.

Narrative Reasoning in Practice A Case Study in Podiatry.

BACKGROUND: Clinical reasoning and decision making within health care are as important as ever in a world where evidence-based health care and patient outcomes are highly valued. It is increasingly recognized that decisions are not made in isolation, and are influenced by many factors, both intrinsic and extrinsic. Expert and novice practitioners share reasoning techniques, and there are many interpretations of reasoning paradigms within the field of health care. METHODS: A reflective diary was kept for 3 months linking personal reflections on a particular clinical decision with theoretical learning on clinical reasoning. Several decision-making paradigms were looked at in relation to the decision, with a deeper focus on narrative reasoning. Narrative reasoning resonated particularly with the author's previous experience studying literature. RESULTS: The clinical decision was usefully analyzed using a narrative reasoning strategy. The decision made by the author was perhaps contrary to the evidence, and yet had a positive outcome. The positive outcome of the decision was looked at within the context of evidence-based practice and ethical practice. CONCLUSIONS: Narrative reasoning comes from within the interpretive research model and puts the patient's experience at the heart of decision making. Narrative reasoning can be a valuable way of combining diagnostic, management, and ethical aspects of care. Further research-particularly in podiatry, where research is lacking-could identify helpful reasoning strategies for care of patients with long-term chronic conditions or complex conditions.

Effect of Health and Training on Ultrasensitive Cardiac Troponin in Marathon Runners.

PURPOSE: Cardiac troponin (cTn) is the gold standard biomarker for assessing cardiac damage. Previous studies have demonstrated increases in plasma cTn because of extreme exercise, including marathon running. We developed an easy-to-use, ultrasensitive assay for cardiac troponin I (cTnI) by combining single-molecule counting (SMC™) technology with dried blood spot (DBS) collection techniques and validated the assay on a cohort of marathon runners by correlating postmarathon cTnI elevations with training or risk variables. METHODS: An SMC-DBS method was developed for accurate and reproducible measurement of cTnI in fingerstick whole blood. Samples were collected from 42 runners both before and immediately after running a marathon. A similar collection was obtained from 22 non-running control individuals. Pre- and postrace questionnaires containing health and training variables were correlated with cTnI concentration. RESULTS: The assay quantified cTnI in all controls and marathon runners, both before and after the race. Prerace concentrations were significantly higher in marathon runners vs controls (median 3.1 vs 0.4 pg/mL; P < 0.0001). Immediate postmarathon concentrations were increased in 98% of runners (median elevation, 40.5 pg/mL; P < 0.001), including many above traditional cutoffs for acute myocardial infarction. Several health and training variables trended toward significant correlation with cTnI elevations. CONCLUSION: While further studies are needed to better understand the mechanisms and clinical implications of exercise-induced cTnI elevations, the present study suggests several variables that may be associated with such elevations and demonstrates a simple, cost-effective method for monitoring cTnI during exercise, managing chronic disease, and/or for assessing risk in large populations.

Error reduction in the finite helical axis for knee kinematics.

Traditionally the FHA is calculated stepwise between data points (sFHA), requiring down sampling to achieve a sufficiently large step size to minimize error. This paper proposes an alternate FHA calculation approach (rFHA), using a unique reference position to reduce error associated with small rotation angles. This study demonstrated error reduction using the rFHA approach relative to the sFHA approach. Furthermore, the rFHA in the femur is defined at each time point providing a continuous representation of joint motion. These characteristics enable the rFHA to quantify small differences in knee joint motion, providing an excellent measure to quantify knee joint stability.

Health service provision and the use of pressure-redistributing devices: mixed methods study of community dwelling individuals with pressure injuries.

BACKGROUND: Health care within the home setting is a vital and growing component of pressure injury (PI) prevention and management. OBJECTIVES: To describe the use of health services and pressure-redistributing devices in community dwelling patients with PI's. DESIGN: Mixed-methods collective case study of a defined, diverse geographic postcode area in the United Kingdom. METHODS: Quantitative retrospective analysis of electronic and paper medical records of adult PI patients from 2015 district nursing reports. Qualitative semi-structured interviews of community dwelling adult patients receiving, or received, treatment for PI in 2016. RESULTS: Mandatory reports (n = 103) revealed that 90 patients were supplied with a variety of pressure-redistributing devices but only one-third of patients used the equipment as recommended. Qualitative interviews (n = 12), reported to COREQ guidelines, revealed that patients felt reliant on community health services, and were concerned about the consistency of their care. CONCLUSIONS: Authentic patient involvement is required to provide care and interventions that are acceptable to PI patients and can be incorporated into self-care strategies and effectively monitored.

Serum activin A does not predict ectopic pregnancy as a single measurement test, alone or as part of a multi-marker panel including progesterone and hCG.

BACKGROUND: To evaluate the diagnostic accuracy of activin A alone or in a multi-marker panel for the prediction of ectopic pregnancy (EP). METHODS: A retrospective analysis was performed on a cohort of 289 women who presented to the emergency department (ED) with vaginal bleeding and/or abdominal pain/cramping and were diagnosed with EP, spontaneous abortion, or viable intrauterine pregnancy. Serum progesterone, hCG, and activin A concentrations were measured on the samples obtained in the ED. Statistical analysis was performed to determine the clinical utility of these biomarkers as single measurement and as a multi-marker panel test for ectopic pregnancy. Women ≥18 y with vaginal bleeding or abdominal pain/cramping. RESULTS: Progesterone (<10 ng/ml), hCG (<6,699 IU/l), and activin A (<0.26 ng/ml) cutoffs were optimized by ROC analysis. These demonstrated sensitivities of 62.9%, 74.2%, and 59.6%, and specificities of 60.5%, and 63.0%, and 61.0% respectively for detecting EP. The multi-marker panel utilizing all three biomarkers had a sensitivity of 70% and specificity of 69%. CONCLUSION: Serum activin A cannot be used as a single measurement or in a multi-marker panel with progesterone and hCG to predict EP.