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Selenium (Se) biofortification of staple cereal crops can improve the Se nutritional status of populations. A field trial employing an enriched stable isotope of Se (77Se) was undertaken over three consecutive cropping seasons in a coarse-textured, calcareous soil in Gilgit-Baltistan, Pakistan. The objectives were to (1) assess the feasibility and efficiency of Se biofortification, (2) determine the fate of residual Se, and (3) assess the consequences for dietary Se intake. Isotopically enriched 77Se (77SeFert) was applied, either as selenate or as selenite, at three levels (0, 10, and 20 g ha-1) to a wheat crop. Residual 77SeFert availability was assessed in subsequent crops of maize and wheat without further 77SeFert addition. Loss of 77SeFert was c.35% by the first (wheat) harvest, for both selenium species, attributable to the practice of flood irrigation and low adsorption capacity of the soil. No 77SeFert was detectable in subsequent maize or wheat crops. The remaining 77SeFert in soil was almost entirely organically bound and diminished with time following a reversible (pseudo-)first-order trend. Thus, repeat applications of Se would be required to adequately biofortify grain each year. In contrast to native soil Se, there was no transfer of 77SeFert to a recalcitrant form. Grain from control plots would provide only 0.5 µg person-1 day-1 of Se. By contrast, a single application of 20 g ha-1 SeVI could provide c. 47 µg person-1 day-1 Se in wheat, sufficient to avoid deficiency when combined with dietary Se intake from other sources (c. 25 µg day-1).In order to differentiate among Valeriana fauriei Briq. and other Eurasian medicinal valerian (V. dioica L., V. hardwickii Wall., V. jatamansi Jones, and V. officinalis L.), we attempted to establish DNA markers. DNA sequences for the psbA-trnH intergenic spacer region of chloroplast DNA (psbA-trnH) and 18S ribosomal RNA, internal transcribed spacer 1 (ITS1), 5.8S ribosomal RNA, internal transcribed spacer 2 (ITS2), and 28S ribosomal RNA of nuclear DNA in V. fauriei and other Eurasian medicinal valerian were compared. Using partial sequences of psbA-trnH (nucleotide positions 1-75 from the 5' end of the intergenic spacer region), V. fauriei and other Eurasian medicinal valerian could be correctly identified to the species level. In addition, the partial sequences of psbA-trnH in V. fauriei contained five different haplotypes, and it was possible to distinguish the origins of valerian from Japan and Eurasia (China and Korea). On the other hand, individuals had heterogeneous sequences of ITS1 and ITS2, making it impossible to use direct sequencing and DNA markers of ITS1 and ITS2 to distinguish species and origins of V. fauriei and other Eurasian medicinal valerian.

Current evidence suggests that the neutrophil-to-lymphocyte ratio (NLR) is a prognostic factor in several types of cancer. In this study, we aimed to evaluate the prognostic impact of clinicopathological factors, including postoperative NLR, in patients with locally advanced non-small-cell lung cancer (LA-NSCLC) who underwent surgery after chemoradiotherapy (CRT) with or without postoperative adjuvant chemotherapy.

The medical records of LA-NSCLC patients treated with trimodality therapy at our institution between June 1999 and May 2019 were reviewed. The association between several clinicopathological factors and overall survival (OS) was analyzed.

A total of 168 patients were included in this study. Regarding the prognosis, the 5-year OS rate was 68.1%, and the 2-year recurrence-free survival rate was 66.1% in the entire population. In multivariate analysis, we identified that high postoperative NLR, not pretreatment or preoperative NLR, was one of the independent factors for unfavorable OS (NLR high vs NLR low; hazard ratio = 2.45, 95% confidence interval 1.53-3.94, p < 0.001). In addition, among patients with high postoperative NLR, patients who received postoperative adjuvant chemotherapy showed significantly better 5-year OS compared with those who did not (p = 0.016). On the other hand, postoperative adjuvant chemotherapy had no impact on the prognosis in patients with low NLR (p = 0.19).

Our results suggest that high postoperative NLR was not only an independent unfavorable prognostic factor in patients with LA-NSCLC who were treated with trimodality therapy, but also a promising indicator for postoperative treatment in this population.

Our results suggest that high postoperative NLR was not only an independent unfavorable prognostic factor in patients with LA-NSCLC who were treated with trimodality therapy, but also a promising indicator for postoperative treatment in this population.

While health-related social needs (HRSN) are known to compromise health, work to date has not clearly demonstrated the relationship between clinically acknowledged social needs, via ICD-10 Z-codes, and readmission.

Assess the rate of 30-, 60-, and 90-day readmission by the level of ICD-10-identified social need. In addition, we examined the associations between demographics, social need, hospital characteristics, and comorbidities on 30-day readmission.

Retrospective study using the 2017 Nationwide Readmission Database PARTICIPANTS We identified 5 domains of HRSN from ICD-10 diagnosis codes including employment, family, housing, psychosocial, and socioeconomic status (SES) and identified how many and which an individual was coded with during the year.

The proportion of patients with 30-, 60-, and 90-day readmission stratified by the number of HRSN domains with a multivariable logistic regression to examine the relationship between the number/type of and readmission adjusting for sex, age, payer, hospien the number of HRSN diagnoses and hospital readmission. This work calls attention to the need to develop interventions to reduce readmissions for those at social risk and demonstrates the significance of ICD-10 Z-codes in health outcomes studies.

Inappropriate use of antibiotics in the outpatient setting is a common problem, yet literature evaluating best practices for stewardship interventions in this setting is sparse.

To evaluate the impact of clinical decision support (CDS) order panels for azithromycin prescribing on the percentage of inappropriate azithromycin prescriptions in primary care clinics.

Single-center, retrospective analysis of azithromycin prescribing within nine primary care clinics. Pre-intervention and post-intervention data included azithromycin prescriptions from November 2016 to April 2017 and February 2019 to July 2019, respectively. Key exclusion criteria included prescriptions for the treatment of a sexually transmitted infection or for prophylaxis against Mycobacterium avium complex.

The azithromycin CDS panel was created to provide point-of-care information on appropriate use of azithromycin along with recommended alternatives based on indications. CDS panels were implemented on January 10, 2019.

The primary compied URI.

Implementation of CDS order panels resulted in a reduction in inappropriate azithromycin prescribing. However, additional improvement in azithromycin prescribing is needed especially for the indications of bronchitis and unspecified URI.

Obesity is associated with elevated blood pressure (BP). In patients with obesity and hypertension, weight loss lowers BP, but the long-term effect of weight loss on BP is less clear.

We aimed to assess the effect of long-term weight loss intervention on BP in normotensive and hypertensive subjects.

Randomized controlled trial.

Two hundred seventy-eight subjects (mean age 47.9 ± 9.3 years, 89% male, 56% hypertensive) with abdominal obesity or elevated serum triglycerides and low high-density lipoprotein cholesterol were recruited.

Eighteen-month weight loss intervention.

Body weight and BP were measured at baseline, after 6 and 18 months.

After 6 months of intervention, in the weight loss phase, body mass index (BMI) decreased by an average of -2.2±1.5 kg/m

(p<0.001) and both diastolic BP (DBP) and systolic BP (SBP) decreased by -2.1±8.8 mmHg and -2.3±12.9 mmHg, respectively (p<0.01 for both). The change in BMI was similar in normotensive and hypertensive subjects (-2.0±1.6 and -2.3±1.5, p = 0.246). However, DBP and SBP decreased significantly (-5.2±7.1 mmHg and -6.2±12.5 mmHg, respectively, p<0.001 for both) in hypertensive subjects, and increased in normotensive subjects (1.8±9.3 mmHg, p = 0.041 and 2.7±11.7 mmHg, p = 0.017, respectively). After 18 months, in the weight maintenance phase, BMI slightly increased (0.9±1.3 kg/m

, p<0.001) but remained significantly lower than at baseline (p<0.0001). Unlike BMI, DBP and SBP increased significantly in hypertensive subjects (p<0.001) and returned almost to baseline levels.

Weight-loss intervention reduced BP in hypertensive patients, but this was not maintained in the long run.

ClinicalTrials.gov Identifier NCT01530724.

ClinicalTrials.gov Identifier NCT01530724.

Patient-perpetrated sexual harassment adversely affects healthcare organizations, staff, and other patients, yet few institutions have clear policies to address it. Understanding the challenges to addressing patient-perpetrated harassment can inform development of institutional guidelines and interventions.

To identify challenges and stakeholder-driven recommendations for addressing patient-perpetrated sexual harassment of women staff and patients at Veterans Health Administration (VA) facilities.

We conducted qualitative interviews with 24 staff, clinicians, and administrators across four VA healthcare facilities.

We used snowball sampling to identify stakeholders with expertise in overseeing care environments, providing care to women patients, and/or managing disruptive patient behavior.

We interviewed participants in-person or via phone using a semi-structured guide. Two members of the research team analyzed the interview data using the constant comparative method.

Participants identified challed by military gender norms, and commitment to reducing harassment at its facilities. Ourfindings highlight the complexity of addressing patient-perpetrated harassment and underscore the need for systemic, multilevel interventions.

VA offers unique opportunities for studying patient-perpetrated harassment of women staff and patients due to its majority-male patient population, culture informed by military gender norms, and commitment to reducing harassment at its facilities. Our findings highlight the complexity of addressing patient-perpetrated harassment and underscore the need for systemic, multilevel interventions.To investigate the association between white matter free water (FW) and common imaging markers of cerebral small vessel diseases (CSVD) in two groups of subjects with different clinical status. One hundred and forty-four community subjects (mean age 60.5) and 84 CSVD subjects (mean age 61.2) were retrospectively included in the present study. All subjects received multi-modal magnetic resonance imaging and clinical assessments. The association between white matter FW and common CSVD imaging markers, including white matter hyperintensities (WMH), dilated perivascular space (PVS), lacunes, and microbleeds, were assessed using simple and multiple regression analysis. LY2109761 The association between FW and cognitive scores were also investigated. White matter FW was positively associated with WMH volume (β = 0.270, p = 0.001), PVS volume (β = 0.290, p less then 0.001), number of microbleeds (β = 0.148, p = 0.043), and age (β = 0.170, p = 0.036) in the community cohort. In the CSVD cohort, FW was positively associated with WMH volume (β = 0.