Florida Center Research Articles

‘FLLA11019‐8’: A new dual‐purpose facultative oat cultivar for grain and forage production in the southern United States

Abstract‘FLLA11019‐8’ (Reg. no. CV‐386, PI 700040) is new facultative oat (Avena sativa L.) cultivar for the southern United States for forage, grain, cover, and wildlife food crop uses. It was co‐developed by the University of Florida and Louisiana State University Agricultural Center and was released in 2020 under the SunGrains, a cooperative small grain breeding program among seven Southern Universities. This line was derived from a single cross between two advanced breeding lines, FL0564‐Ab13 and LA06071SBSB‐S1. Exclusive marketing rights were granted to Ragan & Massey, Inc., and the line is currently commercializing under the names of RAM Forage Oats and PlotSpike Forage Oats. The University of Florida is the lead institution in this release. FLLA11019‐8 (originally named FLLA11‐19S‐8) was developed using the selected bulk breeding method and was selected as an F5:6 head row. The line was evaluated in observation, preliminary, advanced, regional, and state grain and forage yield trials from 2016 to 2021. FLLA11019‐8 was released based on the merits of its broad adaptation, excellent grain yield, volume weight, forage potential, and winter survival. It is resistant to crown rust and stem rust and moderately resistant to Barley yellow dwarf virus. It is a mid‐maturing and mid‐tall height variety. FLLA11019‐8 has semi‐prostrate plant type with vigorous early‐season growth and high tillering capacity. It has performed very well in both grain and forage trials and is broadly adapted to the southern and southeastern United States.

Barriers to Mammography Screening among Black Women at a Community Health Center in South Florida, USA.

In the United States (US), Black/African American women suffer disproportionately from breast cancer health disparities with a 40% higher death rate compared to White women. Mammography screening is considered a critical tool in mitigating disparities, yet Black women experience barriers to screening and are more likely to be diagnosed with advanced-stage breast cancer. The purpose of this study was to assess the relative frequency of mammography screening and to examine perceived and actual barriers to screening among women who receive care in our nurse-led community health center. We conducted a survey examining frequency of mammography screening and beliefs about breast cancer including perceived susceptibility, perceived benefits, and perceived barriers to mammography screening, guided by the Champion Health Belief Model. A total of 30 Black/African American women completed the survey. The mean age of the participants was 54.3 years ± 9.17 (SD); 43.3% had a high school education or less; 50% had incomes below $60,000 per year; 26.7% were uninsured; 10% were on Medicaid; and only 50% were working full-time. We found that only half of the participants reported having annual mammograms 16 (53.3%), 1 (3.3%) every 6 months, 8 (26.6%) every 2-3 years, and 5 (16.7%) never had a mammogram in their lifetime. Frequently cited barriers included: 'getting a mammogram would be inconvenient for me'; 'getting a mammogram could cause breast cancer'; 'the treatment I would get for breast cancer would be worse than the cancer itself'; 'being treated for breast cancer would cause me a lot of problems'; 'other health problems would keep me from having a mammogram'; concern about pain with having a mammogram would keep me from having one; and not being able to afford a mammogram would keep me from having one'. Having no health insurance was also a barrier. This study found suboptimal utilization of annual screening mammograms among low-income Black women at a community health center in Florida and women reported several barriers. Given the high mortality rate of breast cancer among Black/African American women, we have integrated a Patient Navigator in our health system to reduce barriers to breast cancer screening, follow-up care, and to facilitate timely access to treatment, thus ultimately reducing breast cancer health disparities and promoting health equity.

550. Analysis of Staphylococcus aureus resistance patterns and antibiotic prescribing practices in a single tertiary pediatric center in South Florida

Abstract Background Staphylococcus aureus antibiotic resistance in pediatric populations is a dynamic problem that affects the morbidity and mortality of all children. Local efforts to understand its patterns as well as the antibiotic prescribing trends, as well as their relationship, are cornerstone for the development of mitigation strategies. Methods We conducted a retrospective observational study of 11,964 clinical isolates at a tertiary pediatric care center in South Florida collected from 2008 to 2019 to determine the antibiotic susceptibility of Staphylococcus aureus, compare antibiotic resistance patterns between MRSA and MSSA isolates and evaluate antibiotic prescribing practices from 2013 to 2019. Results Methicillin resistance was present in 47.9% (±0.63) isolates with no significant temporal trend. Resistance to clindamycin was on average 24.8% (±1.08), to erythromycin 66.9% (±1.68), to levofloxacin 35.5% (±1.61) and to gentamicin 6.8% (±1.11). MRSA isolates had higher resistance rates to most antibiotics than MSSA (p< 0.05) except for clindamycin for which both had similar rates. Resistance to clindamycin and gentamicin increased significantly from 20% to 25% and from 5 to 15%, respectively, among MRSA and quinolone resistance rose among MSSA from 7% to 13%. Antibiotic prescription rate increased from 56 prescriptions per 1,000 patients to 136 prescriptions per 1,000 patients from 2013 to 2019. There was a positive correlation between erythromycin resistance rate among MRSA and macrolide prescription frequency (p< 0.05). Figure 1.Antibiotic resistance in S aureus isolates from pediatric patients between 2008 and 2019. The trends in erythromycin and gentamicin resistance were statistically significant (p<0.05); all other trends shown were not significant. Figure 2.Comparative annual resistance rate among MSSA and MRSA isolates from pediatric patients between 2008 and 2019 The trend in levofloxacin resistance among MSSA was statistically significant, as well as the trends in erythromycin, clindamycin, and gentamicin in MRSA; all other trends were not significant. Figure 3.Annual antibiotic prescription frequency as a percent of all antibiotics prescribed in outpatient facilities and emergency department at Nicklaus Children’s Hospital between 2013 and 2019Beta-Lactams are expressed as the summation of cephalosporins and penicillins. The frequency at which penicillins, cephalosporins and macrolides were prescribed changed significantly; all other frequencies did not change significantly. Conclusion Pediatric Staphylococcus aureus isolates showed high and stable rates of methicillin resistance during the study period. There is growing clindamycin and gentamicin resistance among MRSA isolates as well as increasing levofloxacin resistance in MSSA isolates. Antibiotic prescribing increased significantly in this population during the study period in South Florida. Disclosures All Authors: No reported disclosures.

262. COVID-19 associated fungal co-infections in Solid Organ Transplant Recipients: A single center case series

Abstract Background During the ongoing Coronavirus disease of 2019 (COVID-19) pandemic, there have been increasing reports of viral, bacterial and fungal co-infections. Two COVID-19-associated fungal infections (CFIs) have been identified – COVID-19 associated pulmonary aspergillosis (CAPA) and COVID-19 associated mucormycosis (CAM), but incidence and occurrence in solid organ transplant recipients (SOTRs) is limited. We describe our experience with CFIs in SOTRs with COVID-19. Methods In a single center retrospective study at a large volume transplant center in South Florida, USA, we included adult SOTRs (≥18 years) diagnosed with COVID-19 between March 1st 2020 and January 31st 2022, with subsequent diagnosis of CFI. We collected information related to demographics, comorbidities, COVID-19 diagnosis and therapeutics, and CFI diagnostics and management. Data obtained was analyzed descriptively. Results We identified 612 SOTRs with COVID-19, of which 23 (3.8%) were diagnosed with CFIs. The patients were predominantly male (17/23, 73.9%), with median age of 59 years (range 43-79) [Table 1]. Twenty (86.9%) were kidney transplant recipients. Majority of SOTRs had lymphopenia (18/23, 78.3%) with elevated inflammatory markers at time of COVID-19 diagnosis. They received most commonly remdesivir and corticosteroids for COVID-19, with 22 (95.6%) needing intensive care unit admission and 19 (82.6%) needing continuous renal replacement therapy. CFIs were diagnosed at median 21 days (range, 3-161) after initial COVID-19 diagnosis. Probable CAPA was diagnosed in most patients (16/23, 69.6%), with CAM noted in 1 patient [Table 2]. 34.8% (8/23) had specific fungal species identified, with elevated fungal markers noted in 95.6% (22/23). Concurrent or prior cytomegalovirus DNAemia was noted in 26.1% (6/23). Patients were followed for median 70 days (range, 19-572), with median hospitalization duration 56 days (range, 7-204). Mortality was noted in 73.9% (17/23). Table 1:COVID-19 related clinical characteristics in study patients (N=23)Table 2:CFI-related clinical characteristics in study patients (N=23) Conclusion Fungal co-infections were noted in a small proportion of our SOTRs, with poor outcomes. Transplant physicians should have a high suspicion for early diagnosis and treatment of CFI. Further studies are needed to determine predictors for CFI and role for anti-fungal prophylaxis. Disclosures All Authors: No reported disclosures.

Polysomnography findings in children with spinal muscular atrophy after onasemnogene-abeparvovec

BackgroundSleep disordered breathing (SDB) is common in patients with neuromuscular diseases, including spinal muscular atrophy (SMA). While polysomnography (PSG) findings have been described in natural history studies of patients with SMA, reports regarding PSG in treated children are limited to nusinersen. We aim to describe the sleep characteristics in a cohort of children treated with Onasemnogene-abeparvovec. MethodsWe conducted a cross-sectional cohort study of children with SMA followed at the University of Florida Center for neuromuscular and rare diseases and had a diagnostic or split night PSG after SMA treatment. ResultsEight children were included in the cohort (four female), aged 5–250 days at diagnosis. Five children had two survival motor neuron 2 (SMN2) copies, two had three SMN2 copies and one subject had four SMN2 copies. Median age at the time of treatment was 46.5 days (range 20–257). All children received onasemnogene-abeparvovec (OA) before their PSG; in addition to OA, one received nusinersen and one received risdiplam. Apnea hypopnea index (AHI) ranged from 3.6 to 24.1/h. REM AHI was higher than NREM AHI. Median Children's Hospital of Philadelphia Infant test of neuromuscular disorders (CHOP-Intend) score at the time of PSG was 55 (range 33–64). There was no correlation between age at treatment, CHOP-Intend score and AHI. ConclusionSDB is common in treated children with SMA, regardless of age at diagnosis, treatment and neuromotor scores. While AHI may not be the only indicator of SDB in this population, indications, timing of PSG in this cohort remain unknown.

Second Neoplasms in Children Following Radiotherapy in the Modern Era: A Bicentric Report from the University of Florida and Memorial Sloan Kettering Cancer Center

<h3>Purpose/Objective(s)</h3> Over the past two decades, eliminating secondary radiation-induced neoplasms has been a primary aim of our field. This study quantifies the results of that effort with a focus on children who received intensity-modulated radiotherapy (IMRT) and proton therapy (PT). <h3>Materials/Methods</h3> A total of 1880 pediatric patients with > 2 years follow-up received radiotherapy between 1999 and 2019, including 348 treated with IMRT and 1532 treated with PT (97% passive-scatter). The median age was 9.2 years old, including 623 patients ≤5 years old. Overall, 31 patients had a known genetic tumor predisposition syndrome, most commonly neurofibromatosis (n=15); 1044 had central nervous system tumors; 191 patients were treated with large volume-radiation, including craniospinal irradiation (CSI) in 135; and 988 patients received alkylating chemotherapy. Patients treated with IMRT were more likely to receive alkylating chemotherapy (76.4% vs 47.1%, p <0.001), but received a lower median radiation dose (50.4 vs 54 Gy, p <0.001) and were marginally less likely to have a tumor predisposition syndrome (0.6% vs 1.9%, p = 0.10). Cumulative incidence method provided estimates of secondary neoplasms including benign and malignant solid tumors as well as leukemia. Multiple variables were assessed using proportional hazard regression for competing risks. The median follow-up duration was 6.5 years (range, 2-21.9) and included 296 and 773 patients with >5 years follow-up in the IMRT and proton cohorts, respectively. <h3>Results</h3> The 5-year local control rate was similar between the 2 cohorts at 90.7% following PT vs 91.4% following IMRT. For all patients, the 5- and 10-year rates of developing a second neoplasm were 1.2% and 3.3%, respectively. On multivariate analysis, the presence of a tumor predisposition syndrome (10.1% vs 1.1%), the use of alkylating chemotherapy (2.1% vs 0.3%), and the use of IMRT (2% vs 1%) were significantly associated with the development of a second neoplasm 5 years after treatment (all p < 0.05). When patients with tumor predisposition syndromes were excluded from the analysis, the use of alkylating chemotherapy (1.9% vs 0.2%) and the use of IMRT (2.0% vs 0.8%) independently retained a significant association with second neoplasms (both p < 0.05). The difference in secondary malignant solid tumors was non-significant; however, 4/14 (29%) malignant solid tumors occurred outside the target region in the patients treated with PT compared to 5/10 (50%) in patients treated with IMRT. <h3>Conclusion</h3> Compared to IMRT, early data reveal a significant reduction in second neoplasms among children treated with PT, most pronounced in those who do not have underlying tumor predisposition syndromes. This could be due to a reduction in leukemia and malignant solid tumors developing in tissue exposed to low-dose radiation outside the target region.

Molecular characteristics and outcomes in Hispanic and non-Hispanic patients with acute myeloid leukemia.

Hispanic patients have been reported to have an increased incidence of AML and possibly inferior outcomes compared to non-Hispanics. We conducted a retrospective study of 225 AML patients (58 Hispanic and 167 non-Hispanic) at two academic medical centers in Florida. Disease characteristics, cytogenetics, mutation profiles, and clinical outcomes were assessed. Hispanic patients were younger at presentation than non-Hispanics (p = 0.0013). We found associations between single gene mutations and ethnicity, with IDH1 mutations being more common in non-Hispanics (95.2% vs. 4.8%, p = 0.0182) and WT1 mutations more common in Hispanics (62.5% vs. 37.5%, p = 0.0455). We also found an emerging trend towards adverse risk cytogenetics in Hispanic patients (p = 0.1796), as well as high risk fusions such as MLL-r (70% vs. 30%, p = 0.004). There was no difference in overall survival (OS) between Hispanic and non-Hispanics patients. When examining only newly diagnosed patients (n = 105), there was improved OS in Hispanics (median 44.7 months vs. 14 months, p = 0.026) by univariate analysis and equivalent OS by multivariate analysis (hazard ratio = 1.52 [95% CI = 0.74-3.15]). Hispanics with a driver mutation not class-defining had improved survival compared to non-Hispanics. Our study demonstrates significant genetic differences between Floridian Hispanics and non-Hispanics, but no difference in OS in patients treated at an academic medical center.

Identifying sources of burnout among clinicians at a cancer center: A qualitative analysis.

429 Background: Clinician burnout leads to increased job turnover and workforce shortages, and reduced patient satisfaction and quality of care. Despite its importance, there has been limited study of burnout among the cancer care workforce including sources of burnout. This information can be used to inform intervention design for use in the cancer care setting specifically. To address this gap, we analyzed open-ended responses to a well-being survey administered to clinicians (physicians and advanced practice providers) at a Cancer Center. Methods: In February 2022, we electronically administered the American Medical Association’s clinician well-being survey to all practicing clinicians at a National Cancer Institute-designated Comprehensive Cancer Center in Florida. Of 700 clinicians, 405 (58%) responded. Of the respondents, 259 (64.0%) answered the free-text question “Tell us more about your stressors and what we can do to minimize them.” We used in-vivo coding to develop qualitative themes across responses. If a given response incorporated multiple themes, we coded the response under all pertinent themes. Results: A majority (76/259) of respondents commented on staffing issues, such as their clinics being understaffed or the quality of current staff. Another frequent theme (64/259) was the electronic health records (EHR) system, such as lack of integration between modules, inbox fatigue, alert fatigue, and inefficient documentation review processes. Respondents also reported scheduling issues as a pain point (56/259), such as having schedules that do not reflect actual clinical practice, being overbooked, and scheduling errors. Documentation burden was also highlighted as an issue across respondents (34/259). Documentation was considered tedious and some respondents reported a mismatch between available documentation tools in the EHR and actual documentation needs. Less common themes reported across respondents included design issues of facility space (e.g., no dedicated workspace to complete work without interruptions) and insufficient time to complete administrative, research, and documentation requirements. Conclusions: Our findings suggest that interventions that optimize staffing models, EHR processes (e.g., documentation), and scheduling practices may reduce burnout for a considerable number of cancer care clinicians.

Effects of Iron Rates on Growth and Development of Young Huanglongbing-affected Citrus Trees in Florida

Essential nutrients for citrus [‘Bingo’ (Citrus reticulata, Blanco)] production are important for different functions, including photosynthesis, resistance to disease, and productivity. During the past 15 to 20 years, citrus production in Florida has significantly declined as a result of the devastating citrus greening disease also called huanglongbing (HLB). Therefore, a greenhouse study was conducted for 2 years, starting in 2018, at the University of Florida/Institute of Food and Agricultural Sciences Citrus Research and Education Center in Florida to evaluate the effect of varying rates of iron on the growth and development of 2-year-old HLB-affected ‘Bingo’ (Citrus reticulata, Blanco) trees on Kuharske citrange rootstock. Four treatments were used in a randomized complete block (HLB status) design with seven single tree replicates for each treatment. The treatments applied were 0.0 (control), 5.6 (standard fertilization, lx), 11.2 (2x), and 22.4 (4x) kg⋅ha−1 iron on HLB-affected and healthy (non-HLB) citrus trees. Data including trunk diameter, tree height, and leaf samples were collected, processed, and analyzed at 3-month intervals for 2 years. At the end of the second year, trees were destructively sampled and processed as above-ground and below-ground biomass. Tree heights were different among iron rates of HLB-affected trees (P &lt; 0.001); however, they were similar for non-HLB trees for both years. Higher average trunk diameters (P &lt; 0.001) were observed for HLB-affected trees that received the 2x rate compared with the 1x rate and the control. In 2019, non-HLB trees showed 13% to 40% higher iron concentrations in leaves than HLB-affected trees. However, leaf iron concentrations were comparable for HLB-affected and non-HLB trees in 2020. Above-ground biomass for HLB-affected trees had between 33% and 44% more biomass (P &lt; 0.01) than below-ground biomass for the corresponding iron fertilization. Iron accumulation correlated positively with all studied nutrients in the above-ground parts for both HLB-affected and non-HLB trees. A 95% confidence interval at which total biomass was nearly maximum corresponded to an iron rate of 9.6 to 11.8 kg⋅ha−1, which was close to the 2x rate. Therefore, soil iron application using the aforementioned rates may be appropriate for better growth and development of young HLB-affected trees.

210.11: COVID-19 Associated Fungal Co-infections in Solid Organ Transplant Recipients: a Single Center Case Series.

Introduction: During the ongoing Coronavirus disease 2019 (COVID-19) pandemic, there have been increasing reports of co-infections with viral, bacterial and fungal pathogens. Two specific COVID-19-related fungal infections have been identified – COVID-19 associated pulmonary aspergillosis (CAPA) and COVID-19 associated mucormycosis (CAM), with limited information available about their incidence and occurrence in solid organ transplant recipients (SOTRs). We describe our experience with COVID-19 associated fungal co-infections (CFIs) in SOTRs with COVID-19. Methods: This was a single center retrospective study at a large volume transplant center in South Florida, USA. We included adult SOTRs (≥18 years) diagnosed with COVID-19 between March 1st 2020 and January 31st 2022, with a subsequent diagnosis of CFI. We collected information related to demographics, comorbidities, COVID-19 diagnosis and therapeutics, and CFI diagnostics and management. We performed descriptive statistical analysis on the data obtained. Results: We identified 612 SOTRs with COVID-19, of which 23 (3.8%) were diagnosed with CFIs. The patients were predominantly male (17/23, 73.9%), with median age of 59 years (range 43-79) (Table 1). Twenty (86.9%) were kidney transplant recipients. Majority of SOTRs had lymphopenia (18/23, 78.3%) with elevated inflammatory markers at time of COVID-19 diagnosis. They received most commonly remdesivir and corticosteroids for COVID-19, with 22 (95.6%) needing intensive care unit admission and 19 (82.6%) needing continuous renal replacement therapy. CFIs were diagnosed at median 21 days (range, 3-161) after initial COVID-19 diagnosis. Probable CAPA was diagnosed in most patients (16/23, 69.6%), with CAM noted in 1 patient (Table 2). 34.8% (8/23) had specific fungal species identified, with elevated fungal markers noted in 95.6% (22/23). Concurrent or prior cytomegalovirus DNAemia was noted in 26.1% (6/23). Patients were followed for median 70 days (range, 19-572), with median hospitalization duration 56 days (range, 7-204). Mortality was noted in 73.9% (17/23). Conclusion: Fungal co-infections were noted in a small proportion of our SOTRs, with poor outcomes. Transplant physicians should have a high suspicion for early diagnosis and treatment of CFI. Further studies are needed to determine predictors for CFI and role for anti-fungal prophylaxis.

Technology devices: Can it enhance pre-service teachers' teaching?

The COVID-19 pandemic has resulted in schools being closed around the world. Globally, most children are outside the classroom. As a result, education has changed dramatically, with the advent of typical e-learning, where teaching is done remotely and on digital platforms. These conditions are very demanding on information skills, media, and technology as a solution to these problems. All school activities had been shifted to an online delivery mode, which causes the implementation of teaching practices to be carried out online. This transfer forces pre-service teachers to have different teaching practice experiences. Technological devices are the facilities they use to support online learning. This study aims to describe the implementation and perceptions of pre-service teachers on their teaching practice experiences during the pandemic. Class observations are made on the implementation of English pre-service teachers’ teaching by implementing technological devices in three public junior high schools in Semarang. To evaluate how the teaching and learning process in applying technological devices, the Technological Integrated Matrix (TIM) by Florida Center for Instructional Technology is used as a framework for analyzing the data. TIM provides a framework for describing and targeting the use of technology to enhance learning. Questionnaires and interviews are also administered to obtain information about the pre-service teachers' perceptions of online learning during the pandemic era. Therefore, despite the limitations of its implementation, teaching practice programs tend to form a positive mindset and teaching attitude for pre-service teachers.

Development of a Prediction Model for Antibiotic-Resistant Urinary Tract Infections Using Integrated Electronic Health Records from Multiple Clinics in North-Central Florida.

Urinary tract infections (UTIs) are common infections for which initial antibiotic treatment decisions are empirically based, often without antibiotic susceptibility testing to evaluate resistance, increasing the risk of inappropriate therapy. We hypothesized that models based on electronic health records (EHR) could assist in the identification of patients at higher risk for antibiotic-resistant UTIs and help guide the selection of antimicrobials in hospital and clinic settings. EHR from multiple centers in North-Central Florida, including patient demographics, previous diagnoses, prescriptions, and antibiotic susceptibility tests, were obtained for 9990 patients diagnosed with a UTI during 2011-2019. Decision trees, boosted logistic regression (BLR), and random forest models were developed to predict resistance to common antibiotics used for UTI management [sulfamethoxazole-trimethoprim (SXT), nitrofurantoin (NIT), ciprofloxacin (CIP)] and multidrug resistance (MDR). There were 6307 (63.1%) individuals with a UTI caused by a resistant microorganism. Overall, the population was majority female, white, non-Hispanic, and older aged (mean = 60.7years). The BLR models yielded the highest discriminative ability, as measured by the out-of-bag area under the receiver-operating curve (AUROC), for the resistance outcomes [AUROC = 0.58 (SXT), 0.62 (NIT), 0.64 (CIP), and 0.66 (MDR)]. Variables in the best performing model were sex, history of UTIs, catheterization, renal disease, dementia, hemiplegia/paraplegia, and hypertension. The discriminative ability of the prediction models was moderate. Nonetheless, these models based solely on EHR demonstrate utility for the identification of patients at higher risk for resistant infections. These models, in turn, may help guide clinical decision-making on the ordering of urine cultures and decisions regarding empiric therapy for these patients.

Introduction to the Special Issue: Understanding the contexts in which vulnerable students learn, develop, and achieve in reading in the United States.

New Directions for Child and Adolescent DevelopmentVolume 2022, Issue 183-184 p. 5-8 COMMENTARY Introduction to the Special Issue: Understanding the contexts in which vulnerable students learn, develop, and achieve in reading in the United States Nicole Patton Terry, Corresponding Author Nicole Patton Terry npattonterry@fsu.edu Florida State University & Florida Center for Reading Research, Tallahassee, Florida, USA Correspondence Nicole Patton Terry, Florida Center for Reading Research, 2010 Levy Ave, Suite 100, Tallahassee, FL 32310, USA. Email: npattonterry@fsu.eduSearch for more papers by this authorAstrid Pohl Zuckerman, Astrid Pohl Zuckerman The Ohio State University, Columbus, USASearch for more papers by this authorPeggy McCardle, Peggy McCardle Peggy McCardle Consulting, LLC, Tarpon Springs, Florida, USASearch for more papers by this author Nicole Patton Terry, Corresponding Author Nicole Patton Terry npattonterry@fsu.edu Florida State University & Florida Center for Reading Research, Tallahassee, Florida, USA Correspondence Nicole Patton Terry, Florida Center for Reading Research, 2010 Levy Ave, Suite 100, Tallahassee, FL 32310, USA. Email: npattonterry@fsu.eduSearch for more papers by this authorAstrid Pohl Zuckerman, Astrid Pohl Zuckerman The Ohio State University, Columbus, USASearch for more papers by this authorPeggy McCardle, Peggy McCardle Peggy McCardle Consulting, LLC, Tarpon Springs, Florida, USASearch for more papers by this author First published: 11 July 2022 https://doi.org/10.1002/cad.20472Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume2022, Issue183-184Special Issue: Education and Intervention in Vulnerable Student Populations: Science and PracticeJuly 2022Pages 5-8 RelatedInformation

Development and assessment of the effectiveness of an LGBT cultural sensitivity training for oncologists: The COLORS training.

11000 Background: Published studies report oncologists have limited knowledge about LGBT health and cancer needs but also report high interest in receiving education regarding the unique health needs of LGBT patients with cancer. As such, our group developed the Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills (COLORS), an interactive web-based LGBT cultural sensitivity training for oncologists that focused on focused on improving knowledge and communication skill-building. We report here on the results from two single-arm feasibility/acceptability trials and one randomized pragmatic trial (RPT) demonstrating effectiveness of the COLORS training. Methods: The first single-arm trial included 44 oncologists from three cancer centers in Florida and the second single-arm trial included 50 oncology fellows recruited through ASCO. The RPT included 225 oncologists randomly selected for equal distribution across the U.S., and participants were randomly assigned to either the COLORS training or a publicly available, web-based LGBT comparison training. Each of these studies included pre- and post-training assessments of LGBT-related knowledge, attitudes, and affirming practices. The RCT included a 3-month follow-up assessment to gauge retention of LGBT-affirming knowledge, attitudes, and practices over time. Results: Both single arm trials demonstrated that the COLORS training was feasible, acceptable, and results from the pre- and post-training assessments suggested the training improved knowledge, attitudes, and affirming practice behaviors. In the RPT, those randomized to COLORS demonstrated significant improvements in LGBT-related attitudes pre- to post-training (p &lt; 0.01), and no significant changes in attitudes were observed among those randomized to the comparison training (p = 0.98). Both trainings yielded significant (p &lt; 0.01) increases from pre- to post-training in LGBT-affirming practice behaviors. Likewise, both trainings yielded significant (p &lt; 0.01) improvements in knowledge from pre- to post-training. Similar significant findings were observed when we analyzed the 3-month follow-up assessment. Conclusions: Results from the prior single-arm trials and the current RCT demonstrate that the COLORS training is effective in improving oncologist knowledge, attitudes, and affirming clinical practices related to the care of LGBT patients with cancer. Part of this work was funded by the Bristol Myers Squibb (BMS) Foundation and BMS Company.

More than just “vaginal dryness”: Addressing an unmet need for sexual health intervention in female cancer survivors.

e24050 Background: Female sexual dysfunction (FSD) in cancer survivors is underreported and therefore undertreated. This study aims to describe the population of female cancer survivors seeking treatment for sexual dysfunction through a novel sexual health after cancer program. Methods: We conducted a retrospective analysis to characterize patients presenting to the MUSIC (Menopause, Urogenital, Sexual Health and Intimacy Clinic) Program at a NCI-designated cancer center in South Florida. Patients received a baseline Female Sexual Function Index (FSFI) and underwent a physical, including abdominopelvic, exam. The FSFI is a 19-item survey previously validated for use in female cancer survivors. Severity of dysfunction (by presenting symptom, physical exam, and FSFI) was correlated to demographic and cancer characteristics. Sexual dysfunction was defined as ≤26.55. Results: Between 2020-2021, 104 female cis-gender women with a median age of 46 (range 19-75) at diagnosis were seen. 56% identified as Hispanic/Latinx. Most were treated for breast (80%) or gynecologic (10%) cancer. Common presenting symptoms included vaginal dryness (55%), painful sex (45%), low desire (36%) and hot flashes (22%). Patients who disclosed details about pain (n = 62) reported penetration was possible but uncomfortable (16%), possible but painful (66%) or impossible due to pain (18%). Those who disclosed changes with orgasm (n = 43) reported it was more difficult (26%), or impossible (23%). Of those completing the FSFI (n = 66), median Desire Domain score was 1.2 (IQR 1.2-2.4), and median Total Score was 8.1 (IQR 2.9-16.4), with 97% of patients meeting criteria for FSD (Table). Conclusions: The present study highlights a continued unmet need to address severe sexual health concerns in the growing female cancer survivor population. Future work will describe treatment strategies employed and their effectiveness at symptom resolution and quality-of-life improvement.[Table: see text]

"I Wear a Mask. I Wear It All the Time. The Kids Don't Wear Masks": Early Childhood Education Mask-Wearing During COVID-19 in Florida.

New federal health guidance was issued for early childhood education (ECE) programs to reduce the risk of COVID-19 in March 2020. The Centers for Disease Control and Prevention recommended mask-wearing for adults and children aged 2 years and older. Wearing masks was a new practice for teachers and children, and this study investigated when and how masks were worn in ECE centers in Florida. This study was part of a larger assessment of the impact of COVID-19 on mealtime routines in ECE centers. Two statewide surveys based on the Trust Model were sent to directors and teachers via Florida Department of Children and Families. Only teachers were interviewed. Data were collected from August to October 2020. The analysis included survey results and interview responses related to mask-wearing. Surveys were completed by 759 directors and 431 teachers, and 29 teachers were interviewed. Survey results indicated that more teachers than children wore masks during pre- and postmeal activities. Interviews revealed three models that explain mask-wearing: (1) teachers only, in which teachers were required to wear a mask, but children were not; (2) teachers and children, in which teachers and children were required to wear a mask; and (3) masks optional, in which teachers and children could choose to wear a mask. Understanding how decisions about mask-wearing were made at the center level can inform training and support health and safety in ECE. Use of personal protective equipment (such as masks) is effective for reducing risk of pathogen transmission for children and adults in ECE settings.

The Influence of Movement-Evoked Pain on Lower Extremity Physical Function in Older Adults

Older adults often exhibit impaired lower extremity physical function, which promotes a sedentary lifestyle and contributes to the development of adverse health outcomes. Studies have identified several factors that contribute to lower extremity physical function in older adults, including body mass index (BMI), self-reported pain severity, and number of painful sites. An understudied area that may improve our understanding of these impairments is movement-evoked pain (MEP). Therefore, the purpose of this study was to determine if movement-evoked pain was associated with lower extremity physical function in older adults. Older adults (n=67) completed several lower extremity physical function tasks, including a balance, gait, and chair stand assessment, and isokinetic knee flexion and extension strength testing. MEP ratings following these tasks were obtained using a visual analog scale (0-100). Pain scores from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were used to quantify pain severity and participants self-reported number of painful sites. Hierarchical linear regressions were run using three blocks of independent variables (Block 1 = BMI, Block 2 = WOMAC pain scores and number of painful sites, Block 3 = Movement-evoked pain) to assess contributions from each factor for each lower extremity physical function task. MEP improved the amount of variance explained in gait double support time (ΔR2 = 0.052, p = 0.023). Pain severity and number of painful sites significantly improved the amount of variance explained in stride length (ΔR2 = 0.104, p = 0.020) and repeated chair stand performance (ΔR2 = 0.205, p < 0.001). MEP accounts for a significant amount of variance in gait performance in older adults beyond the known contributions of BMI, pain severity, and number of painful sites. As such, MEP should be considered in the development of future physical function pain assessments and treatments. Grant support from NIA grants K01AG048259, R01AG059809, R01AG067757, the University of Florida Claude D. Pepper Center (P30AG028740), and the University of Florida McKnight Brain Research Foundation and Center for Cognitive Aging and Memory.

Impact of Simulation on Critical Care Fellows’ Electroencephalography Learning

IntroductionContinuous electroencephalography (EEG) is an important monitoring modality in the intensive care unit and a key skill for critical care fellows (CCFs) to learn. Our objective was to evaluate with CCFs an EEG educational curriculum on a web-based simulator.MethodsThis prospective cohort study was conducted at a major academic medical center in Florida. After Institutional Review Board approval, 13 CCFs from anesthesiology, surgery, and pulmonary medicine consented to take an EEG curriculum. A 25-item EEG assessment was completed at baseline, after 10 EEG interpretations with a neurophysiologist, and after 10 clinically relevant EEG-based simulations providing clinical EEG interpretation hints. A 50-minute tutorial podcast was viewed after the baseline assessment. Main assessment outcomes included multiple outcomes related to web-based simulator performance: percent of hints used, percent of first words on EEG interpretation correct, and percent hint-based EEG interpretation score correct, with higher scores indicating more correct answers. Participants completed a 25-item EEG assessment before (baseline) and after the web-based simulator.ResultsAll 13 CCFs completed the curriculum. Between scenarios, there were differences in percent of hints used (F9,108 = 11.7, p < 0.001), percent of first words correct (F9,108 = 13.6, p < 0.001), and overall percent hint-based score (F9,108 = 14.0, p < 0.001). Nonconvulsive status epilepticus had the lowest percent of hints used (15%) and the highest hint-based score (87%). Overall percent hint-based score (mean across all scenarios) was positively correlated with change in performance as the number of correct answers on the 25-item EEG assessment from before to after the web-based simulator activity (Spearman’s rho = 0.67, p = 0.023).ConclusionsA self-paced EEG interpretation curriculum involving a flipped classroom and screen-based simulation each requiring less than an hour to complete significantly improved CCF scores on the EEG assessment compared to baseline.

Clinicopathological findings of FeLV- positive cats at a secondary referral center in Florida, USA (2008-2019).

ObjectivesThe aim of this study was to describe the seroprevalence, presenting complaint, clinicopathological changes, co-morbidities and outcomes of feline leukemia virus positive cats presented to a specialty referral center in Florida, USA.MethodsIn this retrospective study, medical records of 8050 cats presented to a private referral center from August 2008 to September 2019 were reviewed. Inclusion criteria required was a positive result for feline leukemia virus by point-of-care antigen testing or immunofluorescence assay.ResultsForty-one cases met the inclusion criteria. Of 2002 cats that were tested, 41 cats (2%) met the inclusion criteria. One cat had a negative point of care antigen test result and positive bone marrow IFA result. The mean age at diagnosis was 9 years. The main reasons for presentation were abnormal complete blood cell count results (35%), followed by pleural effusion (18%), and anorexia (15%). The most common laboratory abnormalities included anaemia (71%), of which 74% had a nonregenerative anemia, thrombocytopenia (52%), elevated aspartate aminotransferase (50%), hyperbilirubinemia (35%), and hypokalemia (35%). Seven percent of cats (3/41) were also positive for feline immunodeficiency virus. The most common diagnoses were neoplasia (76%) and bone marrow disorders (12%). Cats with neoplasia were significantly younger. Survival to discharge was 88%.Conclusion and relevanceResults of this study show that feline leukemia virus is uncommon in secondary referral center, even if this represents a population of unhealthy cats. The most common associated diagnosis was neoplasia, which was more likely to be seen in younger cats (< 4 years of age). The mean age of cats positive for feline leukemia virus was also older than previously published data. These findings support the current guidelines which indicate that cats presented with clinical illness should be tested for FeLV at the time of presentation.

Comparison of an automated smartphone-based smoking cessation intervention versus standard quitline-delivered treatment among underserved smokers: protocol for a randomized controlled trial

BackgroundSmoking is the leading cause of preventable morbidity and mortality in the United States. Individuals with low socioeconomic status have disproportionately high smoking rates and greater difficulty quitting smoking. Efficiently connecting underserved smokers to effective tobacco cessation programs is crucial for disease prevention and the elimination of health disparities. Smartphone-based interventions have the potential to enhance the reach and efficacy of smoking cessation treatments targeting underserved smokers, but there is little efficacy data for these interventions. In this study, we will partner with a large, local hunger-relief organization to evaluate the efficacy and economic impact of a theoretically-based, fully-automated, and interactive smartphone-based smoking cessation intervention.MethodsThis study will consist of a 2-group randomized controlled trial. Participants (N = 500) will be recruited from a network of food distribution centers in West Central Florida and randomized to receive either Standard Treatment (ST, n = 250) or Automated Treatment (AT, n = 250). ST participants will be connected to the Florida Quitline for telephone-based treatment and will receive a 10-week supply of nicotine replacement therapy (NRT; transdermal patches and lozenges). AT participants will receive 10 weeks of NRT and a fully-automated smartphone-based intervention consisting of interactive messaging, images, and audiovisual clips. The AT intervention period will span 26 weeks, with 12 weeks of proactive content and 26 weeks of on-demand access. ST and AT participants will complete weekly 4-item assessments for 26 weeks and 3-, 6-, and 12-month follow-up assessments. Our primary aim is to evaluate the efficacy of AT in facilitating smoking abstinence. As secondary aims, we will explore potential mediators and conduct economic evaluations to assess the cost and/or cost-effectiveness of ST vs. AT.DiscussionThe overall goal of this project is to determine if AT is better at facilitating long-term smoking abstinence than ST, the more resource-intensive approach. If efficacy is established, the AT approach will be relatively easy to disseminate and for community-based organizations to scale and implement, thus helping to reduce tobacco-related health disparities.Trial registrationClinical Trials Registry NCT05004662. Registered August 13, 2021.