Early Retention Research Articles

Trial of an mHealth intervention to improve HIV prophylaxis for female sex workers, United Republic of Tanzania.

To evaluate the effect of a mobile health (mHealth) intervention on early retention of female sex workers in human immunodeficiency virus (HIV) pre-exposure prophylaxis services in the United Republic of Tanzania. The study involved 783 female sex workers: 470 from Dar es Salaam who were given the Jichunge mHealth application (app) in addition to standard HIV pre-exposure prophylaxis (intervention arm), and 313 from Tanga who received pre-exposure prophylaxis alone (control arm). Participants were recruited using respondent-driven sampling and followed up for 12months. Early retention was defined as attending a pre-exposure prophylaxis follow-up clinic within 28days of an appointment scheduled for 1month after starting treatment. To assess if the Jichunge app led to higher retention, we conducted intention-to-treat and per-protocol analyses using a regression model adjusted by inverse probability weighting. Early retention in HIV pre-exposure prophylaxis care was observed in 27.6% (130/470) of participants in the intervention arm and 20.1% (63/313) in the control arm. In the adjusted, intention-to-treat analysis, early retention was observed in 29.4% in the intervention arm and 17.7% in the control arm (risk difference: 11.8 percentage points; 95% confidence interval: 5.3-18.3). Early retention in HIV pre-exposure prophylaxis care was significantly greater among female sex workers in the United Republic of Tanzania who used the Jichunge app than in those who did not. Nevertheless, more than two thirds of sex workers using the application did not attend follow-up services after 1month, suggesting that additional interventions are needed.

Early years pharmacist retention – a listening exercise

Abstract Introduction Pressures on pharmacy workforces are increasing, with 88% of hospital pharmacists reporting high risk of burnout and 62% considering leaving their role due to the impact of work on wellbeing.1 Early years pharmacist (EYP) recruitment is increasingly challenging. Traditional pharmacist career pathways are in competition with increasingly preferred portfolio-based careers. Many trusts are introducing band 6 to 7 progressive schemes to improve retention, including at University Hospital Southampton (UHS). However, anecdotal departmental feedback suggests that EYPs feel this scheme is being applied unequally across different sections and there is discontent with differing workload and development opportunities. Aim To develop an understanding of concerns and expectations of Early Years Pharmacists at UHS. Methods All pharmacists in Agenda for Change band 7, and 6 to 7 progression posts, were invited to participate in an in-person forum. Attendance was voluntary but supported by the senior pharmacy management team. The group facilitator, a senior pharmacist known to participants, introduced the session topics, explained the rationale, then asked participants to provide written comments anonymously on a range of topics. Comments were gathered at the end of the session and thematically analysed with review from an experienced qualitative researcher. Whilst deemed a service evaluation, not requiring ethics approval, data was recorded and managed in accordance with best ethical practices. Results Twenty-Eight EYP attendees provided 102 separate comments. Themes identified related to departmental progressive post variations in; on-call expectations, mentoring, opportunities for formal credentialling, and feedback from line managers. The variations were perceived to be unjust. Commonly, points raised related to professional development. Issues included protected study time both for those undertaking post-graduate courses and those not, workload demands meaning that time for development was limited, and inequalities of access. Discussion/Conclusion As anticipated, there was discontent within the group particularly regarding perceived variations in workload, role opportunities and progression across the department. Additionally, there was some antipathy regarding whether things could be improved. However, the forum feedback suggested the opportunity to participate was well received, having provided participants an opportunity to raise their concerns in a confidential, collaborative, manner. Following initial headline feedback of EYP feeling unappreciated, all senior leaders were reminded of the importance of positive feedback and anecdotally the Trust systems for this have been used more frequently since this reminder. There are limitations with this evaluation, the group was too large to truly be considered a focus group and as such the facilitator was unable to interact with all members and probe for further information which may have been helpful. Furthermore, the facilitator was line manager for a small number of the participants, and they may have felt less able to make negative comments despite the anonymous comment collection. Several of the points raised have led to further questions and we now intend to conduct a formal qualitive study using semi-structured interviews with volunteers across the department to obtain more detailed insight into the challenges of this staff group. Meanwhile work will continue to make the EYP process and experience more equitable. Reference 1. Royal Pharmaceutical Society (2023). ‘Workforce and Wellbeing Survey 2023’. Available online. [Accessed 7th May 2024].

Complication rate across the minimally invasive surgical treatments (MISTs): where do we stand? A systematic review of the literature.

Over the past decade, the range of surgical options to benign prostatic obstruction (BPO) has expanded significantly with the advent of minimally invasive surgical therapies (MISTs). Nevertheless, the available evidence in the field is heterogeneous. Efficacy and safety thresholds are yet to be determined. To evaluate perioperative and long-term complications after MISTs - including Aquablation, steam injection (Rezūm), Transperineal laser ablation of the prostate (TPLA), implantation of a prostatic urethral lift (PUL) and temporary implantable nitinol device (iTIND) - in patients with lower urinary tract symptoms due to BPO. A systematic literature search was conducted in January 2024 using Medline (via PubMed), Embase (via Ovid), Scopus, and Web of Science. The search strategy used PICO criteria (Patients, Interventions, Comparisons, Outcomes) [1], focusing specifically on patients with BPH-associated LUTS who underwent MIST or other comparative treatments, aiming to assess both perioperative and long-term safety outcomes. Article selection was conducted in accordance with the PRISMA guidelines. The risk of bias and the quality of the articles included were assessed. A dedicated data extraction form was used to collect the data of interest. The initial electronic search identified 3660 records, of which 24 ultimately met the inclusion criteria and were included in the analysis. Overall, Aquablation was associated with a higher major complications rate of 14% (IQR 6-22), particularly in the case of patients with prostates <70 ml. PUL showed a higher early postoperative acute urinary retention rate (10.9%, IQR 9.2-12.3%), while 1.4% of patients treated with iTIND experienced major perioperative complications. Urinary tract infections were mostly reported in series assessing TPLA and Rezūm. The adoption of MISTs for LUTS due to BPH is associated with a varied spectrum of perioperative and long-term complications. Our findings showed an acceptable safety profile with specific complications dependent on the type of MIST performed, highlighting the importance of individualized patient selection and procedure-specific considerations.

Transitioning to rural practice together: a rural fellowship model (in 6 Ps).

Maintaining a robust healthcare workforce in underserved rural communities continues to be a challenge. To better meet healthcare needs in rural areas, training programs must develop innovative ways to foster transition to, and integration into, these communities. Mountain Area Health Education Center designed and implemented a 12-month post-residency Rural Fellowship program to enhance placement, transition, and retention in rural North Carolina. Utilizing a '6 Ps' framework, the program targeted physicians and pharmacists completing residency with the purpose of recruiting and supporting their transition into the first year of rural practice. To better understand Rural Fellows' experiences and the immediate impact of their Fellowship year, we conducted a semi-structured interview using a narrative technique and evaluated retention rates over time. Interviews with the eight participants, which included Fellowship alumni and current Fellows, demonstrated the impact and influence of the key curricular '6 Ps' framework. An early retention rate of 100% and a long-term retention rate of 87%, combined with expressed clarity of curricular knowledge, skills, and attitudes related to the '6 Ps', demonstrate the potential and effectiveness of this Rural Fellowship model. Participants indicated the Rural Fellowship experience supports the transition to rural practice communities and expands their clinical skills. The Rural Fellowship program demonstrates an effective model to support early career healthcare providers as they begin practice in rural communities in western North Carolina through academic opportunities, personal growth, and professional development. Implementation of this model has demonstrated the success of a rural retention model over a 6-year period. This model has the potential to target an array of clinical providers and disciplines. We started with family medicine and have expanded to psychiatry, obstetrics, pharmacy, and nursing. This study demonstrated that this model supports clinical providers during the critical transition period from residency to practice. Targeting the most important stage of one's medical training, the commencement of professional practice, this is a scalable model for other rural-based health professions education sites where rural recruitment and retention remain a problem.

391 The impact of trace mineral source on systemic immunological status associated with early embryonic loss in lactating dairy cattle

Abstract Milk production has doubled from 1970 to 2009 but has been associated with a decline in fertility. Around 25% of failed pregnancies in dairy cattle are due to embryonic loss. Mineral bioavailability may affect embryonic retention, so we hypothesized that Zn, Cu, and Mn sources will influence systemic immunological status, which affects early embryonic retention. Holstein cows (n = 58) were randomly assigned to one of two daily oral drench trace mineral (Zn, Cu, and Mn) treatments 30 d before breeding (d -30): 1) Inorganic (ITM) or 2) Metal Methionine Hydroxy Analog Chelate (MMHAC). Before treatments began, cows were assigned to a semen type, beef vs. Holstein, equally, across treatments. All cows underwent a double Ovsynch protocol and were artificially inseminated on d 0. Humoral immunological status was assessed in serum samples taken on d 0 and d 7. Immune activity was quantified via a D2Dx systemic immunity score, which assesses samples for the presence of IgG, IgM, cytokines, and complement proteins. Ultrasonography was utilized for pregnancy confirmation on d 35, classifying cows as pregnant (P) or open. Progesterone analysis from d 21 plasma was used to categorize open cows as either non-pregnant (NP) or early embryonic loss (EEL). Statistical analyses in R Studio were completed, in two models based on pregnancy (P vs EEL and NP vs EEL), to determine the effects of mineral treatment, pregnancy status, semen type, and all interactions on humoral immune status. In the P vs EEL model, there were no effects (P &amp;gt; 0.30) of semen type, mineral treatment, pregnancy status, or any interactions on systemic immunity score on the day of breeding (d 0) or d 7. On d 0, cows provided MMHAC had a systemic immunity score of 0.073 ± 0.008 but were not different (P &amp;gt; 0.34) from ITM cows (0.063 ± 0.006). This trend continued on d 7 with systemic immunity scores of MMHAC cows not differing (P &amp;gt; 0.32) from ITM cows (0.055 ± 0.004 and 0.061 ± 0.003; respectively). There was a tendency (P = 0.10) for the three-way interaction of semen type x pregnancy x treatment to influence the immunity score change from d 0 to d 7. Pregnant cows on ITM treatment bred with beef semen had a positive change in immunity score (0.020 ± 0.0085). Whereas ITM cows bred with Holstein semen that underwent EEL had a negative change (-0.015 ± 0.0085); all other means were intermediate. In the NP vs EEL model, there were no effects (P &amp;gt; 0.14) of semen type, treatment, pregnancy status, or any interactions on systemic immunity score on d 0, d 7, or the change between d 0 and d 7. In summary, trace mineral bioavailability tended to affect systemic immunological status in P vs EEL cows but not in NP vs EEL cows, which may allow for the elucidation of immunological status differences during pregnancy establishment.

The Influence of African Heritage on Afro-American Literary Expression

This research paper explores the profound influence of African heritage on Afro-American literary expression. It begins by examining the historical context, emphasizing the impact of the transatlantic slave trade and early Afro-American literature's retention of African cultural elements. The Harlem Renaissance is highlighted as a pivotal moment that celebrated African roots and set the stage for future literary developments. Central themes derived from African heritage, such as resistance, resilience, and connection to ancestry, are analyzed, illustrating their prominence in both historical and contemporary works. The paper deal with storytelling techniques and narrative structures influenced by African oral traditions, folktales, and myths, highlighting how these elements enrich Afro-American literature. The use of rhythmic language, communal narration, and the call- and-response pattern are discussed as significant aspects that enhance narrative depth and cultural authenticity. The integration of African symbols, music, and communal values as cultural motifs is explored, showcasing how these elements infuse literary works with layers of meaning and cultural resonance. The reclamation of African identity is a key focus, with discussions on Afrocentric perspectives in modern literature, the impact of the Black Arts Movement, and contemporary literary movements. The challenges and opportunities of navigating dual heritage and cultural hybridity are addressed, emphasizing the complexities of identity formation and cultural expression.

Divergent roles of early visual cortex and inferior frontal junction in visual working memory

BackgroundRecent studies indicate that both prefrontal and visual regions play critical roles in visual working memory (VWM), with prefrontal regions mainly associated with executive functions, and visual cortices linked to representations of memory contents. VWM involves the selective filtering of irrelevant information, yet the specific contributions of the prefrontal regions and visual cortex in this process remain unclear. ObjectiveTo understand the dynamic causal roles of prefrontal and visual regions in VWM. MethodsThe differentiation of VWM components was achieved using a computational model that incorporated a swap rate for non-target stimuli. Single-pulse magnetic transcranial stimulation (spTMS) was delivered to the early visual cortex (EVC) and the inferior frontal junction (IFJ) across different phases of an orientation recall task that with or without distractors. ResultsOur results indicate that spTMS over the EVC and IFJ influences VWM particularly when distractors are present. VWM precision can be impacted by spTMS applied to either region during the early retention, while spTMS effect is especially prominent when EVC is stimulated during the late retention phase and when directed at the ipsilateral EVC. Conversely, the probability of accurately recalling the target exhibited comparable patterns when spTMS was administered to either the EVC or IFJ. ConclusionsWe highlight the “sensory recruitment” of VWM characterized by critical involvement of EVC particularly in the information-filtering process within VWM. The maintenance of memory content representations necessitates ongoing communication between the EVC and IFJ throughout the entirety of the VWM process in a dynamic pattern.

Changes in therapists’ client dropout rates over time: Findings from a practice‐research group

AbstractResearch has failed to consistently show that therapists facilitate better client outcomes as they gain more experience. The present study was designed to examine changes in early client retention over the course of extended periods of time among 2591 therapists in private practice. Naturalistic data collected between 2018 and 2022 was extracted from a technology‐enabled practice‐research group (PRG). Therapists displayed an increase in client dropout rates as they gained more experience on the PRG. Additionally, larger caseloads on the PRG were associated with lower increases in client dropout over time. Finally, therapists working with clients paying higher out‐of‐pocket fees (e.g., co‐pays) had higher increases in client dropout over time. These findings provide additional evidence supporting the distinction between clinical experience and expertise.

The Johns Hopkins Physician-Scientist Training Program to Enhance Institutional Retention and Entry Into Academic Positions: An Evaluation of Program Effectiveness and Outcomes.

The Johns Hopkins Physician-Scientist Training Program (PSTP) was implemented to overcome well-documented challenges in training and retaining physician-scientists by providing physician-scientist pathway training for residents and clinical fellows. The program's core tenets include monthly seminars, individualized feedback on project proposals, access to mentors, and institutional funding opportunities. This study evaluated the effectiveness and outcomes of the PTSP and provides a framework for replication. A query of institutional demographic data and bibliometric variables of the PSTP participants (2017-2020) at a single academic medical center was conducted in 2021. In addition, a voluntary survey collected personal and program evaluation information. Of 145 PSTP scholars, 59 (41%) were women, and 41 (31%), 8 (6%), and 6 (5%) of scholars self-identified as Asian, Hispanic, and Black, respectively. Thirty-three (23%) scholars received PSTP research support or career development microgrants. Of 66 PSTP graduates, 29 (44%) remained at Johns Hopkins as clinical fellows or faculty. Of 48 PSTP graduates in a post-training position, 42 (88%) were in academia, with the majority, 29 (76%), holding the rank of assistant professor. Fifty-nine of 140 available participants responded to the survey (42% response rate). The top-cited reason for joining the PSTP was exposure to mentors and administration (50/58 respondents, 86%), followed by seeking scholarly opportunities (37/58 respondents, 64%). Most scholars intended to continue a career as a physician-scientist. The PSTP provides internal research support and institutional oversight. Although establishing close mentor-mentee relationships requires individualized approaches, the PSTP provided structured academic pathways that enhanced participating scholars' ability to apply for grants and jobs. The vast majority continued their careers as physician-scientists after training. In light of the national evidence of a "leaky physician-scientist pipeline," programs such as the PSTP can be critical to entry into early academic career positions and institutional retention.

Linkage to HIV care and early retention in HIV care among men in the ‘universal test-and-treat’ era in a high HIV-burdened district, KwaZulu-Natal, South Africa

IntroductionDespite the numerous efforts and initiatives, males with HIV are still less likely than women to receive HIV treatment. Across Sub-Saharan Africa, men are tested, linked, and retained in HIV care at lower rates than women, and South Africa is no exception. This is despite the introduction of the universal test-and-treat (UTT) prevention strategy anticipated to improve the uptake of HIV services. The aim of this study was to investigate linkage to and retention in care rates of an HIV-positive cohort of men in a high HIV prevalence rural district in KwaZulu-Natal province, South Africa.MethodsFrom January 2018 to July 2019, we conducted an observational cohort study in 18 primary health care institutions in the uThukela district. Patient-level survey and clinical data were collected at baseline, 4-months and 12-months, using isiZulu and English REDCap-based questionnaires. We verified data through TIER.Net, Rapid mortality survey (RMS), and the National Health Laboratory Service (NHLS) databases. Data were analyzed using STATA version 15.1, with confidence intervals and p-value of ≤0.05 considered statistically significant.ResultsThe study sample consisted of 343 male participants diagnosed with HIV and who reside in uThukela District. The median age was 33 years (interquartile range (IQR): 29–40), and more than half (56%; n = 193) were aged 18–34 years. Almost all participants (99.7%; n = 342) were Black African, with 84.5% (n = 290) being in a romantic relationship. The majority of participants (85%; n = 292) were linked to care within three months of follow-up. Short-term retention in care (≤ 12 months) was 46% (n = 132) among men who were linked to care within three months.ConclusionWhile the implementation of the UTT strategy has had positive influence on improving linkage to care, men’s access of HIV treatment remains inconsistent and may require additional innovative strategies.

A retrospective cohort analysis of people living with HIV/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar.

The impact of the "Treat all" policy on the individual and in terms of public health is closely related to early diagnosis and retention in care. Patient-level data are scarce in Madagascar. In this study, we aimed to describe the profile of a cohort of newly diagnosed people living with HIV/AIDS (PLHIV), identify their outcomes, and assess factors associated with attrition from care and advanced HIV disease (AHD) at presentation. We conducted a retrospective cohort study of PLHIV aged ≥15 years newly diagnosed at the University Hospital Joseph Raseta Befelatanana Antananarivo from 1 January 2010 to 31 December 2016. A total of 490 PLHIV were included in the cohort analysis. In total, 67.1% were male. The median age (interquartile range) at enrollment in care was 29 years (24-38). Overall, 36.1% of PLHIV were diagnosed with AHD at baseline. The proportion of patients with WHO stage IV at baseline increased significantly from 3.3% in 2010 to 31% in 2016 (p = 0.001 for trend). The probability of retention in care after the diagnosis at 12 months, 24 months, and 36 months was 71.8%, 65.5%, and 61.3%, respectively. Age ≥ 40 years (aHR: 1.55; 95% CI: 1.05-2.29; p = 0.026), low level of education (aHR:1.62; 95% CI: 1.11-2.36; p = 0,013), unspecified level of education (aHR:2.18; 95% CI: 1.37-3.47; p = 0.001) and unemployment (aHR:1.52; 95% CI: 1.07-2.16; p = 0.019) were independently associated with attrition from care. Factors associated with AHD at baseline were age ≥ 40 (aOR: 2.77; 95% CI: 1.38-5.57, p = 0.004), unspecified level of education (aOR: 3.80; 95% CI: 1.58-9.16, p = 0.003) and presence of clinical symptoms at baseline (aOR: 23.81; 95% CI: 10.7-52.98; p < 0.001). Sex workers were independently less likely to have an AHD at presentation (aOR: 0.23; 95% CI: 0.05-0.96, p = 0.044). Sociodemographic determinants influenced retention in care more than clinical factors. The presence of clinical symptoms and sociodemographic determinants were the main factors associated with AHD at baseline.

Effect of different feeding strategies and dietary fiber levels on energy and protein retention in gestating sows.

The aim of the study was to investigate whether increased inclusion of sugar beet pulp (SBP) alters retention of fat, protein, and energy when backfat (BF) is restored in early- and mid-gestation. In total, 46 sows were fed one of four dietary treatments with increasing inclusion of SBP providing dietary fiber (DF) levels of 119, 152, 185, and 217g/kg; sows were assigned to one of three feeding strategies (FS; high, medium, and low) depending on BF thickness at mating and again at day 30 for the following month. On days 0, 30, 60, and 108, body weight (BW) and BF thickness were measured and body pools of protein and fat were estimated using the deuterium oxidetechnique. On days 30 and 60, urine, feces, and blood samples were collected to quantify metabolites, energy, and nitrogen (N) balances. On days 15 and 45, heart rate was recorded to estimate heat energy. At farrowing, total born and weight of the litter were recorded. In early gestation, BW gain (P < 0.01) and body protein retention increased (P < 0.05) with increasing fiber inclusion, while body fat retention increased numerically by 59%. The increase in BF was greatest for sows fed the high FS, intermediate when fed the medium strategy, and negligible for sows fed the lowest FS (P < 0.001). Nitrogen intake, N loss in feces, and N balance increased linearly, whereas N loss in urine tended to decrease with increasing inclusion of fibers in early gestation. Concomitantly, fecal energy output and energy lost as methane increased linearly (P < 0.001), while energy output in urine declined linearly. Total metabolizable energy (ME) intake therefore increased from 36.5 MJ ME/d in the low fiber group to 38.5 MJ ME/d in the high fiber group (P < 0.01). Changing the ME towards more ketogenic energy was expected to favor fat retention rather than protein retention. However, due to increased intake of ME and increased N efficiency with increasing fiber inclusion, the sows gained more weight and protein with increasing fiber inclusion. In conclusion, increased feed intake improved both fat and protein retention, whereas increased DF intake increased protein retention.

Parents’ adverse childhood experiences matter too: The impact of multigenerational trauma on participation in early childhood education for Latinx children

Childhood trauma impacts most children in the United States, with exposure to adverse childhood experiences (ACEs) like abuse, neglect, or witnessing violence linked to negative outcomes across the lifespan. Early childhood education (ECE) programs, such as therapeutic preschools, that utilize two-generation approaches to services have demonstrated proven benefits for children with trauma exposure; however, less is known about the impact of ACEs on early childhood program engagement and retention. The current study, set in a two-generation therapeutic preschool program, examined 173 pairs of primarily Latinx parents and children to understand in what ways parent and child ACEs, coupled with family contextual risks like homelessness and child welfare involvement, impact program engagement for children with trauma histories. Results indicate that children whose parents had an elevated ACE score (four or more trauma experiences) were more likely to terminate ECE participation early compared to children whose parents had less cumulative trauma. Families with parents and children who both had high ACEs were over six times more likely to terminate program participation early. However, once accounting for early termination, ACEs had minimal impact on ECE engagement. These findings highlight the need for ECE programs to consider the whole family at entry and target early retention efforts towards families with greater cumulative trauma histories.

Mesenchymal cells support the early retention of primary alveolar type 2 cells on acellular mouse lung scaffolds

ObjectivesTissue engineering approaches via repopulation of acellular biological grafts provide an exciting opportunity to generate lung grafts for transplantation. Alveolar type 2 (AT2) cells are a promising cell source for re-epithelialization. There are however inherent limitations with respect to their survival and growth, thus impeding their usability for tissue engineering applications. This study investigates the use of mesenchymal stromal cells to support primary AT2 cells for recellularization of mouse lung scaffolds. MethodsAT2 cells and bone marrow-derived mesenchymal cells (BMC) were co-delivered to decellularized mouse lung scaffolds. Recellularized lungs were evaluated for cell surface coverage, viability, and differentiation at 1 and 4 days after cell seeding. Recellularization was evaluated via histological analysis and immunofluorescence. ResultsSimultaneous delivery of AT2 and BMC into acellular lung scaffolds resulted in enhanced cell surface coverage and reduced AT2 cell apoptosis in the recellularized scaffolds at Day 1 but not Day 4. AT2 cell number decreased after 4 days in both of AT2 only and codelivery groups suggesting limited expansion potential in the scaffold. After retention in the scaffold, AT2 cells differentiated into Aqp5-expressing cells. ConclusionsOur results indicate that BMC support AT2 cell survival during the initial attachment and engraftment phase of recellularization. While our findings suggest only a short-term beneficial effect of BMC, our study demonstrates that AT2 cells can be delivered and retained in acellular lung scaffolds; thus with preconditioning and supporting cells, may be used for re-epithelialization. Selection and characterization of appropriate cell sources for use in recellularization, will be critical for ultimate clinical application.

Boll distribution in the cotton canopy is affected by nitrogen management and cover crops in a sandy soil under water scarcity

Context or problemA favorable cotton boll distribution within the plant canopy can promote early fruit retention and increase crop yield and fiber quality, particularly in rainfed crops in sandy soils that are subject to periodic water deficits. However, the effects of different cover crop rotation systems combined with different nitrogen (N) rates and sources on boll distribution and cotton earliness are unknown. Objective or research questionThe objective of this study was to evaluate the boll distribution and earliness of cotton as a function of the cover crop rotation system and N sources and rates, in a sandy soil of a tropical region of Brazil prone to drought. MethodsA field study was carried out for two growing seasons (2018–2020) in southeastern Brazil in an area with sandy soil. The treatments consisted of the following crop rotation systems, which were implemented in 2016: Fallow; single grass; grass + grass; grass + legume; and MIX (grass+legume+grass). In addition, N rates of 70, 100, and 130 kg ha−1 (applied as topdressing) and two N sources (urea; and controlled-release urea, CRU) were evaluated. ResultsLow water availability in the 2018/2019 crop season resulted in early plants that reached 95% boll yield below fruiting node 12 when 70 kg ha−1 N (urea) was applied. Satisfactory rainfall in the 2019/2020 crop season resulted in 95% boll yield below fruiting node 14 when 130 kg ha−1 N was applied for all N sources and rotation systems. Applying CRU increased the boll distribution in the top third of the plant. Applying 130 kg ha−1 N increased the boll distribution in the middle and top thirds of the plant, particularly in the treatments with legume cover crops and CRU. In the crop season with higher rainfall and yield potential, the rotation systems without legumes that received 70 kg ha−1 N (urea) had a lower boll distribution in the top third of the plant. ConclusionsCotton boll distribution is affected by cover crop rotation systems, N rates and sources and water availabity throughout the season. The best strategy for improving early boll setting is to apply lower rates of N as CRU in a rotation system with a mixture of grasses and legumes as cover crops. Additionally, there is still a challenge to increase the cotton earliness in years with high water availability. Implications or significanceCover crops and increased efficiency fertilizers are important to improve boll setting throughout the entire cotton canopy. Because these technologies improve the availability of nitrogen and water in the soil, especially in dry years. Improving cotton earliness is still a challenge in low-altitude regions, since plant cycle is naturally short in these environments, due to the greater accumulation of degrees days. Even so, the use of lower N rates associated with cover crops and controlled-release urea may have a small increase in cotton earliness, but mainly help in early fruit retention.

Neuropathological characterization of PiB binding in postmortem striatum in Down syndrome

AbstractBackgroundAmyloid‐beta plaques form in the brain throughout life in people with Down syndrome (DS) and are one of the hallmarks of Alzheimer disease (AD) neuropathology. The regional progression of amyloid buildup in DS is similar to that of late onset AD (LOAD) in the neurotypical population. The development of positron emission tomography (PET) ligands like Pittsburgh Compound B (PiB) has allowed researchers and clinicians to visualize and track amyloid accumulation in the brain throughout life. Using this technology, a unique pattern emerges in people with DS, where the earliest and strongest PiB PET retention is in the striatum, unlike LOAD but similar to autosomal dominant AD. Frontal cortex PiB PET retention is similar in all groups. We used a fluorescent derivative of PiB, cyano‐PiB (CN‐PiB), to investigate PiB labeling postmortem in DS striatum. We hypothesized that striatal CN‐PiB load increases with age and is greater than in the frontal cortex, similar to observations from PiB PET studies of adults with DS.MethodWe conducted CN‐PiB labeling in postmortem striatum and frontal cortex from 44 cases with DS ages ranging from 42 to 70 years (25F/19M, mean PMI 7.4 hours). Whole slide imaging and automated image analysis were used to derive individual plaque‐level information regarding load, size, and distribution of CN‐PiB+ plaques in DS with age.ResultCN‐PiB labeled plaques in both the striatum and frontal cortex were also positive for amyloid‐beta antibodies targeting epitopes 1‐16, 17‐24, and x‐42. Preliminary data suggest that striatal CN‐PiB load (median = 2.3%) is not higher compared to the frontal cortex in DS (median = 10%). Striatal CN‐PiB load did not change with age from 42 to 70 years, suggesting an early saturation (IQR = 3.5%).ConclusionCN‐PiB labeled amyloid‐beta plaque load in the striatum in DS is comparable to conventional neuropathologic analysis and does not differ from frontal cortical load. Other aspects of PiB‐binding or pathologies may contribute to the early and prominent striatal PiB PET retention reported in DS. It will be important in future studies to include younger cases with DS.

Myeloid Derived Suppressor Cell Kinetics in Peripheral Blood Correlate with Efficacy and Toxicity of CAR T Cell Therapy in Relapsed or Refractory B Cell Lymphoma

Introduction. CAR T-cell therapy is potentially curative for patients with relapsed or refractory B-cell lymphoma (BCL). However, about 60% of patients fail CAR T-cell therapy. Immune-related adverse events (irAE) like cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS) occur in an inflammatory state. Myeloid-derived suppressor cells (MDSCs) expand during acute inflammation as steady-state hematopoiesis switches to emergency myelopoiesis. We hypothesized that the acute inflammatory conditions created by CAR T-cell therapy may alter MDSC kinetics and investigated MDSC expansion in the context of CAR T-cell efficacy and toxicity in BCL. Methods. Patients with BCL receiving standard-of-care CAR T-cell therapy were enrolled in a prospective sample collection study. Blood samples were collected before lymphodepletion (baseline), prior to and at early intervals after CAR T-cell infusion. Viable white blood cell (WBC) and MDSC counts were evaluated by multicolor flow cytometry. Phenotypically, MDSCs were defined as immature myeloid cells (CD11b + CD33 + HLA-DR -/low IL-4R +) and divided into monocytic (M-MDSC, CD14 +) and polymorphonuclear (PMN-MDSC, CD15 +) subsets. Clinical response was assessed by Lugano criteria at 1, 3 and 6 months. Incidence and severity of CRS and ICANS were recorded. Cell counts were analyzed by descriptive statistics and reported as mean ± standard error or fold-change from baseline. Kinetics of MDSCs in blood and correlation with clinical outcomes were evaluated by Wilcoxon matched pair signed rank t-test and Mann Whitney U-test. Results. Forty-three BCL patients (41 large BCL, 2 mantle cell lymphoma) were enrolled in the study. Median age was 64 (range 27-83), 32.6% were female. Racial and ethnic minority groups represented 14% of enrolled subjects. One patient developed grade 5 ICANS and was not evaluable for response. Thirty-seven (86%) developed leukopenia and all received granulocyte colony stimulating factor (G-CSF) starting on day 5 post-CAR T infusion. WBC count fell sharply from baseline following lymphodepletion (7.7E +05±8.6E +04 baseline vs 2.9E +05±9.2E +04/mL, p&amp;lt;0.0001) and continued to decline 2-3 days post-CAR T infusion (baseline vs 1.4E +05±2.1E +04/mL, p&amp;lt;0.0001) before returning to baseline within 1 week post-CAR T (i.e. within 3 days of G-CSF). MDSCs followed similar kinetics early on but significantly increased from baseline levels by 1-week post-CAR T (3.4E +03±5.8E +02 baseline vs 8.5E +03±1.7E +02 /mL, p&amp;lt;0.0001). This effect was mainly driven by an exuberant expansion of M-MDSC observed in 33/43 patients (median 6.1-fold increase from baseline at 1 week, range 0.5-4301). Seven patients (16.3%) had progressive disease (PD) at 1 month, 6 (13.9%) additional patients progressed at 3 months and 4 (9.3%) more progressed at 6 months after CAR T-cell infusion. M-MDSC expansion 1-week post-CAR T was only observed in 3/7 refractory patients compared with 28/35 responding patients (Fisher's exact test, p=0.0635). Patients who progressed at 3 months had poorer M-MDSC retention compared to patients with sustained response (1.7E +02±6.1E +01 PD vs 1.4E +03±2.4E +01/mL at 2-week post-infusion, p&amp;lt;0.1). Similarly, patients who progressed at 6 months had lower M-MDSC compared with sustained responders (2.0E +02±8.1E +01 PD vs 4.5E +02±1.4E +02 ml at 1-month post-infusion, p&amp;lt;0.05). Thirteen patients (30.2%) developed &amp;gt; grade 2 CRS and had lower PMN-MDSC retention rate 2-3 days post-CAR-T compared with those with no/low-grade CRS (4.4E +02±2.6E +02 vs 1.4E +03±3.9E +02/mL, p&amp;lt;0.05). Similarly, patients who had ICANS &amp;gt; grade 2 (n=14, 32.5%) had lower PMN-MDSC early retention compared to those with no or low-grade ICANS (5.0E +02±2.5E +02 vs 1.5E +03±4.1E +02/mL, p&amp;lt;0.05). Further analyses are currently underway to bridge these findings with the kinetics of CAR T-cells and T-cell repertoire post-CAR T. Conclusions. The proinflammatory milieu after CAR-T and the use of G-CSF can lead to significant expansion of M-MDSCs. Rather than an impediment to CAR T therapy, M-MDSC expansion and retention are associated with favorable clinical response and PMN-MDSC with a lower risk of developing high grades CRS or ICANS. Whether MDSCs play a mechanistic role remains to be elucidated, but they may have a role as a biomarker in predicting outcomes after CAR T-cell therapy in BCL.

APLICAÇÃO DO MAPEAMENTO DO FLUXO DE VALOR EM UM PROCESSO DE AUTOCONTROLE DA INJEÇÃO PLÁSTICA

Product quality and customer satisfaction are directly related. For the business to function properly, the customer must be satisfied. There are currently several methods for controlling product quality, one of which is self-control. This research applied Value Stream Mapping to analyze self-control in the plastic injection process in the chosen company, seeking to prove the efficiency of the decision to apply selfcontrol compared to the period without using it in the process. A qualitative research was carried out based on a case study in a consumer goods company with medium size, having in part of its production, the plastic injection process. To reach the final objective, the data prior to the implementation of selfcontrol in the plastic injection process, the quality, productivity and scrap indicators referring to six months of production were evaluated in order to have a solid base of information, and consequently using the mapping of value stream for before and after analysis. With this research, it was demonstrated that the implemented self-control method was a correct decision by the engineering sector, implying the improvement of the process and early retention of problems with non-conforming parts that could generate a bad experience for the customer.

1637P Early retention of KRAS mutations in cfDNA is an ominous sign for pancreatic cancer patients during chemotherapy: A prospective cohort study

1637P Early retention of KRAS mutations in cfDNA is an ominous sign for pancreatic cancer patients during chemotherapy: A prospective cohort study

Experiences of stigma and HIV care engagement in the context of Treat All in Rwanda: a qualitative study

Background‘Treat All’ policies recommending immediate antiretroviral therapy (ART) soon after HIV diagnosis for all people living with HIV (PLHIV) are now ubiquitous in sub-Saharan Africa. While early ART initiation and retention is effective at curtailing disease progression and transmission, evidence suggests that stigma may act as a barrier to engagement in care. This study sought to understand the relationships between HIV stigma and engagement in care for PLHIV in Rwanda in the context of Treat All.MethodsBetween September 2018 and March 2019, we conducted semi-structured, qualitative interviews with adult PLHIV receiving care at two health centers in Kigali, Rwanda. We used a grounded theory approach to data analysis to develop conceptual framework describing how stigma influences HIV care engagement in the context of early Treat All policy implementation in Rwanda.ResultsAmong 37 participants, 27 (73%) were women and the median age was 31 years. Participants described how care engagement under Treat All, including taking medications and attending appointments, increased their visibility as PLHIV. This served to normalize HIV and use of ART but also led to high levels of anticipated stigma in the health center and community at early stages of treatment. Enacted stigma from family and community members and resultant internalized stigma acted as additional barriers to care engagement. Nonetheless, participants described how psychosocial support from care providers and family members helped them cope with stigma and promoted continued engagement in care.ConclusionsTreat All policy in Rwanda has heightened the visibility of HIV at the individual and social levels, which has influenced HIV stigma, normalization, psychosocial support and care engagement in complex ways. Leveraging the individual and community support described by PLHIV to deliver evidence-based, peer or provider-delivered stigma reduction interventions may aid in attaining Treat All goals.