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To observe and describe nurse-caregiver communication of hospital-to-home transition information at the time of discharge at a tertiary children's hospital of Western Australia. A multi-stage qualitative descriptive design involved 31 direct clinical observations of hospital-to-home transition experiences, and semi-structured interviews with 20 caregivers and 12 nurses post-discharge. Eleven caregivers were re-interviewed 2–4 weeks post-discharge. Transcripts of audio recordings and field notes were analyzed using content analysis. Medical records were examined to determine patients' usage of hospital services within 30 days of discharge. Four themes emerged from the content analysis: structure of hospital-to-home transition information; transition information delivery; readiness for discharge; and recovery experience post-hospital discharge. Examination of medical records found seven patients presented to the Emergency Department within 2–19 days post-discharge, of which three were readmitted. Primary caregivers of three readmitted patients all had limited English proficiency. The study affirmed the complexity of transitioning pediatric patients from hospital to home. Inconsistent content and delivery of information impacted caregivers' perception of readiness for discharge and the recovery experience. Nurses need to assess readiness for discharge to identify individual needs using a validated tool. Inclusion of education on hospital-to-home transition information and discharge planning/process is required in the orientation program for junior and casual staff to ensure consistency of information delivery. Interpreter services should be arranged for caregivers with limited language proficiency throughout the hospital stay especially when transition information is being provided. Nurses should apply teach-back techniques to improve caregivers' comprehension of information. • Verbally delivered transition information generally consists of 6 components. • Inconsistent contents and the approach of transition information delivery by nurses. • Caregivers had mixed views towards the transition information. • Some caregivers had concerns and perceived their child was not ready for discharge. • Eight caregivers reported delayed recovery post-discharge from unexpected health issues. [ABSTRACT FROM AUTHOR]

(1) To investigate the demographic characteristics of mild stroke survivors and their association with discharge location. (2) To assess the presence of and factors contributing to racial disparities in discharge location among mild stroke survivors. Retrospective cohort study using electronic health records with a diagnosis of acute onset ischemic stroke, hemorrhagic stroke, or transient ischemic attack from January 1, 2015 through April 30, 2023. Large academic hospital in an urban area. A convenience sample of 2,953 mild stroke survivors (NIHSS 0-4) admitted to the hospital for acute onset ischemic stroke, hemorrhagic stroke, or transient ischemic attack between January 1, 2015 and April 30, 2023 with complete data. Not applicable. Logistic regression was used to analyze the relationship between demographic variables, clinical characteristics, the Social Vulnerability Index (SVI), and discharge location. The average age of mild stroke survivors was 69.82±15.51. Most patients had no significant disability on the mRS following their stroke (38.43%). Most mild stroke survivors were discharged home after their initial acute hospitalization (72.88%). The majority of patients were White (65.46%), followed by Black (19.40%). Black patients were significantly younger (p<0.001) and demonstrated significantly more social vulnerability across all measures (p<.001) compared to White patients. Black stroke survivors and individuals with higher social vulnerability had a higher proportion of discharges to skilled nursing facilities (p=0.001). Logistic regression showed that Black patients (β=-0.23, p=0.05) and patients living areas with high vulnerability in housing type and transportation (β=-0.37, p=0.03) were less likely to be discharged home. Mild stroke survivors have a high rate of home discharge, potentially because less severe stroke symptoms have a reduced need for intensive care. Racial disparities in discharge location were evident, with Black stroke survivors experiencing higher rates of institutionalized care and lower likelihood of being discharged home compared to White counterparts. All authors declare no disclosures. [ABSTRACT FROM AUTHOR]

The objectives of this study were to identify functional limitations in patients with coronavirus 2019 (COVID-19) admitted to acute care hospitals; to evaluate functional limitations by demographic, medical, and encounter characteristics; and to examine functional limitations in relation to discharge destination. and Setting:This is a cross-sectional, retrospective study of adult patients with COVID-19 who were discharged from 2 different types of hospitals (academic medical center and a community hospital) within 1 health care system from January 1 to April 30, 2020. Patients were identified from the Cedars-Sinai COVID-19 data registry who had a new-onset positive test for severe acute respiratory syndrome coronavirus 2. A total of 273 patients were identified, which included 230 patients who were discharged alive and 43 patients who died and were excluded from the study sample. Not applicable. Functional limitations in patients with COVID-19 in acute care hospitals and the predictors for discharge disposition. A total of 230 records were analyzed including demographic, encounter, medical, and functional variables. In a propensity score–matched cohort based on age and comorbidity, 88.2% had functional physical health deficits, 72.5% had functional mental health deficits, and 17.6% experienced sensory deficits. In the matched cohort, individuals discharged to an institution experienced greater physical (62.7% vs 25.5%, P <.001) and mental health (49.0% vs 23.5%, P =.006) deficits than patients discharged home. Marital status (odds ratio, 3.17; P =.011) and physical function deficits (odds ratio, 3.63; P =.025) were associated with an increase odds ratio of discharge to an institution. This research highlights that functional status is a strong predictor for discharge destination to an institution for patients with COVID-19. Patients who were older, in the acute care hospital longer, and with comorbidities were more likely to be discharged to an institution. Rehabilitation is a significant aspect of the health care system for these vulnerable patients. The challenges of adjusting the role of rehabilitation providers and systems during the pandemic needs further exploration. Moreover, additional research is needed to look more closely at the many facets and timing of functional status needs, to shed light in use of interdisciplinary rehabilitation services, and to guide providers and health care systems in facilitating optimal recovery and patient outcomes. [ABSTRACT FROM AUTHOR]

To conduct a scoping review on classifications of mild stroke based on stroke severity assessments and/or clinical signs and symptoms reported in the literature. Electronic searches of PubMed, PsycINFO (Ovid), and Cumulative Index to Nursing and Allied Health (CINAHL–EBSCO) databases included keyword combinations of mild stroke, minor stroke, mini stroke, mild cerebrovascular, minor cerebrovascular, transient ischemic attack, or TIA. Inclusion criteria were limited to articles published between January 2003 and February 2018. Inclusion criteria included studies (1) with a definition of either mild or minor stroke, (2) written in English, and (3) with participants aged 18 years and older. Animal studies, reviews, dissertations, blogs, editorials, commentaries, case reports, newsletters, drug trials, and presentation abstracts were excluded. Five reviewers independently screened titles and abstracts for inclusion and exclusion criteria. Two reviewers independently screened each full-text article for eligibility. The 5 reviewers checked the quality of the included full-text articles for accuracy. Data were extracted by 2 reviewers and verified by a third reviewer. Sixty-two studies were included in the final review. Ten unique definitions of mild stroke using stroke severity assessments were discovered, and 10 different cutoff points were used. The National Institutes of Health Stroke Scale was the most widely used measure to classify stroke severity. Synthesis also revealed variations in classification of mild stroke across publication years, time since stroke, settings, and medical factors including imaging, medical indicators, and clinical signs and symptoms. Inconsistencies in the classification of mild stroke are evident with varying use of stroke severity assessments, measurement cutoff scores, imaging tools, and clinical or functional outcomes. Continued work is necessary to develop a consensus definition of mild stroke, which directly affects treatment receipt, referral for services, and health service delivery. [ABSTRACT FROM AUTHOR]

Cucurbit powdery mildew caused by Podosphaera xanthii is a major challenge to cucurbit production worldwide. In the United States, the fungus has become resistant to fungicides in FRAC Groups 1, 3, U6, 7, 11, and 13, however the extent of this resistance is not known in the Florida population. Commercially labeled fungicides, thiophanate-methyl (Topsin 70WDG), cyflufenamid (Torino), flutriafol (Rhyme), quinoxyfen (Quintec), and myclobutanil (Rally 40 WSP), were selected to screen for sensitivity against locally obtained isolates under laboratory, greenhouse, and field conditions. Laboratory and greenhouse assessments of disease severity and control were made after a single application of each fungicide, while field trial assessments were made after weekly applications. Quinoxyfen, myclobutanil, cyflufenamid, and flutriafol gave adequate control of powdery mildew, while thiophanate-methyl failed to control P. xanthii. No formulation was successful in preventing the establishment and sporulation of P. xanthii at the maximum or near-maximum labeled field rate under laboratory, greenhouse, and field conditions. Further research is required to monitor the Florida population for early detection of fungicide resistance, to establish new effective fungicidal concentrations, and to optimize fungicide application regimes. • Thiophanate-methyl does not control cucurbit powdery mildew (PM) in Florida. • Quinoxyfen, myclobutanil, cyflufenamid & flutriafol preventative sprays control PM. • Cyflufenamid provides good powdery mildew control after first visual detection in the field. [ABSTRACT FROM AUTHOR]

To determine the efficacy of a hybrid model utilizing in-person and video visits for outpatient skilled therapies. Retrospective chart review of outpatient skilled therapy visits from 1/1/2019 to 2/1/2022. Percent achievement of short and long-term goals for patients undergoing a hybrid model vs a traditional in-person model of therapy will be assessed. Ambulatory skilled therapy clinics. Achievement of short-term goals (STG) and long-term goals (LTG) were documented in 81 unique patients undergoing ambulatory physical therapy, occupational therapy, or speech therapy. Not applicable. Percentage of short-term and long-term goals achieved. Preliminary results for documented short term goals demonstrate 57% achieved 100% of STG, 16% achieved 50-80%, and 27% achieved 25% or less goals. For documented long term goals 35% achieved 100%, 21% achieved for 50-80%, and 44% achieved 25% or less goals. Additionally, 16% of patients stopped skilled therapy early due to acute medical issues, insurance issues, or loss to follow-up and subsequently 11% had achieved 0% of long-term goals and 9% achieved 0% of short-term goals. A hybrid model of skilled therapy utilizing both in-person and video visits appears to be effective with over half of patients being able to achieve 100% of their short-term goals. In future analysis a larger sample population will be included, comparison of goals achieved to a historical matched cohort and stratification of results by subtypes of skilled therapies. The authors have no disclosures. [ABSTRACT FROM AUTHOR]

Policy drives practice, and health services research (HSR) is at the intersection of policy, practice, and patient outcomes. HSR specific to rehabilitation and disability is particularly needed. As rehabilitation researchers and providers, we are uniquely positioned to provide the evidence that guides reforms targeting rehabilitative care. We have the expertise to define the value of rehabilitation in a policy-relevant context. HSR is a powerful tool for providing this evidence. We need to continue building capacity for conducting rigorous, timely rehabilitation-related HSR. Fostering stakeholder engagement in these research efforts will ensure we maintain a patient-centered focus as we address the “Triple Aim” of better care, better health, and better value. In this Special Communication we discuss the role of rehabilitation researchers in HSR. We also provide information on current resources available in our field for conducting HSR and identify gaps for capacity building and future research. Health care reforms are a reality, and through HSR we can give rehabilitation a strong voice during these transformative times. [ABSTRACT FROM AUTHOR]

To describe potential quality issues with rehabilitation data extracted from electronic health records (EHR) and approaches to data cleaning and management. Secondary analysis of EHR and billing data. Data included demographic, diagnostic, functional assessment at admission and discharge, time billed, and CPT codes for rehabilitation services. Inpatient rehabilitation service at a large, urban academic hospital. Adults with acquired brain injury (n=799) admitted between 2011 and 2016. N/A. Mobility and self-care function at discharge. Demographic, diagnostic, functional measures, and billing data were obtained for the initial inpatient rehabilitation discharges for 799 adults with acquired brain injury from 2011-2016. Demographic, diagnostic, and functional data had been pre-cleaned during initial extraction procedure. Minimal missing or erroneous entries were identified in these data; 100% of the sample had complete FIM data for both admission and discharge. Billing data presented the greatest variability. Specifically, some billing entries included both rehabilitation units billed (e.g., 8-22 minutes) and actual minutes of treatment (e.g, 15 minutes), whereas others included only units billed. Treatment minutes were not required to be recorded in all years of data. Because units billed was a required entry, it was the more reliable measure of service delivery. All entries with rehabilitation units billed had valid CPT code descriptors. Thus, it was necessary to understand data entry processes and how they had changed over time to interpret raw data about service delivery and develop a coding approach that maximized reliability. EHR may provide useful data for large observational studies of rehabilitation processes and outcomes. It is essential to have team members who are familiar with institution-specific front-end documentation and billing procedures. Challenges, opportunities, and strategies to address data accuracy will be discussed. The authors have nothing to disclose. The views expressed in this presentation are those of the authors and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the United States Government. [ABSTRACT FROM AUTHOR]

Bacterial leaf spot of lettuce, induced by Xanthomonas campestris pv. vitians , constitutes a major disease on commercial lettuce ( Lactuca sativa ) production in south Florida. Under greenhouse conditions, resorcinol, two antioxidants, and various sugar alcohols such as mannitol, were evaluated alone, and in combination with Tanos ® 50DF (25% a.i. of each component cymoxanil and famoxadone, E.I du Pont de Nemours and Company, Wilmington, DE) for control of bacterial leaf spot. Among the compounds evaluated, resorcinol (35–50% disease control) and mannitol (9–45%) were the most effective. In field trials, different mixtures containing propionic acid, mannitol, resorcinol, Tanos and or copper hydroxide (Kocide 3000 ® , 46.1%, 30% copper equivalent) were evaluated for the control of bacterial leaf spot of lettuce. Field data support a moderate impact of Tanos in disease reduction. Both greenhouse and field data support a synergistic interaction between Tanos and the compounds including copper, in disease reduction. The mixture Tanos + resorcinol, or copper/resorcinol, Tanos + copper provided better or similar disease control than copper alone. No phytotoxicity was observed in our trials. In an integrated management program for bacterial leaf spot of lettuce, Tanos may be useful in tank mixes with these compounds and copper. [ABSTRACT FROM AUTHOR]

To investigate the feasibility and validity of the V-SASS, a tool for clinicians to easily identify vision function and functional visual deficits and facilitate appropriate referrals and intervention. Prospective, multi-site study conducted across four states (California, Texas, Illinois, and Minnesota) and six facilities. Acute care hospital (22%), inpatient rehabilitation (36.9%), and outpatient rehabilitation (41.1%). 141 participants with new onset stroke, average age 61.8 years old, 51.4% male, 48.6% female; 56.4% white, 28.6% Black/African American, 9% Hispanic and 6% Asian/Pacific Islander. N/A. Validation and feasibility of the V-SASS. The three domains of the V-SASS, inclusive of visual complaints, and static and functional observations, were assessed respectively. In the vision complaint domain, 70.5% of participants identified vision symptoms. 52.6% of the participants were observed to have vision symptoms in the static observation domain. In the final domain, functional observations, 31.9% of the participants exhibited signs of visual dysfunction. Each domain is further subdivided by chief signs and symptoms relative to the topic. Nineteen individuals were confirmed to have been seen by a vision specialist. Of these, 100% had either a vision function (60.0%) or functional vision (80.0%) deficit. 52.6% were found to have both a vision function and functional vision deficit. Feasibility of the V-SASS addressed by various elements, including ease of administration, likability of screen arrangement, confidence in use, and overall recommendations of the V-SASS. All areas addressed were in favor of the V-SASS (all above 75%). Frustration while using the V-SASS was also captured with 24.8% indicating some level of frustration. The three domains of the V-SASS identified vision signs and symptoms, with prevalence rates (70.5%) consistent with the literature (Rowe et al., 2019). Validity of the V-SASS was confirmed (100% of participants who screened positive were found to have vision deficits by a vision specialist). The V-SASS demonstrates feasibility in multiple clinical and geographic settings, though future research to further investigate robustness is warranted. N/A. [ABSTRACT FROM AUTHOR]

Co-morbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) are common, difficult to treat, and associated with poor prognosis. This review aimed to determine the efficacy of individual and group psychological interventions aimed at treating comorbid PTSD and SUD, based on evidence from randomised controlled trials. Our pre-specified primary outcomes were PTSD severity, drug/alcohol use, and treatment completion. We undertook a comprehensive search strategy. Included studies were rated for methodological quality. Available evidence was judged through GRADE. Fourteen studies were included. We found that individual trauma-focused cognitive–behavioural intervention, delivered alongside SUD intervention, was more effective than treatment as usual (TAU)/minimal intervention for PTSD severity post-treatment, and at subsequent follow-up. There was no evidence of an effect for level of drug/alcohol use post-treatment but there was an effect at 5–7 months. Fewer participants completed trauma-focused intervention than TAU. We found little evidence to support the use of individual or group-based non-trauma-focused interventions. All findings were judged as being of low/very low quality. We concluded that there is evidence that individual trauma-focused psychological intervention delivered alongside SUD intervention can reduce PTSD severity, and drug/alcohol use. There is very little evidence to support use of non-trauma-focused individual or group-based interventions. [ABSTRACT FROM AUTHOR]

Abstract: Cymoxanil and famoxadone, the components of Tanos 50DF® (25% a.i. of each product, E.I. du Pont de Nemours and Company, Wilmington, DE) were evaluated alone, together, and in combination with copper hydroxide and/or mancozeb for the control of bacterial spot on tomato and pepper, and bacterial leaf spot on lettuce. Neither Tanos nor its components alone had in vitro inhibitory activity against the copper-insensitive and copper-sensitive species of Xanthomonas evaluated. However, there was a synergistic interaction between copper hydroxide and Tanos in reducing the growth of a copper-resistant strain of Xanthomonas perforans. It appears that both components of Tanos are required for synergism since the addition of only cymoxanil or famoxadone to copper hydroxide did not induce significant reduction of bacterial populations in comparison to copper hydroxide alone. Increased disease control was not obtained on plants in greenhouse trials. In most of the greenhouse trials, the mixture of copper hydroxide and mancozeb combined with Tanos tended to induce similar level of disease control in comparison to different mixtures containing copper hydroxide, cymoxanil and famoxadone indicating that mancozeb might not be necessary in the management of copper-tolerant strains of Xanthomonads. [Copyright &y& Elsevier]

Abstract: Ostir GV, Granger CV, Black T, Roberts P, Burgos L, Martinkewiz P, Ottenbacher KJ. Preliminary results for the PAR-PRO: a measure of home and community participation. Objective: To develop a measure of home and community participation related to the World Health Organization’s International Classification of Functioning, Disability and Health. Design: Cross-sectional analysis of survey data. Setting: Nine medical inpatient rehabilitation facilities from 6 states. Participants: A total of 594 patients of mixed impairment type admitted for inpatient rehabilitation in 2002. Mean age was 74.0 years and 61.4% were women. Interventions: Not applicable. Main Outcome Measures: Reliability and validity of the participation instrument. Results: A 20-item instrument of home and community participation was developed (PAR-PRO). The instrument showed good internal consistency and good Rasch person and item fit statistics. Four subfactors were identified beyond the unidimensional construct of participation including domestic management, socialization, physical vigor, and generative activities. The PAR-PRO total participation score correlated inversely with age (r=−.31, P<.001) but did not differ by sex. Conclusions: The 20-item PAR-PRO instrument of home and community participation displayed good psychometric characteristics. The instrument shows promise as a broad measure of home and community involvement for persons with disabilities. Further work is needed to support its application for people without disability. [Copyright &y& Elsevier]

Abstract: We found in a previous study that after leaves of kumquat [Fortunella margarita (Lour.) Swingle] cv ‘Nagami’ were inoculated with Xanthomonas axonopodis pv. citri (Xac), total superoxide dismutase activity (SOD) increased to promote higher H2O2 concentrations that coincided with a 4-fold decline in Xac populations (). The objective of the current study was to determine how activities and isoforms of important enzymes that catabolize H2O2, specifically catalase (CAT), ascorbate peroxidase (APOD), and the Class III peroxidases (POD) that are located in the apoplast, change in infected kumquat leaves to affect concentration and compartmentalization of H2O2. DAB (3,3-diaminobenzidine) staining of the Xac-infected leaves confirmed higher overall concentration of H2O2 as in our earlier study. One day after inoculation (dai), APOD activity declined below the controls and declines steadily up to 10dai when the experiment was terminated. CAT activity was similar to the controls until 4dai then declined rapidly to about 60% the activity of the controls by 6dai, after which it remained fairly constant until 10dai. There were 4 CAT isoforms in control leaves and 5 isoforms in infected leaves. The CAT-1 isoform band was much smaller in infected plants than the control at all sampling times. The CAT-3 isoform band disappeared at 10dai. The CAT-5 isoform band, which was not observed in control leaves, appeared only at 4dai in infected leaves. POD activity of infected leaves increased above the controls starting 1dai and reached a maximum of about 3-fold higher than the controls 8dai after which it declined. Two POD isoforms were detected in control and infected plants. This study demonstrated that the higher accumulation of H2O2 in kumquat leaves infected with Xac was promoted during pathogenesis first by the suppression of APOD activity and later by suppression of CAT activity. We propose that the higher SOD and lower APOD and CAT activities in the symplast contributed H2O2 substrate for the higher POD activity in the apoplast, which is known to be involved in plant defense against pathogens. [Copyright &y& Elsevier]

Abstract: Sweet orange (Citrus sinensis L. Osb.) ‘Hamlin’ is a canker (Xanthomonas axonopodis pv. citri: Xac) susceptible citrus genotype grown commercially worldwide. Canker causes severe economic losses and restricts the marketability of crop for export. Little is known about the role of oxidative stress in canker development. In the present investigation, sweet orange ‘Hamlin’ leaves were artificially inoculated with Xac to determine the impact of Xac infection on hydrogen peroxide (H2O2) metabolism. Characteristic symptoms following artificial inoculation were water soaking of the infiltrated zone between 2 and 8 days after inoculation (dai); raised epidermis accompanying tiny yellow colored bacterial colonies at 8dai; and yellowing and necrosis of the infected zone by 12–16dai. In planta Xac population increased 1000 fold by 14dai from an initial population of 7.3×106 cfucm−2 (0dai). Peak concentrations of H2O2 were observed at 24h and between 8 and 10dai and coincided with higher activity of total superoxide dismutase (SOD). Lower levels of H2O2 in infected leaves were maintained by Xac induced higher activities of catalase (CAT), ascorbate peroxidase (APOD), and guaiacol peroxidase (POD). It appears Xac altered H2O2 metabolism in C. sinensis L. Osb. ‘Hamlin’ to enhance survival and growth. [Copyright &y& Elsevier]

Abstract: Grapefruit is one of the most susceptible citrus genotypes to Asiatic Citrus Canker, caused by Xanthomonas axonopodis pv. citri (Xac), that can cause severe losses in citrus yield and quality. Although much is known about citrus response to Xac, little is known of the role of antioxidant metabolism. Grapefruit leaves were artificially injected with a strain of Xac obtained from a commercial grove in Florida and components of oxidative metabolism were measured. Symptoms observed included water soaking (2dai; days after inoculation), raised and ruptured epidermis (6–8dai), formation of necrotic lesions (16dai), and leaf abscission (21dai). The Xac population increased to a maximum (≈109 CFU/cm2) 8dai and then declined to ≈107 CFU/cm2 by 20dai. Lipid peroxidation was higher in infected leaves than uninoculated controls from 4 to 21dai indicating greater oxidative stress. H2O2 concentration demonstrated a biphasic pattern with peak concentrations at 4 and 13dai and minimum concentrations that were lower than the controls at 10 and 20dai. The H2O2 concentration somewhat corresponded with superoxide dismutase (SOD) activity, which generates H2O2 via dismutase of superoxide ions. Total SOD activity in Xac-infected leaves increased to a maximum at 4dai, the day of highest H2O2 concentration, and then declined and remained at or below controls. Mn-SOD and Fe-SOD activities both increased to maximum activities at 4dai. Mn-SOD had four isoforms in Xac-infected leaves but only three in the controls. Fe-SOD had three isoforms in both infected and control plants. Suppression of H2O2 in Xac-infected leaves also corresponded to higher activities of the H2O2 catabolising enzymes catalase (CAT), ascorbate peroxidase (APOD), and peroxidase (POD). Two additional CAT isoforms were detected in infected leaves and not the controls. Three POD isoforms were detected in both control and infected leaves. Previous research has shown that Xac is sensitive to intraplant H2O2 concentration, however, the pattern of Xac in this study did not correspond to H2O2 concentration, which initially increased due to enhanced SOD activity, but was later suppressed apparently with the aid of peroxidases. In conclusion, Xac infection altered H2O2 metabolism in grapefruit leaves by changes in the activities and isoforms of SODs, CATs, PODs and APOD. [Copyright &y& Elsevier]