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Regenerative agricultural practices strive to produce food that have lower economic, environmental, and social impacts defined by the processes used (i.e. using cover crops, reducing tillage) or by proposed outcomes (i.e. improving soil health, improving biodiversity). In almond orchards the regeneration of ecosystem health and productivity can be achieved through practices including recycling of almond hull and shell resources as soil amendments, reducing dust production during harvest, and minimizing synthetic fertilizer inputs. The current and set standards of conventional almond production poses a unique challenge when proposing regenerative agriculture goals. To facilitate almond harvest and simplify irrigation and fertigation practices, almond orchards are typically managed with the orchard floor bare, and trees are grown in rows with irrigation and fertilization localized exclusively to the 3.6 meter (12-ft) wide soil strip below the tree canopy. The alleyways are often left unirrigated and bare to facilitate almond harvest. These conventional practices reduce soil health, whereas with the advent of off-ground harvesting, opportunities exist to incorporate cover crops (CC) and the use of organic matter amendments (OMA) including almond hulls and shells (AHS) to maintain a more permanent mulch layer to protect the soil. This thesis examined the changes in soil physical, chemical, and biological properties from the use of AHS and a CC mix of 60% oats, 35% spring peas, and 5% yellow mustard in a randomized complete block design field trial. Nutrient cycling and OMA decomposition dynamics was analyzed one and two years after practice adoption. Effects on soil aggregate stability, particulate organic matter (POM), mineral associated organic matter (MAOM), microbial biomass, and soil moisture in amended trees harvested using on-ground and off-ground harvest machines were determined. Results showed increased C and N in microaggregate and macroaggregate soil organic matter fractions, increased saprophytes and arbuscular mycorrhizal fungi, and improved soil moisture in amended soils. Exchangeable potassium (XK) and soil organic matter (SOM) increased in the amended on and off-ground harvest treatments and was highly correlated with microbial communities measured. We found that after 3 years of AHS OMA and catch-frame harvest, MAOM and soil aggregate stability increased due to this undisturbed forest litter layer which may allow more microbial processes to contribute to more MAOM over time. Cover crop biomass was highest in oats but peas contributed the highest soil N. 192 days after AHS application, an average of 38% of the AHS material decomposed and 90 days after the CC were seeded, an average of 69% of the CC material decomposed.

Background: Reports suggest a potential association between coronavirus disease 2019 (COVID-19) vaccines and acute central nervous system (CNS) inflammation. Objective: The main objective of this study is to describe features of acute CNS inflammation following COVID-19 vaccination. Methods: A retrospective observational cohort study was performed at the BARLO MS Centre in Toronto, Canada. Clinicians reported acute CNS inflammatory events within 60 days after a COVID-19 vaccine from March 2021 to August 2022. Clinical characteristics were evaluated. Results: Thirty-eight patients (median age 39 (range: 20–82) years; 60.5% female) presented within 0–55 (median 15) days of a receiving a COVID-19 vaccine and were diagnosed with relapsing remitting multiple sclerosis (MS) ( n = 16), post-vaccine transverse myelitis ( n = 7), clinically isolated syndrome ( n = 5), MS relapse ( n = 4), tumefactive demyelination ( n = 2), myelin oligodendrocyte glycoprotein antibody disease ( n = 1), neuromyelitis optica spectrum disorder ( n = 1), chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids ( n = 1) and primary autoimmune cerebellar ataxia ( n = 1). Twenty-two received acute treatment and 21 started disease-modifying therapy. Sixteen received subsequent COVID-19 vaccination, of which 87.5% had no new or worsening neurological symptoms. Conclusion: To our knowledge, this is the largest study describing acute CNS inflammation after COVID-19 vaccination. We could not determine whether the number of inflammatory events was higher than expected.

Prior reports evaluating SARS-CoV-2 vaccine efficacy in chronic lymphocytic leukaemia (CLL) used semiquantitative measurements of anti-S to evaluate immunity; however, neutralization assays were used to assess functional immunity in the trials leading to vaccine approval. Here, we identified decreased rates of seroconversion in vaccinated CLL patients and lower anti-S levels compared to healthy controls. Notably, we demonstrated similar results with the Roche anti-S assay and neutralization activity. Durable responses were seen at six months; augmentation with boosters was possible in responding patients. Absence of normal B cells, frequently seen in patients receiving Bruton tyrosine kinase and B-cell lymphoma 2 inhibitors, was a strong predictor of lack of seroconversion.

The POLARIX trial demonstrated the superiority of polatuzumab vedotin (Pola) over vincristine in the R-CHOP regimen for large B-cell lymphomas, but it is unknown if Pola can be safely incorporated into intensified regimens (eg. DA-EPOCH-R) typically utilized for the highest risk histologies. This was a single-center, open label, prospective clinical trial of 6 cycles of Pola-DA-EPCH-R in aggressive large B-cell lymphomas. The primary endpoint was to estimate the safety of Pola-DA-EPCH-R as measured by the rate of dose-limiting toxicities (DLTs) in the first 2 cycles with pre-specified suspension rules. Secondary and exploratory endpoints included efficacy and correlation with ctDNA levels. We enrolled 18 patients on study, and with only three DLTs observed, the study met its primary endpoint for safety. There were five serious adverse events including grade 3 febrile neutropenia (3, 17%), grade 3 colonic perforation in the setting of diverticulitis (1, 6%), and grade 5 sepsis/typhlitis (1, 6%). Among 17 evaluable patients, the best overall response rate was 100% and complete response rate of 76%. With median follow up of 12.9 months, 12-month EFS was 72% (95% CI 54-96%) and 12-month OS was 94% (95% CI 84-100%). No patient with undetectable ctDNA at the end of treatment has relapsed to date. Using Pola to replace vincristine in the DA-EPOCH-R regimen met its primary safety endpoint. These data support the further evaluation and use of this approach in histologies where the potential benefit of both an intensified regimen and Pola may be desired.

We reviewed Clostridioides difficile–positive patients discharged on fidaxomicin after local adoption of 2021 C. difficile infection (CDI) guidelines. From 14 June to 3 October 2021, 80% (12/15) had copayments of $0–$35 and 27% (4/15) required prior authorization. The 30-day CDI recurrence was 7%.

ObjectiveTo identify the prevalence of self-reported symptoms of depression and anxiety among patients in remission from autoimmune encephalitis (AE).BackgroundAlthough prior studies have found a high prevalence of residual cognitive deficits among patients in remission from AE, there is a paucity of data on long-term psychiatric outcomes for this patient population. In normal populations, median Patient Health Questionaire-9 (PHQ9) and General Anxiety Disorder-7 (GAD7) scores were reported to be, respectively, around 3 and 2, with prevalence of depressive and anxiety symptoms on these questionnaires reported as around 24% and 23%.Design/MethodsRetrospective cross-sectional cohort study at a tertiary center AE clinic between 2012-01-01 and 2021-12-31. Patients were contacted via phone or regular follow-up and completed the PHQ9 and GAD7.ResultsForty-one patients were contacted; 29 responded (71%) and were included. Seventeen (59%) were female. Median age was 32.5 years (range 5-77). Autoantibody results were N-methyl-D-aspartate receptor (n = 14, 48%), negative (n = 7, 24%), leucine-rich glioma-inactivated 1 (n = 6, 21%), and contactin-associated protein-like 2 (n = 1, 3%). Median time from disease onset to questionnaire collection was 6.3 years (range 1.5-23.0). Ten patients (37%) were experiencing symptoms of depression as measured by the PHQ9, with six (60%) reporting moderate-to-severe symptoms. Median PHQ9 score was 3 (range 0-18). Six patients (22%) were experiencing symptoms of anxiety on the GAD7, with one (17%) reporting moderate-to-severe symptoms. Median GAD7 score was 2 (range 0-10). Eight patients (28%) reported a psychiatric history prior to the onset of AE, which was associated with increased PHQ9 scores (p = 0.04, Wilcoxon rank sum test).ConclusionsThe prevalence of self-reported depressive and anxious symptoms in this cohort in remission from AE was similar to general populations. Patients with a psychiatric history that preceded onset of AE had higher PHQ9 scores. These results may be affected by censoring bias and lower sensitivity of self-reported diagnostic tools.

ObjectiveTo describe features of central nervous system (CNS) demyelinating events following vaccination against coronavirus disease 19 (COVID-19).BackgroundSeveral reports suggest a potential association between COVID-19 vaccines and acute CNS inflammation.Design/MethodsA case series was performed at the BARLO MS Centre in Toronto, Ontario, Canada. Clinicians reported patients who experienced an acute CNS demyelinating event within 60 days after receiving at least one COVID-19 vaccination from March 2021 to January 2022. Clinical characteristics were evaluated.ResultsTwenty patients were identified (median age 39 years (range 25-82); 13 (65.0%) female). Two had pre-existing multiple sclerosis (MS). Individuals received the Pfizer (n = 14), Moderna (n = 5) or Astrazeneca (n = 1) COVID-19 vaccines. Within 1-53 days (median 12) of the first (n = 8) or second (n = 12) vaccine dose, patients developed transverse myelitis (TM) (n = 15), optic neuritis (n = 4) or brain demyelination (n = 4). Diagnoses at last follow up (median 114 days (range 39-255)) were relapsing remitting MS (n = 8), post-vaccine TM (n = 5), clinically isolated syndrome (n = 3), myelin oligodendrocyte glycoprotein antibody disease (n = 2), MS relapse (n = 1) and neuromyelitis optica spectrum disorder (n = 1). Thirteen patients received pulse corticosteroids, and of these, 4 received plasma exchange. Seven did not receive acute treatment. 20.0% returned to baseline (n = 4), 75.0% partially recovered (n = 15) and 5.0% worsened (n = 1). At last follow up, 11 were on disease modifying therapy and 9 were not. Nine patients received a subsequent COVID-19 vaccine. Of these, one experienced symptom recrudescence without radiologic evidence of a new demyelinating attack.ConclusionsTo our knowledge, this is the largest series to date describing acute CNS demyelination after vaccination against COVID-19. The rate of vaccination in the eligible general population was high during the time of the cases and we could not determine whether the number of demyelinating events was higher than expected. Repeat vaccination was not associated with recurrent adverse events in this small observational series.

Forced normalization is the development of psychiatric symptoms in a patient experiencing remission of seizures. We present a case of Lennox Gastaut syndrome in which forced normalization developed after vagus nerve stimulation was stopped. The patient had drug resistant epilepsy and failed anti-seizure drugs, vagus nerve stimulation, and a partial callosotomy. The patient had multiple types of seizures including drop attacks, absences, and tonic–clonic seizures. He tried vagus nerve stimulation for two years without success. Forced normalization developed after the vagus nerve stimulator was turned off. This is the first case to our knowledge to describe forced normalization after turning off the vagus nerve stimulator., Highlights • Forced normalization (FN) is the development of psychiatric symptoms in a patient experiencing remission of seizures • FN should be on the differential diagnosis in patients presenting with new onset psychosis and seizure freedom • To our knowledge this is the first case that reports the presence of forced normalization after VNS is turned off

Efforts to reduce preterm and low-weight births are among the leading public health objectives in the United States and the world. A necessary component of any public health endeavor is surveillance. The Department of Defense (DoD) Birth and Infant Health Registry (Registry) uses electronic healthcare utilization data to assess reproductive health outcomes among military families. Infant health outcomes are coded using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM). The objective of this study was to determine the accuracy of using electronically derived ICD-9-CM codes for assessing gestational age and birth weight among Registry infants compared to medical records.The authors assessed birth outcome agreement by comparing electronic Registry data for infants born at military treatment facilities (MTFs) from 1999-2002 and 1,858 randomly selected birth medical records from 17 MTFs, with descriptive statistics and measures of agreement, including the kappa statistic.Of the 1,858 reviewed infant records, 1,669 were successfully matched to the Registry analytic dataset for analyses. Despite small differences in parental demographics, this investigation established "near perfect" agreement for the primary outcomes: kappa of 0.83 for preterm and 0.87 for low birth weight. Subgroup analyses revealed no significant differences in gestational age and birth-weight agreement based on the presence of a birth defect, military parent rank, branch of military service, or specific hospital characteristics.Electronically derived ICD-9-CM codes provide an accurate assessment of the gestational age and low birth weight reflected in the birth medical records of infants in a large birth and infant health registry. These findings support the integrity of Registry data for investigations assessing preterm and low-weight births among U.S. service member families.