USDA PERSPECTIVE ON THE OUTLOOK FOR COTTON

Crop Production/Industries,

Post-denial Strategies: How to Get from No to Yes

U.S. Citizenship and Immigration Services (USCIS) seems to be denying more petitions than ever these days. Cases that were solid approvals a few years ago now are receiving denials, even though the law and regulations have not changed. But don’t give up hope. Opportunities exist to overcome denials. This practice advisory focuses on post-denial strategies for petitions filed with USCIS, not strategies in immigration court. The article discusses motions to reopen, motions for reconsideration, appeals to the USCIS Administrative Appeals Office (AAO), and litigation. This practice advisory also discusses when filing a new petition may be a better option, and how the beneficiary’s status, including unlawful presence, may affect the options

Post-denial Strategies: How to Get from No to Yes

U.S. Citizenship and Immigration Services (USCIS) seems to be denying more petitions than ever these days. Cases that were solid approvals a few years ago now are receiving denials, even though the law and regulations have not changed. But don’t give up hope. Opportunities exist to overcome denials. This practice advisory focuses on post-denial strategies for petitions filed with USCIS, not strategies in immigration court. The article discusses motions to reopen, motions for reconsideration, appeals to the USCIS Administrative Appeals Office (AAO), and litigation. This practice advisory also discusses when filing a new petition may be a better option, and how the beneficiary’s status, including unlawful presence, may affect the options

Adult Patients Living with Human Immunodeficiency Virus Hospitalized for Community-Acquired Pneumonia in the United States: Incidence and Outcomes

Background: Community-acquired pneumonia (CAP) is a common infectious reason for hospitalization of adults in the United States (US), including those with Human Immunodeficiency Virus (HIV). While there are studies detailing the incidence and outcomes for all adults with CAP we are not aware of a recent study detailing incidence and outcomes in adult HIV patients hospitalized with CAP. The objectives of this study were (1) to define the current incidence and outcomes of adult HIV patients hospitalized with CAP in Louisville, Kentucky, and (2) to estimate the burden of CAP in the US HIV adult population. Methods: This was a secondary analysis of The University of Louisville Pneumonia Study; a prospective population-based cohort study of all hospitalized adults with CAP who were residents of Louisville, Kentucky, from 1 June 2014 to 31 May 2016. Results: A total of 110 unique patients living with HIV were hospitalized with CAP during our two-year study. The annual incidence of adults living with HIV hospitalized with CAP is estimated to be 1,950 per 100,000. Of the estimated 1.1 million adults living with HIV in the US currently we predict that 21,450 will be hospitalized with CAP annually. The median time to clinical stability in adult patients living with HIV hospitalized with CAP was 2 (IQR: [1, 3]) days. The median length of stay for adult patients living with HIV hospitalized with CAP was 4 (IQR: [3, 7]) days. Mortality occurred as follows; in-hospital: 1.8%, 30-day 6.8%, 6-month 15.5%, and 1 year 20.2%. Conclusion: The estimated annual incidence of adult patients living with HIV and hospitalized with CAP was found to be 1,950 per 100,000 suggesting that 21,450 adults living with HIV will be admitted with CAP yearly across the US. This is a similar incidence to that recently predicted for the elderly. Mortality occurred as follows; in-hospital: 1.8%, 30-day 6.8%, 6-month 15.5%, and 1 year 20.2%. Our 30-day mortality rate for adult patients living with HIV hospitalized for CAP was similar to other figures in the literature

Compliance with Guidelines for Treatment of Staphylococcus aureus Bacteremia is Associated with Decreased Mortality in Patients Hospitalized for Community-Acquired Pneumonia with Staphylococcus aureus Bacteremia

Introduction: Staphylococcus aureus bacteremia has a minimum treatment duration of two weeks, while S. aureus community-acquired pneumonia (CAP) treatment is at least five days. Treatment failure, persistent bacteremia, and recurrence are common among patients with community-acquired S. aureus bacteremia. There is conflicting information in the current Infectious Diseases Society of America (IDSA) guidelines for the treatment of S.aureus bacteremia patients with CAP. Therefore, the appropriate treatment duration and modality for S. aureus CAP with bacteremia is unclear. The objective of this study was to compare outcomes among patients with S. aureus CAP and bacteremia treated in compliance versus non-compliance with IDSA S. aureus bacteremia guidelines. Methods: This was a secondary data analysis of the Community-Acquired Pneumonia Organization (CAPO) study database. Logistic regression was used to compare outcomes. Results: A total of 117 patients with S. aureus CAP and bacteremia were included in the study. Compliance with S. aureus bacteremia guidelines was documented in 67 patients, and non-compliance was documented in 50 patients. Compliance with IDSA S. aureus bacteremia guidelines resulted in a decrease in odds of re-hospitalization of 30% after adjusting for confounding variables between the compliant and non-compliant groups (adjusted odds ratio (aOR) 0.70 [95% CI 0.29–1.70]; P=0.42). The 30-day mortality for the compliant group was 6% and for the non-compliant group was 10%; P=0.576. The 1-year mortality for the compliant group was 19% and for the non-compliant group was 44%; P=0.011. Conclusion: The present study demonstrated that when treated in compliance with IDSA guidelines for S. aureus bacteremia, there was decreased 1-year mortality for patients hospitalized for S. aureus CAP with bacteremia. In this case, the IDSA S. aureus bacteremia guidelines recommend treating uncomplicated S. aureus bacteremia with CAP for at least two weeks of antimicrobials and at least four weeks of antimicrobials for complicated S. aureus bacteremia with CAP

Acute Ethanol Administration Rapidly Increases Phosphorylation of Conventional Protein Kinase C in Specific Mammalian Brain Regions in Vivo

Background Protein kinase C (PKC) is a family of isoenzymes that regulate a variety of functions in the central nervous system including neurotransmitter release, ion channel activity, and cell differentiation. Growing evidence suggests that specific isoforms of PKC influence a variety of behavioral, biochemical, and physiological effects of ethanol in mammals. The purpose of this study was to determine whether acute ethanol exposure alters phosphorylation of conventional PKC isoforms at a threonine 674 (p-cPKC) site in the hydrophobic domain of the kinase, which is required for its catalytic activity. Methods Male rats were administered a dose range of ethanol (0, 0.5, 1, or 2 g/kg, intragastric) and brain tissue was removed 10 minutes later for evaluation of changes in p-cPKC expression using immunohistochemistry and Western blot methods. Results Immunohistochemical data show that the highest dose of ethanol (2 g/kg) rapidly increases p-cPKC immunoreactivity specifically in the nucleus accumbens (core and shell), lateral septum, and hippocampus (CA3 and dentate gyrus). Western blot analysis further showed that ethanol (2 g/kg) increased p-cPKC expression in the P2 membrane fraction of tissue from the nucleus accumbens and hippocampus. Although p-cPKC was expressed in numerous other brain regions, including the caudate nucleus, amygdala, and cortex, no changes were observed in response to acute ethanol. Total PKC? immunoreactivity was surveyed throughout the brain and showed no change following acute ethanol injection

Antimicrobial Stewardship in Hospitalized Patients with Respiratory Infections: Ten-Year Experience from the Robley Rex Louisville VA Medical Center

Rationale: Antibiotic stewardship has been defined as coordinated interventions designed to improve and measure the appropriate use of antibiotic agents. Respiratory infections are the most common infectious reason for hospitalization in the United States. Therefore, one could extrapolate that respiratory infections are then also the most common reason for hospital antibiotic use and possess the highest potential for hospital antibiotic misuse. The primary objective of this article was to evaluate the role of antimicrobial stewardship on improving antibiotic use for respiratory infections in hospitalized patients on intravenous (IV) antibiotics at the Robley Rex Louisville VAMC over a 10-year period. Methods: This was a retrospective review of the Robley Rex Louisville VAMC ASP Switch Therapy and Antimicrobial Review database. The study included all Robley Rex Louisville VAMC patients admitted to the hospital and placed on IV antibiotics between January 1st 2007 and December 31st 2016. Results: Recommendations from an antimicrobial stewardship team (AST) improve hospital IV antibiotic use in respiratory infections to a level above 90%. Conclusion: AST recommendations regarding antibiotic use for respiratory infections improve compliance with hospital guidelines. There is an ongoing role for antimicrobial stewardship programs overtime

CIB1 is an endogenous inhibitor of agonist-induced integrin αIIbβ3 activation

In response to agonist stimulation, the αIIbβ3 integrin on platelets is converted to an active conformation that binds fibrinogen and mediates platelet aggregation. This process contributes to both normal hemostasis and thrombosis. Activation of αIIbβ3 is believed to occur in part via engagement of the β3 cytoplasmic tail with talin; however, the role of the αIIb tail and its potential binding partners in regulating αIIbβ3 activation is less clear. We report that calcium and integrin binding protein 1 (CIB1), which interacts directly with the αIIb tail, is an endogenous inhibitor of αIIbβ3 activation; overexpression of CIB1 in megakaryocytes blocks agonist-induced αIIbβ3 activation, whereas reduction of endogenous CIB1 via RNA interference enhances activation. CIB1 appears to inhibit integrin activation by competing with talin for binding to αIIbβ3, thus providing a model for tightly controlled regulation of αIIbβ3 activation

Beyond planning tools: Experiential learning in climate adaptation planning and practices

In the past decade, several dedicated tools have been developed to help natural resources professionals integrate climate science into their planning and implementation; however, it is unclear how often these tools lead to on-the-ground climate adaptation. Here, we describe a training approach that we developed to help managers effectively plan to execute intentional, climate-informed actions. This training approach was developed through the Climate Change Response Framework (CCRF) and uses active and focused work time and peer-to-peer interaction to overcome observed barriers to using adaptation planning tools. We evaluate the effectiveness of this approach by examining participant evaluations and outlining the progress of natural resources projects that have participated in our trainings. We outline a case study that describes how this training approach can lead to place and context-based climate-informed action. Finally, we describe best practices based on our experience for engaging natural resources professionals and helping them increase their comfort with climate-informed planning