Professional Quality of Life and Fear of Covid-19 Moderated by Perceived Job Market Outlook: Predicting Registered Nurse Turnover Intentions in South Florida During the Covid-19 Pandemic

Background:

The nursing shortage and the aging of the nursing workforce is a growing concern for health care institutions. Understanding nurses attitudes toward turnover intentions is a crucial step to develop effective policies and maintain nurse staffing continuity.

Objective:

This research aims to study the impact of the Professional Quality of Life and Fear of COVID-19 moderated by perceived Job Market Outlook on South Florida registered nurses by predicting turnover intentions.

Methods:

From March to August, 2021, 202 registered nurses from seven South Florida counties completed the self-reporting Professional Quality of Life, Fear of COVID-19, and perceptions of Job Market Outlook surveys when predicting turnover intentions in a quantitative nonexperimental predictive correlational design research study.

Results:

Results showed that in the professional quality of life, burnout significantly predicted (p <.001) registered nurses (n=202) turnover intentions during the COVID-19 pandemic. Secondary traumatic stress, compassion satisfaction and fear of COVID-19 did not significantly predict registered nurses’ turnover intentions. Hierarchical regression analysis confirmed burnout is significantly more predictive than no model of turnover intentions accounting for more variance at 15.45% (p < .001). Perceived job market outlook did not moderate between the independent variables and the dependent variable turnover intentions.

Conclusion:

This research reveals the deleterious impact of burnout in the registered nurses’ professional quality of life and turnover intentions warranting the need for health care institutions and nursing leadership to collaborate on the needs of the nursing workforce on a micro and macro level.

Tumor mutational load predicts survival after immunotherapy across multiple cancer types

Immune checkpoint inhibitor (ICI) treatments benefit some patients with metastatic cancers, but predictive biomarkers are needed. Findings in selected cancer types suggest that tumor mutational burden (TMB) may predict clinical response to ICI. To examine this association more broadly, we analyzed the clinical and genomic data of 1,662 advanced cancer patients treated with ICI, and 5,371 non-ICI-treated patients, whose tumors underwent targeted next-generation sequencing (MSK-IMPACT). Among all patients, higher somatic TMB (highest 20% in each histology) was associated with better overall survival. For most cancer histologies, an association between higher TMB and improved survival was observed. The TMB cutpoints associated with improved survival varied markedly between cancer types. These data indicate that TMB is associated with improved survival in patients receiving ICI across a wide variety of cancer types, but that there may not be one universal definition of high TMB.

Mutational landscape of metastatic cancer revealed from prospective clinical sequencing of 10,000 patients

Tumor molecular profiling is a fundamental component of precision oncology, enabling the identification of genomic alterations in genes and pathways that can be targeted therapeutically. The existence of recurrent targetable alterations across distinct histologically defined tumor types, coupled with an expanding portfolio of molecularly targeted therapies, demands flexible and comprehensive approaches to profile clinically relevant genes across the full spectrum of cancers. We established a large-scale, prospective clinical sequencing initiative using a comprehensive assay, MSK-IMPACT, through which we have compiled tumor and matched normal sequence data from a unique cohort of more than 10,000 patients with advanced cancer and available pathological and clinical annotations. Using these data, we identified clinically relevant somatic mutations, novel noncoding alterations, and mutational signatures that were shared by common and rare tumor types. Patients were enrolled on genomically matched clinical trials at a rate of 11%. To enable discovery of novel biomarkers and deeper investigation into rare alterations and tumor types, all results are publicly accessible.

TGF-β induction of FGF-2 expression in stromal cells requires integrated smad3 and MAPK pathways

Transforming Growth Factor-β (TGF-β) regulates the reactive stroma microenvironment associated with most carcinomas and mediates expression of many stromal derived factors important for tumor progression, including FGF-2 and CTGF. TGF-β is over-expressed in most carcinomas, and FGF-2 action is important in tumor-induced angiogenesis. The signaling mechanisms of how TGF-β regulates FGF-2 expression in the reactive stroma microenvironment are not understood. Accordingly, we have assessed key signaling pathways that mediate TGF-β1-induced FGF-2 expression in prostate stromal fibroblasts and mouse embryo fibroblasts (MEFs) null for Smad2 and Smad3. TGF-β1 induced phosphorylation of Smad2, Smad3, p38 and ERK1/2 proteins in both control MEFs and prostate fibroblasts. Of these, Smad3, but not Smad2 was found to be required for TGF-β1 induction of FGF-2 expression in stromal cells. ChIP analysis revealed a Smad3/Smad4 complex was associated with the -1.9 to -2.3 kb upstream proximal promoter of the FGF-2 gene, further suggesting a Smad3-specific regulation. In addition, chemical inhibition of p38 or ERK1/2 MAPK activity also blocked TGF-β1-induced FGF-2 expression in a Smad3-independent manner. Conversely, inhibition of JNK signaling enhanced FGF-2 expression. Together, these data indicate that expression of FGF-2 in fibroblasts in the tumor stromal cell microenvironment is coordinately dependent on both intact Smad3 and MAP kinase signaling pathways. These pathways and key downstream mediators of TGF-β action in the tumor reactive stroma microenvironment, may evolve as putative targets for therapeutic intervention.

WFDC1 is a key modulator of inflammatory and wound repair responses

WFDC1/ps20 is a whey acidic protein four-disulfide core member that exhibits diverse growth and immune-associated functions in vitro. In vivo functions are unknown, although WFDC1 is lower in reactive stroma. A Wfdc1-null mouse was generated to assess core functions. Wfdc1-null mice exhibited normal developmental and adult phenotypes. However, homeostasis challenges affected inflammatory and repair processes. Wfdc1-null mice infected with influenza A exhibited 2.75-log-fold lower viral titer relative to control mice. Wfdc1-null infected lungs exhibited elevated macrophages and deposition of osteopontin, a potent macrophage chemokine. In wounding studies, Wfdc1-null mice exhibited an elevated rate of skin closure, and this too was associated with elevated deposition of osteopontin and macrophage recruitment. Wfdc1-null fibroblasts exhibited impaired spheroid formation, elevated adhesion to fibronectin, and an increased rate of wound closure in vitro. This was reversed by neutralizing antibody to osteopontin. Osteopontin mRNA and cleaved protein was up-regulated in Wfdc1-null cells treated with lipopolysaccharide or polyinosinic-polycytidylic acid coordinate with constitutively active matrix metallopeptidase-9 (MMP-9), a protease that cleaves osteopontin. These data suggest that WFDC1/ps20 modulates core host response mechanisms, in part, via regulation of osteopontin and MMP-9 activity. Release from WFDC1 regulation is likely a key component of inflammatory and repair response mechanisms, and involves the processing of elevated osteopontin by activated MMP-9, and subsequent macrophage recruitment.

Recruitment of CD34(+) fibroblasts in tumor-associated reactive stroma: the reactive microvasculature hypothesis

Reactive stroma co-evolves with cancer, exhibiting tumor-promoting properties. It is also evident at sites of wound repair and fibrosis, playing a key role in tissue homeostasis. The specific cell types of origin and the spatial/temporal patterns of reactive stroma initiation are poorly understood. In this study, we evaluated human tumor tissue arrays by using multiple labeled, quantitative, spectral deconvolution microscopy. We report here a novel CD34/vimentin dual-positive reactive fibroblast that is observed in the cancer microenvironment of human breast, colon, lung, pancreas, thyroid, prostate, and astrocytoma. Recruitment of these cells occurred in xenograft tumors and Matrigel plugs in vivo and was also observed in stromal nodules associated with human benign prostatic hyperplasia. Because spatial and temporal data suggested the microvasculature as a common site of origin for these cells, we analyzed microvasculature fragments in organ culture. Interestingly, fibroblasts with identical phenotypic properties and markers expanded radially from microvasculature explants. We propose the concept of reactive microvasculature for the evolution of reactive stroma at sites of epithelial disruption common in both benign and malignant disorders. Data suggest that the reactive stroma response is conserved among tissues, in normal repair, and in different human cancers. A more clear understanding of the nature and origin of reactive stroma is needed to identify novel therapeutic targets in cancer and fibrosis.

The reactive stroma microenvironment and prostate cancer progression

Reactive stroma initiates during early prostate cancer development and coevolves with prostate cancer progression. Previous studies have defined the key markers of reactive stroma and have established that reactive stroma biology influences prostate tumorigenesis and progression. The stem/progenitor cells of origin and the mechanisms that regulate their recruitment and activation to myofibroblasts or carcinoma-associated fibroblasts are essentially unknown. Key regulatory factors have been identified, including transforming growth factor β, interleukin-8, fibroblast growth factors, connective tissue growth factor, wingless homologs-Wnts, and stromal cell-derived factor-1, among others. The biology of reactive stroma in cancer is similar to the more predictable biology of the stroma compartment during wound repair at sites where the epithelial barrier function is breached and a stromal response is generated. The coevolution of reactive stroma and the biology of how reactive stroma-carcinoma interactions regulate cancer progression and metastasis are targets for new therapeutic approaches. Such approaches are strategically designed to inhibit cancer progression by uncoupling the reactive stroma niche.

TGF-β1 induces an age-dependent inflammation of nerve ganglia and fibroplasia in the prostate gland stroma of a novel transgenic mouse

TGF-β1 is overexpressed in wound repair and in most proliferative disorders including benign prostatic hyperplasia and prostate cancer. The stromal microenvironment at these sites is reactive and typified by altered phenotype, matrix deposition, inflammatory responses, and alterations in nerve density and biology. TGF-β1 is known to modulate several stromal responses; however there are few transgenic models to study its integrated biology. To address the actions of TGF-β1 in prostate disorders, we targeted expression of an epitope tagged and constitutively active TGF-β1 via the enhanced probasin promoter to the murine prostate gland epithelium. Transgenic mice developed age-dependent lesions leading to severe, yet focal attenuation of epithelium, and a discontinuous basal lamina. These changes were associated with elevated fibroplasia and frequency of collagenous micronodules in collapsed acini, along with an induced inflammation in nerve ganglia and small vessels. Elevated recruitment of CD115+ myeloid cells but not mature macrophages was observed in nerve ganglia, also in an age-dependent manner. Similar phenotypic changes were observed using a human prostate epithelium tissue recombination xenograft model, where epithelial cells engineered to overexpress TGF-β1 induced fibrosis and altered matrix deposition concurrent with inflammation in the stromal compartment. Together, these data suggest that elevated TGF-β1 expression induces a fibroplasia stromal response associated with breach of epithelial wall structure and inflammatory involvement of nerve ganglia and vessels. The novel findings of ganglia and vessel inflammation associated with formation of collagenous micronodules in collapsed acini is important as each of these are observed in human prostate carcinoma and may play a role in disease progression.

Pelvic fractures-A guide to classification and management

Pelvic fractures are common in polytrauma and continue to pose a difficult management dilemma for even the most experienced clinicians. Due to the high energy mechanisms involved, there are often multiple other injuries and many specialists may be involved. Deriving an effective management strategy relies on early diagnosis and prioritisation of the most immediately life-threatening injuries. Contrary to ATLS advice, CT can be used to facilitate this even in the haemodynamically unstable patient. This article defines the role of CT in pelvic fractures and provides an overview of fracture classification.

Extensive perineal soft tissue disruption with 'open-book' pelvic fracture

We present a case in which direct visualisation of the nature and extent of a perineal soft tissue injury following pelvic trauma was achieved through the use of multi-modality and multi-planar imaging. The case emphasises the importance of a flexible approach to imaging as a problem-solving technique after severe pelvic trauma.

Therapeutic impact of percutaneous spinal biopsy in spinal infection

OBJECTIVE

To investigate the therapeutic impact of percutaneous spinal biopsy in patients with suspected spinal infection.

DESIGN AND PATIENTS

A review of the case notes and imaging features of 36 patients who underwent percutaneous spinal biopsy was performed. From this group 20 patients with a prebiopsy diagnosis of spinal osteomyelitis were identified. Management before biopsy was noted including the use of antimicrobial therapy. The results of the histology and microbiology were noted along with the subsequent diagnosis and management.

RESULTS

Eight of the 20 patients (40%) had received antibiotics before the biopsy. An organism was isolated in 8/20 cases (40%). Of the eight patients on antibiotics, two grew an organism (25%), including one case of candida in a patient receiving flucloxacillin. Out of 12 patients not on antibiotics there were six cases where an organism was isolated (50%). The result of the biopsy led to a change in management in seven of the 20 patients (35%).

CONCLUSIONS

Many clinicians are treating spinal osteomyelitis empirically with antibiotics before biopsy, but this reduces the chance of isolating an organism and determining antibiotic sensitivity. Despite this biopsy led to a change in management in 35% of cases.

Adductor-related groin pain in athletes: correlation of MR imaging with clinical findings

OBJECTIVE

To evaluate gadolinium-enhanced MR imaging in athletes with chronic groin pain and correlate with the clinical features.

DESIGN AND PATIENTS

MR examinations performed in 52 athletes (51 male, 1 female; median age 26 years) with chronic groin pain and 6 asymptomatic control athletes (6 male; median age 29 years) were independently reviewed by two radiologists masked to the clinical details. Symptom duration (median 6 months) and clinical side of severity were recorded. Anatomical areas in the pelvis were scored for abnormality (as normal, mildly abnormal or abnormal) and an overall assessment for side distribution of abnormality was recorded, initially without post-gadolinium sequences and then, 3 weeks later (median 29 days), the post-gadolinium sequences only. Correlation between radiological and clinical abnormality was calculated by Spearman's correlation.

RESULTS

Abnormal anterior pubis and enthesis enhancement significantly correlated with clinical side for both radiologists (both P=0.008). Abnormal anterior pubis and adductor longus enthesis oedema was significant for one radiologist ( P=0.009). All other features showed no significant correlation ( P>0.05). In the control cases there was no soft tissue abnormality but symphyseal irregularity was present ( n=2). For both radiologists assessment of imaging side severity significantly correlated with clinical side for post-gadolinium ( P=0.048 and P=0.023) but not non-gadolinium sequences ( P>0.05).

CONCLUSION

The extent and side of anterior pubis and adductor longus enthesis abnormality on MR imaging significantly and reproducibly correlates with the athletes' current symptoms in chronic adductor-related groin pain.

Micellar high-performance liquid chromatographic determination of folylpolyglutamate hydrolase activity

A rapid and sensitive method for the quantitative determination of folylpolyglutamate hydrolase activity in crude tissue extracts was developed. The procedure is based on high-performance liquid chromatographic separation of folate analogue mono- and polyglutamates on a reversed-phase column using sodium dodecyl sulfate in water as the mobile phase. Interfering substances in tissue extracts were removed by gel filtration on centrifugally-eluted mini-columns of Sephadex G-25 prior to incubation of polyglutamate substrate with tissue extract hydrolase. Reactions were terminated by denaturation of the enzyme in sodium dodecyl sulfate, which subsequently served as the micellar solvent system for chromatographic separation of substrate from reaction products.