Transformed Waldenström Macroglobulinemia Responsive to Tafasitamab Plus Lenalidomide: A Case Report.

The histologic transformation (HT) of Waldenström macroglobulinemia (WM) into diffuse large-cell lymphoma is an uncommon but poor-prognostic event for which there is no standard therapy. Knowledge of this entity is mainly derived from largely retrospective studies, which report abysmal average survival rates even with the utilization of first-line chemoimmunotherapy and especially in patients who meet the high-risk criteria based on prognostic indices used for WM. We present the case of a 75-year-old man with high-risk, transformed WM who was ineligible for standard chemoimmunotherapy (due to pancytopenia and multiple comorbidities) and was consequently treated with tafasitabmab, an anti-CD19 monoclonal antibody plus lenalidomide. Tafasitamab plus lenalidomide (TAF/LEN) is a recently approved therapy for relapsed or refractory de novo diffuse large-cell lymphoma (DLCL) but has not been previously studied in transformed low-grade lymphomas or WM. We show that TAF/LEN resulted in a complete and durable response of the DLCL by PET/CT and a complete bone marrow response of lymphoplasmacytoid cells, including the normalization of complex cytogenetic abnormalities. The extraordinary response of our patient to TAF/LEN suggests that this combination may be an effective and tolerable therapy for transformed WM as well as relapsed or refractory non-transformed WM. Clinical trials of TAF/LN for the treatment of Waldenström macroglobulinemia are recommended.

Correction: Transformed Waldenström Macroglobulinemia Responsive to Tafasitamab Plus Lenalidomide: A Case Report.

[This corrects the article DOI: 10.7759/cureus.32403.].

Seed Banks as Incidental Fungi Banks: Fungal Endophyte Diversity in Stored Seeds of Banana Wild Relatives.

Seed banks were first established to conserve crop genetic diversity, but seed banking has more recently been extended to wild plants, particularly crop wild relatives (CWRs) (e.g., by the Millennium Seed Bank (MSB), Royal Botanic Gardens Kew). CWRs have been recognised as potential reservoirs of beneficial traits for our domesticated crops, and with mounting evidence of the importance of the microbiome to organismal health, it follows that the microbial communities of wild relatives could also be a valuable resource for crop resilience to environmental and pathogenic threats. Endophytic fungi reside asymptomatically inside all plant tissues and have been found to confer advantages to their plant host. Preserving the natural microbial diversity of plants could therefore represent an important secondary conservation role of seed banks. At the same time, species that are reported as endophytes may also be latent pathogens. We explored the potential of the MSB as an incidental fungal endophyte bank by assessing diversity of fungi inside stored seeds. Using banana CWRs in the genus Musa as a case-study, we sequenced an extended ITS-LSU fragment in order to delimit operational taxonomic units (OTUs) and used a similarity and phylogenetics approach for classification. Fungi were successfully detected inside just under one third of the seeds, with a few genera accounting for most of the OTUs-primarily Lasiodiplodia, Fusarium, and Aspergillus-while a large variety of rare OTUs from across the Ascomycota were isolated only once. Fusarium species were notably abundant-of significance in light of Fusarium wilt, a disease threatening global banana crops-and so were targeted for additional sequencing with the marker EF1α in order to delimit species and place them in a phylogeny of the genus. Endophyte community composition, diversity and abundance was significantly different across habitats, and we explored the relationship between community differences and seed germination/viability. Our results show that there is a previously neglected invisible fungal dimension to seed banking that could well have implications for the seed collection and storage procedures, and that collections such as the MSB are indeed a novel source of potentially useful fungal strains.

The transformation of health care for patients: Information and communication technology, digiceuticals, and digitally enabled care.

The way patients access care and interact with health care systems is rapidly changing through the use of information and communication technology (ICT). Health care is being transformed through digital innovations, such as wearable technology, remote monitoring, patient portals, mobile applications (apps), and new service models such as telemedicine and virtual visits. Through a review of the current literature, this article presents the use of digitally enabled tools and ICT, including electronic health records, telehealth, remote patient monitoring, and mobile health apps. These effective and innovative digitally enabled tools have expanded options for patients interested in actively engaging in their own health. Information and communication technology can improve health outcomes, enhance the patient experience, and curtail costs. Providers must stay fluent with ICT options to best collaborate with patients. Although providers recognize that patient-centered care can improve effectiveness and efficiency, many have been slow to incorporate digital therapeutics, or "digiceuticals," into practice.

Development of a Course on Complex Humanitarian Emergencies: Preparation for the Impact of Climate Change.

PURPOSE: The effects of climate change are far-reaching and multifactorial, with potential impacts on food security and conflict. Large population movements, whether from the aftermath of natural disasters or resulting from conflict, can precipitate the need for humanitarian response in what can become complex humanitarian emergencies (CHEs). Nurses need to be prepared to respond to affected communities in need, whether the emergency is domestic or global. The purpose of the article is to describe a novel course for nursing students interested in practice within the confines of CHEs and natural disasters. METHODS AND FRAMEWORK: The authors used the Sphere Humanitarian Charter and Minimum Standards as a practical framework to inform the course development. They completed a review of the literature on the interaction on climate change, conflict and health, and competencies related to working CHEs. Resettled refugees, as well as experts in the area of humanitarian response, recovery, and mitigation from the Centers for Disease Control and Prevention and nongovernmental organizations further informed the development of the course. CLINICAL RELEVANCE: This course prepares the nursing workforce to respond appropriately to large population movements that may arise from the aftermath of natural disasters or conflict, both of which can comprise a complex humanitarian disaster. Using The Sphere Project e-learning course, students learn about the Sphere Project, which works to ensure accountability and quality in humanitarian response and offers core minimal standards for technical assistance. These guidelines are seen globally as the gold standard for humanitarian response and address many of the competencies for disaster nursing (http://www.sphereproject.org/learning/e-learning-course/).

Strategies to Enhance Success Among Dual-Specialty Students in Advanced Practice Nursing Programs.

BACKGROUND: In attempts to simultaneously address the 2008 Consensus model and meet the growing need for advanced practice nurses with a robust scope of practice, some schools of nursing offer dual advanced practice nursing (APN) programs. METHOD: Built on the successes of multiple dual programs at two universities, this article provides specific practice strategies to enhance academic success among students and faculty in dual-specialty APN programs. RESULTS: Faculty- and student-led strategies are outlined, addressing the academic and professional aspects of the dual APN role. With implementation of these strategies, graduation and subsequent dual certification rates in these programs remains extremely high. CONCLUSION: Adaptation of these strategies to support student and faculty efforts can potentiate additional opportunities for successful dual APN programs. [J Nurs Educ. 2016;55(8):463-466.

Nursing and complex humanitarian emergencies: Ebola is more than a disease.

To effectively address the Ebola outbreak in West Africa, it must be viewed in terms of the connections between health, politics, security, the environment, and poverty. For the people in the countries involved and those responding, it is more than the viral illness. Although the medical management of the disease is far from simple, it is really only the proximal event of much greater social upheaval in the region, creating what is known as a complex humanitarian emergency (CHE). This article describes a course to introduce nursing students to CHEs and the role of nurses in the field of global response. CHEs are becoming more frequent with high death and disease rates. Nurses must become familiar with their complexity and multifaceted response. Although the planning for the course predated the current epidemic, the Ebola outbreak in West Africa served as an excellent exemplar for the health sector response in CHEs.

An innovative approach to enhance dermatology competencies for advanced practice nurses: service­learning with a migrant farm worker health clinic.

The purpose of this article is to describe a novel service­learning opportunity for graduate nursing students that promotes competency in dermatology. A hybrid service­learning course with online didactic content is described, along with tools for evaluation of dermatology competencies. Student evaluation of the course is discussed, and selected research articles are reviewed. Advanced practice nursing and medical education frequently does not adequately prepare primary care providers to be competent in the assessment and management of dermatologic conditions. Embedding dermatology content in a service­learning program can optimize the provision of care, strengthen competencies in dermatology and inter-professional care, and allow students to gain a deeper understanding of the population with which they work. The innovative service­learning program presented is a model for advanced practice nursing education. Tools for evaluating clinical competency and courses often need validation.

Nightingale theory and intentional comfort touch in management of tinea pedis in vulnerable populations.

Vulnerable populations, specifically migrant farm workers and persons experiencing homelessness, are often at an increased risk for foot infections. This risk is related to their working and living conditions, socioeconomic status, limited access to health care, frequent exposure to wet environments, limited access to clean and dry socks and shoes, bathing or laundry facilities, and daily routines that requires them to be on their feet for long periods of time. After years of caring for these populations and hundreds of clinical encounters, an evidence-based, effective method of foot care that incorporates intentional comfort touch has been developed. This article describes methods for mitigating the severity of fungal growth, decreasing the risk of secondary infections, and improving skin integrity by manipulating the micro-environment of the patients' feet. This includes fundamental aspects of hygiene as described by Florence Nightingale's Environmental Theory that suggests that direct sunlight, fresh air, and cleanliness improves health.

"We never used to do things this way": behavioral health care reform in New Mexico.

This column describes the first year of efforts in New Mexico to reform the behavioral health system. The process, guided by principles of cultural exchange theory, seeks to establish a "collaborative culture" among all stakeholders involved, including state agencies, consumers, families, advocates, and providers. Challenges have included inadequate system funding; insufficient development of skill sets among state personnel; underestimation of time and labor needed to address complex tasks; varying federal statutory and funder requirements for individual agencies; lack of a solid infrastructure for data collection, management, and dissemination; and clear definitions of the roles and relationships of local stakeholders to the state leadership group.