The American College of Medical Toxicology Annual Scientific Meeting: A Look Back and the Path Forward.

More than 20 years that have elapsed since the inaugural American College of Medical Toxicology Spring Conference in 2002. During this time, the now ACMT Annual Scientific Meeting has grown in many ways, as demonstrated by the increase in attendance and abstract submissions, and diversification of educational offerings, and partners. Most importantly, the scientific rigor and presentation of new knowledge has continued to mature, and the conference is now firmly rooted in the annual educational schedule for medical toxicologists. In anticipation of the upcoming 2025 ASM, we reflect upon the evolution and growth of ACMT's research and educational agendas, and the Annual Scientific Meeting itself.

American College of Medical Toxicology Research Agenda 2024-2030.

ACMT recognizes the pivotal role of high-quality research in advancing medical science. As such, the establishment of a formal research agenda for ACMT is a leap forward in communicating the priorities of the College, its members, and the patient populations we serve. This thoughtfully crafted agenda will serve as a strategic compass for ACMT, guiding our pursuit of scientific discovery, fostering innovation, and enhancing outcomes for patients and communities affected by poisonings and exposures.

The Automatic Context Measurement Tool (ACMT) to Compile Participant-Specific Built and Social Environment Measures for Health Research: Development and Usability Study.

BACKGROUND: The environment shapes health behaviors and outcomes. Studies exploring this influence have been limited to research groups with the geographic information systems expertise required to develop built and social environment measures (eg, groups that include a researcher with geographic information system expertise). OBJECTIVE: The goal of this study was to develop an open-source, user-friendly, and privacy-preserving tool for conveniently linking built, social, and natural environmental variables to study participant addresses. METHODS: We built the automatic context measurement tool (ACMT). The ACMT comprises two components: (1) a geocoder, which identifies a latitude and longitude given an address (currently limited to the United States), and (2) a context measure assembler, which computes measures from publicly available data sources linked to a latitude and longitude. ACMT users access both of these components using an RStudio/RShiny-based web interface that is hosted within a Docker container, which runs on a local computer and keeps user data stored in local to protect sensitive data. We illustrate ACMT with 2 use cases: one comparing population density patterns within several major US cities, and one identifying correlates of cannabis licensure status in Washington State. RESULTS: In the population density analysis, we created a line plot showing the population density (x-axis) in relation to distance from the center of the city (y-axis, using city hall location as a proxy) for Seattle, Los Angeles, Chicago, New York City, Nashville, Houston, and Boston with the distances being 1000, 2000, 3000, 4000, and 5000 m. We found the population density tended to decrease as distance from city hall increased except for Nashville and Houston, 2 cities that are notably more sprawling than the others. New York City had a significantly higher population density than the others. We also observed that Los Angeles and Seattle had similarly low population densities within up to 2500 m of City Hall. In the cannabis licensure status analysis, we gathered neighborhood measures such as age, sex, commute time, and education. We found the strongest predictive characteristic of cannabis license approval to be the count of female children aged 5 to 9 years and the proportion of females aged 62 to 64 years who were not in the labor force. However, after accounting for Bonferroni error correction, none of the measures were significantly associated with cannabis retail license approval status. CONCLUSIONS: The ACMT can be used to compile environmental measures to study the influence of environmental context on population health. The portable and flexible nature of ACMT makes it optimal for neighborhood study research seeking to attribute environmental data to specific locations within the United States.

Extracorporeal Membrane Oxygenation (ECMO) for Severe Toxicological Exposures: Review of the Toxicology Investigators Consortium (ToxIC).

Although there have been many developments related to specific strategies for treating patients after poisoning exposures, the mainstay of therapy remains symptomatic and supportive care. One of the most aggressive supportive modalities is extracorporeal membrane oxygenation (ECMO). Our goal was to describe the use of ECMO for toxicological exposures reported to the American College of Medical Toxicology (ACMT) Toxicology Investigators Consortium (ToxIC). We performed a retrospective review of the ACMT ToxIC Registry from January 1, 2010 to December 31, 2013. Inclusion criteria included patients aged 0 to 89 years, evaluated between January 2010 through December 2013, and received ECMO for toxicological exposure. There were 26,271 exposures (60 % female) reported to the ToxIC Registry, 10 (0.0004 %) received ECMO: 4 pediatric (< 12 years), 2 adolescent (12-18 years), and 4 adults (>18 years). Time of initiation of ECMO ranged from 4 h to 4 days, with duration from 15 h to 12 days. Exposures included carbon monoxide/smoke inhalation (2), bitter almonds, methanol, and several medications including antihistamines (2), antipsychotic/antidepressant (2), cardiovascular drugs (2), analgesics (2), sedative/hypnotics (2), and antidiabetics (2). Four ECMO patients received cardiopulmonary resuscitation (CPR) during their hospital course, and the overall survival rate was 80 %. ECMO was rarely used for poisoning exposures in the ACMT ToxIC Registry. ECMO was utilized for a variety of ages and for pharmaceutical and non-pharmaceutical exposures. In most cases, ECMO was administered prior to cardiovascular failure, and survival rate was high. If available, ECMO may be a valid treatment modality.

The crystal structure of an isopenicillin N synthase complex with an ethereal substrate analogue reveals water in the oxygen binding site.

Isopenicillin N synthase (IPNS) is a non-heme iron oxidase central to the biosynthesis of ß-lactam antibiotics. IPNS converts the tripeptide δ-(L-α-aminoadipoyl)-L-cysteinyl-D-valine (ACV) to isopenicillin N while reducing molecular oxygen to water. The substrate analogue δ-(L-α-aminoadipoyl)-L-cysteinyl-O-methyl-D-threonine (ACmT) is not turned over by IPNS. Epimeric δ-(L-α-aminoadipoyl)-L-cysteinyl-O-methyl-D-allo-threonine (ACmaT) is converted to a bioactive penam product. ACmT and ACmaT differ from each other only in the stereochemistry at the ß-carbon atom of their third residue. These substrates both contain a methyl ether in place of the isopropyl group of ACV. We report an X-ray crystal structure for the anaerobic IPNS:Fe(II):ACmT complex. This structure reveals an additional water molecule bound to the active site metal, held by hydrogen-bonding to the ether oxygen atom of the substrate analogue.