Cluster of Nontoxigenic Corynebacterium diphtheriae Infective Endocarditis and Rising Background C. diphtheriae Cases-Seattle, Washington, 2020-2023.

BACKGROUND: Nontoxigenic Corynebacterium diphtheriae, often associated with wounds, can rarely cause infective endocarditis (IE). Five patients with C. diphtheriae IE were identified within 12 months at a Seattle-based hospital system. We reviewed prior C. diphtheriae-positive cultures to determine if detections had increased over time and evaluated epidemiologic trends. METHODS: We conducted a formal electronic health record search to identify all patients aged ≥18 years with C. diphtheriae detected in a clinical specimen (ie, wound, blood, sputum) between 1 September 2020 and 1 April 2023. We collected patient demographics, housing status, comorbidities, substance-use history, and level of medical care required at detection. We extracted laboratory data on susceptibilities of C. diphtheriae isolates and on other pathogens detected at the time of C. diphtheriae identification. RESULTS: Between 1 September 2020 and 1 April 2023, 44 patients (median age, 44 years) had a C. diphtheriae-positive clinical culture, with most detections occurring after March 2022. Patients were predominantly male (75%), White (66%), unstably housed (77%), and had a lifetime history of injecting drugs (75%). Most C. diphtheriae-positive cultures were polymicrobial, including wound cultures from 36 (82%) patients and blood cultures from 6 (14%) patients, not mutually exclusive. Thirty-four patients (77%), including all 5 patients with C. diphtheriae IE, required hospital admission for C. diphtheriae or a related condition. Of the 5 patients with IE, 3 died of IE and 1 from COVID-19. CONCLUSIONS: Findings suggest a high-morbidity outbreak disproportionately affecting patients who use substances and are unstably housed.

Genomic, functional and structural analyses elucidate evolutionary innovation within the sea anemone 8 toxin family.

BACKGROUND: The ShK toxin from Stichodactyla helianthus has established the therapeutic potential of sea anemone venom peptides, but many lineage-specific toxin families in Actiniarians remain uncharacterised. One such peptide family, sea anemone 8 (SA8), is present in all five sea anemone superfamilies. We explored the genomic arrangement and evolution of the SA8 gene family in Actinia tenebrosa and Telmatactis stephensoni, characterised the expression patterns of SA8 sequences, and examined the structure and function of SA8 from the venom of T. stephensoni. RESULTS: We identified ten SA8-family genes in two clusters and six SA8-family genes in five clusters for T. stephensoni and A. tenebrosa, respectively. Nine SA8 T. stephensoni genes were found in a single cluster, and an SA8 peptide encoded by an inverted SA8 gene from this cluster was recruited to venom. We show that SA8 genes in both species are expressed in a tissue-specific manner and the inverted SA8 gene has a unique tissue distribution. While the functional activity of the SA8 putative toxin encoded by the inverted gene was inconclusive, its tissue localisation is similar to toxins used for predator deterrence. We demonstrate that, although mature SA8 putative toxins have similar cysteine spacing to ShK, SA8 peptides are distinct from ShK peptides based on structure and disulfide connectivity. CONCLUSIONS: Our results provide the first demonstration that SA8 is a unique gene family in Actiniarians, evolving through a variety of structural changes including tandem and proximal gene duplication and an inversion event that together allowed SA8 to be recruited into the venom of T. stephensoni.

Evaluation of computed tomography perfusion and angiogram use in stroke evaluation for thrombectomy at a community emergency department setting.

PURPOSE: Evaluate concordance of provider practices with clinical guidelines for thrombectomy screening in an emergency department (ED) via computed tomography perfusion and angiogram (CT-P/A). METHODS: A retrospective observational study was conducted for patients 18 years or older who received a CT-P/A of the head and neck in a US Midwestern ED between September 2019 through June 2021. Healthcare system records reviewed for patient information, CT-P/A findings, and treatment decisions. RESULTS: During study period, 68,403 patients presented to the ED with 718 (1.1%) receiving a CT-P/A. Of these patients, 105 (14.6%) were transferred to a regional facility for potential thrombectomy, with 74 (70.5%) receiving procedure, 28 (26.7%) not receiving procedure, and 3 (2.9%) with insufficient follow-up information. Of patients receiving CT-P/A, 23 met DAWN criteria for thrombectomy, with 21 (91.3%) transferred for potential thrombectomy and 20 (95.2%) receiving the procedure; in comparison, 81 patients (11.7%) did not meet all DAWN criteria and were transferred for potential thrombectomy, with 52 (64.2%) receiving procedure. Lastly, 55 patients met DEFUSE-3 criteria for thrombectomy with 49 (89.1%) being transferred for potential thrombectomy and 45 (91.8%) receiving procedure. In comparison, 53 patients who did not meet all DEFUSE-3 criteria were transferred for potential thrombectomy, with 27 (50.9%) receiving procedure. CONCLUSIONS: This study helps to understand CT-P/A usage, especially in patients that fall outside of treatment criteria in the current thrombectomy literature. Results may have value to institutions interested in using CT-P/A as a diagnostic tool as well as institutions already incorporating it in stroke assessments.

Analysis of ingestion admissions in a midsized pediatric intensive care unit.

BACKGROUND: Pediatric ingestion of toxic substances is a complicated cause of morbidity. Currently, there is limited literature on toxic ingestions resulting in pediatric intensive care unit (PICU) admissions. METHODS: A retrospective study was conducted to quantify the number and financial costs of admissions for toxic ingestion. Secondary objectives were to determine common types of ingestions and interventions as well as examine the relationship between intentional ingestion status and patient age. Data were obtained from a retrospective review of records from April 2016 through August 2018 from a PICU located in the Midwestern USA. RESULTS: There were 360 unique patient encounters used in primary analyses. Intentional ingestion and suicidal ideation documented in 72% and 54% of patients, respectively.Patients younger than nine had an 87% (95% confidence interval: 80%, 92%) lower risk for intentional ingestion. The median lengths of stay were 1.0 (interquartile range [IQR]: 1.0, 1.0) days with a median cost of $2498 (IQR: $1870, $3592) USD. There was no patient mortality identified in the sample. CONCLUSION: The types of ingestions appeared to match those of the National Poison Control Database. Lengths of stay were short and had a non-nominal cost. A greater age was associated with an increased risk of intentional ingestions.

A Functional Approach to the Assessment of Non-Suicidal Self-Injury on YouTube.

This research explores representations of non-suicidal self-injury (NSSI) on social media. The current study aims to examine the applicability of a functional model of NSSI to videos posted on YouTube by analyzing the 100 most viewed YouTube videos relating to NSSI at a point in time in 2018. Motivations for continued engagement in NSSI were examined for each content creator who posted one of the top 100 most viewed videos relating to NSSI. Categorizations of a content creator's motivation were based on Nock and Prinstein (2004) four-function model (FFM) of NSSI, in which the motivations, or functions, of NSSI are categorized by two dichotomous factors: (a) positive (i.e., involves the addition of a favorable stimulus) or negative (i.e., involves the removal of an aversive stimulus) and (b) automatic (i.e., intrapersonal) or social (i.e., interpersonal). Uploaders most endorsed automatic negative reinforcement (50%), followed by automatic positive (26%), social positive (3%), and social negative (3%). Considering the growing number of children and adolescents with near constant access to internet and social media, there may be implications for further development of safety measures for social media platforms.＿ The results of this study may be valuable for parents, health care professionals, and educators, who should be aware of available social media content relating to NSSI and consider implementing additional media-literacy and media-safety education in school curriculums and programming for children and adolescents. Furthermore, health care professional should be aware that misconceptions of NSSI may have an impact on patients' willingness to seek treatment, or the attitude with which treatment is sought.

Scaling of oscillatory kinematics and Froude efficiency in baleen whales.

High efficiency lunate-tail swimming with high-aspect-ratio lifting surfaces has evolved in many vertebrate lineages, from fish to cetaceans. Baleen whales (Mysticeti) are the largest swimming animals that exhibit this locomotor strategy, and present an ideal study system to examine how morphology and the kinematics of swimming scale to the largest body sizes. We used data from whale-borne inertial sensors coupled with morphometric measurements from aerial drones to calculate the hydrodynamic performance of oscillatory swimming in six baleen whale species ranging in body length from 5 to 25 m (fin whale, Balaenoptera physalus; Bryde's whale, Balaenoptera edeni; sei whale, Balaenoptera borealis; Antarctic minke whale, Balaenoptera bonaerensis; humpback whale, Megaptera novaeangliae; and blue whale, Balaenoptera musculus). We found that mass-specific thrust increased with both swimming speed and body size. Froude efficiency, defined as the ratio of useful power output to the rate of energy input ( Sloop, 1978), generally increased with swimming speed but decreased on average with increasing body size. This finding is contrary to previous results in smaller animals, where Froude efficiency increased with body size. Although our empirically parameterized estimates for swimming baleen whale drag were higher than those of a simple gliding model, oscillatory locomotion at this scale exhibits generally high Froude efficiency as in other adept swimmers. Our results quantify the fine-scale kinematics and estimate the hydrodynamics of routine and energetically expensive swimming modes at the largest scale.

MAGNAMWAR: an R package for genome-wide association studies of bacterial orthologs.

Summary: Here we report on an R package for genome-wide association studies of orthologous genes in bacteria. Before using the software, orthologs from bacterial genomes or metagenomes are defined using local or online implementations of OrthoMCL. These presence-absence patterns are statistically associated with variation in user-collected phenotypes using the Mono-Associated GNotobiotic Animals Metagenome-Wide Association R package (MAGNAMWAR). Genotype-phenotype associations can be performed with several different statistical tests based on the type and distribution of the data. Availability and implementation: MAGNAMWAR is available on CRAN. Contact: john_chaston@byu.edu.

A process of convergent amplification and tissue-specific expression dominates the evolution of toxin and toxin-like genes in sea anemones.

Members of phylum Cnidaria are an ancient group of venomous animals and rely on a number of specialized tissues to produce toxins in order to fulfil a range of ecological roles including prey capture, defence against predators, digestion and aggressive encounters. However, limited comprehensive analyses of the evolution and expression of toxin genes currently exist for cnidarian species. In this study, we use genomic and transcriptomic sequencing data to examine gene copy number variation and selective pressure on toxin gene families in phylum Cnidaria. Additionally, we use quantitative RNA-seq and mass spectrometry imaging to understand expression patterns and tissue localization of toxin production in sea anemones. Using genomic data, we demonstrate that the first large-scale expansion and diversification of known toxin genes occurs in phylum Cnidaria, a process we also observe in other venomous lineages, which we refer to as convergent amplification. Our analyses of selective pressure on sea anemone toxin gene families reveal that purifying selection is the dominant mode of evolution for these genes and that phylogenetic inertia is an important determinant of toxin gene complement in this group. The gene expression and tissue localization data revealed that specific genes and proteins from toxin gene families show strong patterns of tissue and developmental-phase specificity in sea anemones. Overall, convergent amplification and phylogenetic inertia have strongly influenced the distribution and evolution of the toxin complement observed in sea anemones, while the production of venoms with different compositions across tissues is related to the functional and ecological roles undertaken by each tissue type.

A qualitative assessment of a dog program for youth offenders in an adult prison.

OBJECTIVE: Dog programs occurring in prison tend to generate positive public opinion and media portrayals, yet they often lack empirical validation. This is the first study to examine the key themes that drive a dog program aimed at incarcerated youth serving time in an adult prison. DESIGN AND SAMPLE: A sample of male youth (n = 31) were provided survey questions on a rescue dog program. A grounded qualitative approach was employed with open-ended responses. RESULTS: The following themes emerged: the symbolism of the dog its role in therapy, perceptions of positive behaviors and rehabilitation, a sense of normality, and universal support by inmates. CONCLUSION: This study supports the potential for utilizing rescue dogs in therapeutic interventions in which the vulnerable inmate can discuss early trauma, interpersonal dysfunction and histories of deviance. The dog symbolized the potential for incarcerated youth to engage in discussion of sensitive topics in a safe manner. Policy implications also include the function of dogs in creating a normalizing effect on the prison unit itself, one that can promote rehabilitation. There was universal support for the program which is rare in the prison milieu. Theoretically, positive outcomes occurred in an indirect manner, though more research is needed.

Working with prisoners who self-harm: A qualitative study on stress, denial of weakness, and encouraging resilience in a sample of correctional staff.

BACKGROUND: Rates of self-harm are high among prisoners. Most research focuses on the vulnerable prisoner, and there is little on the impact of these behaviours on staff. AIMS: To investigate staff perceptions of self-harming behaviours by prisoners, including their views on its causes, manifestation, prevention in institutions, and impact on them. METHODS: Semistructured interviews were conducted with 20 administrative and 21 therapeutic prison staff who are responsible in various ways for prisoners who self-harm. Their narratives were explored using interpretative phenomenological analysis. RESULTS: Despite prison staff being experienced with prisoners' self-harming behaviours, including severe acts of self-harm, they were apt to reject any negative impact on their own mental health or well-being. This denial of negative impact was accompanied by perceptions of the inmate's actions being manipulative and attention seeking. Prison staff also perceived institutional responses to self-harming behaviours by prisoners as being mixed, ambiguous, or showing preference for relying on existing suicide protocols rather than task-specific guidance. CONCLUSIONS: Although staff gave explanations of prisoner self-harm in terms of "manipulative behaviour," prisoners' self-harm is, in fact, complex, challenging, and often severe. This staff perception may reflect denial of impact of often distressing behaviours on them personally and their own coping mechanisms. This could be feeding in to a perceived lack of clear and effective institutional responses to the self-harm, so further research is needed to determine how staff could broaden their views, and respond more effectively to prisoners. Psychologically informed group work and/or reflective practice are among the candidates for such help for staff.

Subchondroplasty of the Foot: Two Case Reports.

Early avascular necrosis of metatarsal heads and cuboid injuries are uncommon conditions encountered by foot and ankle specialists. Treatment options are limited and typically include long periods of offloading or non-weightbearing. There is limited published information on alternative treatment approaches for such pathologies when conservative therapies fail. Presented are 2 patient cases treated with a percutaneous calcium phosphate injection after failure of standard therapy, persistent pain, and bone marrow edema in the foot.

Treatment of Hallux Varus After Traumatic Adductor Hallucis Tendon Rupture.

Hallux varus is a deformity of acquired and less commonly congenital etiologies. It can present secondary to the release of the soft tissues surrounding the first metatarsophalangeal joint surfaces during bunion surgery. If the condition is left untreated, it can be debilitating, with progressive pain and destruction of joint surfaces. Many procedures have been described for the treatment of iatrogenic causes of hallux varus; however, little has been reported regarding the success of procedures when used for less typical traumatic causes. In the present report, a case is presented of surgical repair of a traumatic hallux varus using a suture and button fixation device and 3-year patient follow-up data.

Overdoses and Substance Toxicity in Patients Admitted to Intensive Care Units in a Midwestern U.S. City.

Toxic exposures with serious outcomes have increased over the last decade. Limited data exists on the pattern and outcomes of overdose-exposure patients requiring intensive care unit (ICU) admission. The primary objective of this study was to characterize the causes, treatments, and outcomes of toxic exposures in a mid-sized Midwestern health system. The secondary objective was to report cumulative economic costs associated with these patients. Data were obtained from medical records of patients 18 years or older with a diagnosis code of overdose admitted to the ICU at 2 teaching hospitals between August 1, 2012, and July 31, 2014. There were 470 (10%) of the 4,495 total ICU admissions that met inclusion criteria during the study period. Average patient age was 39 (SD = 14.2) years, with 64% females. Intentional overdose exposure was the cause of 87% of admissions. The majority (70%) of exposures involved multiple pharmacological agents, including ethanol. Most patients did not require therapeutic maneuvers, nor used decontamination methods. Primary substance classes included analgesics, benzodiazepines, ethanol, selective serotonin reuptake inhibitor antidepressants, and methamphetamine. Two hundred sixty-five (56%) patients were ICU to direct home discharges, whereas 198 (42%) were transferred to a lower level of care. The mortality rate in the sample was 1%. Average hospital charges per admission were $20,375 and average ICU charges were $5,284, which summed to more than $2 million in total charges. Causes, treatments, and outcomes of toxic exposures admitted to the ICU in a mid-sized Midwestern city reveal a potential ICU burden. Financial health care costs associated with these toxic exposures were substantial. Greater public health efforts are needed to attempt to minimize preventable admissions and better understand antecedents.

Evaluation of Fixation Techniques for Metatarsocuneiform Arthrodesis.

First metatarsocuneiform joint arthrodesis has been used in foot and ankle surgery for the treatment of hallux abductovalgus deformity, among other pedal pathologic entities. The goal of the present retrospective study was to compare the fusion rates and complications of an intraplate compression screw fixation, crossing solid core screw fixation, and a single interfragmentary screw with a simple locking plate. All procedures were performed by a single surgeon, and all patients received an identical postoperative protocol. A medical record review was performed of 147 evenly distributed surgical methods. All patients were non-weightbearing by protocol for 4 weeks. The patient covariates included sex, age, nicotine status, osteoporosis, and diabetes. These variables were balanced among the treatment groups and were noncontributory, with the exception of sex. Male patients had a 6 times greater odds of experiencing nonunion. The overall nonunion rate was 6.7%, with 4% symptomatic and requiring revision. The individual nonunion rates for each method were 2% for intraplate compression screw fixation, 5% for single interfragmentary screw with locking plate fixation, and 9% for crossing solid core screw fixation. None of the differences reached statistical significance. The corresponding hardware removal rates were 12%, 11%, and 0%.

Influence of clinical and pathologic features on the pathologist's diagnosis of mycosis fungoides: a pilot study.

Although clinicopathologic correlation is critical in the diagnosis of early mycosis fungoides (MF), how clinical information directly affects the pathologist's interpretation is unknown. This pilot study aimed to assess the influence of provided clinical information and specific histopathologic features on the histopathologic diagnosis of MF vs. its inflammatory simulants. A computerized survey recorded diagnostic impressions by 24 dermatopathologists of 30 hematoxylin-eosin stained images, including 15 MF images and 15 dermatitis images. Images were accompanied by concordant clinical descriptions (33%), no clinical information (33%) or discordant clinical descriptions (33%). Percentage of correctly classified MF histopathologic images for the three scenarios of concordant clinical information, no clinical information or discordant clinical information were 32% (kappa 0.19), 56% (kappa 0.12) and 16% (kappa 0.33), respectively. The percentage of correctly classified slides presented with no clinical information was different from the other two groups (p < 0.0001). Pautrier collections were most associated with correct classification. Clinical information may play a significant role in the histopathologic diagnosis of MF, although there may be some value in initial blinded histopathologic interpretation. Specific histopathologic features differ in relative importance in the diagnosis of MF.

Evaluation and treatment of depression in adult trauma patients.

A retrospective study examined in-hospital antidepressant medication (ADM) use in adult trauma patients with an intensive care unit stay of 5 or more days. One fourth of patients received an ADM, with only 33% of those patients having a documented history of depression. Of patients who received their first ADM from a trauma or critical care physician, only 5% were discharged with a documented plan for psychiatric follow-up. The study identified a need for standardized identification and management of depressive symptoms among trauma patients in the inpatient setting.

Surgical correction of checkrein deformity after malunited distal tibia fracture: a case report.

Checkrein deformities are rare and involve entrapment or tethering of the flexor hallucis longus and, occasionally, flexor digitorum longus tendons. The deformity has typically been secondary to traumatic fractures of the talus, calcaneus, or deep posterior compartment syndrome resulting from fractures of the tibia and fibula and most fractures of the ankle. These result in flexion contractures at the interphalangeal joint of the hallux. Because of the rarity of this deformity, no single surgical technique has been defined as the standard. Previous interventions have included release of adhesions with or without Z-plasty lengthening of the involved tendons. The present study reports a case of checkrein deformity secondary to a malunited distal tibia fracture, with flexion deformities to digits 1 through 3. The patient underwent successful surgical correction with flexor tenotomies to the affected digits with interphalangeal arthrodesis to the hallux.