Increased recognition of Q fever aortitis as a chronic manifestation of Q fever in tropical North Queensland, Australia.

Aortitis is a life-threatening, manifestation of chronic Q fever. We report a series of 5 patients with Q fever aortitis who have presented to our hospital in tropical Australia since 2019. All diagnoses were confirmed with polymerase chain reaction (PCR) testing of aortic tissue. Only one had a previous diagnosis of acute Q fever, and none had classical high-risk exposures that might increase clinical suspicion for the infection. All patients underwent surgery: one died and 3 had significant complications. Q fever aortitis may be underdiagnosed; clinicians should consider testing for Coxiella burnetii in people with aortic pathology in endemic areas.

Candida dubliniensis chronic meningitis in an immunocompetent patient: Case report and literature review.

Chronic meningitis due to Candida species is a rare presentation generally associated with immunocompromise. We present a case of chronic meningitis due to Candida dubliniensis in an immunocompetent systemically well man who presented with 32 months of headache and visual changes. This is the fourth reported case in an immunocompetent patient. Injecting drug use was identified as a risk factor in all cases which presented similarly, with prolonged headache and papilloedema. A significant delay to diagnosis is common to all the reported cases. Candidal chronic meningitis in immunocompetent patients may be underdiagnosed due to lack recognition of risk factors, timely cerebrospinal fluid sampling and appropriate culture.

Long-Term Care Planning, Preparedness, and Response Among Rural Long-Term Care Providers.

OBJECTIVE: Rural Long-term Care (LTC) providers face unique challenges when planning, preparing for, and responding to disasters. We sought to better understand challenges and identify best practices for LTC in rural areas. METHODS: Case studies including key informant interviews and site visits were conducted with LTC staff and emergency planning, preparedness, and response partners in three rural communities. Themes were identified across sites using inductive coding. RESULTS: Communication across disaster phases continues to be a challenge for LTC providers in rural communities for all disaster types. Communication challenges limit LTC providers' ability to address patient needs during emergencies and limit the resilience of providers and patients to future disasters. Limited coordination among local leadership and LTC providers prevents dissemination of information, resources, and services, and slows response and recovery time. Including LTC providers as stakeholders in planning and exercises may improve communication and coordination. CONCLUSION: More than two decades into efforts to increase preparedness of health care systems to all hazards, rural LTC facilities still face challenges related to communication and coordination. Agencies at the federal, state, and local level should include input from rural LTC stakeholders to address gaps in communication and coordination and increase their disaster resilience.

Modeling the Early Stages of Phase Separation in Disordered Elastin-like Proteins.

Elastin-like proteins (ELPs) are known to undergo liquid-liquid phase separation reversibly above a concentration-dependent transition temperature. Previous studies suggested that, as temperature increases, ELPs experience an increased propensity for type II ß-turns. However, how the ELPs behave below the phase transition temperature itself is still elusive. Here, we investigate the importance of ß-turn formation during the early stages of ELP self-association. We examined the behavior of two ELPs, a 150-repeat construct that had been investigated previously (ELP[V5G3A2-150] as well as a new 40-repeat construct (ELP40) suitable for nuclear magnetic resonance measurements. Structural analysis of ELP40 reveals a disordered conformation, and chemical shifts throughout the sequence are insensitive to changes in temperature over 20°C. However, a low population of ß-turn conformation cannot be ruled out based on chemical shifts alone. To examine the structural consequences of ß-turns in ELPs, a series of structural ensembles of ELP[V5G3A2-150] were generated, incorporating differing amounts of ß-turn bias throughout the chain. To mimic the early stages of the phase change, two monomers were paired, assuming preferential interaction at ß-turn regions. This approach was justified by the observation that buried hydrophobic turns are commonly observed to interact in the Protein Data Bank. After dimerization, the ensemble-averaged hydrodynamic properties were calculated for each degree of ß-turn bias, and the results were compared with analytical ultracentrifugation experiments at various temperatures. We find that the temperature dependence of the sedimentation coefficient (s20,wo) can be reproduced by increasing the ß-turn content in the structural ensemble. This analysis allows us to estimate the presence of ß-turns and weak associations under experimental conditions. Because disordered proteins frequently exhibit weak biases in secondary structure propensity, these experimentally-driven ensemble calculations may complement existing methods for modeling disordered proteins generally.