Tufts University

Antibiotic resistance is one of the greatest public health challenges of our time. International efforts to curb resistance have largely focused on drug development and limiting unnecessary antibiotic use. However, in areas where water, sanitation, and hygiene infrastructure is lacking, we propose that bacterial flow between humans and animals can exacerbate the emergence and spread of resistant pathogens. Here, we describe the consequences of poor environmental controls by comparing mobile resistance elements among Escherichia coli recovered from humans and meat in Cambodia, a middle-income country with substantial human–animal connectivity and unregulated antibiotic use. We identified identical mobile resistance elements and a conserved transposon region that were widely dispersed in both humans and animals, a phenomenon rarely observed in high-income settings. Our findings indicate that plugging leaks at human–animal interfaces should be a critical part of addressing antibiotic resistance in low- and especially middle-income countries.

The recent publication of practice guidelines for management of patients with disorders of consciousness (DoC) in the United States and Europe was a major step forward in improving the accuracy and consistency of terminology, diagnostic criteria, and prognostication in this population. There remains a pressing need for a more precise brain injury classification system that combines clinical semiology with neuroimaging, electrophysiologic, and other biomarker data. To address this need, the National Institute of Neurological Disorders and Stroke launched the Common Data Elements (CDEs) initiative to facilitate systematic collection of high-quality research data in studies involving patients with neurological disease. The Neurocritical Care Society’s Curing Coma Campaign expanded this effort in 2018 to develop CDEs for DoC. Herein, we present CDE recommendations for behavioral phenotyping of patients with DoC. The Behavioral Phenotyping Workgroup used a preestablished, five-step process to identify and select candidate CDEs that included review of existing National Institute of Neurological Disorders and Stroke CDEs, nomination and systematic vetting of new CDEs, CDE classification, iterative review, and approval of panel recommendations and development of corresponding case review forms. We identified a slate of existing and newly proposed basic, supplemental, and exploratory CDEs that can be used for behavioral phenotyping of adult and pediatric patients with DoC. The proposed behavioral phenotyping CDEs will assist with international harmonization of DoC studies and allow for more precise characterization of study cohorts, favorably impacting observational studies and clinical trials aimed at improving outcome in this population.

https://www.jmra.in/article-details/19951

Ancient glass objects typically show distinctive effects of deterioration as a result of environmentally induced physicochemical transformations of their surface over time. Iridescence is one of the distinctive signatures of aging that is most commonly found on excavated glass. In this work, we present an ancient glass fragment that exhibits structural color through surface weathering resulting in iridescent patinas caused by silica reprecipitation in nanoscale lamellae. This archaeological artifact reveals an unusual hierarchically assembled photonic crystal with extremely ordered nanoscale domains, high spectral selectivity, and reflectivity (~90%), that collectively behaves like a gold mirror. Optical characterization paired with nanoscale elemental analysis further underscores the high quality of this structure providing a window into this sophisticated natural photonic crystal assembled by time.

Morality seems to play a special role in human life distinct from conventional norms, like those of etiquette, or simple preferences based on subjective tastes. There are various theories of the foundations of morality, some of which treat morality as “subjective” in an important way. “Moral realism” is, however, a family of theories that take morality to have an objective factual basis, such that morality is not “up to us” and is not “under our control.” The twenty-five chapters in the volume, as well as the introduction by the editors, explore the central ideas and themes constituting moral realism and defend particular views about it. The volume is divided into four parts: “About Moral Realism and its Varieties,” “Naturalism,” “Non-naturalism,” and “Neither Naturalism Nor Non-Naturalism.”

We present a case series of four patients with systemic sclerosis and skeletal myopathy. While idiopathic inflammatory myopathies, or myositis, are thought to be the most common type of muscle disease seen in systemic sclerosis, we highlight four cases where unique clinical findings and careful assessment ruled out myositis mimics. Key diagnostic tools that can be helpful for clinicians to diagnose a neuromuscular disease are also detailed in this report.

This essay provides commentary on the five articles collected for this special issue of Interest Groups & Advocacy on “Interest Groups in U.S. Local Politics.” There are many strengths to be found in these articles but two stand out: first, the articles focus on central issues of contemporary urban society; and second, these works offer a rich mix of methodological approaches to studying city politics. Overall, these articles are notably imaginative and highly original. I offer further analysis by placing them in the broader context of ongoing research on organized interests. In turn, I discuss the low barrier to entry for urban interest groups, mobilization and citizen participation in city policymaking, and how the politics of place distinguishes urban advocacy from Washington lobbying.

Background Indications for removal of syndesmotic screws are not fully elucidated. This study aimed to determine factors related to elective syndesmotic screw removal. Methods Patients who underwent fixation of ankle syndesmotic injuries were included. Screw removal was offered after a minimum of 12 weeks after surgery for pain, stiffness or patient desire to remove painful or broken hardware. Patient demographics, surgical data, distance of the syndesmotic screw from the joint, location of the screw at the physeal scar, and number of syndesmotic screws placed were collected for all patients. Bivariate and multivariate analyses were performed to determine the relationship between patient characteristics and screw removal and independent predictors of hardware removal. Results Of 160 patients, 60 patients (38%) with an average age of 36.1 (range: 18-84) years underwent elective syndesmotic screw removal at a mean of 7 (range, 3-47) months after initial fixation. The most common reason for screw removal (50/60 patients) was ankle stiffness and pain (83%). Patients who underwent screw removal were more likely to be younger (36.1 years ± 13.0 vs 46.6 years ± 18.2, P < .001) and have a lower ASA score (2 ± 0.8 vs 2.1 ± 0.7, P = .003) by bivariate analysis. Of patients who underwent screw removal, 21.7% (13/60) had a broken screw at the time of removal. Whether the screw was placed at the physeal scar was not significantly associated with patient decision for hardware removal ( P = .80). Conclusion Younger and healthier patients were more likely to undergo elective removal of syndesmotic hardware. Screw distance from joint and screw placement at the physeal scar were not significantly associated with hardware removal. Level of Evidence Level III, retrospective cohort study.

The frequency of invasive fungal infections has risen dramatically in recent decades, mostly because of a larger population of at-risk patients who are immunocompromised, neutropenic, or critically ill. For clinicians evaluating these patients, it has become increasingly important to make the diagnosis early so that timely antifungal therapy can be instituted. While histopathology and culture for the causative fungus are required for a definitive diagnosis, adequate tissue samples from protected anatomical sites are not always available and culture may lack sensitivity and require several weeks for results to become available. Thus, immunodiagnosis has become an important adjunctive strategy to diagnose most of the clinically relevant fungi. Many immunodiagnostic methods have been developed and generally target three important aspects of the infection: host antibody, fungal antigen, and fungal metabolites. This chapter outlines the available immunologic tests according to what component of the invading pathogen or host immune response they target and provides some discussion of their strengths and weaknesses. In addition to a review of pan-fungal testing using 1,3-β-D-glucan, the discussion is focused on the following diseases: invasive candidiasis, invasive aspergillosis, cryptococcosis, histoplasmosis, blastomycosis, coccidioidomycosis, and paracoccidioidomycosis. Recommendations for utilizing the currently available immunodiagnostic tests are discussed for individual fungal species and specific disease manifestations.

Aspergillosis is caused by Aspergillus, a hyaline mold responsible not only for invasive aspergillosis but also a variety of noninvasive or semi-invasive conditions. These syndromes range from colonization to allergic responses to Aspergillus, including allergic bronchopulmonary aspergillosis (ABPA), to semi-invasive or invasive infections, spanning a spectrum from chronic necrotizing pneumonia to invasive pulmonary aspergillosis.

Justin Clarke-Doane offers what purports to be a stand-alone argument, relying on Gödel’s second incompleteness theorem, that if we hold that PA + Con(PA) and PA + ~ Con(PA) are equally true of their intended subjects, then there is no objective fact as to whether PA is consistent. It is shown that the argument is fallacious, although illuminating: The fallaciousness of the argument arises from a 20th-century shift in our understanding of interpreted languages from the view—derived from our experience of language—of sentences as intrinsically interpreted to one which sharply distinguishes syntax and semantics, and treats uninterpreted syntactic forms as endowed with interpretations by models. It is shown that this syntax/semantic distinction, because it is “unintuitive” induces fallacies such as the one that Clarke-Doane’s argument exemplifies.

For thousands of years, humans have enjoyed the novel flavors, increased shelf-life, and nutritional benefits that microbes provide in fermented foods and beverages. Recent sequencing surveys of ferments have mapped patterns of microbial diversity across space, time, and production practices. But a mechanistic understanding of how fermented food microbiomes assemble has only recently begun to emerge. Using three foods as case studies (surface-ripened cheese, sourdough starters, and fermented vegetables), we use an ecological and evolutionary framework to identify how microbial communities assemble in ferments. By combining in situ sequencing surveys with in vitro models, we are beginning to understand how dispersal, selection, diversification, and drift generate the diversity of fermented food communities. Most food producers are unaware of the ecological processes occurring in their production environments, but the theory and models of ecology and evolution can provide new approaches for managing fermented food microbiomes, from farm to ferment.

Introduction Patients with inflammatory bowel diseases (IBD) commonly require analgesic medications to treat pain, which may be associated with complications. We examined trends of analgesic use according to age of IBD onset. Methods This nationwide cohort study included adults diagnosed with IBD between 1996-2021 in Denmark. Patients were stratified according to their age of IBD onset: 18-39 years (young adult), 40-59 years (adult), and 60+ years (older adult). We examined the proportion of patients who received prescriptions for analgesic medications within 1 year after IBD diagnosis: strong opioids, tramadol, codeine, non-steroidal anti-inflammatory drugs (NSAIDs), and paracetamol. Multivariable logistic regression was performed to examine the association between age of IBD onset with strong opioid prescriptions and the composite of strong opioid/tramadol/codeine prescriptions. Results We identified 54,216 adults with IBD. Among these, 25,184 (46.5%) were young adults, 16,106 (29.7%) were adults, and 12,926 (23.8%) were older adults at IBD onset. Older adults most commonly received analgesic prescriptions of every class. Between 1996-2021, strong opioid, tramadol, and codeine prescriptions were stable while paracetamol prescriptions increased and NSAID prescriptions decreased. After multivariable logistic regression, older adults had higher adjusted odds of receiving strong opioid prescriptions (aOR 1.95, 95%CI 1.77-2.15) and the composite of strong opioid/tramadol/codeine prescriptions (aOR 1.93, 95%CI 1.81-2.06) within 1 year after IBD diagnosis compared to adults. Discussion In this nationwide cohort, older adults most commonly received analgesic prescriptions within 1 year after IBD diagnosis. Additional research is needed to examine the etiology and sequelae of increased analgesic prescribing to this demographic.

Background Older adults with Heart Failure (HF) and their spouse/partner experience significant negative impact on their health and relationship. Yet, few interventions focus on the HF couple. Informed by the Theory of Dyadic Illness Management, the Taking Care of Us© (TCU) intervention was designed to improve illness collaboration, communication, and confidence within older couples living with HF. Methods A randomised controlled trial was used to explore this early-phase psychosocial intervention in comparison to an education attention-control condition. Both programs were delivered virtually over two months to couples in the United States. Thirty seven couples (adults with heart failure [AwHF] and their spouse/partners) were randomised (18 to TCU and 19 to attention-control) with 24 couples completing the follow-up assessment (12 couples per condition). AwHF were on average 69.9 (SD = 9.6) years of age, predominantly male (70%) and reported being in NYHA Stage II/III (73%). Between-group effect sizes are reported due to small sample. Results At follow-up, TCU AwHF reported bigger declines in dyspnoea (d = 0.66), pain interference (d = 1.23) and fatigue (d = 0.18) than the educational condition. Additionally, TCU couples reported greater improvements in collaborative HF management (d = 0.17 for AwHF; d = 0.40 for spouses), collaborative coping (d = 0.68 for AwHF; d = 0.49 for spouses), shared physical activity (d = 0.72 for AwHF), shared fun activities (d = 0.70 for AwHF; d = 0.52 for spouses), and communication as a couple (d = 0.38 for AwHF; d = 0.20 for spouses). TCU AwHF reported being more likely to reduce fluid (d = 0.35) and take a diuretic (d = 0.22) when needed; TCU spouses reported being more likely to recommend reducing salt (d = 0.37), fluid (d = 0.16), and taking a diuretic (d = 0.54) when needed. Finally, AwHF in the attention-control condition reported bigger improvements in confidence to manage HF (d = 0.18) than TCU AwHF. Conclusion Preliminary data of the TCU© program shows promise for improving collaboration, communication, and health in older couples with HF.

We prove that, given a polyhedron \({\mathcal {P}}\) in \({\mathbb {R}}^3\), every point in \({\mathbb {R}}^3\) that does not see any vertex of \({\mathcal {P}}\) must see eight or more edges of \({\mathcal {P}}\), and this bound is tight. More generally, this remains true if \({\mathcal {P}}\) is any finite arrangement of internally disjoint polygons in \({\mathbb {R}}^3\). We also prove that every point in \({\mathbb {R}}^3\) can see six or more edges of \({\mathcal {P}}\) (possibly only the endpoints of some these edges) and every point in the interior of \({\mathcal {P}}\) can see a positive portion of at least six edges of \({\mathcal {P}}\). These bounds are also tight.