Scedosporium prolificans Septic Arthritis

Scedosporium prolificans is an emerging fungal pathogen that can cause significant morbidity, and even mortality, in both immunocompromised and immunocompetent patients. Approximately 10% of patients affected by this rare fungal pathogen present with septic osteomyelitis or arthritis. Overall, the rate of mortality is close to 50%, and several patients with orthopedic infections have required amputations.1 Our patient is a 59-year-old woman, with a history of rheumatoid arthritis requiring immunosuppressants, who presented with a 5-month history of right wrist pain and swelling. She described an oscillating course of swelling, erythema, and pain involving the dorsal aspect of her wrist that did not show sustained response to antibiotics or a radiocarpal joint steroid injection given by other providers. On initial examination, she was afebrile with dorsal wrist swelling. There was no erythema, but wrist mobility was limited. She had tenderness throughout the wrist, but no fluctuance or drainage. All initial laboratory work was normal. Right wrist X-ray showed severe osteopenia with some mild evidence of cortical erosion. Despite the normal laboratory values, her presenting findings of swelling, radiographic erosions, and immunocompromised state prompted concern for atypical septic arthritis. The patient subsequently underwent wrist exploration for tissue and culture harvest. In addition to extensive wrist synovectomy, the proximal pole of the scaphoid, lunate, triquetrum, capitate, hamate, and metacarpal bases all showed evidence of necrosis that required debridement. One week later, her fluid aspirate and bone cultures unexpectedly grew an unidentified fungal species, and she was taken back to the operating room for further debridement and placement of a voriconazole-impregnated cement spacer. The culture grew pan-resistant Scedosporium prolificans, and based on recommendations from Rheumatology and Infectious Disease, the patient was started on a 6-week course of intravenous micafungin, and immunosuppressive medications were stopped. She returned to the operating room for debridement and serial treatments with polyhexamethylene biguanide (PHMB) irrigation until intraoperative tissue cultures showed no growth. PHMB is an antiseptic medication that has been described as a local adjunct to the treatment of resistant fungal infections.2–4 After successful eradication of her infection, she underwent wrist reconstruction and fusion with a double-barrel free fibula osteocutaneous flap. She is now 18 months out from her reconstruction, has healed uneventfully, and has a functional, painless upper extremity

Qualitative Criterion for Interception in a Pursuit/Evasion Game

A qualitative account is given of a differential pursuit/evasion game. A criterion for the existence of an intercept solution is obtained using future cones that contain all attainable trajectories of target or interceptor originating from an initial position. A sufficient and necessary conditon that an opportunity to intercept always exist is that, after some initial time, the future cone of the target be contained within the future cone of the interceptor. The sufficient condition may be regarded as a kind of Nash equillibrium.Comment: 8 pages; revsions and corrigend

Together, Our Voices Will Strengthen the Weaving: Using Autoethnography and Narrative Inquiry to Indigenize Sense of Belonging in Higher Education

Native American students in higher education are often asked to find a sense of belonging in places and spaces that do not reflect their cultures or worldviews. This can lead to isolation and a feeling of having to choose between themselves and their identities as Indigenous peoples. This contributes to poorer mental health, loss of well-being, and decreased academic success. The purpose of this study was to ask seven Native American participants how they defined sense of belonging from their own worldviews. Participants were also asked about spaces and places in higher education that helped or did not help them belong, and how this affected their mental health, well-being, and ability to succeed in the university setting. Using a metaphor of a Cherokee double-walled basket, we drew from our collective stories to define belonging in the following ways: connection, safety, acknowledgment, respect, presence, purpose, and growth. These themes became a model of Indigenized belonging called “Having the Spirit in the Circle”. Two other key themes that affected belonging were gatekeepers and way-makers. Gatekeepers in higher education created barriers to success and way-makers decreased barriers. What we learned together will be used to inform universities about ways they can change current academic success structures to promote belonging that aligns with Indigenous ways of knowing and being and to help Native American students succeed

Rumination and Quality of Life among Northern Plains Indians

Native Americans (NAs) share unique risk factors for poor mental health. In response, mental health providers must address barriers to treatment while making the most of low resource situations. One way to increase usefulness of treatment is to address the mechanisms underlying multiple mental health disorders. Rumination is a style of thinking marked by repeated thoughts about distress and is well-recognized as a diagnostic factor for underlying disorders in the general population. Secondary data from the Mood Disorder Assessment Validation with Northern Plains Indians (NPI) pilot study was used to examine the relationship between rumination and anxiety, depression, and substance abuse, as well as overall quality of life. Results indicated that as rumination increased, significant increases occurred in severity of symptoms reported for both women and men- but lower perceived quality of life only occurred in the presence of depressive symptoms. Significant differences arose between NPI women and men, with women reporting higher rumination, anxiety, and depression and men reporting higher substance abuse. Based on these results, rumination is useful as a transdiagnostic factor for NPI by uncovering the nature of maladaptive coping mechanisms. In addition, quality of life assessments are culturally-relevant ways to target maladaptive coping and replace unhealthy coping with more adaptive coping via culturally congruent methods

Generalized wordlength patterns and strength

Xu and Wu (2001) defined the \emph{generalized wordlength pattern} $(A_1, ..., A_k)$ of an arbitrary fractional factorial design (or orthogonal array) on $k$ factors. They gave a coding-theoretic proof of the property that the design has strength $t$ if and only if $A_1 = ... = A_t = 0$. The quantities $A_i$ are defined in terms of characters of cyclic groups, and so one might seek a direct character-theoretic proof of this result. We give such a proof, in which the specific group structure (such as cyclicity) plays essentially no role. Nonabelian groups can be used if the counting function of the design satisfies one assumption, as illustrated by a couple of examples

EDUCATIONAL PROGRAMS TO ADDRESS THE ECONOMIC ADJUSTMENTS FACING TOBACCO FARMERS AND RURAL COMMUNITIES

This paper discusses the context within which educational programs tailored to tobacco producers and related rural communities have developed. Discussion is expanded by examining current program approaches employed by various organizations. Many of these organizations have a manual stake in helping producers in tobacco communities develop their management capacity. A range of initiatives aimed at facilitating economic adjustment is compared, including the major issues addressed and expected outcomes. Many of the initiatives have made useful contributions; however, gaps and limitations remain. These are considered as future educational efforts and issues are discussed.educational programs, tobacco producers, Community/Rural/Urban Development,

Ab initio calculations of the hydrogen bond

Recent x-ray Compton scattering experiments in ice have provided useful information about the quantum nature of the interaction between H$_2$O monomers. The hydrogen bond is characterized by a certain amount of charge transfer which could be determined in a Compton experiment. We use ab-initio simulations to investigate the hydrogen bond in H$_2$O structures by calculating the Compton profile and related quantities in three different systems, namely the water dimer, a cluster containing 12 water molecules and the ice crystal. We show how to extract estimates of the charge transfer from the Compton profiles.Comment: 16 pages, 7 figures, to appear in Phys. Rev.

Participants’ preferred choice of practitioner for orofacial symptoms

BACKGROUND: Patients seeking treatment from general medical practitioners (GP) may be unaware or ill-informed that dentists are the more appropriate professionals to manage their orofacial symptoms, being able to diagnose and treat, or, if deemed necessary, appropriately refer. AIMS: To: (1) determine from a group of patients (n = 37) their initial preference of health care provider, when seeking treatment for orofacial symptoms (2) establish their awareness of the appropriate proficiency of the dentist, and, (3) determine the referral pathway before patients attended the Tygerberg Oral Medicine Clinic. METHODS: A cross sectional study design; quantitative data was collected by a modified previously published Bell-questionnaire with closed-ended questions. RESULTS: 53.8% of patients preferred a dentist to attend to a mouth or jaw problem and 46.1%, a GP. When clinical scenarios were posed, all directly related to the scope of practice of the dental practitioner, it was of concern that 47.3% chose the GP and 52.67% chose the dentist. CONCLUSION: Patients initially chose the GP for many orofacial diseases, although they indicated at the Oral Medicine clinic that the dentist had the most relevant knowledge. Participants did not associate some of the orofacial symptoms with the training of dentists

Missing and Murdered Indigenous Women (MMIW): Bringing Awareness through the Power of Student Activism

Students are often an underutilized resource for advocacy and activism. Students have a unique positionality as members of academia who greatly understand the power and privilege higher education can bring- particularly when they have intersectional identities as women, minorities, and members of marginalized groups. This article tells the stories of two such Native American women who are using their power and privilege as it intersects with lived experience to bring awareness to the epidemic of Missing and Murdered Indigenous Women (MMIW). The article brings light to what drives them to promote social justice movements and how they work to institute positive change. Through their experiences, they share suggestions for how advanced professionals and professional organizations can aid students in engaging in social justice movements through empowerment, connection, and support. With students as the feet on the ground and the voice for the voiceless, we hope to promote awareness of MMIW and institute lasting change to protect our Native American women and girls

Authentication of Red Snapper (\u3cem\u3eLutjanus campechanus\u3c/em\u3e) Fillets Using a Combination of Real-time PCR and DNA Barcoding

Red snapper (Lutjanus campechanus) is a historically overfished and highly valued species that is commonly substituted with other fish, such as tilapia, rockfish, and other snapper species. The objective of this study was to assess the ability of real-time PCR to be used as a screening tool to rapidly test commercial fillets for the presence of red snapper, followed by species identification of negative samples with DNA barcoding. A total of 24 frozen, fresh, or thawed (previously frozen) fillets labeled as “red snapper” were tested with real-time PCR, along with 54 fillets from fish that are common substitutes for red snapper. Real-time PCR parameters were optimized to reduce cross-reactivity. All samples were also tested with DNA barcoding to confirm the identity of fish species. Among the 78 total samples, 3 were authenticated as red snapper with DNA barcoding and successfully detected with real-time PCR. An additional two samples were initially identified as red snapper with real-time PCR but confirmed negative with DNA barcoding, resulting in a false positive rate of 2.7%. Overall, 39.7% of all samples and 91.7% of “red snapper” samples were mislabeled. Red snapper was substituted with other snapper species, rockfish, sea bream, and mahi-mahi. These results illustrate the ability of real-time PCR to be used as a screening tool and the importance of species confirmation with DNA barcoding. Real-time PCR has the potential to be used as a rapid on-site screening tool for regulatory and industry officials to determine the authenticity of red snapper fillets