The Expansion of Lyme Disease: A Case of Infection in the Absence of Known Exposure

Lyme disease is a systemic infection caused by the spirochete Borrelia burgdorferi often carried the Ixodes tick. It is associated with dermatologic manifestations, most notably the “bullseye rash” of erythema migrans. The disease can progress in stages to involve other organs such as joints, heart, and the nervous system. Lyme disease is continuing to spread, with West Virginia cases increasing dramatically in the last 2 decades. As a result, physicians are likely to encounter this disease more often, making recognition and early treatment a top priority in order to prevent potentially dangerous sequelae. We present a case of a 60-year-old man who presented with multiple erythematous annular plaques and was subsequently diagnosed with Lyme disease. He had no known exposure to ticks, was treated for Lyme Disease, and subsequently developed a Jarisch- Herxheimer reaction (JHR)

Eruptive Lentigines Confined to Resolving Psoriatic Plaques Following Treatment with Guselkumab

Eruptive lentigines in the area of resolving psoriatic plaques has been well documented in the literature following successful treatment with multiple therapies. This is historically associated with light treatment but has been expanded to include other therapies such as anti-tumor necrosis factor therapies and, more recently, some biologics5. Guselkumab (Tremfya) is an IgG1λ monoclonal antibody used in the treatment of plaque psoriasis with only one case of eruptive lentigines confined to resolving psoriatic plaques (ELRP) noted as a side effect. We present the second such case of ELRP associated with successful treatment of plaque psoriasis with Guselkumab, as it is important to document potential side effects of medications regardless of their severity

Toward a moral reckoning on structural racism: Examining structural factors, encouraging structural thinking, and supporting structural intervention

The racial reckoning of 2020 involved the largest social movement protest in U.S. history, but support for the Black Lives Matter movement declined shortly after. To advance a moral reckoning on structural racism that dismantles racialized structures and redresses racial inequities, we call on scholar activists within the field of community psychology to realign their own practices by (a) examining structural factors; (b) encouraging structural thinking; and (c) supporting structural intervention for racial justice. Two structural factors–political determinants and commercial determinants–maintain the status quo of structural racism, undermining efforts for racial equity. As a result, we encourage the development of structural thinking, which provides a structural analysis of racism and leads to support for structural intervention. With an intersectional race and class perspective, we detail how structural thinking could be developed among the professional managerial class (through structural competency) and among the oppressed class (through critical consciousness). Finally, we discuss structural intervention factors and approaches that can redress racial inequities and produce structural change. Ultimately, we provide a pathway for community psychologists to support activists building a multiracial, multiclass coalition to eliminate structures and systems of racial, political, and economic injustice. Highlights Community psychologists can support activists working toward a moral reckoning on structural racism. Harmful political and commercial determinants maintain structural racism and racial inequities. Structural thinking and structural intervention are essential for addressing structural racism. First-order change interventions should build structural competency or critical consciousness. Second-order change interventions should leverage systemic-level promotion and prevention

Smartphone Mobile Application to Enhance Diagnosis of Skin Cancer: A Guide for the Rural Practitioner

Primary care physicians occupy a vital position to impact many devastating conditions, especially those dependent upon early diagnosis, such as skin cancer. Skin cancer is the most common cancer in the United States and despite improvements in skin cancer therapy, patients with a delay in diagnosis and advanced disease continue to have a grave prognosis. Due to a variety of barriers, advanced stages of skin cancer are more prominent in rural populations. In order to improve early diagnosis four things are paramount: increased patient participation in prevention methods, establishment of screening guidelines, increased diagnostic accuracy of malignant lesions, and easier access to dermatologists. Recent expansion in smartphone mobile application technology offers simple ways for rural practitioners to address these problems. More than 100,000 health related applications are currently available, with over 200 covering dermatology. This review will evaluate the newest and most useful of those applications offered to enhance the prevention and early diagnosis of skin cancer, particularly in the rural population

On the influence of tree size on the climate–growth relationship of New Zealand kauri (Agathis australis): insights from annual, monthly and daily growth patterns

Many tree-ring-based climate reconstructions are based on the assumption that the climate reaction of trees is independent of their size. Here, we test this assumption for New Zealand kauri (Agathis australis), one of the longest tree ring-based proxies for the El Niño-Southern Oscillation (ENSO). The most recent kauri chronology contains a large amount of archaeological material, e.g. timber for which the original tree size is often unknown. We analyzed the climate–growth relationship of different-sized kauri in a pristine forest using different temporal scales, i.e. annually, monthly and daily data on tree growth and climate conditions. Trees of different life stages exhibited approximately the same seasonal growth peaks during austral spring (October and November). The dormancy period overlaps with the period where weekly air temperature maxima are below ca. 17–18 °C, and where the corresponding daily minima are below ca. 8 °C. However, both correlation functions between annual growth and seasonal climate as well as Kalman filter regressions between daily growth and climate conditions suggest an influence of tree size on the climate–growth relationship for kauri. Smaller trees (DBH < 40 cm) contain weaker climate signals than larger trees. Therefore, the precautionary stripping of near-pith material (first 20 cm) from kauri chronologies may result in more uniform responses to climate forcing and thus enhance the reliability of long-term climate reconstructions

On the influence of tree size on the climate-growth relationship of New Zealand kauri ( Agathis australis ): insights from annual, monthly and daily growth patterns

Many tree-ring-based climate reconstructions are based on the assumption that the climate reaction of trees is independent of their size. Here, we test this assumption for New Zealand kauri (Agathis australis), one of the longest tree ring-based proxies for the El Niño-Southern Oscillation (ENSO). The most recent kauri chronology contains a large amount of archaeological material, e.g. timber for which the original tree size is often unknown. We analyzed the climate-growth relationship of different-sized kauri in a pristine forest using different temporal scales, i.e. annually, monthly and daily data on tree growth and climate conditions. Trees of different life stages exhibited approximately the same seasonal growth peaks during austral spring (October and November). The dormancy period overlaps with the period where weekly air temperature maxima are below ca. 17-18°C, and where the corresponding daily minima are below ca. 8°C. However, both correlation functions between annual growth and seasonal climate as well as Kalman filter regressions between daily growth and climate conditions suggest an influence of tree size on the climate-growth relationship for kauri. Smaller trees (DBH<40cm) contain weaker climate signals than larger trees. Therefore, the precautionary stripping of near-pith material (first 20cm) from kauri chronologies may result in more uniform responses to climate forcing and thus enhance the reliability of long-term climate reconstruction

Fat mass and obesity associated (FTO) gene influences skeletal muscle phenotypes in non-resistance trained males and elite rugby playing position

Background FTO gene variants have been associated with obesity phenotypes in sedentary and obese populations, but rarely with skeletal muscle and elite athlete phenotypes. Methods In 1089 participants, comprising 530 elite rugby athletes and 559 non-athletes, DNA was collected and genotyped for the FTO rs9939609 variant using real-time PCR. In a subgroup of non-resistance trained individuals (NT; n = 120), we also assessed structural and functional skeletal muscle phenotypes using dual energy x-ray absorptiometry, ultrasound and isokinetic dynamometry. In a subgroup of rugby athletes (n = 77), we assessed muscle power during a countermovement jump. Results In NT, TT genotype and T allele carriers had greater total body (4.8% and 4.1%) and total appendicular lean mass (LM; 3.0% and 2.1%) compared to AA genotype, with greater arm LM (0.8%) in T allele carriers and leg LM (2.1%) for TT, compared to AA genotype. Furthermore, the T allele was more common (94%) in selected elite rugby union athletes (back three and centre players) who are most reliant on LM rather than total body mass for success, compared to other rugby athletes (82%; P = 0.01, OR = 3.34) and controls (84%; P = 0.03, OR = 2.88). Accordingly, these athletes had greater peak power relative to body mass than other rugby athletes (14%; P = 2 x 10-6). Conclusion Collectively, these results suggest that the T allele is associated with increased LM and elite athletic success. This has implications for athletic populations, as well as conditions characterised by low LM such as sarcopenia and cachexia

Diagnosis of ventilator-associated pneumonia in critically ill adult patients-a systematic review and meta-analysis.

The accuracy of the signs and tests that clinicians use to diagnose ventilator-associated pneumonia (VAP) and initiate antibiotic treatment has not been well characterized. We sought to characterize and compare the accuracy of physical examination, chest radiography, endotracheal aspirate (ETA), bronchoscopic sampling cultures (protected specimen brush [PSB] and bronchoalveolar lavage [BAL]), and CPIS > 6 to diagnose VAP. We searched six databases from inception through September 2019 and selected English-language studies investigating accuracy of any of the above tests for VAP diagnosis. Reference standard was histopathological analysis. Two reviewers independently extracted data and assessed study quality. We included 25 studies (1639 patients). The pooled sensitivity and specificity of physical examination findings for VAP were poor: fever (66.4% [95% confidence interval [CI]: 40.7–85.0], 53.9% [95% CI 34.5–72.2]) and purulent secretions (77.0% [95% CI 64.7–85.9], 39.0% [95% CI 25.8–54.0]). Any infiltrate on chest radiography had a sensitivity of 88.9% (95% CI 73.9–95.8) and specificity of 26.1% (95% CI 15.1–41.4). ETA had a sensitivity of 75.7% (95% CI 51.5–90.1) and specificity of 67.9% (95% CI 40.5–86.8). Among bronchoscopic sampling methods, PSB had a sensitivity of 61.4% [95% CI 43.7–76.5] and specificity of 76.5% [95% CI 64.2–85.6]; while BAL had a sensitivity of 71.1% [95% CI 49.9–85.9] and specificity of 79.6% [95% CI 66.2–85.9]. CPIS > 6 had a sensitivity of 73.8% (95% CI 50.6–88.5) and specificity of 66.4% (95% CI 43.9–83.3). Classic clinical indicators had poor accuracy for diagnosis of VAP. Reliance upon these indicators in isolation may result in misdiagnosis and potentially unnecessary antimicrobial use