Coyotes as Reservoirs for Onchocerca lupi, United States, 2015-2018.

The Onchocerca lupi nematode infects dogs, cats, and humans, but whether it can be spread by coyotes has been unknown. We conducted surveillance for O. lupi nematode infection in coyotes in the southwestern United States. We identified multiple coyote populations in Arizona and New Mexico as probable reservoirs for this species.

COYOTES (CANIS LATRANS) IN ARIZONA, USA, EXHIBIT IMMUNE AND GENETIC EVIDENCE OF RICKETTSIAL INFECTIONS.

Rocky Mountain spotted fever (RMSF), caused by the bacterium Rickettsia rickettsii, was recognized as endemic in Arizona, US after a 2002 outbreak and has since been a public health concern. The brown dog tick (Rhipicephalus sanguineus sensu lato) is the principal vector of this pathogen in Arizona. Domesticated dogs (Canis lupus familiaris) are the tick's main host, so free-roaming dogs in peridomestic areas have been named the primary risk factor for human cases of RMSF. However, the sudden emergence and long-distance dispersal of the pathogen have not been adequately explained, and one possible mechanism could include wildlife. Coyotes (Canis latrans) are wide ranging in Arizona and closely related to dogs, so it is possible that brown dog ticks parasitize coyotes and infect them. Although R. rickettsii is the most severe spotted fever group (SFG) rickettsial pathogen in humans, others occur in Arizona, and antibodies raised against them are cross-reactive, so we more-broadly hypothesized that coyotes in Arizona are exposed to SFG rickettsiae. We collected coyote tissues in spring 2016 and 2017. We tested sera for antibodies to R. rickettsii and found 9% (8/94) of samples were antibody-positive with titers of ≥256. Subsequent quantitative PCR analyses of skin showed evidence for Rickettsia spp. in 2.9% (4/138) of samples. These data suggest that coyotes have a role in the maintenance of SFG rickettsiae in Arizona. Further investigation is warranted to reveal which specific pathogen-vector complexes act on coyotes in the region and whether they represent a risk to human health.

Guidelines for intensive care unit design.

OBJECTIVE: To develop a guideline to help guide healthcare professionals participate effectively in the design, construction, and occupancy of a new or renovated intensive care unit. PARTICIPANTS: A group of multidisciplinary professionals, designers, and architects with expertise in critical care, under the direction of the American College of Critical Care Medicine, met over several years, reviewed the available literature, and collated their expert opinions on recommendations for the optimal design of an intensive care unit. SCOPE: The design of a new or renovated intensive care unit is frequently a once- or twice-in-a-lifetime occurrence for most critical care professionals. Healthcare architects have experience in this process that most healthcare professionals do not. While there are regulatory documents, such as the Guidelines for the Design and Construction of Health Care Facilities, these represent minimal guidelines. The intent was to develop recommendations for a more optimal approach for a healing environment. DATA SOURCES AND SYNTHESIS: Relevant literature was accessed and reviewed, and expert opinion was sought from the committee members and outside experts. Evidence-based architecture is just in its beginning, which made the grading of literature difficult, and so it was not attempted. The previous designs of the winners of the American Institute of Architects, American Association of Critical Care Nurses, and Society of Critical Care Medicine Intensive Care Unit Design Award were used as a reference. Collaboratively and meeting repeatedly, both in person and by teleconference, the task force met to construct these recommendations. CONCLUSIONS: Recommendations for the design of intensive care units, expanding on regulatory guidelines and providing the best possible healing environment, and an efficient and cost-effective workplace.

Early intensive care unit mobility therapy in the treatment of acute respiratory failure.

OBJECTIVE: Immobilization and subsequent weakness are consequences of critical illness. Despite the theoretical advantages of physical therapy to address this problem, it has not been shown that physical therapy initiated in the intensive care unit offers benefit. DESIGN AND SETTING: Prospective cohort study in a university medical intensive care unit that assessed whether a mobility protocol increased the proportion of intensive care unit patients receiving physical therapy vs. usual care. PATIENTS: Medical intensive care unit patients with acute respiratory failure requiring mechanical ventilation on admission: Protocol, n = 165; Usual Care, n = 165. INTERVENTIONS: An intensive care unit Mobility Team (critical care nurse, nursing assistant, physical therapist) initiated the protocol within 48 hrs of mechanical ventilation. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the proportion of patients receiving physical therapy in patients surviving to hospital discharge. Baseline characteristics were similar between groups. Outcome data are reflective of survivors. More Protocol patients received at least one physical therapy session than did Usual Care (80% vs. 47%, p < or = .001). Protocol patients were out of bed earlier (5 vs. 11 days, p < or = .001), had therapy initiated more frequently in the intensive care unit (91% vs. 13%, p < or = .001), and had similar low complication rates compared with Usual Care. For Protocol patients, intensive care unit length of stay was 5.5 vs. 6.9 days for Usual Care (p = .025); hospital length of stay for Protocol patients was 11.2 vs. 14.5 days for Usual Care (p = .006) (intensive care unit/hospital length of stay adjusted for body mass index, Acute Physiology and Chronic Health Evaluation II, vasopressor). There were no untoward events during an intensive care unit Mobility session and no cost difference (survivors + nonsurvivors) between the two arms, including Mobility Team costs. CONCLUSIONS: A Mobility Team using a mobility protocol initiated earlier physical therapy that was feasible, safe, did not increase costs, and was associated with decreased intensive care unit and hospital length of stay in survivors who received physical therapy during intensive care unit treatment compared with patients who received usual care.

Nuclear factor-kappaB is an important modulator of the altered gene expression profile and malignant phenotype in squamous cell carcinoma.

We reported previously that transcription factor nuclear factor (NF)-kappaB is constitutively activated in human and murine squamous cell carcinomas (SCCs). The role of NF-kappaB in the cumulative changes in gene expression with transformation and progression of the murine SCC Pam 212 and after switching off NF-kappaB by a dominant negative inhibitor kappaB mutant (IkappaBalphaM) was explored by profiling with a 15,000-element cDNA micoarrray. Remarkably, NF-kappaB modulated the expression of >60% of the 308 genes differentially expressed between normal keratinocytes and metastatic SCCs. NF-kappaB directly or indirectly modulated expression of programs of genes functionally linked to proliferation, apoptosis, adhesion, and angiogenesis. Among these, changes in expression of cyclin D1, inhibitor of apoptosis-1, mutant Trp53, and beta-catenin detected with modulation of NF-kappaB by microarray were confirmed by Western and Northern blot. NF-kappaB DNA binding motifs were detected in the promoter of approximately 63% of genes showing increased expression and 33% of the genes showing decreased expression. The ACTACAG motif implicated in the NF-kappaB-dependent down-regulation of mRNA expression of MyoD and Sox9 was detected in the coding portion of about 15% of genes showing increased or decreased expression. Inactivation of NF-kappaB inhibited malignant phenotypic features including proliferation, cell survival, migration, angiogenesis, and tumorigenesis. These results provide evidence that NF-kappaB is an important modulator of gene expression programs that contribute to the malignant phenotype of SCC.

Effectiveness of hotline, advocacy, counseling, and shelter services for victims of domestic violence: a statewide evaluation.

The authors report the results of an evaluation of services provided by 54 Illinois domestic violence agencies. In collaboration with the University of Illinois at Chicago evaluation team, domestic violence advocates identified services to be evaluated, specified desired outcomes of those services, and participated in developing measures of those outcomes in both English and Spanish. With in the limitations of the study, outcomes were positive in all four program areas: hotline, counseling, advocacy, and shelter. The authors then discuss implications for evaluation of domestic violence programs that maintain victim safety as a guiding principle.

A statewide evaluation of services provided to rape survivors.

This article presents the descriptive results of a statewide evaluation of hotline, advocacy, and counseling services provided to sexual assault victims in Illinois. Collaborative efforts of a multidisciplinary research team and sexual assault service providers resulted in victim-sensitive evaluation measures and data that reflect, for the first time, the collective impact of services on rape victims across the state of Illinois. Results of the evaluation suggest that, overall, services provided to rape victims provided support, increased information and knowledge, and helped victims to understand options and make decisions. The evaluation approach is notable for its collaborative nature and its sensitivity to rape victims during help-seeking and delivery; however, due to the high levels of distress common among rape survivors, some evaluation methods may not be appropriate for crisis intervention services such as hotline or advocacy. Implications for future evaluation research and policy are noted.

Comparison of 3 methods of detecting acute respiratory distress syndrome: clinical screening, chart review, and diagnostic coding.

BACKGROUND: Although the incidence of acute respiratory distress syndrome has been studied, few researchers have prospectively assessed the search tool used to identify cases. METHODS: For 5 months, all patients admitted to a medical intensive care unit in a teaching hospital were evaluated daily to determine whether criteria for acute respiratory distress syndrome were met, and physicians' progress notes and discharge summaries for these prospectively identified patients were reviewed for mention of the syndrome. Discharge forms were reviewed for the codes (International Classification of Diseases, Ninth Revision) specific to acute respiratory distress syndrome (518.82 or 518.85). RESULTS: Of 314 patients admitted, 65 prospectively met the criteria for acute respiratory distress syndrome. Of these 65 patients, 31 had acute respiratory distress syndrome mentioned in their progress notes, and 4 of the 31 were subsequently assigned a code of 518.82 or 518.85. Patients with a physician's notation for acute respiratory distress syndrome in their charts had a higher mortality (22/31 [71%]) than did the patients with no such notation (10/34 [29%]). This difference could not be accounted for by differences in length of stay, mean age, score on Acute Physiology and Chronic Health Evaluation III, or number of days in the unit before meeting the criteria. CONCLUSIONS: The incidence of acute respiratory distress syndrome is underestimated when based on either diagnostic coding or physicians' notes without testing of the accuracy of coding. Both physicians and medical record coding specialists may require training in use of terms related to acute respiratory distress syndrome.

Counseling services for battered women: a comparison of outcomes for physical and sexual assault survivors.

Approximately 15% of married or cohabiting women and as many as 60% of battered women are raped at least once by their partners. This study compared community-based counseling outcomes of battered women with outcomes of women who were both raped and battered by their partners. Over time, both groups improved in wellbeing and coping. Although those both battered and raped progressed more in counseling, they had lower scores before and after counseling compared to women who were battered only. Implications for research and intervention are discussed.

Role of activated protein C in the pathophysiology of severe sepsis.

Sepsis is a complex syndrome that can lead to multiple organ failure and death. Severe sepsis has been associated with mortality rates ranging from 28% to 50% and is the most common cause of death in the noncardiac intensive care unit. Despite advances in both antibiotic therapy and supportive care, the mortality rate due to severe sepsis has remained fundamentally unchanged in the past several decades. With increased understanding of the pathophysiology of sepsis, particularly the intricate interplay between activation of coagulation and inflammation, novel therapeutic agents that may improve clinical outcomes are being researched and developed. The epidemiology, pathophysiology, and treatment of severe sepsis are reviewed. Also discussed are the recently published results from a multicenter, randomized, placebo-controlled phase 3 clinical trial of drotrecogin alfa (activated), a recombinant form of human activated protein C, in patients with severe sepsis. The nursing implications of this new approved therapy are discussed.