A Case of Reverse Takotsubo Cardiomyopathy After Administering a Local Anesthetic Containing Epinephrine.

Takotsubo cardiomyopathy (TCM) is a rare syndrome characterized by acute and transient distinctive wall motion abnormalities accompanied by other defined objective findings. There are many variants of TCM, including the reverse (or basal) subtype. While the pathogenesis is not fully understood, both endogenous and exogenous catecholamines have been implicated. This case report describes a 30-year-old active-duty military female who developed reverse TCM immediately following local anesthetic with epinephrine administration in preparation for an elective septorhinoplasty. She developed electrocardiogram (ECG) changes, temporary hemodynamic instability, and cardiac troponin elevation. Transthoracic echocardiogram (TTE) demonstrated significantly reduced systolic and diastolic function, with akinesis of the basal segments and normal wall motion of the apical segments, consistent with a reverse Takotsubo pattern. Coronary computed tomography (CT) angiography showed normal coronary arteries. Repeat TTE was performed two days after the initial event and showed near-complete resolution of the wall motion abnormalities. Fourteen days later, TTE showed normalization of cardiac function. While there is a favorable prognosis for most patients with this diagnosis, there does remain the potential for significant adverse outcomes, risk of recurrence, and a non-negligible mortality rate. It is widely known that physical and emotional triggers can precipitate TCM through the release of catecholamines. This case, in addition to numerous other case reports, provides further documentation and support that exogenous epinephrine administration is also associated with the development of TCM. Clinicians should consider the diagnosis of Takotsubo cardiomyopathy if hemodynamic or ECG changes arise following epinephrine administration.

Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Among Residents and Employees in a Veterans Affairs Community Living Center: A 42-Month Prospective Cohort Study.

Background: Understanding routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in long-term care facilities is essential for the development of effective control measures. Methods: Between March 1, 2020, and August 31, 2023, we identified coronavirus disease 2019 (COVID-19) cases among residents and employees in a Veterans Affairs community living center that conducted routine screening for asymptomatic COVID-19. Contact tracing was conducted to identify suspected transmission events, and whole genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples. Results: During the 42-month study period, 269 cases of COVID-19 were diagnosed, including 199 employees and 70 residents. A total of 48 (24.1%) employees and 30 (42.9%) residents were asymptomatic. Sequencing analysis provided support for multiple events in which employees transmitted SARS-CoV-2 to co-workers and residents. There was 1 episode of likely transmission of SARS-CoV-2 from one resident to another resident, but no documented transmissions from residents to employees. Conclusions: Transmission of SARS-CoV-2 in the community living center predominantly involved transmission from employees to co-workers and residents. There is a need for improved measures to prevent transmission of SARS-CoV-2 by healthcare personnel.

The Structural Role of N170 in Substrate-Assisted Deacylation in KPC-2 ß-Lactamase.

The amino acid substitutions in Klebsiella pneumoniae carbapenemase 2 (KPC-2) that have arisen in the clinic are observed to lead to the development of resistance to ceftazidime-avibactam, a preferred treatment for KPC bearing Gram-negative bacteria. Specific substitutions in the omega loop (R164-D179) result in changes in the structure and function of the enzyme, leading to alterations in substrate specificity, decreased stability, and more recently observed, increased resistance to ceftazidime/avibactam. Using accelerated rare-event sampling well-tempered metadynamics simulations, we explored in detail the structural role of R164 and D179 variants that are described to confer ceftazidime/avibactam resistance. The buried conformation of D179 substitutions produce a pronounced structural disorder in the omega loop - more than R164 mutants, where the crystallographic omega loop structure remains mostly intact. Our findings also reveal that the conformation of N170 plays an underappreciated role impacting drug binding and restricting deacylation. The results further support the hypothesis that KPC-2 D179 variants employ substrate-assisted catalysis for ceftazidime hydrolysis, involving the ring amine of the aminothiazole group to promote deacylation and catalytic turnover. Moreover, the shift in the WT conformation of N170 contributes to reduced deacylation and an altered spectrum of enzymatic activity.

Older adults' support seeking from their adult children: The Support-Seeking Strategy Scale.

Due to the unavailability of assessment tools focused on support recipients, the aged-care literature has not been able to document the support seeking that occurs within familial support contexts. Therefore, we developed and validated a Support-Seeking Strategy Scale in a large sample of aging parents receiving care from their adult children. A pool of items was developed by an expert panel and administered to 389 older adults (over 60 years of age), all of whom were receiving support from an adult child. Participants were recruited on Amazon mTurk and Prolific. The online survey included self-report measures assessing parents' perceptions of support received from their adult children. The Support-Seeking Strategies Scale was best represented by 12 items across three factors-one factor representing the directness with which support is sought (direct) and two factors regarding the intensity with which support is sought (hyperactivated and deactivated). Direct support seeking was associated with more positive perceptions of received support from an adult child, whereas hyperactivated and deactivated support seeking were associated with more negative perceptions of received support. Older parents use three distinct support-seeking strategies: direct, hyperactivated, and deactivated with their adult child. The results suggest that direct seeking of support is a more adaptive strategy, whereas persistent and intense seeking of support (i.e., hyperactivated support seeking) or suppressing the need for support (i.e., deactivated support seeking) are more maladaptive strategies. Future research using this scale will help us better understand support seeking within the familial aged-care context and beyond. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Characterization of a Novel Pathogen in Immunocompromised Patients: Elizabethkingia anophelis-Exploring the Scope of Resistance to Contemporary Antimicrobial Agents and ß-lactamase Inhibitors.

Background: Elizabethkingia anophelis is an emerging Gram-negative nonlactose fermenter in the health care setting, where it causes life-threatening infections in immunocompromised patients. We aimed to characterize the molecular mechanisms of antimicrobial resistance and evaluate the utility of contemporary antibiotics with the intent to offer targeted therapy against an uncommonly encountered pathogen. Methods: Whole-genome sequencing (WGS) was conducted to accurately identify isolate species and elucidate the determinants of ß-lactam resistance. Antimicrobial susceptibility testing was performed using broth microdilution and disk diffusion assays. To assess the functional contribution of the major metallo-ß-lactamase (MBL) encoding genes to the resistance profile, bla BlaB was cloned into pBCSK(-) phagemid vector and transformed into Escherichia coli DH10B. Results: WGS identified the organism as E. anophelis. MBL genes bla BlaB-1 and bla GOB-26 were identified, in addition to bla CME-2, which encodes for an extended-spectrum ß-lactamase (ESBL). Plasmids were not detected. The isolate was nonsusceptible to all commonly available ß-lactams, carbapenems, newer ß-lactam ß-lactamase inhibitor combinations, and to the combination of aztreonam (ATM) with ceftazidime-avibactam (CAZ-AVI). Susceptibility to the novel siderophore cephalosporin cefiderocol was determined. A BlaB-1 transformant E. coli DH10B isolate was obtained and demonstrated increased minimum inhibitory concentrations to cephalosporins, carbapenems, and CAZ-AVI, but not ATM. Conclusions: Using WGS, we accurately identified and characterized an extensively drug-resistant E. anophelis in an immunocompromised patient. Rapid evaluation of the genetic background can guide accurate susceptibility testing to better inform antimicrobial therapy selection.

Unpacking the association between attachment insecurity and PTSD symptoms: The mediating role of coping strategies.

OBJECTIVE: The current study provides a proof of concept for an aspect of the trauma and attachment model outlined in Marshall and Frazier (2019), which argues that attachment insecurity is associated with PTSD symptoms via hyperactivating/deactivating coping strategies, especially in the context of high trauma severity. METHOD: 302 participants who had experienced a traumatic event(s) completed a survey. RESULTS: The results showed significant indirect effects between attachment insecurity and PTSD symptoms via hyperactivating/deactivating coping strategies, especially in the context of high trauma severity. In low trauma severity, hyperactivating strategies were not as strongly associated with PTSD symptoms and deactivating strategies not associated with PTSD symptoms. Hyperactivating and deactivating strategies were the mediators for attachment anxiety models and deactivating strategies was the mediator for attachment avoidance models. CONCLUSIONS: This proof of concept for Marshall and Frazier (2019) provides a platform for future research to better understand PTSD symptoms from an attachment framework. Interventions are likely to benefit by assisting people high on attachment avoidance and anxiety to modify their deactivating tendencies following a trauma of high severity and also assisting people high on attachment anxiety to modify their hyperactivating tendencies posttrauma, especially following a high trauma severity. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Social network structure and combating social disconnection: Implications for physical health.

Disconnection from one's social network has detrimental links to physical health outcomes, and there has been increased interest in treating social disconnection as a public health issue. Two perspectives guide much of the research on social networks, social disconnection, and physical health. One perspective emphasizes the quality of social ties over the quantity of social ties, whereas the other emphasizes quantity over quality. In this article, we discuss the importance of combining these perspectives to promote forming networks consisting of a few close relationships in addition to some peripheral ties to effectively combat social disconnection and maintain and promote better health. We also highlight important avenues for future research, including identifying critical moderators (e.g., age, culture) and using social network interventions to address issues of causality.

The Association Between Relationship Events and Experiences and Partner Evaluations: An Ideal Standards Perspective.

Drawing on the Ideal Standards Model, the current study investigated whether the relationship events and experiences that occur on a given day in romantic relationships were associated with partner evaluations. Individuals in a current romantic relationship (N = 104) completed daily measures of positive and negative relationship events and experiences and partner evaluations for seven consecutive days. As hypothesized, findings demonstrated that on a given day negative relationship events and experiences were associated with evaluating partners as falling short of mate ideals, while positive relationship events and experiences were associated with evaluating partners as more closely meeting ideals. The findings demonstrate the importance of the relational context in evaluations of a partner against ideal standards.

Carer burden and dyadic attachment orientations in adult children-older parent dyads.

BACKGROUND AND OBJECTIVES: This study takes an interpersonal approach to the study of carer burden in families where adult children care for older parents. The aim of the study was to determine whether different pairings of attachment insecurity in older parent-adult child dyads are predictive of carer burden. RESEARCH DESIGN AND METHODS: Seventy dyads whereby adult children provided weekly care to their older parents completed self-report measures of attachment. Adult children also completed a measure of carer burden. RESULTS: Anxious-avoidant attachment insecurity pairings in parent-child dyads were associated with increases in carer burden. However, anxious-anxious and avoidant-avoidant attachment insecurity pairings were not associated with burden. DISCUSSION AND IMPLICATIONS: The attachment insecurity of the care-recipient was found to moderate the association between a carer's attachment insecurity and burden, but only when the care-recipient's attachment insecurity differed to that of the carer's. These findings have implications for research, policy, and practice in aged care. The findings highlight the importance of focusing on attachment insecurity in aging families as well as taking a dyadic perspective when studying caregiving outcomes such as carer burden. The findings suggest that carers who may require the greatest support are those whose parents demonstrate contrasting orientations of attachment insecurity.

A γ-Lactam Siderophore Antibiotic Effective against Multidrug-Resistant Gram-Negative Bacilli.

Treatment of multidrug-resistant Gram-negative bacterial pathogens represents a critical clinical need. Here, we report a novel γ-lactam pyrazolidinone that targets penicillin-binding proteins (PBPs) and incorporates a siderophore moiety to facilitate uptake into the periplasm. The MIC values of γ-lactam YU253434, 1, are reported along with the finding that 1 is resistant to hydrolysis by all four classes of ß-lactamases. The druglike characteristics and mouse PK data are described along with the X-ray crystal structure of 1 binding to its target PBP3.

Police surveillance of cell phone location data: Supreme Court versus public opinion.

The Fourth Amendment to the US Constitution protects individuals from unreasonable searches and seizures. As technology evolves, courts must examine Fourth Amendment concerns implicated by the introduction of new and enhanced police surveillance techniques. Recent Supreme Court cases have demonstrated a trend towards reconsidering the mechanical application of traditional Fourth Amendment doctrine to define the scope of constitutional protections for modern technological devices and personal data. The current research examined whether public opinion regarding privacy rights in electronic communications is in accordance with these Supreme Court rulings. Results suggest that cell phone location data is perceived as more private and deserving of protections than other types of location data, but the privacy of other types of information recorded on cell phones is valued even more than location data. These results have implications for the police and courts considering how the Fourth Amendment will apply to smart phone technologies.

Understanding posttrauma reactions within an attachment theory framework.

The purpose of this paper is to review recent research on posttrauma reactions (i.e., posttraumatic stress disorder [PTSD] symptoms and self-reported posttraumatic growth [PTG]) using attachment theory as a framework. Attachment orientations are significantly related to PTSD symptoms: insecure attachment orientations (particularly attachment anxiety) are positively associated with PTSD symptoms whereas attachment security is negatively associated with PTSD symptoms. Although associations appear to be reciprocal, research typically focuses on insecure attachment orientations predicting PTSD symptoms and the possible mechanisms of those relations, particularly a lack of social support. Some trauma characteristics (e.g., trauma severity) also appear to moderate the association between attachment and PTSD symptoms. Research on attachment orientations and PTG, however, has yielded mixed results. More rigorous methods are needed to better understand the role of attachment orientations in actual growth from pre to post-trauma.

Learning from Excellence: the 'Yaytix' programme.

BACKGROUND AND AIMS: Learning from error can have a negative impact on the staff involved in the error ('second victim phenomenon'1). We created a project, based on the principles of the Learning from Excellence project,2 to learn from excellence and correct the imbalance of negative to positive feedback in the context of hospital practice. METHODS AND RESULTS: Using a questionnaire, we surveyed staff on existing feedback mechanisms and morale. We then introduced a system where staff recorded and commented on examples of excellence in practice. Recipients and their supervisors received copies of these reports and the feedback was analysed and discussed with senior staff (consultant, senior charge nurse, managers). We re-audited the staff two months after starting this project and noted improvements in staff morale and in positive reporting. CONCLUSIONS: This project has improved the process of giving and learning from positive feedback and had a significant impact on staff morale. We can also demonstrate an example of improved clinical practice (from feedback received) and will now attempt to measure clinical outcomes with a new prospective study. Finally, we hope to set up a regional programme of reporting excellence in South-East Scotland.

The occurrence of earlier changes in family dynamics and friendship conflict predicting adolescent functional somatic symptoms: A large-scale prospective study.

OBJECTIVE: To better understand the role earlier stressful environments have in predicting functional somatic symptoms (FSS) in late adolescence, this study explores the effect the occurrence of earlier changes in family dynamics and friendship conflict have on FSS. METHOD: We used data from the Consortium for Longitudinal Studies on Child Abuse and Neglect (N = 1,314), a large, prospective study of children at risk for maltreatment and their parent/caregiver from approximately 4 to 18 years of age. RESULTS: We found a significant, small (Effect Size = .10), positive association between the frequency of family dynamic change during middle childhood (ages 6-12 years) and FSS at age 18 but not during middle adolescence (ages 14 and 16). Conflict with a same-sex best friend at age 16 moderated the association between the frequency of change and FSS. The frequency of family dynamic change in middle childhood and middle adolescence was associated with greater FSS among those who reported greater conflict but not for those who reported experiencing lower conflict. Overall, these effects were specific to friendship conflict and remained when other friendship processes (intimacy and companionship) were included, did not generalize to anxiety/depressive symptoms, and predicted FSS without comorbid anxiety/depressive symptoms. No gender differences were found. The change-conflict interaction differed according to type of family dynamic change (parental vs. residential). CONCLUSION: Findings emphasize how earlier exposure to frequent changes in family dynamics in middle childhood is particularly associated with late-adolescent health, especially in the context of greater friendship conflict. (PsycINFO Database Record

Weathering the storm? The impact of trauma on romantic relationships.

The current paper reviews the recent literature examining the impact of trauma on romantic relationships. We introduce the Dyadic Responses to Trauma (DRT) Model as a framework for organizing existing research and guiding future research. A traumatic event affects romantic relationships for the better or for the worse depending on the diverse trauma-related experiences people can have, influencing the way partners interact with each other and ultimately the quality of the relationship. In addition, recent research demonstrates how romantic partners can demonstrate resiliency in spite of a negative trauma experience depending on how they interpret and cope with the experience individually and as a couple.

Standing on shaky ground? Dyadic and longitudinal associations between posttraumatic stress and relationship quality postearthquake.

In the current study, we took a unique dyadic approach to examine how people's relationship quality following an earthquake was associated with their and their partner's posttraumatic stress symptoms (PTSS) and whether support exchanges in the relationship protected relationship quality in the face of this adversity. Ninety-nine heterosexual couples were studied over 4 time points for approximately 15 months following the Canterbury, New Zealand, earthquakes. The data were analyzed using moderated growth-curve modeling in an Actor-Partner Interdependence Model framework. In line with predictions, both partners' PTSS scores were associated with lower relationship quality at Time 1 (the first assessment postearthquake). These associations, however, were attenuated by more frequent provisions of support between relationship partners, especially for men, at least in the short term. The associations, however, changed across time, suggesting that coping in a relationship context post trauma is a dynamic, fluid process. These findings demonstrate the importance of adopting a dyadic perspective and examining effects across time. They also highlight the importance of examining resources within the relationship context to more fully understand how PTSS affects relationships. (PsycINFO Database Record

Can Ceftazidime-Avibactam and Aztreonam Overcome ß-Lactam Resistance Conferred by Metallo-ß-Lactamases in Enterobacteriaceae?

Based upon knowledge of the hydrolytic profile of major ß-lactamases found in Gram-negative bacteria, we tested the efficacy of the combination of ceftazidime-avibactam (CAZ-AVI) with aztreonam (ATM) against carbapenem-resistant enteric bacteria possessing metallo-ß-lactamases (MBLs). Disk diffusion and agar-based antimicrobial susceptibility testing were initially performed to determine the in vitro efficacy of a unique combination of CAZ-AVI and ATM against 21 representative Enterobacteriaceae isolates with a complex molecular background that included blaIMP, blaNDM, blaOXA-48, blaCTX-M, blaAmpC, and combinations thereof. Time-kill assays were conducted, and the in vivo efficacy of this combination was assessed in a murine neutropenic thigh infection model. By disk diffusion assay, all 21 isolates were resistant to CAZ-AVI alone, and 19/21 were resistant to ATM. The in vitro activity of CAZ-AVI in combination with ATM against diverse Enterobacteriaceae possessing MBLs was demonstrated in 17/21 isolates, where the zone of inhibition was ≥21 mm. All isolates demonstrated a reduction in CAZ-AVI agar dilution MICs with the addition of ATM. At 2 h, time-kill assays demonstrated a ≥4-log10-CFU decrease for all groups that had CAZ-AVI with ATM (8 µg/ml) added, compared to the group treated with CAZ-AVI alone. In the murine neutropenic thigh infection model, an almost 4-log10-CFU reduction was noted at 24 h for CAZ-AVI (32 mg/kg every 8 h [q8h]) plus ATM (32 mg/kg q8h) versus CAZ-AVI (32 mg/kg q8h) alone. The data presented herein require us to carefully consider this new therapeutic combination to treat infections caused by MBL-producing Enterobacteriaceae.

Nitrogen cycling process rates across urban ecosystems.

Nitrogen (N) pollution of freshwater, estuarine, and marine ecosystems is widespread and has numerous environmental and economic impacts. A portion of this excess N comes from urban watersheds comprised of natural and engineered ecosystems which can alter downstream N export. Studies of urban N cycling have focused on either specific ecosystems or on watershed-scale mass balances. Comparisons of specific N transformations across ecosystems are required to contextualize rates from individual studies. Here we reviewed urban N cycling in terrestrial, aquatic, and engineered ecosystems, and compared N processing in these urban ecosystem types to native reference ecosystems. We found that net N mineralization and net nitrification rates were enhanced in urban forests and riparian zones relative to reference ecosystems. Denitrification was highly variable across urban ecosystem types, but no significant differences were found between urban and reference denitrification rates. When focusing on urban streams, ammonium uptake was more rapid than nitrate uptake in urban streams. Additionally, reduction of stormwater runoff coupled with potential decreases in N concentration suggests that green infrastructure may reduce downstream N export. Despite multiple environmental stressors in urban environments, ecosystems within urban watersheds can process and transform N at rates similar to or higher than reference ecosystems.

Occurrence and Potential Biological Effects of Amphetamine on Stream Communities.

The presence of pharmaceuticals, including illicit drugs in aquatic systems, is a topic of environmental significance because of their global occurrence and potential effects on aquatic ecosystems and human health, but few studies have examined the ecological effects of illicit drugs. We conducted a survey of several drug residues, including the potentially illicit drug amphetamine, at 6 stream sites along an urban to rural gradient in Baltimore, Maryland, U.S.A. We detected numerous drugs, including amphetamine (3 to 630 ng L(-1)), in all stream sites. We examined the fate and ecological effects of amphetamine on biofilm, seston, and aquatic insect communities in artificial streams exposed to an environmentally relevant concentration (1 µg L(-1)) of amphetamine. The amphetamine parent compound decreased in the artificial streams from less than 1 µg L(-1) on day 1 to 0.11 µg L(-1) on day 22. In artificial streams treated with amphetamine, there was up to 45% lower biofilm chlorophyll a per ash-free dry mass, 85% lower biofilm gross primary production, 24% greater seston ash-free dry mass, and 30% lower seston community respiration compared to control streams. Exposing streams to amphetamine also changed the composition of bacterial and diatom communities in biofilms at day 21 and increased cumulative dipteran emergence by 65% and 89% during the first and third weeks of the experiment, respectively. This study demonstrates that amphetamine and other biologically active drugs are present in urban streams and have the potential to affect both structure and function of stream communities.

Acid rain mitigation experiment shifts a forested watershed from a net sink to a net source of nitrogen.

Decades of acid rain have acidified forest soils and freshwaters throughout montane forests of the northeastern United States; the resulting loss of soil base cations is hypothesized to be responsible for limiting rates of forest growth throughout the region. In 1999, an experiment was conducted that reversed the long-term trend of soil base cation depletion and tested the hypothesis that calcium limits forest growth in acidified soils. Researchers added 1,189 kg Ca(2+) ha(-1) as the pelletized mineral wollastonite (CaSiO3) to a 12-ha forested watershed within the Hubbard Brook Experimental Forest in the White Mountains of New Hampshire. Significant increases in the pH and acid-neutralizing capacity of soils and streamwater resulted, and the predicted increase in forest growth occurred. An unanticipated consequence of this acidification mitigation experiment began to emerge a decade later, with marked increases in dissolved inorganic nitrogen (DIN) exports in streamwater from the treated watershed. By 2013, 30-times greater DIN was exported from this base-treated watershed than from adjacent reference watersheds, and DIN exports resulting from this experiment match or exceed earlier reports of inorganic N losses after severe ice-storm damage within the study watershed. The discovery that CaSiO3 enrichment can convert a watershed from a sink to a source of N suggests that numerous potential mechanisms drive watershed N dynamics and provides new insights into the influence of acid deposition mitigation strategies for both carbon cycling and watershed N export.