Tick-Borne Relapsing Fever in the White Mountains, Arizona, USA, 2013-2018.

Tick-borne relapsing fever (TBRF) is a bacterial infection transmitted by tick bites that occurs in several different parts of the world, including the western United States. We describe 6 cases of TBRF acquired in the White Mountains of Arizona, USA, and diagnosed during 2013-2018. All but 1 case-patient had recurrent fever, and some had marked laboratory abnormalities, including leukopenia, thrombocytopenia, hyperbilirubinemia, and elevated aminotransaminases. One patient had uveitis. Diagnosis was delayed in 5 of the cases; all case-patients responded to therapy with doxycycline. Two patients had Jarisch-Herxheimer reactions. The White Mountains of Arizona have not been previously considered a region of high incidence for TBRF. These 6 cases likely represent a larger number of cases that might have been undiagnosed. Clinicians should be aware of TBRF in patients who reside, recreate, or travel to this area and especially for those who sleep overnight in cabins there.

Pulmonary nocardiosis in cystic fibrosis.

BACKGROUND: The treatment of Nocardia species found in the sputum of cystic fibrosis patients is of unknown value. METHODS: We conducted a retrospective analysis of the impact of directed oral antibiotic therapy against Nocardia spp. isolated from the sputum of 17 cystic fibrosis patients over a 10-year period. Pulmonary Function Tests were used as the clinical indicator of the disease state and the data were analyzed by general linear mixed model statistics with univariate analysis. RESULTS: Pulmonary Function Test values of all patients studied showed no significant difference before, during, or after the antibiotic treatment period. Treatment groups did not differ from non-treatment groups. This held true for Forced Expiratory Volume over 1 s and Functional Vital Capacity analysis. In addition, individual patient analysis did not reveal any trends or outliers. CONCLUSIONS: Oral antibiotic therapy of cystic fibrosis patients colonized with Nocardia does not appear to affect clinical outcome. This suggests that deferring therapy may be an acceptable alternative and justifies conducting a future placebo controlled trial. In addition, this study model may be useful in analyzing the effect of therapy on other rare and difficult organisms, such as fungi and mycobacteria in the cystic fibrosis population.

Increasing community integration and inclusion for people with intellectual disabilities.

Historically residential facilities for individuals with intellectual disabilities have served the role of segregation and congregation with no real focus on integration into the community. More recently the focus has been to get people out of residential institutions and into community-based living settings. This work examines an approach to changing the systems and culture at a large residential facility to create higher rates of transitions to community-based living settings. A multi-phased systematic implementation approach is discussed in which each successive phase builds upon the previous phase. This approach creates opportunities for community integrated activities and then utilizes these community contexts as functional learning opportunities. Results are evaluated in the areas of community presence, community participation, community integration and community inclusion. Data indicate significant increases in each of these areas based on changing the facility focus, simplifying the intrusive accountability systems, aligning resources and teaching staff how to utilize support plans more efficiently to teach skills in functionally appropriate community integrated activities.

Potential roles for the PIM1 kinase in human cancer - a molecular and therapeutic appraisal.

In vitro experiments have shown the PIM1 kinase to have diverse biological roles in cell survival, proliferation and differentiation. In humans, PIM1 is often expressed in both normal and transformed cells. The PIM1 kinase is a true oncogene implicated in early transformation and tumour progression in haematopoietic malignancies and prostate carcinomas. It is associated with aggressive subgroups of lymphoma, is a marker of poor prognosis in prostate carcinomas and has been suggested to have a role in hormone insensitivity of prostate malignancies. PIM1 has a possible role in other carcinomas with 6p21 genomic alterations. On one hand, PIM1 (due to its role in malignancy) appears to be a promising target for drug development programmes but, on the other hand, the complexity of its molecular structure has posed challenges in the development of PIM1 inhibitors. In this review we discuss PIM1 expression in human tissues (including some new data from our laboratory), its role in human malignancies, as well as the possibilities and challenges in the development of target therapy for PIM1.

Psychosocial treatment malls for people with intellectual disabilities.

The provision of active treatment for people with intellectual disabilities has been seminal in the literature and in practice for a number of years. Active treatment has programmatic, financial, and legal ramifications for agencies and should be at the center of all appropriate treatment plans. The current work examines the use of psychosocial rehabilitation treatment malls to deliver active treatment to people with intellectual disabilities. The history, development, and implementation of these methods are discussed, with emphasis on services that are functional, meaningful, and portable. The importance of the therapeutic milieu is considered in context and discussed as the primary pathway to increased community integration. Finally, future directions of the treatment malls are considered.