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In 2017 and 2019, five outbreaks of infections from multiple strains of Salmonella linked to the consumption of whole, fresh Maradol papayas were reported in the United States, resulting in 325 ill persons. Traceback, laboratory, and epidemiologic evidence indicated papayas as the likely vehicle for each of these outbreaks and identified the source of papayas. State and U.S. Food and Drug Administration (FDA) laboratories recovered Salmonella from papaya samples from various points of distribution, including at import entry, and conducted serotyping, pulsed-field gel electrophoresis, and phylogenetic analyses of whole genome sequencing data. Federal and state partners led traceback investigations to determine the source of papayas. Four different suppliers of papayas were linked by traceback and laboratory results to five separate outbreaks of Salmonella infections associated with papayas. In 2017, multiple states tested papaya samples collected at retail, and Maryland and Virginia investigators recovered strains of Salmonella associated with one outbreak. FDA collected 183 papaya samples in 2017, and 11 samples yielded 62 isolates of Salmonella. Eleven serotypes of Salmonella were recovered from FDA papaya samples, and nine serotypes were closely related genetically by pulsed-field gel electrophoresis and whole genome sequencing to clinical isolates of four outbreaks, including the outbreak associated with positive state sample results. Four farms in Mexico were identified, and their names were released to the general public, retailers, and foreign authorities. In 2019, FDA collected 119 papaya samples, three of which yielded Salmonella; none yielded the 2019 outbreak strain. Investigators determined that papayas of interest had been sourced from a single farm in Campeche, Mexico, through traceback. This information was used to protect public health through public guidance, recalls, and import alerts and helped FDA collaborate with Mexican regulatory partners to enhance the food safety requirements for papayas imported from Mexico. HIGHLIGHTS

Background High adherence to remote monitoring (RM) in pacemaker (PM) patients improves outcomes; however, adherence remains suboptimal. Bluetooth low-energy (BLE) technology in newer-generation PMs enables communication directly with patient-owned smart devices using an app without a bedside console. Objective To evaluate the success rate of scheduled RM transmissions using the app compared to other RM methods. Methods The BlueSync Field Evaluation was a prospective, international cohort evaluation, measuring the success rate of scheduled RM transmissions using a BLE PM or cardiac resynchronization therapy PM coupled with the MyCareLink Heart app. App transmission success was compared to 3 historical “control” groups from the Medtronic de-identified CareLink database: (1) PM patients with manual communication using a wand with a bedside console (PM manual transmission), (2) PM patients with wireless automatic communication with the bedside console (PM wireless); (3) defibrillator patients with similar automatic communication (defibrillator wireless). Results Among 245 patients enrolled (age 64.8±15.6 years, 58.4% men), 953 transmissions were scheduled through 12 months, of which 902 (94.6%) were successfully completed. In comparison, transmission success rates were 56.3% for PM manual transmission patients, 77.0% for PM wireless patients, and 87.1% for defibrillator wireless patients. Transmission success with the app was superior across matched cohorts based on age, sex, and device type (single vs dual vs triple chamber). Conclusion The success rate of scheduled RM transmissions was higher among patients using the smart device app compared to patients using traditional RM using bedside consoles. This novel technology may improve patient engagement and adherence to RM., Graphical abstract

Managing the vast amounts of eggshell and sea-shell waste that is produced globally each year is becoming very problematic as this material is simply disposed of in landfills. This waste results in odor production and microbial growth directly leading to environmental stresses. Transforming this waste into valuable biomaterials pose significant environmental and economic advantages as discarded waste have materials that can be utilized. The objective of this work was to develop inexpensive, bioactive hydroxyapatite-based scaffolds for tissue engineering applications by using an eco-friendly and sustainable approach. Engineering nano hydroxyapatite (EnHA) was derived from chicken eggshell and clam sea-shell waste by using an energy efficient microwave assisted wet chemical precipitation method. X-ray diffraction (XRD), Field emission scanning electron microscopy (FESEM), Transmission electron microscopy (TEM), and Energy dispersive spectroscopy (EDS) were used to analyze the biomaterials. Results show that the particles are highly crystalline hydroxyapatite (HA) with acicular shapes and within nanometer size ranges. The chemical compositions match exactly that of naturally occurring HA. The EnHA infused polymer scaffolds were fabricated using slurry-based solution 3D printing techniques. The slurry solutions composed of 70 wt% EnHA and 30 wt% Polycarpolactone (PCL). The XRD, SEM, EDS, and in vitro cell studies were conducted to determine the ability of the scaffolds to support cell adhesion and maintain viability. The scaffolds supported cellular attachment and maintenance when observed over a period of several days, suggesting their potential for future tissue regeneration research and applications.

Cells maintain a small arsenal of resolving functions to process and eliminate complex DNA intermediates that result as a consequence of homologous recombination and distressed replication. Ordinarily the homologous recombination system serves as a high-fidelity mechanism to restore the integrity of a damaged genome, but in the absence of the appropriate resolving function it can turn DNA intermediates resulting from replication stress into pathological forms that are toxic to cells. Here we have investigated how the nucleases Mus81 and Gen1 and the helicase Blm contribute to survival after DNA damage or replication stress in Ustilago maydis cells with crippled yet homologous recombination-proficient forms of Brh2, the BRCA2 ortholog and primary Rad51 mediator. We found collaboration among the factors. Notable were three findings. First, the ability of Gen1 to rescue hydroxyurea sensitivity of dysfunctional Blm requires the absence of Mus81. Second, the response of mutants defective in Blm and Gen1 to hydroxyurea challenge is markedly similar suggesting cooperation of these factors in the same pathway. Third, the repair proficiency of Brh2 mutant variants deleted of its N-terminal DNA binding region requires not only Rad52 but also Gen1 and Mus81. We suggest these factors comprise a subpathway for channeling repair when Brh2 is compromised in its interplay with DNA.

As a result of impairments to fresh surface water quality due to phosphorus enrichment, substantial research effort has been put forth to quantify agricultural runoff phosphorus as related to on-field practices. While the analysis of runoff dissolved phosphorus is well prescribed and leaves little room for variability in methodology, there are several methods and variations of sample preparation reagents as well as analysis procedures for determining runoff total phosphorus. Due to the variation in methodology for determination of total phosphorus and an additional laboratory procedure required to measure suspended solids, the objectives of the current study are to i. compare the performance of three persulfate digestion methods (Acid Persulfate, USGS, and Alkaline Persulfate) for total phosphorus percent recovery across a wide range of suspended sediments (SS), and ii. evaluate the ability of using Al and/or Fe in digestion solution to predict SS as a surrogate to the traditional gravimetric method. Percent recovery of total phosphorus was determined using suspensions prepared from soils collected from 21 agricultural fields in Ohio. The Acid Persulfate method was most effective, with an average total phosphorus percent recovery of 96.6%. The second most effective method was the USGS with an average total phosphorus recovery of 76.1%. However, the Alkaline Persulfate method performed poorly with an average 24.5% total phosphorus recovery. As a result application of Alkaline Persulfate digestion to edge of field monitoring may drastically underestimated runoff total phosphorus. In addition to excellent recovery of total phosphorus, the Acid Persulfate method combined with analysis of Al and Fe by inductively coupled plasma atomic emission spectrometry provides a robust estimate of total SS. Due to the large quantity of samples that can result from water quality monitoring, an indirect measure of total SS could be very valuable when time and budget constraints limit the number of procedures that can be run on a single water sample.

High temperature hydrogen attack (HTHA) and creep damage and cracking are time-dependent phenomena which can occur at relatively low temperatures (300–500 °C) in low alloy steel components used in petroleum refinery and petrochemical plant. The present study combines a novel multiaxial ductility creep model with a sub-grain level fugacity partial pressure strain-based failure criterion due to a build-up of methane gas to predict progressive damage accumulation and HTTA degradation in an aging nozzle component. Finite element (FE) simulations using appropriate subroutines for the coupled approach allow progressive failure predictions combining HTHA and creep deformation in a C-0.5Mo steel inlet nozzle which had seen 80,000 h operation. A sensitivity study has been carried out to quantify the effects of different operating temperatures, failure strains, hydrogen concentration and pressure and material hydrogen diffusivity on the levels of damage in the nozzle over its lifetime. The predictions accurately bound the measured damage observed in the nozzle component and highlight the sensitivity of the model with respect to the input variables.

Compressible cellular metal sandwich structures made from a 3D assembly of square cross section 6061 T6 aluminum alloy tubes, and face sheets of the same alloy have been attached to a vertical pendulum and impacted by synthetic wet sand with an incident velocity of ∼300 ms−1. The transmitted impulse of samples with thick (relatively rigid) and thin face sheets are compared to that transferred by an incompressible solid aluminum test block of the same dimensions. A discrete particle-based simulation method was used to simulate the experiments and to investigate the soil particle – structure interaction with the cellular structures. The simulated results agreed very well with experimental data; both showed that the impulse transferred to cellular structures with a 22 MPa core strength was 10–15% less than that transferred to a solid block of similar dimensions. However, the simulations reveal that the some of this apparent mitigation resulted from a subtle sand interaction between the bottom of the test structure and the sand box used for the tests. When this sand box effect was eliminated in the simulations, a small impulse reduction from cellular structures with thin face sheets was still observed. However, this was found to be a result of dynamic deflection of the edges of the front face sheet. When this effect was eliminated (by the use of a rigid front face), the simulations showed a small (5%) impulse reduction occurred for cellular structure whose compressive strength was much less than the pressure applied by the sand. This was a consequence of rapid core compression which increased the travel distance (and lateral spreading) of late arriving sand during the sand loading process. Weak cellular structures, that suffered significant crushing, also reduce the impulse transfer rate.

An experiment tested whether physical disorder affected low to moderate income African–American children’s choice of street to walk on and their parents’ choice of a street for them to walk on. The experiment used an innovative desktop simulation in which 32 fourth and fifth grade African–American children and 30 parents viewed and explored pairs of virtual walk-through streets manipulated on disorder (across three contexts and two other street and sidewalk characteristics) and picked from each pair the one to walk on (child) or for the child to walk on (parent). Each participant was asked to report the reasons for the choices. The analysis revealed that children and their parents were more likely to walk (or have the child walk) on streets lower in disorder. Reported reasons for choices confirmed the importance of physical disorder in affecting walking choices. Low-cost improvements in order may make streets more desirable for recreational walking.

A vertical pendulum apparatus has been used to experimentally investigate the impulse and pressure applied by the impact of wet synthetic sand upon the flat surface of a back supported solid aluminum test block. The transferred impulse and maximum pressure applied to the sample were both found to decrease with increasing standoff distance between the bottom of the sand layer and the impact face of the solid block. A particle based simulation method was used to model the sand's acceleration by the explosive and its impact with the test structure. This method was found to successfully predict both the impulse and pressure transferred during the tests. Analysis of the experimentally validated simulations indicates that the momentum transmitted to the test structure is approximately equal to the free field momentum of the incoming sand, consistent with the idea that the sand stagnates against a planar surface upon impact. The decrease in transferred impulse with increasing standoff distance arises from a small reduction in sand particle velocity due to momentum transfer to air particles, and an increase in lateral spreading of the sand particles as the standoff distance increased. This spreading results in a smaller fraction of the sand particles impacting the (finite) area of the test sample impact face.

The National Institutes of Health Undiagnosed Diseases Program evaluates patients for whom no diagnosis has been discovered despite a comprehensive diagnostic workup. Failure to diagnose a condition may arise from the mutation of genes previously unassociated with disease. However, we hypothesized that this could also co-occur with multiple genetic disorders. Demonstrating a complex syndrome caused by multiple disorders, we report two siblings manifesting both similar and disparate signs and symptoms. They shared a history of episodes of hypoglycemia and lactic acidosis, but had differing exam findings and developmental courses. Clinical acumen and exome sequencing combined with biochemical and functional studies identified three genetic conditions. One sibling had Smith–Magenis Syndrome and a nonsense mutation in the RAI1 gene. The second sibling had a de novo mutation in GRIN2B , which resulted in markedly reduced glutamate potency of the encoded receptor. Both siblings had a protein-destabilizing homozygous mutation in PCK1 , which encodes the cytosolic isoform of phosphoenolpyruvate carboxykinase (PEPCK-C). In summary, we present the first clinically-characterized mutation of PCK1 and demonstrate that complex medical disorders can represent the co-occurrence of multiple diseases.

Brh2, the BRCA2 ortholog in the fungus Ustilago maydis, harbors two different DNA-binding domains, one located in the N-terminal region and the other located in the C-terminal region. Here we were interested in comparing the biochemical properties of Brh2 fragments, Brh2(NT) and Brh2(CT), respectively, harboring the two different DNA-binding regions to understand the mechanistic purpose of dual DNA-interaction domains. With oligonucleotide substrates to model different DNA conformations, it was found that the substrate specificity of Brh2(NT) and Brh2(CT) was almost indistinguishable although avidity was different depending on salt concentration. DNA annealing activity inherent in Brh2 was found to be attributable to Brh2(NT). Likewise, activity responsible for a second-end capture reaction modeling a later step in repair of DNA double-strand breaks was found attributable to Brh2(NT). Efficient annealing of DNA strands coated with RPA required full length Brh2 rather than Brh2(NT) suggesting Brh2(CT) contributes to the activity when RPA is present. Brh2(NT) and Brh2(CT) were both found capable of physically interacting with RPA. The results suggest that while the two DNA-binding regions of Brh2 appear functionally redundant in certain aspects of DNA repair, they differ in fundamental properties, and likely contribute in different ways to repair processes involving or arising from stalled DNA replication forks.

Approximately 80% of the land area draining into the western Lake Erie Basin is in Ohio, much of which is agricultural. Therefore, the potential for agricultural phosphorus (P) loading from Ohio is a concern for the water quality of western basin rivers, embayments and open water. This work demonstrates soil P relationships across Ohio soils and its implications for potential revisions of Ohio P risk assessment tools. The objectives were, using a selection of soils representative of soils across Ohio, (i) to determine if soil survey classification (series) could be an indicator of hydrous oxide content and, (ii) to determine if agronomic soil test P (STP) Mehlich 3 (M3-P), Bray P, or alternative measures of soil P saturation (Psat) were comparable to oxalate Psat for predicting P solubility, and therefore, useful for Ohio P risk assessment tools. Results showed no significant difference ( P > 0.01) in soil hydrous oxide content when grouped by soil series. However, significant ( P

Recent studies implicate a number of DNA repair proteins in mammalian telomere maintenance. However, because several key repair proteins in mammals are missing from the well-studied budding and fission yeast, their roles at telomeres cannot be modeled in standard fungi. In this report, we explored the dimorphic fungus Ustilago maydis as an alternative model for telomere research. This fungus, which belongs to the phylum Basidiomycota, has a telomere repeat unit that is identical to the mammalian repeat, as well as a constellation of DNA repair proteins that more closely mimic the mammalian collection. We showed that the two core components of homology-directed repair (HDR) in U. maydis, namely Brh2 and Rad51, both promote telomere maintenance in telomerase positive cells, just like in mammals. In addition, we found that Brh2 is localized to telomeres in vivo, suggesting that it acts directly at chromosome ends. We surveyed a series of mutants with DNA repair defects, and found many of them to have short telomeres. Our results indicate that factors involved in DNA repair are probably also needed for optimal telomere maintenance in U. maydis, and that this fungus is a useful alternative model system for telomere research.

Through collaborative partnerships established between current researchers and The Moton Community House (a local community center), African American women (ages 16–49 yrs) from the Southeast Community of Newport News, Virginia, USA were surveyed to assess the reproducibility and consistency of fish consumption patterns (ingestion rates, exposure frequencies, weight, and fish consumption rates) derived from a community-specific fish consumption survey. Women were also surveyed to assess the reliability of the survey responses, and to estimate daily mercury intake. Fish consumption patterns were reproducible and the survey responses were reliable. Comparison between years revealed that fish consumption patterns remained consistent over time. In addition, the high fish consumption rate estimated in 2008 (147.8 g/day; 95% CI: 117.6–185.8 g/day) was confirmed with a rate (134.9 g/day; 95% CI: 88–207 g/day) not materially different and still considerably higher than mean fish consumption rates reported for U.S. women. Daily mercury intake rates were estimated using consumption data from 2008 and three consumption scenarios (canned white, canned light, and no tuna) due to confirmed differences in mercury concentration between canned white and light tuna. Arithmetic mean daily mercury intake rates were 0.284 μg/kg bw/day (95% CI: 0.229–0.340 μg/kg bw/day) using canned white tuna, 0.212 μg/kg bw/day (95% CI: 0.165–0.259 μg/kg bw/day) using light tuna, and 0.197 μg/kg bw/day (95% CI: 0.151–0.243 μg/kg bw/day) using no tuna. Approximately 58%–73% of the daily mercury intake rates for African American women in the Southeast Community exceeded US EPA's oral reference dose (RfD) of 0.10 μg/kg bw/day for mercury. In addition, 2% of the rates exceeded a level (1.00 μg/kg bw/day) documented to produce adverse health effects. Past and current investigations confirmed that even though women in this community were not subsistence fishers, they are subsistence fish consumers.

Introduction Proper monitoring of patients' behavior is essential for effective treatment and efficient disposition of psychiatric cases in the adult emergency department. The goal of the current study was to examine an attempt to implement the Behavioral Activity Rating Scale, an existing single-item measure of behavioral activity, as part of a behavioral management triage strategy for psychiatric patients in an emergency department. Methods For the period beginning approximately 2 months after use of the behavioral activity measure was initiated in the emergency department, charts from 284 consecutive patients who presented to the department with a chief complaint that was psychiatric in nature were reviewed. Results Level of adoption of the measure by emergency nurses was lower than desired; only 46% of charts reviewed contained a behavioral activity rating. Ratings were less likely to be recorded during the night shift than during other shifts. As predicted, ratings indicative of elevated behavioral activity were associated with physician orders for formal behavioral management (ie, intramuscular, intravenous, or orally dissolving sedating medications or physical restraint). Discussion The findings of this study suggest that a single-item behavioral activity measure may be an efficient, effective, and discreet way for emergency nursing staff to communicate with one another and with physicians about psychiatric patients in need of behavioral management in adult emergency departments. The findings also suggest that a broad implementation approach is needed to achieve desired levels of adoption by emergency nursing staff.

The use of community-based participatory research (CBPR) methods to conduct environmental exposure assessments provides valuable insight about disparities in seafood consumption and contaminant exposure. Ninety-five community-specific seafood consumption surveys were administered to low-income African–American women (ages 16–49) residing in the Southeast community of Newport News, VA, USA, for the purpose of assessing potential dietary mercury exposure. Only the results of the seafood consumption surveys are presented in this manuscript. Approximately 65% of the women surveyed do not fish; however, 83% had consumed seafood within the last 7 days. Whiting, shrimp, and canned tuna were the three items most frequently consumed. Ninety-three percent of the women surveyed stated that grocery/seafood markets were the main sources of the seafood items generally consumed. The mean seafood consumption rate for the women surveyed was 147.8 g/day (95% CI: 117.6–185.8), a rate substantially higher than the mean seafood consumption rate reported for US women (1.8 g/day 95% CI: 1.51–2.04). Shrimp, croaker, and blue crab were the top three seafood items with the highest summed amount (g/day) consumed. There was no significant association between demographic variables (age, income, education, and weight) and total number of seafood items listed, ingestion rate (g/meal), exposure frequency (meals/year), and seafood consumption rate (g/day). By using CBPR to assess seafood consumption in this community, we learned that even though women in Southeast Newport News, Virginia are not subsistence fishers, they consume seafood at a subsistence fisher rate. Of the three seafood items most frequently consumed, canned tuna potentially plays a significant role in dietary mercury exposure for women in this community. Future work includes determining mercury concentrations in seafood items consumed and generating community-specific statements of dietary mercury risks.

We present the first known case of the monoblastic type of myeloid sarcoma (also known as extramedullary myeloid tumor, chloroma, and granulocytic sarcoma) with diffuse involvement of the gastrointestinal tract. The patient originally presented with diarrhea and crampy abdominal discomfort. Endoscopically, the disease showed a diffuse inflammatory process mimicking a number of benign conditions, such as inflammatory bowel disease and autoimmune enteropathy. Sequential biopsies of the upper and lower gastrointestinal tract showed a diffuse infiltrate of increasingly atypical cells. The disease progressed to systemic involvement, including widespread lymphadenopathy, splenomegaly, and pulmonary deposits; the patient died 13 months after the development of initial symptoms. The immunohistochemical and histologic profiles of this case are diagnostic of the monoblastic type of myeloid sarcoma.

Accumulating evidence for Rad51-catalyzed DNA strand invasion during double-strand break repair features a 3' single-stranded tail as the preferred substrate for reaction, but paradoxically, the preferred substrate in model reactions in vitro is the 5' end. Here, we examined the Rad51-promoted 5' end invasion reaction in the presence of Brh2, the BRCA2 family protein in Ustilago maydis. Using plasmid DNA and a homologous duplex oligonucleotide with 5' protruding single-stranded tail as substrates, we found that Brh2 can stimulate Rad51 to promote the formation of a four-stranded complement-stabilized D loop. In this structure, the incoming recessed complementary strand of the oligonucleotide has switched partners and can now prime DNA synthesis using the recipient plasmid DNA as template, circumventing a lesion that blocks elongation when the 5' protruding tail serves as template for fill-in synthesis. We propose that template switching promoted by Brh2 provides a mechanism for recombination-mediated bypass of lesions blocking synthesis during DNA replication.