Search

Spontaneous intramural hematoma of the colon is very rare and is typically induced by anticoagulant therapy, bleeding diathesis, or abdominal trauma. The symptoms are nonspecific and can vary from mild, crampy abdominal pain to hemorrhagic shock. The duodenum and small bowel are the most common sites of involvement. Spontaneous intramural colonic hematoma is a relatively rare cause of small bowel obstruction, only seen in 1 out of 2500 hospitalized patients with a history of anticoagulant use. We present a rare case of spontaneous colonic intramural hematoma leading to full thickness bowel lumen compromise resulting in small bowel obstruction. Additionally, this patient presented with secondary polycythemia due to chronic hypoxemia with no prior history of anticoagulant use before hospital admission and heparin drip use.

Introduction. Pentazocine, a synthetic opioid with partial agonist and antagonist activity administered by parenteral injection, was used clinically in the 1970s. Dermatologic complications at injection sites were reported soon after its introduction. These complications are thought to be underreported. Many well-documented cases describe the development of fibrosis and calcinosis at the site of parenteral pentazocine injections, but few reports document management or successful treatment of the long-term sequelae of these manifestations. Case Report. The successful use of STSG for the treatment of chronic nonhealing ulcers secondary to pentazocine-induced cutaneous fibrosis in a 78-year-old male is presented. In the early 1970s, he was started on 3-times-daily intramuscular pentazocine injections to treat pain secondary to ulcerative colitis. He injected himself in the proximal thighs and buttocks for a period of approximately 10 years. He gradually developed severe soft tissue calcifications of both buttocks and anterior thighs. In the mid-to-late 1980s, the pentazocine injections were discontinued. The diffuse sclerosis and disfiguring fibrosis remained. Conclusions. This case underscores the lasting effects of pentazocine-induced cutaneous sclerosis and fibrosis, with cutaneous complications manifesting in this patient even decades after use. It also highlights the novel use of STSG as a treatment strategy for these cutaneous complications.

A combination of a review of the literature and a survey of practices by fellow Nutrition and Dietetics Program faculty at the University of the District of Columbia were conducted to discover ways to maintain student engagement in practicum courses required for a dynamic undergraduate Didactic Program in Dietetics. This reviewer found through a comprehensive examination of the literature, along with a survey of her program colleagues, that flexibility and planning provide the opportunity for faculty to improve lecture and practicum courses during a pandemic. Emphasis on a high level of engagement enabled students to maintain their ability to apply the theory covered in their nutrition courses to practical problems. This approach will prepare students to enter post-graduate supervised practice and entry into careers as registered dietitians and licensed nutritionists with the confidence and skills that they need to succeed.

For more than half a century, exploring a complete sequence of the oceanic crust from the seafloor through the Mohorovičić discontinuity (Moho) and into the uppermost mantle has been one of the most challenging missions of scientific ocean drilling. Such a scientific and technological achievement would provide humankind with profound insights into the largest realm of our planet and expand our fundamental understanding of Earth's deep interior and its geodynamic behavior. The formation of new oceanic crust at mid-ocean ridges and its subsequent aging over millions of years, leading to subduction, arc volcanism, and recycling of some components into the mantle, comprise the dominant geological cycle of matter and energy on Earth. Although previous scientific ocean drilling has cored some drill holes into old (> 110 Ma) and young (< 20 Ma) ocean crust, our sampling remains relatively shallow (< 2 km into intact crust) and unrepresentative of average oceanic crust. To date, no hole penetrates more than 100 m into intact average-aged oceanic crust that records the long-term history of seawater–basalt exchange (60 to 90 Myr). In addition, the nature, extent, and evolution of the deep subseafloor biosphere within oceanic crust remains poorly unknown. To address these fundamentally significant scientific issues, an international workshop “Exploring Deep Oceanic Crust off Hawai`i” brought together 106 scientists and engineers from 16 countries that represented the entire spectrum of disciplines, including petrologists, geophysicists, geochemists, microbiologists, geodynamic modelers, and drilling/logging engineers. The aim of the workshop was to develop a full International Ocean Discovery Program (IODP) proposal to drill a 2.5 km deep hole into oceanic crust on the North Arch off Hawai`i with the drilling research vessel Chikyu. This drill hole would provide samples down to cumulate gabbros of mature (∼ 80 Ma) oceanic crust formed at a half spreading rate of ∼ 3.5 cm a−1. A Moho reflection has been observed at ∼ 5.5 km below the seafloor at this site, and the workshop concluded that the proposed 2.5 km deep scientific drilling on the North Arch off Hawai`i would provide an essential “pilot hole” to inform the design of future mantle drilling.

We describe rapid spread of multidrug-resistant gram-negative bacteria among patients in dedicated coronavirus disease care units in a hospital in Maryland, USA, during May–June 2020. Critical illness, high antibiotic use, double occupancy of single rooms, and modified infection prevention practices were key contributing factors. Surveillance culturing aided in outbreak recognition and control.

In many places along the U.S. East and Gulf of Mexico coasts, barrier islands are the first line of defense against extreme weather events threatening our coastlines. The trademark of these barrier islands are sand dunes that are intricately bound, from a sedimentary perspective, to the beach. Coastal storms, such as Hurricanes Matthew (2016), Irma and Maria (2017), and Florence (2018) have devastating impacts on these environments. This study investigated the volumetric changes of an anthropogenic and controlled beach-dune system on Isle of Palms, South Carolina, for approximately one year following Hurricanes Matthew (2016) and Irma (2017). This research reveals that these systems did not recover. The average loss of sand at the beach was -15.5% (nv = -0.89), whereas the dunes gained an average of 13.3% (nv = 0.79), when compared to the already diminished post-storm volumes. When considering the pre-Hurricane Irma to pre-Hurricane Florence temporal period, the recovery percentages for the anthropogenic and control dunes was -15.5% and -40.1%, respectively, suggesting a net loss of sand. Cumulative storms, such as those experienced on the coast of South Carolina and many other coasts, pose a substantial threat to the long-term viability of coastal dune systems. However, recovery at the control site in the form of incipient foredune growth is promising. This paper concludes with a list of influencing factors to dune recovery.

The upper crustal volcanic section of the Oman suprasubduction zone ophiolite is divided into an older V1 sequence, overlain by slightly younger V2 lavas and (in places) a final V3 sequence. Paleomagnetic data from the V1 and V2 sequences of the northern massifs of the ophiolite have been used previously to infer that clockwise rotation of the Oman lithosphere began while the upper crust was actively accreting, with V1 lavas apparently more rotated than the overlying V2 units. This inference has been largely accepted by the geological community and has influenced models for the spreading history and geodynamic evolution of the Oman ophiolite.Here we present new paleomagnetic data from well-exposed and structurally well-constrained volcanic sequences in the Salahi and Fizh massifs of the ophiolite that discredit this interpretation. In contrast to previous studies that employed standard structural tilt corrections, we use a net tectonic rotation approach to determine rotation parameters, taking confidence limits on input variables into account using Monte Carlo modelling. Importantly, we correct the magnetization direction and structural orientation of the older V1 lavas for the effects of the net tectonic rotation of the younger V2 lavas prior to calculating rotation parameters for the older units. Results demonstrate that both massifs rotated ~120° clockwise around steeply-plunging rotation axes after eruption of the V2 lavas. This rotation occurred during roll-back of the Neotethyan subduction zone in response to impingement of the Arabian margin with the trench. Early rotation of the Salahi V1 lavas around shallowly-plunging, broadly ridge-parallel axes indicates only simple tilting between eruption of the V1 and V2 sequences, and no early rotation of the Fizh V1 lavas is required at all. These new constraints on the evolution of the ophiolite therefore provide no evidence of vertical axis rotation during accretion of the Oman volcanic sequences.

International Ocean Discovery Program (IODP) Expedition 357 drilled 17 shallow sites distributed ~10 km in the spreading direction (from west to east) across the Atlantis Massif oceanic core complex (Mid-Atlantic Ridge, 30°N). Mantle exposed in the footwall of the Atlantis Massif oceanic core complex is predominantly nearly wholly serpentinized harzburgite with subordinate dunite. Altered peridotites are subdivided into three types: (I) serpentinites, (II) melt-impregnated serpentinites, and (III) metasomatic serpentinites. Type I serpentinites show no evidence of melt-impregnation or metasomatism apart from serpentinization and local oxidation. Type II serpentinites have been intruded by gabbroic melts and are distinguishable in some cases on the basis of macroscopic and microscopic observations, e.g., mm-cm scale mafic-melt veinlets, rare plagioclase (˂0.5 modal % in one sample) or by the local presence of secondary (replacive) olivine after orthopyroxene; in other cases, ‘cryptic’ melt-impregnation is inferred on the basis of incompatible element enrichments. Type III serpentinites are characterized by silica metasomatism manifest by alteration of orthopyroxene to talc and amphibole, and by anomalously high anhydrous SiO2 concentrations (59–61 wt%) and low MgO/SiO2 values (0.48–0.52). Although many chondrite-normalized rare earth element (REE) and primitive mantle-normalized incompatible trace element anomalies, e.g., negative Ce-anomalies, are attributable to serpentinization, other compositional heterogeneities are due to melt-impregnation. On the basis of whole rock incompatible trace elements, a dominant mechanism of melt-impregnation is distinguished in the central and eastern serpentinites from fluid-rock alteration (mostly serpentinization) in the western serpentinites, with increasing melt-impregnation manifest as a west to east increase in enrichment in high-field strength elements and light REE. High degrees of melt extraction are evident in low whole-rock Al2O3/SiO2 values and low concentrations of Al2O3, CaO and incompatible elements. Estimates of the degree of melt extraction based on whole rock REE patterns suggest a maximum of ~20% non-modal fractional melting, with little variation between sites. As some serpentinite samples are ex situ rubble, the magmatic histories observed at each site are consistent with a local source (from the fault zone) rather than rafted rubble that would be expected to show more heterogeneity and no spatial pattern. In this case, the studied sites may provide a record of enhanced melt-rock interactions with time, consistent with proposed geological models. Alternatively, sites may signify heterogeneities in these processes at spatial scales of a few km. ISSN:0009-2541 ISSN:1872-6836

Necrotizing soft tissue infections (NSTIs) are highly aggressive and may be lethal if untreated. Polymicrobial infections of the groin and lower limb have been documented secondary to invasive colorectal cancer (CRC). We present a case of CRC diagnosed more than 4 years after the development of NSTI. There are documented cases of NSTIs concomitant with a preexisting CRC. In this case, however, the patient’s initial presentation was an NSTI followed by later diagnosis of CRC. A previously treated NSTI that is not healing appropriately may be an early indicator for CRC.

Objectives: This study sought to identify coronavirus disease 2019 (COVID-19) risk communication materials distributed in Jamaica to mitigate the effects of the disease outbreak. It also sought to explore the effects of health risk communication on vulnerable groups in the context of the pandemic. Methods: A qualitative study was conducted, including a content analysis of health risk communications and in-depth interviews with 35 purposively selected elderly, physically disabled, persons with mental health disorders, representatives of government agencies, advocacy and service groups, and caregivers of the vulnerable. Axial coding was applied to data from the interviews, and all data were analyzed using the constant comparison technique. Results: Twelve of the 141 COVID-19 risk communication messages directly targeted the vulnerable. All participants were aware of the relevant risk communication and largely complied. Barriers to messaging awareness and compliance included inappropriate message medium for the deaf and blind, rural location, lack of Internet service or digital devices, limited technology skills, and limited connection to agencies that serve the vulnerable. Conclusion: The vulnerable are at increased risk in times of crisis. Accessibility of targeted information was inadequate for universal access to health information and support for vulnerable persons regardless of location and vulnerability.

Background COVID-19 has taken its toll on citizens in all 50 states of the United States. The United States (U.S.) leads the world with 30,291,863 confirmed reported cases and 549,664 deaths as of March 29, 2021 compared to globally confirmed cases at 127,442,926 and 2,787,915 deaths as of March 29, 2021. The U.S. federal government primarily left the response to the virus to individual states, and each implemented varying measures designed to protect health of citizens and the state’s economic well-being. Unintended consequences of the virus and measures to stop its spread may include decreased physical activity and exercise, shifting access and consumption of food, and lower quality-of-life. Therefore, our primary goal was to quantify the impact of COVID-19 on health and well-being by measuring changes in physical activity, mental health-quality of life, food security and nutrition in adults ages 40 and older. We believed shifts in health behaviors would be more prevalent in minorities, less educated, lower socio-economic status, older adults, and those with underlying health conditions, so a secondary goal was to determine the impact of COVID-19 on these sub-populations. Methods We conducted an online survey with 9969 adults 40 years and older between 9 August and 15 September 2020 in urban areas across the four U.S. census regions. The survey included questions about demographic variables, pre-existing health conditions, physical activity, access to food, quality-of-life, and nutritional food status and asked participants to respond with information from pre-pandemic and pandemic conditions. We used paired-sample t-tests to detect changes in variables after the start of the pandemic and Cohen’s d to determine effect sizes. Results Our main findings showed a decrease in physical activity since the onset of COVID-19 for minorities and non-minorities. Food security also slightly increased for minorities during the pandemic, but we found no other changes in food security, quality-of-life indicators, or nutritional status of those who responded to this survey. Conclusions It is concerning that physical activity declined. Such activity helps maintain physical and mental health, and it is also an important time to socialize for many older adults. In many ways, our data indicate that the older adult population in U.S. cities may be more resilient than expected during the pandemic. However, the pandemic could have negative impacts that we did not detect, either due to the survey instrument or the timing of our survey, so the health and well-being of older adults should continue to be monitored in order to mitigate potential negative impacts.

Uncommon, or rare, yeast infections are on the rise given increasing numbers of patients who are immunocompromised or seriously ill. The major pathogens include those of the genera Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon (ie, basidiomycetes) and Kodamaea, Malassezia, Pseudozyma (ie, now Moesziomyces or Dirkmeia), Rhodotorula, Saccharomyces, and Sporobolomyces (ie, ascomycetes). A considered approach to the complex, multidisciplinary management of infections that are caused by these pathogens is essential to optimising patient outcomes; however, management guidelines are either region-specific or require updating. In alignment with the One World-One Guideline initiative to incorporate regional differences, experts from diverse geographical regions analysed publications describing the epidemiology and management of the previously mentioned rare yeasts. This guideline summarises the consensus recommendations with regards to the diagnostic and therapeutic options for patients with these rare yeast infections, with the intent of providing practical assistance in clinical decision making. Because there is less clinical experience of patients with rare yeast infections and studies on these patients were not randomised, nor were groups compared, most recommendations are not robust in their validation but represent insights by use of expert opinions and in-vitro susceptibility results. In this Review, we report the key features of the epidemiology, diagnosis, antifungal susceptibility, and treatment outcomes of patients with Geotrichum, Saprochaete, Magnusiomyces, and Trichosporon spp infections.

The Oman ophiolite is a natural laboratory for the study of processes operating above a nascent subduction zone. It formed in the Late Cretaceous by supra-subduction zone spreading and shortly afterwards was emplaced onto the Arabian continental margin. Twelve massifs in the ophiolite expose complete sections of the Neotethyan oceanic lithosphere, including upper mantle peridotites, lower crustal gabbros, and upper crustal sheeted dykes and lava flows. Previous palaeomagnetic studies have suggested that the southern massifs of the ophiolite were affected by a large-scale remagnetization event during emplacement, that completely replaced original remanences acquired during crustal accretion. In contrast, primary magnetizations are preserved throughout the northern massifs. This study aimed to: (i) apply palaeomagnetic, magnetic fabric and rock magnetic techniques to analyse crustal sections through the southern massifs of the Oman ophiolite to investigate further the extent and nature of this remagnetization event; and (ii) use any primary magnetizations that survived this event to document intraoceanic rotation of the ophiolite prior to emplacement. Our new data confirms that remagnetization appears to have been pervasive throughout the southern massifs, resulting in presence of shallowly-inclined NNW directions of magnetization at all localities. An important exception is the crustal section exposed in Wadi Abyad (Rustaq massif) where directions of magnetization change systematically through the gabbro-sheeted dyke transition. Demagnetization characteristics are shown to be consistent with acquisition of a chemical remanent overprint that decreased in intensity from the base of the ophiolite upwards. The top of the exposed Wadi Abyad section (in the sheeted dyke complex) appears to preserve original SE-directed remanences that are interpreted as primary seafloor magnetizations. Similar SE primary remanences were also isolated at a control locality in the Salahi massif, outside of the region of remagnetization. Net tectonic rotation analysis at these non-remagnetised sites shows an initial NNE-SSW strike for the supra-subduction zone ridge during spreading, comparable with recently published models for the regional evolution of the ophiolite.

Background Physical activity (PA) is an integral part of successful aging. However, many older adults (OAs) are not meeting current PA recommendations. Objective To assess the PA needs, preferences, and practices of community-residing OAs. Study Design, Setting, Participants This qualitative study assessed the PA needs and preferences of 117 community-residing OAs. Thirteen focus groups (FG) were held in Iowa (IA, 5 FG) and Washington, DC (DC, 8 FG). FG discussions centered on perceived PA needs, motivators and barriers, and preferred PA programming attributes. Each FG was audio-recorded. Participants also completed a sociodemographic survey. IA participants (n = 51) were recruited at congregate meal sites while DC participants (n = 66) were recruited from 2 OAs volunteer programs. Measurable Outcome/Analysis FG recordings were transcribed verbatim and reviewed for major themes using standard theme analysis protocols. Sociodemographic data were analyzed using descriptive statistics. Kruskal-Wallis H Test assessed between group differences for sociodemographic attributes (P Results The mean age of participants was 74.4 ± 7.0 years. Participants were mostly educated (77.2%) females (83.1%) in “average or higher” health (84.8%). IA participants were more educated than DC participants (P Conclusions This sample of community-residing OAs are not meeting PA recommendations. The perceived PA needs and preferences were similar regardless of being rural- or urban-residing. These findings provide useful information to better enable tailoring of PA messaging and programming for community-residing OAs.

Scholars have consistently shown that people with mental illness are at an elevated risk for victimization experiences when compared to their non-disordered counterparts (Goodman et al., 2001; Hiday et al. 1999; Hiday et al., 2002; Silver, 2002; Teplin et al., 2005; Walsh et al., 2003). Researchers have identified numerous risk factors that elevate the risk of victimization experiences amongst people with mental illness; yet, little is known about what factors may protect this group of people from victimization That is, what is currently missing in the literature is the assessment of why, despite elevated risk, some persons with mental illness are notvictimized – known as resiliency. Utilizing multiple datasets, factors that are associated with resiliency from victimization amongst those with mental illness are investigated using multiple measure strategies for resiliency. Further, subsequent analyses examining group differences based on biological sex within the resiliency process are explored. Additional analyses examining how protective factors may differ within diagnostic categories are also examined. The applicability of resiliency models for people with mental illness are also explored. Results suggest that two domains of protective factors are important in the resiliency process from victimization amongst this population including those related to social support and those related to institutions such as the school. Results also suggest there are differences in protective factors that influence resiliency based on biological sex and protective factors within different diagnostic categories are identified. Finally, the compensatory resilience model appears to be the most applicable for people with mental illness. Future research and prevention implications are discussed.

Conducting and documenting a mental health assessment is considered a central activity from a clinical and organizational perspective. In recent years, thinking and practice in mental health service delivery has changed considerably to embrace principles of recovery, trauma-informed care, and strengths-based approaches. The aim of the present study was to determine the degree to which these concepts are reflected in the content of assessment formats across mental health services in Australia and New Zealand. Copies of mental health assessments used in each state and territory in Australia, and three District Health Boards in New Zealand were obtained. Assessment formats were compared for similarities and differences, and to determine whether concepts of recovery, trauma-informed care, and strengths-based approaches were incorporated. The assessment formats analysed (n = 11) contained many traditional features targeted at identifying harms, problems, risks, and pathology. Some attempts to redress this discrepancy were evident. Overall, assessment formats did not adequately voice the individual's perspective or promote a truly comprehensive assessment through an exploration of individual strengths, skills and abilities, past successes, and future hopes. Assessment formats across Australia and New Zealand are not currently aligned with contemporary thinking and practice in mental health care. Given the heavy influence that mental health assessment has on clinical decision making in particular, a reappraisal of the focus and content of formats used is urgently required.