Posttraumatic stress disorder (PTSD) is associated with lower cortical thickness (CT) in prefrontal, cingulate, and insular cortices in diverse trauma-affected samples. However, some studies have ...failed to detect differences between PTSD patients and healthy controls or reported that PTSD is associated with greater CT. Using data-driven dimensionality reduction, we sought to conduct a well-powered study to identify vulnerable networks without regard to neuroanatomic boundaries. Moreover, this approach enabled us to avoid the excessive burden of multiple comparison correction that plagues vertex-wise methods. We derived structural covariance networks (SCNs) by applying non-negative matrix factorization (NMF) to CT data from 961 PTSD patients and 1124 trauma-exposed controls without PTSD. We used regression analyses to investigate associations between CT within SCNs and PTSD diagnosis (with and without accounting for the potential confounding effect of trauma type) and symptom severity in the full sample. We performed additional regression analyses in subsets of the data to examine associations between SCNs and comorbid depression, childhood trauma severity, and alcohol abuse. NMF identified 20 unbiased SCNs, which aligned closely with functionally defined brain networks. PTSD diagnosis was most strongly associated with diminished CT in SCNs that encompassed the bilateral superior frontal cortex, motor cortex, insular cortex, orbitofrontal cortex, medial occipital cortex, anterior cingulate cortex, and posterior cingulate cortex. CT in these networks was significantly negatively correlated with PTSD symptom severity. Collectively, these findings suggest that PTSD diagnosis is associated with widespread reductions in CT, particularly within prefrontal regulatory regions and broader emotion and sensory processing cortical regions.
Primary fungal diseases in marine mammals are rare. Mucormycosis, a disease caused by fungi of the order Mucorales, has been documented in few cetaceans and pinnipeds. In 2012, the first case of ...mucormycosis in the Pacific Northwest was documented in a dead stranded harbor porpoise (Phocoena phocoena) in Washington state. Since then, mucormycosis has been detected in a total of 21 marine mammals; fifteen harbor porpoises, five harbor seals (Phoca vitulina), and one southern resident killer whale (Orcinus orca). Infected animals were predominately found in the inland waters of Washington and British Columbia, and one harbor seal was recovered in northern Oregon. Fungal hyphae were detected histologically in a variety of tissues, including brain, lung, spleen, pancreas, kidneys, muscle, lymph nodes, and skin. Three fungal species were identified from seven cases by PCR screening or fungal culture; Rhizomucor pusillus (four cases), Lichtheimia corymbifera (two cases), and Cunninghamella bertholletiae. Underlying conditions such as emaciation, current or recent pregnancy, multisystemic parasitism, protozoal infection, and herpesvirus were found in several affected animals. Reasons for the appearance and subsequent increase of these fungal infections in marine mammals are unknown. The emergence of this disease as a source of marine mammal mortality in the Pacific Northwest is of particular concern for endangered southern resident killer whales that spend time in this region. Current population-level stressors such as insufficient prey, high levels of contaminants, and noise pollution, could predispose them to these fatal infections.
The pervasive use of antibiotics in human medicine, veterinary medicine, and agriculture can result in a significant increase in the spread and environmental persistence of antibiotic resistance in ...marine ecosystems. This study describes the presence and distribution of antibiotic-resistant bacteria in Salish Sea harbor seals (Phoca vitulina) and harbor porpoises (Phocoena phocoena) and evaluates species, age class, and geographic differences in resistance patterns. Isolates from 95 dead-stranded animals (74 seals/21 porpoises) were tested for resistance to a suite of 15 antibiotics. Of the 95 sampled, 85 (89%) (67 seals/18 porpoises) successfully yielded 144 isolates, with 37% resistant to at least one antibiotic and 26% multi-drug resistant (24% and 39% of seal and porpoise isolates, respectively). Overall, and by study region, porpoises were significantly more likely to harbor resistant organisms compared to seals. Significant differences between age classes were noted for the antibiotics amoxicillin, cephalexin, and cefovecin. Overall isolate resistance was significantly greater in porpoises than seals for several individual antibiotics. Multiple antibiotic resistance (MAR) indices greater than 0.2 were observed in 55% of multi-drug resistant isolates, suggesting seal and porpoise exposure to anthropogenic pollution. The relatively high and disparate prevalence of antibiotic resistance in these common, but ecologically dissimilar, marine mammals reflects a potentially large environmental pool of antibiotic resistant organisms in the Salish Sea or inherently different resistance gene patterns between the two species.
Studying patterns in marine mammal stranding cases can provide insight into changes in population health, abundance, and distribution. Cetaceans along the United States West coast strand for a wide ...variety of reasons, including disease, injury, and poor nutritional status, all of which may be caused by both natural and anthropogenic factors. Examining the potential drivers of these stranding cases can reveal how populations respond to changes in their habitat, notably oceanographic variability and anthropogenic activities. In this study, we aim to synthesize recent patterns in 1,819 cetacean strandings across 26 species in the Pacific Northwest from 2000 to 2019 to compare with previous findings. Additionally, we aim to quantify the effects of localized and basin-scale oceanographic conditions on monthly stranding cases for five focal species using generalized additive models in order to explore potential relationships between strandings and changes in biophysical features that could affect foraging conditions or other important physiological cues. Our results suggest that strandings of harbor porpoises, gray whales, humpback whales, Dall’s porpoises, and striped dolphins are correlated with certain environmental variables, including sea surface temperature, chlorophyll concentration, and the Pacific Decadal Oscillation depending on the species. While it remains challenging to identify the causal mechanisms that underlie these relationships for a given species or population based on its utilization of such a complex ecosystem, improving our understanding of periods of increased strandings can enhance our knowledge of how these species interact with their environment and assist conservation and management efforts. This study enhances the utility of stranding records over time beyond simply reporting trends and has broader applicability to other geographic regions amid global climate change.
Postmortem data for harbor seals (Phoca vitulina richardsii) in the Salish Sea were analyzed for epidemiologic trends in congenital diseases. Cleft palate, cleft lips, or both (n=8) and cardiac ...defects (n=5) were the most common congenital abnormalities, followed by cases with multiple defects (n=4). No temporal trends or spatial clusters of cases were seen from 2003 to 2019, during which time monitoring effort was consistent. Cases could not be linked to specific causes such as environmental contamination or maternal malnutrition. Our study suggests that a yearly prevalence of 2.9%±2.2 is the endemic level of congenital disease in this stable harbor seal population. Continued monitoring of birth defects and overall harbor seal population status could help to identify emerging teratogens.
The purpose of this consensus document was to develop feasible, evidence‐based occupational heat safety recommendations to protect the US workers that experience heat stress. Heat safety ...recommendations were created to protect worker health and to avoid productivity losses associated with occupational heat stress. Recommendations were tailored to be utilized by safety managers, industrial hygienists, and the employers who bear responsibility for implementing heat safety plans. An interdisciplinary roundtable comprised of 51 experts was assembled to create a narrative review summarizing current data and gaps in knowledge within eight heat safety topics: (a) heat hygiene, (b) hydration, (c) heat acclimatization, (d) environmental monitoring, (e) physiological monitoring, (f) body cooling, (g) textiles and personal protective gear, and (h) emergency action plan implementation. The consensus‐based recommendations for each topic were created using the Delphi method and evaluated based on scientific evidence, feasibility, and clarity. The current document presents 40 occupational heat safety recommendations across all eight topics. Establishing these recommendations will help organizations and employers create effective heat safety plans for their workplaces, address factors that limit the implementation of heat safety best‐practices and protect worker health and productivity.
Plain Language Summary
Workers who experience heat stress on the job are at greater risk for heat‐related injuries, illnesses, and productivity losses. This document was created to present effective heat safety recommendations to protect workers from the dangers of heat. A meeting of 51 experts created 40 heat safety recommendations within eight heat safety topics: heat hygiene, hydration, heat acclimatization, environmental monitoring, physiological monitoring, body cooling, textiles and personal protective gear, and emergency action plan implementation. These recommendations will assist safety managers and employers implement heat safety recommendations that can be implemented at their worksite and can protect their workers.
Key Points
This document presents feasible, evidenced‐based occupational heat safety recommendations to protect workers from the dangers of heat
A roundtable of 51 experts created 40 heat safety recommendations within eight heat safety topics: heat hygiene, hydration, heat acclimatization, environmental monitoring, physiological monitoring, body cooling, textiles and personal protective gear, and emergency action plan implementation
Implementing feasible and effective heat safety plans in the workplace will protect worker health and mitigate productivity losses
Objective
Systemic juvenile idiopathic arthritis–associated lung disease (SJIA‐LD) is a life‐threatening disease complication. Key questions remain regarding clinical course and optimal treatment ...approaches. The objectives of the study were to detail management strategies after SJIA‐LD detection, characterize overall disease courses, and measure long‐term outcomes.
Methods
This was a prospective cohort study. Clinical data were ed from the electronic medical record, including current clinical status and changes since diagnosis. Serum biomarkers were determined and correlated with presence of LD.
Results
We enrolled 41 patients with SJIA‐LD, 85% with at least one episode of macrophage activation syndrome and 41% with adverse reactions to a biologic. Although 93% of patients were alive at last follow‐up (median 2.9 years), 37% progressed to requiring chronic oxygen or other ventilator support, and 65% of patients had abnormal overnight oximetry studies, which changed over time. Eighty‐four percent of patients carried the HLA‐DRB1*15 haplotype, significantly more than patients without LD. Patients with SJIA‐LD also showed markedly elevated serum interleukin‐18 (IL‐18), variable C‐X‐C motif chemokine ligand 9 (CXCL9), and significantly elevated matrix metalloproteinase 7. Treatment strategies showed variable use of anti–IL‐1/6 biologics and addition of other immunomodulatory treatments and lung‐directed therapies. We found a broad range of current clinical status independent of time from diagnosis or continued biologic treatment. Multidomain measures of change showed imaging features were the least likely to improve with time.
Conclusion
Patients with SJIA‐LD had highly varied courses, with lower mortality than previously reported but frequent hypoxia and requirement for respiratory support. Treatment strategies were highly varied, highlighting an urgent need for focused clinical trials.
Abstract Objective To determine whether a positive screen on the Traumatic Brain Injury-4 (TBI-4) can be used to identify veterans who use more inpatient and outpatient mental health services. Design ...Validation cohort. Setting Medical center. Participants Individuals seeking Veterans Health Administration mental health services (N=1493). Interventions Not applicable. Main Outcome Measures One year of inpatient and outpatient mental health utilization data after the TBI-4 screen date. Results In the year postmental health intake, those who answered positively to any of the 4 TBI-4 screening questions (criterion 1) or question 2 (criterion 2; ever having been knocked out) had significantly more psychiatric hospitalizations than those who met neither criterion. Those who were positive by criterion 2 also had significantly fewer outpatient mental health contacts. Conclusions Veterans screening positive for history of traumatic brain injury on the TBI-4 had more hospital stays in the year postmental health intake. Those who reported having been knocked out also had fewer outpatient mental health visits. These findings may suggest an overall relation in this population between greater needs for mental health care and likelihood of prior injury. For those with a history of loss of consciousness, the reduced use of outpatient care may reflect greater problems engaging in treatment or with preventive aspects of the health care system during non-crisis periods. Using a screener (eg, the TBI-4) could facilitate identification of veterans who might benefit from targeted and intensive outpatient interventions to avoid frequent inpatient psychiatric hospitalization.
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