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Tick vectors and tick-borne disease are increasingly impacting human populations globally. An important challenge is to understand tick movement patterns, as this information can be used to improve management and predictive modeling of tick population dynamics. Evolutionary analysis of genetic divergence, gene flow, and local adaptation provides insight on movement patterns at large spatiotemporal scales. We develop low coverage, whole genome resequencing data for 92 samples representing range-wide variation in blacklegged ticks, Ixodes scapularis, across the U.S. Through analysis of population genomic data, we find that tick populations are structured geographically, with gradual isolation by distance separating three population clusters in the northern U.S., southeastern U.S., and a unique cluster represented by a sample from Tennessee. Populations in the northern U.S. underwent population contractions during the last glacial period and diverged from southern populations at least 50 thousand years ago. Genome scans of selection provide strong evidence of local adaptation at genes responding to host defenses, blood-feeding, and environmental variation. In addition, we explore the potential of low coverage genome sequencing of whole-tick samples for documenting the diversity of microbial pathogens. Metagenomic analyses recover important tick-borne pathogens and their geographical variation, including the higher prevalence of Borrelia burgdorferi in northern populations, geographic strain variation in Rickettsia species, and the rare occurrence of B. miyamotoi and Anaplasma phagocytophilum. The combination of restricted pathogen distribution, isolation by distance, and local adaptation in blacklegged ticks demonstrates that gene flow, including recent expansion, is limited to geographical scales of a few hundred kilometers.

Case report.To report a case of very delayed repeated meningitis after surgical treatment of scoliosis.Delayed infection after spine surgery is a well-reported phenomenon, presenting usually with local wound symptoms and back pain. The occurrence of meningitis after spinal instrumentation is reported but not common. Delayed repeated episodes of meningitis after surgical treatment of scoliosis have never been reported.We report a case of a 44-year-old gentleman, submitted to surgical treatment of scoliosis years ago, who presented with repeated episodes of meningitis due to the formation of an abnormal communication between an infected cyst in the bone cavity where the rods were located and the intradural space in the lumbar spine. Computerized tomography and magnetic resonance imaging revealed the presence of a bone cyst with thickened layering, and surgical exploration revealed the communication between this cystic cavity and the intradural space. After surgical closure of the dural space and cleaning of the cyst, the patient responded well to antibiotic therapy and was free of new episodes of meningitis up to the last follow-up, 1 year after the surgical treatment. Clinical diagnosis of delayed postoperative infection in spine surgery may be difficult if no wound signs are present. Clinical symptoms vary and may include increased back pain, wound redness, swelling and drainage, elevated erythrocyte sedimentation rate and white blood count, fever, and malaise.Delayed meningitis can be a late complication of spinal instrumentation for scoliosis. A high index of suspicion is necessary.

Necrosis is a form of cell death that is often associated with highly aggressive forms of cancer, is of prognostic value in treatment planning. Mass Spectrometry (MS) is a highly sensitive analytic platform capable of providing a molecular profile of cancer on the basis of mass to charge (m/z) ratio of tissue constituent molecules. MS analysis of ex vivo tissue slices from metastatic murine xenograft tumors from LM2-4 cell line with Desorption Electrospray Ionization Mass Spectrometry (DESI-MS) allowed direct comparisons with histology images to determine the molecular profile of necrotic tissues. The necrotic tissue is characterized by the presence of a ceramide absent from the viable cancer regions. The spatial distribution of this ion fully correlated to necrotic areas from pathology in additional independent tumor samples examined. The same ion was detected from in situ necrotic tissue using tissue aerosols generated by hand-held ablation probes coupled to evaporative ionization interface in only a few seconds of sampling. These developments further establish MS as a novel tool for rapid pathology that is highly complementary to current histology based methods widely used in characterization of cancer in both imaging mode (to provide spatial information on cancer border) and profiling mode (to provide information on cancer type and subtype); all based on unique molecular profile associated with each cancer type and subtype. Current efforts in creating cancer molecular profile libraries will facilitate translation. Citation Format: Arash Zarrine-Afsar, Bindesh Shrestha, Alessandra Tata, Michael Woolman, Manuela Ventura, Nicholas Bernards, Milan Ganguly, Howard Ginsberg, Jinzi Zheng, Emma Bluemke. Rapid detection of necrosis in breast cancer with ex vivo and in situ mass spectrometry analysis methods [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 741. doi:10.1158/1538-7445.AM2017-741

Background: For patients and family members, access to timely specialty medical care for emergent spinal conditions is a significant stressor to an already serious condition. Timing to surgical care for emergent spinal conditions such as spinal trauma is an important predictor of outcome. However, few studies have explored ethnographically the views of surgeons and other key stakeholders on issues related to patient access and care for emergent spine conditions. The primary study objective was to determine the challenges to the provision of timely care as well as to identify areas of opportunities to enhance care delivery.\ud \ud Methods: An ethnographic study of key administrative and clinical care providers involved in the triage and care of patients referred through CritiCall Ontario was undertaken utilizing standard methods of qualitative inquiry. This comprised 21 interviews with people involved in varying capacities with the provision of emergent spinal care, as well as qualitative observations on an orthopaedic/neurosurgical ward, in operating theatres, and at CritiCall Ontario’s call centre.\ud \ud Results: Several themes were identified and organized into categories that range from inter-professional collaboration through to issues of hospital-level resources and the role of relationships between hospitals and external organizations at the provincial level. Underlying many of these issues is the nature of the medically complex emergent spine patient and the scientific evidentiary base upon which best practice care is delivered. Through the implementation of knowledge translation strategies facilitated from this research, a reduction of patient transfers out of province was observed in the one-year period following program implementation.\ud \ud Conclusions: Our findings suggest that competing priorities at both the hospital and provincial level create challenges in the delivery of spinal care. Key stakeholders recognized spinal care as aligning with multiple priorities such as emergent/critical care, medical through surgical, acute through rehabilitative, disease-based (i.e. trauma, cancer), and wait times initiatives. However, despite newly implemented strategies, there continues to be increasing trends over time in the number of spinal CritiCall Ontario referrals. This reinforces the need for ongoing inter-professional efforts in care delivery that take into account the institutional contexts that may constrain individual or team efforts.

Insects of at least six orders were found in the stomachs of four wild-shotChiropotes satanas chiropotes from Surinam, thus providing further evidence of omnivory in this genus of Neotropical primates.

1 Directional movement by foraging honey bees (Apis mellifera L.) was studied on several flower arrays. The most frequent move among equidistant flower stalks was straight ahead from stalk to stalk with frequencies decreasing for increasing turn angles. Turns to the left were about equal in frequency to turns to the right. 2 Bees maintained directionality when moving from flower stalks that had been rotated 90° counterclockwise while the bee was on the stalk (no difference between moves from rotated stalks and unrotated controls). Thus, directionality is maintained by the bee and is not an artefact of flower distribution. 3 Bees also maintained directionality when the entire array was rotated around the flower stalk the bee was on. Thus, bees use an external cue to orientate in a given direction rather than fixing on an inflorescence within the flower array. 4 Bees foraging on very different flower arrays differed in patterns of directionality and in distances flown between flower stalks. Therefore, even though bees maintain directionality using external cues, flower distribution can nevertheless influence flight patterns.