Writing a new finding in science to a non - scientific audience

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The following file is the article. Therefore, I was looking for someone who can analyze the article and write the findings in a language that a non- scientific audience can understand. The requirements and the rubric are attached here along with the article.

Writing a new finding in science to a non - scientific audience
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Writing a new finding in science to a non - scientific audience
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Mycologia ISSN: 0027-5514 (Print) 1557-2536 (Online) Journal homepage: http://www.tandfonline.com/loi/umyc20 Mushroom poisoning epidemiology in the United States William E. Brandenburg & Karlee J. Ward To cite this article: William E. Brandenburg & Karlee J. Ward (2018) Mushroom poisoning epidemiology in the United States, Mycologia, 110:4, 637-641, DOI: 10.1080/00275514.2018.1479561 To link to this article: https://doi.org/10.1080/00275514.2018.1479561 Published online: 31 Jul 2018. Submit your article to this journal Article views: 309 View Crossmark data Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=umyc20 MYCOLOGIA 2018, VOL. 110, NO. 4, 637–641 https://doi.org/10.1080/00275514.2018.1479561 Mushroom poisoning epidemiology in the United States William E. Brandenburga,b and Karlee J. Ward c a Family Medicine Residency of Idaho, RTT Caldwell, 777 N. Raymond Street, Boise, Idaho 83704-9251; bWest Valley Medical Center, 1717 Arlington Avenue, Caldwell, Idaho 83605; cPediatric Intensive Care Unit, Saint Luke’s Hospital, 190 E Bannock Street, Boise, Idaho 83712 ARTICLE HISTORY ABSTRACT Ingestion of wild and potentially toxic mushrooms is common in the United States and many other parts of the world. US poison centers have been logging cases of mushroom exposure in The National Poison Data System (NPDS) annual publications for over 30 years. This study compiles and analyzes US mushroom exposures as reported by the NPDS from 1999 to 2016. Over the last 18 years, 133 700 cases (7428/year) of mushroom exposure, mostly by ingestion, have been reported. Cases are most frequently unintentional (83%, P < 0.001); cause no or only minor harm (86%, P < 0.001); and in children <6 years old (62%, P < 0.001). Approximately 704 (39/year) exposures have resulted in major harm. Fiftytwo (2.9/year) fatalities have been reported, mostly from cyclopeptide (68–89%)-producing mushrooms ingested by older adults unintentionally. The vast majority of reported ingestions resulted in no or minor harm, although some groups of mushroom toxins or irritants, such as cyclopepides, ibotenic acid, and monomethylhydrazine, have been deadly. Misidentification of edible mushroom species appears to be the most common cause and may be preventable through education. INTRODUCTION Names such as death cap (Amanita phalloides), destroying angel (Amanita bisporigera), and deadly webcap (Cortinarius rubellus) conjure fear in the minds of mushroom hunters, or mycophagists, and for good reason (Trudell and Ammirati 2009; Evenson and Denver Botanic Gardens 2015). At the time of this publication, treatment of ingestions for the above mushrooms is supportive, and no curative or antidotal interventions are currently available (Berger and Guss 2005a, 2005b). Mushrooms are spore-producing fruiting bodies of the kingdom Fungi (Arora 1986). Approximately 135 000 species of fungi, many of which produce mushrooms (also include yeast, mold, and mildews), have been described (Hibbett et al. 2017). But recent studies have extrapolated a potential 2.2–3.8 million global species (Hawksworth and Lucking 2017). The vast majority pose no or only minor harm following ingestion (Arora 1986; Berger and Guss 2005a, 2005b; Trudell and Ammirati 2009; Evenson and Denver Botanic Gardens 2015). Fungi have evolved elaborate biochemical pathways, forming compounds that are physiologically relevant and sometimes pathologic to humans and other animals. Pharmaceutical drugs including penicillins, statins, cyclosporine, ergot alkaloids such as ergotamine, and antifungals such as micafungin were all originally discovered in fungi Received 7 February 2018 Accepted 18 May 2018 KEYWORDS Cyclopeptide; monomethylhyrazine; mycotoxin; National Poison Data System; psilocybin (Bills and Gloer 2016). Mushrooms are also rich in macronutrients and vitamins, and several are considered culinary delicacies (Arora 1986). As such, they are sought after by mycologists and mushroom hunters alike. Foraging for mushrooms is very popular worldwide and represents tradition in many cultures (Diaz 2005). “Mushrooming” is also quite popular in the United States. Most states have mycological societies that host yearly mushroom-hunting outings that emphasize accurate identification and safety (North American Mycological Association 2017). The popularity of mushroom hunting along with the ubiquitous presence of fungi in both natural and landscaped settings has led to numerous mycotoxin exposures. The true annual incidence of mushroom poisoning is unknown, but US poison centers have been logging exposure data for over 30 years in what is known as the National Poison Data System (NPDS). Every year this information is presented in an annual publication composed of data from all US poison centers. This review compiles and characterizes potentially toxic mushroom exposure data in the United States over the last 18 years as reported by the NPDS. MATERIALS AND METHODS Mushroom exposures and fatalities between 1999 and 2016 were obtained from the NPDS (Litovitz et al. CONTACT William E. Brandenburg webranden@gmail.com This article was originally published with errors, which have now been corrected in the online version. Please see Correction (https://doi.org/10.1080/ 00275514.2018.1551669). © 2018 The Mycological Society of America Published online 31 Jul 2018 638 BRANDENBURG AND WARD: MUSHROOM POISONING EPIDEMIOLOGY 2000, 2001, 2002; Watson et al. 2003, 2004, 2005; Lai et al. 2006; Bronstein et al. 2007, 2008, 2009, 2010, 2011, 2012; Mowry et al. 2013, 2014, 2015, 2016; Gummin et al. 2017). Data were available on both exposures and fatalities. Descriptors included age range; whether the exposure was unintentional or intentional; whether the exposure was treated in a health care facility; as well as clinical outcome, including none, minor, moderate, major, or death. Data on fatalities included exact age, the mushroom species (if available) and/or toxin group, co-exposures with other substances, as well as the exposures’ likely contribution to death. Many new descriptors, such as sex, have been added throughout the years. This new information has been omitted from this study to preserve homogeneity between given years. The mean age of those killed from mushroom exposures is reported, along with the standard deviation and age range. The NPDS classifies mushrooms by their primary toxin or effect, including cyclopeptides, orellanine, ibotenic acid, monomethylhydrazine, muscarine and histamine, coprine, hallucinogenic (psilocybin and psilosin), gastrointestinal irritants, miscellaneous nontoxic, miscellaneous potentially toxic, and unknown. Many other groups of toxins have been documented, and it is likely that many others are yet to be discovered (Nelson et al. 2011). Information obtained was compiled and statistically analyzed using one-way analysis of variance (ANOVA) and t tests from openepi.com software. unintentional (83%, P < 0.001); cause no or only minor harm (86%, P < 0.001); or in children <6 years old (62%, P < 0.001). Mushroom toxin exposures represent about 0.2% of the total reported cases to the NPDS, and their incidence appears to be relatively stable over the study period. TABLE 2 lists the total number of reported exposures by toxin group over the 18 years studied. The most common known group of exposures was of hallucinogenic- or psilocybin-producing mushrooms. These exposures represent a different demographic than most other toxin groups. Users are most commonly >6 years old (95%, P < 0.001) and do so intentionally (83%, P < 0.001). There has only been one reported single-ingestion fatality, a 19-year-old in 2002, from hallucinogenic mushrooms over the last 18 years. Fifty-two (2.9/year) fatalities have occurred, mostly from cyclopeptide (68–89%)-producing mushrooms ingested by older adults (62 ± 19 years, age range 10– 90) unintentionally (60–64%). Eight mushroom fatalities involved co-ingestions of cocaine, methamphetamines, opiates, acetaminophen, baclofen, and bupropion. It is believed that these other substances contributed more to the demise than the ibotenic acid, Ganoderma lucidum (Reishi), and hallucinogenic mushrooms co-ingested. As such, these eight cases were omitted from TABLE 3. Two fatalities were suicides. The exact species of fungi was identified in only 12 fatalities; these are listed in TABLE 4. RESULTS DISCUSSION Over the last 18 years, 133 700 cases (7428/year) of mushroom exposure, mostly ingestions, have been reported (TABLE 1). Cases are most frequently Approximately three deaths from mushroom poisoning are reported annually to the NPDS. This number is far less, per capita, than those reported in many European Table 1. Mushroom poisoning exposures reported to poison centers in the United States, 1999–2016. Age Year 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Total Reason for exposure Exposures (n) <6 6–19 >19 Unintentional Intentional Other 8996 5976 1554 1302 7646 1212 21 9394 6457 1486 1412 8114 1174 18 8483 5537 1427 1458 7219 1136 24 8722 5160 1654 1850 6977 1590 23 8252 4922 1604 1680 6563 1478 25 8601 4947 1817 1779 6706 1725 19 7146 4156 1421 1499 5524 1446 18 9183 5537 1471 1495 7320 1282 27 7733 4543 1352 1189 5957 1218 12 6034 3144 1157 1144 4375 1093 15 5902 3012 1068 1230 4134 1223 15 6275 3889 1010 1314 4681 1012 15 6818 3809 1054 1356 5159 1053 22 6600 3700 1041 1307 4970 1017 22 6575 3819 964 1264 5074 921 20 6474 3562 949 1402 4926 931 12 6091 3431 879 1216 4632 855 13 6421 3389 915 1477 4708 934 11 133 700 78 990 22 823 25 374 104 685 21 300 332 Health outcome Treated in a health care facility 2930 2927 2800 3294 3213 3489 3362 3053 2634 2367 2221 2158 2348 2233 1981 2196 1839 2175 47 220 None Minor Moderate Major Death 4656 992 576 56 6 4635 987 588 28 0 3946 1013 600 38 0 3751 1157 848 45 5 3537 1090 717 37 4 3769 1094 848 59 5 2923 968 635 46 6 3447 1021 606 53 2 2887 830 577 35 0 2191 738 565 39 4 2107 807 522 41 3 2310 881 478 23 1 2518 846 555 38 2 2306 846 494 35 7 2544 855 424 31 1 2273 907 466 37 3 2231 808 422 24 1 2215 940 478 39 2 54 246 16 780 10 399 704 52 MYCOLOGIA Table 2. Mushroom poisoning by toxin group. Group n (%) Orellanine Coprine Muscarine and histamine Monomethylhydrazine Ibotenic acid Cyclopeptides Gastrointestinal irritants Psilocybin and psilosin Unknown 59 (0.046) 222 (0.17) 365 (0.28) 703 (0.55) 751 (0.59) 832 (0.65) 3275 (2.6) 12 341 (10) 110 864 (86) Table 3. Fatal mushroom ingestions by toxin group. Group Psilocybin and psilosin Ibotenic acid Gastrointestinal irritants Monomethylhydrazine Unknown Cyclopeptides n (%) 1 (2.3) 1 (2.3) 1 (2.3) 2 (4.5) 9 (21) 30 (68) Table 4. Species identified in fatal ingestions. Species Amanita phalloides Amanita bisporigera Amanita muscaria Amanita pantherina Lepiota josserandii Coprinus comatus Common name Death cap Destroying angel Fly agaric Panther cap Deadly lepiota Shaggy mane n 5 3 2 1 1 1 countries such as Italy and France (Diaz 2005). Between 68% and 89% of these deaths have been from cyclopeptide-producing mushrooms. Older adults, who mistake these species for edible varieties, represent the most common demographic reported in fatal ingestions. In most cases, identifying these toxic varieties is achievable with proper education. As such, many of these deaths may have been preventable. Mushroom toxins have highly variable effects (Nelson et al. 2011; Olsen et al. 2017). The amount consumed, preparation, co-ingestions, regional and seasonal differences in toxin density within a given species, and the mycophagist’s metabolism and genetic makeup all seem to play a role (Nelson et al. 2011; Olsen et al. 2017). The variety of outcomes in the NPDS illustrates this point, and a great example is the genus Gyromitra or false morels (Trudell and Ammirati 2009). These mushrooms are sometimes intentionally eaten and appear to have no effect on many individuals, especially after being gathered in the Pacific Northwest and cooked (Berger and Guss 2005b). However, Gyromitra have caused at least two deaths in the last 18 years in the United States, and avoidance is generally recommended. Even clinical outcomes from cyclopeptide ingestion appear to vary greatly. In one 2016 case study of 16 patients in California who ingested death cap mushrooms, the dose consumed and need for liver transplant was not well correlated (Vo et al. 2017). In 639 general, healthy individuals, 10–60 years old, are much less likely to die following ingestion of cyclopeptides than older, younger, or sicker individuals (Beug 2017). Hallucinogenic mushrooms, often Psilocybe species, but sometimes even ibotenic acid/muscimol-producing mushrooms, are often sought after for their mind-altering effects in both recreational and spiritual settings (Vendramin and Brvar 2014; Thomas et al. 2017). Both of these groups have caused rare fatalities, and psilocybin mushrooms may also be useful in the treatment of depression, addiction, and other psychiatric disorders, under proper supervision (Thomas et al. 2017). In the United States, hallucinogenic mushrooms are currently a Schedule 1 controlled substance commonly illicitly used (Drug Enforcement Administration 2018). As such, it was not surprising that such exposures represented a different demographic than other mushroom exposures reported. The vast majority of mushroom exposures in the NPDS have been harmless. Of those reported, only 11 155 have actually been medically relevant (death, moderate or major harm), although 47 220 have resulted in a visit to the hospital, usually the emergency department (Berger and Guss 2005a). Trends remain consistent with previous data from the NPDS between 1979 and 1998 (Nelson et al. 2011). Mushroom identification requires time and practice. Direct mentorship in the field is often considered essential. With proper education, mushroom foraging can be a safe outdoor activity. Many excellent field guides are available (Arora 1986; Trudell and Ammirati 2009; Evenson and Denver Botanic Gardens 2015). Those cited also contain valuable tips for safe and environmentally conscious harvesting. Initially focusing on the identification of cyclopeptide-producing mushrooms may be very useful, as avoiding their ingestion would prevent most fatalities. The vast majority of mushroom exposures are of unknown varieties. As treatments and prognosis often differ by type ingested, individuals presenting to health care facilities are greatly encouraged to bring a picture or ideally a sample of the ingested mushroom. LIMITATIONS The NPDS consists of only those cases that have been reported to US poison centers by patients, those who take care of them, health care providers, and occasionally other third parties. Some reports are also created retrospectively based on calls from autopsies or other case reports. It is likely that many mushroom poisoning exposures have gone unreported, especially those that have resulted in no or minor harm. Trends from the 640 BRANDENBURG AND WARD: MUSHROOM POISONING EPIDEMIOLOGY NPDS between 2000 and 2015 indicate that calls regarding exposures treated in hospital settings are increasing in frequency, whereas outpatient unintentional exposure calls are on the decline (Anderson et al. 2017). Fatal exposures may also go unreported. As such, the actual total incidence of mushroom poisoning and fatal mushroom ingestion in the United States cannot be determined from this study. As stated above, psilocybin mushrooms are commonly used in recreational settings for their mind-altering effects. Like most illicit drugs, it is likely that the majority of exposures are never reported, limiting the generalizability of conclusions drawn from this study. There were some discrepancies between exposures and fatalities in the NPDS. Annually, there is a table on total exposures, which also lists fatalities, and another table on fatalities alone, which contains more demographic data. Although both reported 52 fatalities, in at least three instances the year and/or toxin group were discordant. This paper reports fatalities based on the fatality-specific table in the NPDS annual reports. ACKNOWLEDGMENTS The authors thank Louree Clem (1917–2017) for her mentorship in scientific inquiry, writing, and environmental stewardship. ORCID Karlee J. Ward http://orcid.org/0000-0002-9222-7135 LITERATURE CITED Anderson BD, Seung H, Klein-Schwartz W. 2017. Trends in types of calls managed by U.S. poison center 2000–2015. Clinical Toxicology. Epub ahead of print. doi:10.1080/ 15563650.2017.1410170 Arora D. 1986. Mushrooms demystified. 2nd ed. New York: Ten Speed Press. p. 4–6. Berger KJ, Guss DA. 2005a. Mycotoxins revisited: part I. Journal of Emergency Medicine 28:53–62. Berger KJ, Guss DA. 2005b. Mycotoxins revisited: part II. Journal of Emergency Medicine 28:175–183. Beug MW. 2017. Mushroom poisoning in North America 2015–2016. North American Mycological Society. [cited 2018 Jul 11]. Available from: http://namyco.org/docs/ AmatoxinPoisoning2015-16.pdf Beug 2017. Bills GF, Gloer JB. 2016. Biologically active secondary metabolites from the Fungi. Microbiology Spectrum, doi:10.1128/microbiolspec.FUNK-0009-2016 Bronstein AC, Spyker DA, Cantilena LR, Green J, Rumack BH, Heard SE. 2007. 2006 annual report of the American Association of Poison Control Centers’ National Poisoning Data System (NPDS). Clinical Toxicology 45:815–917. Bronstein AC, Spyker DA, Cantilena LR, Green J, Rumack BH, Heard SE. 2008. 2007 annual report of the American Association of Poison Control Centers’ National Poisoning Data System (NPDS): 25th Annual Report. Clinical Toxicology 46:927–1057. Bronstein AC, Spyker DA, Cantilena LR, Green J, Rumack BH, Griffin SL. 2009. 2008 annual report of the American Association of Poison Control Centers’ National Poisoning Data System (NPDS): 26th Annual Report. Clinical Toxicology 47:911–1084. Bronstein AC, Spyker DA, Cantilena LR, Green J, Rumack BH, Griffin SL. 2010. 2009 annual report of the American Association of Poison Control Centers’ National Poisoning Data System (NPDS): 27th Annual Report. Clinical Toxicology 48:979–1178. Bronstein AC, Spyker DA, Cantilena LR, Green J, Rumack BH, Dart RC. 2011. 2010 annual report of the American Association of Poison Control Centers’ National Poisoning Data System (NPDS): 28th Annual Report. Clinical Toxicology 49:910–941. Bronstein AC, Spyker DA, Cantilena LR, Rumack BH, Dart RC. 2012. 2011 annual report of the American Association of Poison Control Centers’ National Poisoning Data System (NPDS): 29th Annual Report. Clinical Toxicology. 50:911–1164. Diaz JH. 2005. Evolving global epidemiology, syndromic classification, general management, and prevention of unknown mushroom poisonings. Critical Care Medicine 33:419–426. Drug Enforcement Administration. 2018. Controlled Substances. [cited 2018 Jul 17]. Available from: https:// www.deadiversion.usdoj.gov/schedules/orangebook/c_cs_ alpha.pdf Evenson VS, Denver Botanic Gardens. 2015. Mushrooms of the Rocky Mountain region: Colorado, New Mexico, Utah, Wyoming. Portland, Oregon: Timber Press Field Guide. 298 p. Gummin DD, Mowry DA, Spyker DA, Brooks DE, Fraser MO, Banner W. 2017. 2016 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 34th annual report. Clinical Toxicology 55:1074–1254. Hawksworth DL, Lucking R. 2017. Fungal diversity revisited: 2.2 to 3.8 million species. Microbiology Spectrum, doi:10.1128/microbiolspec.FUNK-0052-2016. 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Litovitz TL, Klein-Schwartz W, White S, Cobaugh DJ, Youniss J, Omslaer JC, Drab A, Benson BE. 2001. 2000 annual report of the American Association of Poison MYCOLOGIA Control Centers toxic exposures surveillance system. American Journal of Emergency Medicine 19:337–395. Litovitz TL, Klein-Schwartz W, Rodgers GC, Cobaugh DJ, Youniss J, Omslaer JC, May ME, Woolf AD, Benson BE. 2002. 2001 annual report of the American Association of Poison Control Centers toxic exposures surveillance system. American Journal of Emergency Medicine 20:391–452. Mowry JB, Spyker DA, Cantilena LR, Bailey JE, Ford MF. 2013. 2012 annual report of the American Association of Poison Control Centers’ National Poisoning Data System (NPDS): 30th Annual Report. Clinical Toxicology 51:949–1229. Mowry JB, Spyker DA, Cantilena LR, McMillan N, Ford MF. 2014. 2013 annual report of the American Association of Poison Control Centers’ National Poisoning Data System (NPDS): 31st Annual Report. Clinical Toxicology 52:1032– 1283. Mowry JB, Spyker DA, Brooks DE, McMillan N, Schauben JL. 2015. 2014 annual report of the American Association of Poison Control Centers’ National Poisoning Data System (NPDS): 32nd Annual Report. Clinical Toxicology 53:962–1146. Mowry JB, Spyker DA, Brooks DE, Zimmerman A, Schauben JL. 2016. 2015 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 33rd Annual Report. Clinical Toxicology 54:924– 1109. Nelson LS, Lewin NA, Howland MA, Hoffman RS, Goldfrank LR. 2011. Mushrooms. In: Goldfrank LR, ed. Goldfrank’s toxicologic emergencies, 9th ed. New York: McGrawHill. p. 1522–1549. North American Mycological Association. 2017. Promoting, pursuing and advancing the science of mycology. [cited 2018 Jul 11]. Available from: http://www.namyco.org/ 641 Olsen KR, Anderson IB, Benowitz NL, Blanc PD, Clark RF, Kearney TE, Kim-Katz SY, Wu AHB. 2017. Poisoning and drug overdose, 7th ed. New York: McGrawHill. p. 292–297. Thomas K, Benjamin M, Lastra D. 2017. Psilocybin-assisted therapy: a review of a novel treatment for psychiatric disorders. Journal of Psychoactive Drugs 49:446–455. Trudell S, Ammirati J. 2009. Mushrooms of the Pacific Northwest. Portland, Oregon: Timber Press Field Guide. 352 p. Vendramin A, Brvar M. 2014. Amanita muscaria and Amanita pantherina poisoning: two syndromes. Toxicon 90:269–272. Vo KT, Montgomery ME, Mitchell ST, Scheerlinck PH, Colby DK, Meier KH, Kim-Katz S, Anderson IB, Offerman SR, Olson KR, Smollin CG. 2016. Amanita phalloides mushroom poisoning—northern California, December 2016. MMWR Morbidity and Mortality Weekly Report 66:549–553. Watson WA, Litovitz TL, Rodgers GC, Klein-Schwartz W, Youniss J, Rose SR, Borys D, May ME. 2003. 2002 annual report of the American Association of Poison Control Centers toxic exposures surveillance system. American Journal of Emergency Medicine 21:353–421. Watson WA, Litovitz TL, Klein-Schwartz W, Rodgers GC, Youniss J, Reid N, Rouse WG, Rembert RS, Borys D. 2004. 2003 annual report of the American Association of Poison Control Centers toxic exposures surveillance system. American Journal of Emergency Medicine 22:335–404. Watson WA, Litovitz TL, Rodgers GC, Klein-Schwartz W, Reid N, Youniss J, Flanagan A, Wruk KM. 2005. 2004 annual report of the American Association of Poison Control Centers toxic exposures surveillance system. American Journal of Emergency Medicine. 23:589–666.

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