In light of the era of microbial drug resistance, the current study aimed to better understand the relationships between sequence, higher-order structure, and mechanism of action for five designed peptides against multidrug-resistant (MDR) pathogens. All peptides studied were 15 residues long, were polycationic, adopted alpha-helical structures within hydrophobic environments (excluding the D-amino acid-substituted peptide MA-d), and contained N-terminal glycine residues, a novel antimicrobial peptide (AMP) design principle. Increasing hydrophobicity enhanced MICs (<500 g/ml to <7.4 g/ml) without significantly increasing hemolytic activity (18% maximum hemolysis at 3,400 g/ml). To the best of our knowledge, this is the first study to have successfully adapted and used a transmission electron microscopy (TEM) immunogold method to investigate the mechanism of action of short (ϳ15 residues long) AMPs within bacteria. We propose a "floodgate" mechanism to possibly explain membrane deformation and the relative absence of membraneassociated peptides 10 h into incubation.

Key Points Question What potential role do personalized paintings that are created to honor the lives of deceased patients in the intensive care unit have for grieving family members, and how might they influence family members’ experiences with bereavement? Findings In this qualitative study, families described personalized paintings as representing a legacy of their loved one. Participants indicated that the paintings were symbolic of the care their loved one received, validated the sentiment that the patient was remembered, and helped the families feel less alone during their time of grief. Meaning The creation of personalized patient paintings may foster postmortem connections between family members and clinicians and may ease bereavement following a death in the intensive care unit setting.

BACKGROUND: Robinsoniella peoriensis is an anaerobic gram-positive bacilli first isolated from swine manure in 2003 but has since been associated with human infections. METHODS: We describe a pediatric case of R. peoriensis infection following a below-knee amputation for a limb injury and its treatment. Methods of identifying R. peoriensis and reported in vitro antimicrobial minimum inhibitory concentrations from the literature are reviewed. RESULTS: R. peoriensis is readily identifiable via 16S rRNA gene sequencing and Matrix-Assisted Laser Desorption Ionization-Time of Flight. There variability in the antibiotic susceptibility profiles reported in the literature, but antibiotics with low in vitro minimum inhibitor concentrations against R. peoriensis include beta-lactam/beta-lactamase inhibitors, carbapenems, vancomycin, and metronidazole. CONCLUSION: This is the first reported case of R. peoriensis infection following a traumatic injury in Canada to our knowledge and highlights the importance of recognizing this organism and other anaerobes in settings where wounds are grossly contaminated with soil.

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