Search

Background: Extrapulmonary nontuberculous mycobacteria (ENTM) infections are difficult to treat and often require prolonged therapy or surgery. Few population-based studies describe ENTM epidemiology, though well-known healthcare-associated outbreaks have occurred. Using the first year of multi-site ENTM surveillance, we characterized rates and how frequently ENTM infections may be related to healthcare. Methods: CDC’s Emerging Infections Program conducted active, laboratory- and population-based surveillance for ENTM cases in 4 sites (Colorado [5 counties], Minnesota [statewide], New York [1 county], and Oregon [statewide]) in 2021. An incident ENTM case was NTM isolation from a non-pulmonary specimen, excluding stool or rectal swabs, in a resident of the surveillance area without either medical record documentation of prior ENTM infection or isolation of ENTM in the prior 12 months. Demographic, clinical, information on selected healthcare and community exposures, and laboratory data were collected via medical record review. We calculated incidence per 100,000 population using U.S. Census population estimates and performed descriptive analyses. Results: A total of 180 incident ENTM cases were reported in 2021. The crude annual incidence rate was 1.3 per 100,000 persons. Incidence increased with age (from 0.95 per 100,000 among 0–17 year-olds to 2.65 per 100,000 among persons ≥65), ranged from 0.8 among non-Hispanic Asian persons to 1.6 per 100,000 in non-Hispanic Black persons, and was similar among males (1.3 per 100,000) and females (1.4 per 100,000; Figure 1). Mycobacterium avium complex (64 [35.6%]) was the most frequently isolated species group, followed by Mycobacterium chelonae complex (31 [17.2%]). Skin and soft tissue infections were the most frequent infection type (37 [20.6%]); 27 cases (15.0%) were associated with disseminated and/or only bloodstream infection, and 56 cases (31.1%) had no infection type documented. Among 93 cases with localized ENTM infections (i.e., infections that were not disseminated and/or only bloodstream infections), 38.7% had only healthcare-related exposures, 14% had only community-related exposures and 6.5% had both exposure types at the site of infection (Figure 2). Healthcare-related exposures at the infection site included surgery (23.7%), injection/infusion (21.5%), and medical devices (18.3%). The most frequent community-related exposure at the infection site was trauma (17.2%). Only one case was part of a known outbreak, which was healthcare-associated. Conclusions: ENTM infections are relatively rare, but nearly half of patients with localized ENTM infections had prior healthcare-related exposures. This indicates that the burden of ENTM infections related to healthcare may be much larger than what has been suggested from reported outbreaks.

Background: Previous analyses describing the relationship between SARS-CoV-2 infection and Staphylococcus aureus have focused on hospital-onset S. aureus infections occurring during COVID-19 hospitalizations. Because most invasive S. aureus (iSA) infections are community-onset (CO), we characterized CO iSA cases with a recent positive SARS-CoV-2 test (coinfection). Methods: We analyzed CDC Emerging Infections Program active, population- and laboratory-based iSA surveillance data among adults during March 1–December 31, 2020, from 11 counties in 7 states. The iSA cases (S. aureus isolation from a normally sterile site in a surveillance area resident) were considered CO if culture was obtained 73 years, LTCF residence 3 days before iSA culture, and/or CVC present any time during the 2 days before iSA culture. More often, iSA cases with SARS-CoV-2 coinfection were admitted to the intensive care unit ≤2 days after iSA culture (37.7% vs 23.3%, P

Background: Incidence of methicillin-sensitive Staphylococcus aureus (MSSA) bloodstream infections (BSIs) in the United States during 2012–2017 has been reported to have been stable for hospital-onset BSIs and to have increased 3.9% per year for community-onset BSIs. We sought to determine whether these trends continued in more recent years and whether there were further differences within subgroups of community-onset BSIs. Methods: We analyzed CDC Emerging Infections Program active, population- and laboratory-based surveillance data during 2016–2019 for MSSA BSIs from 8 counties in 5 states. BSI cases were defined as isolation of MSSA from blood in a surveillance area resident. Cases were considered hospital onset (HO) if culture was obtained >3 days after hospital admission and healthcare-associated community-onset (HACO) if culture was obtained on or after day 3 of hospitalization and was associated with dialysis, hospitalization, surgery, or long-term care facility residence within 1 year prior or if a central venous catheter was present ≤2 days prior. Cases were otherwise considered community-associated (CA). Annual rates per 100,000 census population were calculated for each epidemiologic classification; rates of HACO cases among chronic dialysis patients per 100,000 dialysis patients were calculated using US Renal Data System data. Annual increases were modeled using negative binomial or Poisson regression and accounting for changes in the overall population age group, and sex. Descriptive analyses were performed. Results: Overall, 8,344 MSSA BSI cases were reported. From 2016–2019 total MSSA BSI rates increased from 23.9 per 100,000 to 28.5 per 100,000 (6.6% per year; P < .01). MSSA BSI rates also increased significantly among all epidemiologic classes. HO cases increased from 2.5 per 100,000 to 3.2 per 100,000 (7.9% per year; P = .01). HACO cases increased from 12.7 per 100,000 to 14.7 per 100,000 (7.0% per year; P = .01). CA cases increased from 8.4 per 100,000 to 10.4 per 100,000 (6.7% per year; P < .01) (Fig. 1). Significant increases in MSSA BSI rates were also observed for nondialysis HACO cases (9.3 per 100,000 to 11.1 per 100,000; 7.8% per year; P < .01) but not dialysis HACO cases (1,823.2 per 100,000 to 1,857.4 per 100,000; 1.4% per year; P = .59). Healthcare risk factors for HACO cases were hospitalization in the previous year (82%), surgery (31%), dialysis (27%), and long-term care facility residence (19%). Conclusions: MSSA BSI rates increased from 2016–2019 overall, among all epidemiologic classes, and among nondialysis HACO cases. Efforts to prevent MSSA BSIs among individuals with healthcare risk factors, particularly those related to hospitalization, might have an impact on MSSA BSI rates.

IntroductionThe assessment of fluid responsiveness is important in the management of shock but conventional methods of assessing fluid responsiveness are often inaccurate. Our study aims to evaluate changes in objective hemodynamic parameters as measured using electrical cardiometry (ICON® monitor) following the fluid bolus in children presenting with shock and to evaluate whether any specific hemodynamic parameter can best predict fluid responsiveness among children with shock.Materials and MethodsWe conducted a prospective observational study in children presenting with shock to our emergency department between June 2020 and March 2021. We collected the parameters such as heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and hemodynamic data such as cardiac output CO), cardiac index (CI), index of contractility (ICON), stroke volume (SV), stroke index (SI), corrected flow time (FTC), systolic time ratio (STR), variation of index of contractility (VIC), stroke volume variation (SVV), systemic vascular resistance (SVR), and thoracic fluid content (TFC) using the ICON monitor before and after fluid bolus (FB). We assessed percent change (Δ) and used paired-sample Student’s t-test to compare pre- and post-hemodynamic data and Mann–Whitney U-test to compare fluid responders and non-responders. P-Values < 0.05 were considered statistically significant.ResultsWe recorded 42 fluid interventions in 40 patients during our study period. The median IQR age was 10.56 (4.8, 14.8) years with male/female ratio (1.2:1). There was a significant decrease in ΔRR [−1.61 (−14.8, 0); p = 0.012], ΔDBP [−5.5 (−14.4, 8); p = 0.027], ΔMAP [−2.2 (−11, 2); p = 0.018], ΔSVR [−5.8 (−20, 5.2); p = 0.025], and ΔSTR [−8.39 (−21, 3); p = 0.001] and significant increase in ΔTFC [6.2 (3.5, 11.4); p = 0.01] following FB. We defined fluid responders by an increase in SV by ≥10% after a single FB of 20 ml/kg crystalloid. Receiver operating curve analysis revealed that among all the parameters, 15% change in ICON had an excellent AUC (0.85) for the fluid responsiveness.ConclusionOur study showed significant changes in objective hemodynamic parameters, such as SVR, STR, and TFC following FB in children presenting with shock. A 15% change in ICON had an excellent predictive performance for the fluid responsiveness among our cohort of pediatric shock.

Abstract Class II division 1 malocclusions are common, and first permanent molars are frequently compromised teeth. Removal of compromised maxillary first permanent molars with planned orthodontic treatment can result in favorable treatment outcomes.

Introduction: Hip fractures are common and costly in the elderly population, often contributing to loss of function and independence. Prompt, coordinated surgical care may improve clinical and economic outcomes for this population. Materials and Methods: We created an interdisciplinary care program focused on minimizing time spent immobilized awaiting surgery and streamlining the care pathway for hip fracture. Patients older than 65 years with any hip fracture type including hip fracture repair Diagnosis-Related Group codes (MS-DRG 480, 481, or 482) and MS-DRG 469 and 470 with a hip fracture diagnosis were included in the study. The Hip Fracture Care program (HFCP) was implemented on a staggered basis in 3 hospitals in the HonorHealth system. Time to surgery, length of stay, and discharge location (home/skilled nursing facility) were compared pre- and post-intervention, utilizing an interrupted time series analysis to account for background trends. Results: More than 2000 patients across the 3 facilities received HFCP care; demographics were similar for the 826 patients serving as the pre-implementation comparison group. Mean (standard deviation [SD]) length of stay decreased from 5.6 (4.0) to 4.7 (2.9) days (mean difference 0.9 days; P < .05). Mean (SD) time from admission to the operating room decreased from 30.8 (21.1) to 25.6 (20.5) hours (mean difference 5.2 hours; P < .05). There was no change in the proportion of patients discharged to home versus skilled nursing facility. Discussion: Optimal care of this vulnerable population can significantly reduce the time to surgery and length of stay. Conclusions: Length of stay was reduced by nearly 1 day with implementation of a multifactorial program for hip fracture care.

Faculty members play a valuable role in the reputation of higher education institutions and adult learners' academic success. It is imperative for faculty members to be adept at using the institution's learning management system to maintain their instructional materials and teach using a technological system. The purpose of this study was to examine the learning experiences of faculty at a state technical college who were required to participate in a new technology adoption of the Blackboard Learning Management System (LMS). A qualitative case study design was used that consisted of semi-structured interviews with eight participants, document review, and observational memos. The findings revealed that the initial training meeting was basic, the training packet was burdensome to complete, the institution's webinars and tutorials were underutilized, and participants designed their own training strategies to learn the system. Two conclusions emerged that indicated: (1) the formal learning methods were insufficient and sufficient and (2) faculty's informal learning strategies created a process of self-directed and collaborative learning approaches that more directly served their needs.

Abstract Introduction A team of faculty members with expertise in bacteriology, parasitology, virology, gastroenterology, and pharmacology developed this team-based learning (TBL) activity to support an interactive, learner-centered, presentation-based integrated curriculum at the West Virginia School of Osteopathic Medicine. A strength of this module is the focus on diagnostic bacteriology, something that is easily overlooked in the classroom. Methods The TBL follows the standard format and allows students to practice integrating their basic science knowledge in the areas of microbiology, diagnostic bacteriology, and pharmacology to be able to diagnose and treat a patient presenting with acute diarrhea with a suspected infectious etiology. Results This TBL was implemented in modified form in the gastrointestinal course for first-year medical students at the West Virginia School of Osteopathic Medicine. The average grade for the individual readiness assurance test was 78% (maximum score of 100%, minimum score of 40%). Discussion The TBL could be improved by adding an epidemiology component. A more focused TBL could be designed by concentrating on one category of pathogen (e.g., bacteria, viruses or protozoan). Another limitation is the use of UpToDate as a reading assignment. UpToDate articles are updated over time and care must be taken to examine the content to be sure that it contains all of the desired learning material.

Abstract Introduction This exercise on primary immunodeficiency diseases is designed as a small-group discussion module to be used for first- or second-year medical students. The primary goal is to introduce major concepts of primary immune deficiency in a clinical case-based setting. Methods Students should complete a pretest and preliminary reading, then attend a small-group discussion session lasting approximately 2 hours. This resource includes supplemental material containing growth charts, clues to diagnosing primary immune deficiency, posttest, and posttest answers. However, faculty are free to modify the exercise to fit the needs of their own course or institution. Results A pilot run of this exercise was done with three groups of four second-year students in August 2009. Seventy-three percent recommended use of the exercise, 73% said the exercise achieved its objectives, and 100% said the primary immunodeficiency diseases increased their understanding of immunodeficiency. Additionally, instructions were clarified based upon the student feedback. Discussion The table of potential laboratory tests in section three may cause students to spend too much time and get bogged down as they try to approach the case as real physicians. We plan to limit their time working on this table so that the emphasis remains on the immunologic concepts.

The COVID-19 pandemic changed how organizational leaders managed their staff and handled operations. As those operational changes were implemented, the experiential learning theory (ELT) was practiced by the leaders, staff, and human resource development (HRD) practitioners. In general, employees' operational practices were created to work in a building and not remotely. The normalcy of driving to the workplace changed for many employees to work from any remote location. The purpose of this article is to highlight how ELT helped organizational leaders and HRD practitioners adapt during the COVID-19 pandemic. Many employees did not think that work in their profession could be completed remotely, but when a worldwide pandemic occurred, organizational leaders and HRD practitioners were ingenious and practiced ELT to stay open for business.

This article provides classroom examples and commentaries for extending and deepening culturally relevant science teaching efforts in classrooms. It examines instructional efforts used by one of the authors with high school and university students. Together, the three authors rethink and reconsider several aspects against a culturally relevant pedagogical backdrop. The commentary points out considerations for focusing on student achievement, cultural competence, and critical and sociopolitical consciousness. The necessity and difficulty of centering culture, equity, and power relations are emphasized.

Teacher-education programs continue to face the challenge of improving the preparation of teachers for diversity in particular racially diverse and low-income students. Certain factors such as dispositions, self-reflection, and prior experiences contribute to preservice teachers' attitudes and beliefs toward diversity and social justice issues. Similarly, these prior experiences, self-reflections, culture, gender, and theoretical orientations may affect the teacher educators' attitudes and beliefs and may impact how they teach for social justice and equity. This autoethnography examines the journey of a teacher educator and looks at how her prior experiences impacted her as a social-justice educator.

This original pedagogical study captured three preservice teachers' experiences using visual literacy strategies as an approach to teaching English language learners (ELLs) science academic language. The following research questions guided this study: (1) What are the experiences of preservice teachers' use of visual literacy to teach science academic language with ELLs in an elementary classroom? and (2) What are the strengths/limitations of incorporating visual literacy into the classroom with ELLs? Data revealed that preservice teachers recognized the significance and benefits of utilizing visual literacy as a method to teaching science academic language to ELLs. Results also indicated that elementary students employed self-discovery, knowledge, and the contextual use of academic language during three different lessons. Findings from this study suggest that even though there were some limitations to incorporating visual literacy strategies into the science classroom, preservice teachers find the approach helpful to teaching academic language to ELLs. Along similar lines, teachers of this study appeared to be motivated and eager to use the strategy again in the future. Implications for practice and further directions for research are discussed.