Pediatric Infectious Diseases Milestones: A Step in the Right Direction to Evaluate Subspecialty Learners.

We share the work of the ACGME Pediatric Infectious Diseases Working Group in creating the Pediatric Infectious Diseases-Specific Milestones and discuss key considerations that lead to the reformation of competencies to better assess learners in Pediatric Infectious Diseases.

Rapidly Evolving and Fatal Miliary Tuberculosis and COVID-19 Infection in an Infant.

Tuberculosis (TB) and SARS-CoV-2 (COVID-19) are two important infectious diseases causing morbidity and mortality worldwide. Active TB infection can stimulate host immune responses and together with COVID-19, may lead to cytokine storm and immune dysregulation leading to multi-organ failure. We present a rare case of both miliary tuberculosis and SARS-CoV-2 co-infection in an infant who was a 6-month-old previously healthy term boy.

Use of vinasse and coffee waste as chelating agent of photo-Fenton landfill leachate treatment.

This research studies the use of vinasse (VS) coming from Pisco and caffeic acid (Caa) from solid coffee waste as chelating agents of this process, to carry out a photo-Fenton process using UVc lamps of 254-nm wavelength for 60 min, at the natural pH of the landfill leachate (8.9). Without the chelating agent, there was a removal of UV 254 and COD of 54.

Human papillomavirus vaccine effectiveness by number of doses: Updated systematic review of data from national immunization programs.

Background: Human papillomavirus (HPV) vaccines were first licensed as a three-dose series. Two doses are now widely recommended in some age groups; there are data suggesting high efficacy with one dose. We updated a systematic literature review of HPV vaccine effectiveness by number of doses in observational studies.

A Snapshot of Current US Medical School Off-Ramp Programs-a Way to Leave Medical School with Another Degree.

Although most students finish medical school, those who do not frequently have no obvious programmatic alternatives. In recent years, a growing number of medical schools have been developing "off-ramp" programs to help such learners. We surveyed 12 medical schools with off-ramp programs to understand their characteristics and challenges.

Long-term operation of a permeable reactive barrier with diffusive exchange.

In this study, we evaluate the long term operation of a bench-scale reactor which simulates a permeable reactive barrier with sulfidic diffusive exchange (SDES PRB) to treat acid mine drainage (AMD), considering that treatment costs are very sensitive to the useful life for passive reactors. Its functioning was evaluated for a much longer period of 591 days compared to previous SDES PRB studies, with two influents simulating moderately and highly acid groundwater contaminated by AMD. First, we fed water amended with 200 mg/L Zn and 3300 mg/L SO at pH 4.

Meaning of well-being of older institutionalized persons in abandonment situation.

Objective: To understand the meaning of well-being of older persons in situation of abandonment.

Methods: a qualitative phenomenological study, carried out in a nursing home in Tepic, Nayarit, from 2017 to 2019. Intentional sampling with 12 older persons aged 60 and above.

Murine Typhus Outbreak Presenting as Multisystem Inflammatory Syndrome in Children During SARS-CoV-2 Pandemic.

Multisystem inflammatory syndrome in children is a severe illness associated with the SARS-CoV-2 pandemic that possesses features overlapping with other pediatric diseases causing systemic inflammation. Significant diagnostic and treatment uncertainty remain, and clinicians should maintain a broad differential when evaluating patients for multisystem inflammatory syndrome in children, as antibiotic-susceptible infections such as murine typhus may present similarly.

Perinatal HIV-1 Infection in an Extremely Low Birth Weight Infant.

There is limited guidance on how to treat extremely premature infants with HIV infection. This can lead to delay of antiretroviral therapy initiation adversely affecting magnitude of HIV reservoir and disease progression. We report perinatal HIV-1 infection in an extremely low birth weight infant born at 24 5/7 weeks of gestation.

Health Disparities Past the Classroom: The Impact of Frontier Medicine on Students.

In 2000, the Liaison Committee on Medical Education issued a standard for cultural competence for medical students, stating the necessity of understanding different belief systems and cultures and how biases can affect health care and perpetuate health disparities. While many programs travel overseas to address this standard, our study evaluated an in-state, study-away, service-learning mission trip program's efficacy of improving cultural competence and awareness of health disparities, as well as facilitating the ease of participation for students. Our overall goal was to provide a rich field opportunity in our own backyard that would allow students to visit a foreign environment without leaving the country, simultaneously eliminating the financial burden that comes with international travel and to expose the students to health disparities through partnership with local community centers and clinics present in the frontier region of southwest Texas (2016 - 2018).

Long-Term Compassionate Use of Cefiderocol To Treat Chronic Osteomyelitis Caused by Extensively Drug-Resistant Pseudomonas aeruginosa and Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae in a Pediatric Patient.

We report a 15 year-old Nigerian adolescent male with chronic osteomyelitis caused by an extensively drug-resistant (XDR) strain of sequence type 773 (ST773) carrying and an extended spectrum β-lactamase (ESBL)-producing strain. The patient developed neurological side effects in the form of circumoral paresthesia with polymyxin B and asymptomatic elevation of transaminases with aztreonam (used in combination with ceftazidime-avibactam). Cefiderocol treatment for 14 weeks plus bone implantation resulted in apparent cure and avoided amputation.

Teaching Medical Spanish to Improve Population Health: Evidence for Incorporating Language Education and Assessment in U.S. Medical Schools.

Language concordance between patients and physicians is an important factor in providing safe and effective health care, with Spanish as the predominant and fastest growing non-English language in the United Sates. However, despite increasing demand for medical Spanish education, valid concerns about inadvertently increasing provider use of limited Spanish with patients, lack of knowledge of best practice in education and assessment, and lack of institutional support still present barriers to medical Spanish education in medical schools. The authors conducted a narrative review of existing literature that evaluates the link between medical Spanish education of physicians and language concordance.

Use of sawdust as pretreatment of photo-Fenton process in the depuration of landfill leachate.

A research of the depuration of landfill leachate using sawdust as activated carbon material to be applied in adsorption process as pretreatment of solar photo-Fenton and solar photo-Fenton + O, was carried out. The activated sawdust shows very irregular shapes and pores, and a high capacity to remove ammonium (87.0%), iron (70.

Medical Spanish Standardization in U.S. Medical Schools: Consensus Statement From a Multidisciplinary Expert Panel.

Medical Spanish (MS) education is in growing demand from U.S. medical students, providers, and health systems, but there are no standard recommendations for how to structure the curricula, evaluate programs, or assess provider performance or linguistic competence.

Strategies for Teaching Linguistic Preparedness for Physicians: Medical Spanish and Global Linguistic Competence in Undergraduate Medical Education.

In accordance with Liaison Committee on Medical Education (LCME) curriculum content standards, medical schools are expected to teach physician communication skills and cultural competence. Given the sustained U.S.

Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis.

Background: More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination.

Methods: In this updated systematic review and meta-analysis, we used the same search strategy as in our previous paper.

TREATMENT COMPLETION AND IMPLEMENTATION BY PATIENTS INITIATING TICAGRELOR.

Background: In secondary prevention of adverse events and death following acute coronary syndrome, patients may benefit from adhering to a ticagrelor treatment.

Objectives: The authors assessed the proportion of new ticagrelor users who completed 12 months of treatment, explored the factors associated with treatment completion and, among the completers, evaluated the 12-month treatment implementation.

Methods: A retrospective administrative health database inception cohort study was conducted in a population that included Quebec residents ≥18 years of age who initiated ticagrelor between January 1, 2012 and March 31, 2014.

Adherence stages measured by patient-reported outcome instruments in adults with asthma: a scoping review.

: Individuals who are adherent to their asthma inhaled maintenance medication: (1) initiate their treatment (take the first dose); (2) implement it (take it as per prescribed dosing regimen); and persist with it (take it for the entire prescribing period). To avoid unnecessary hospitalizations and costs, patient adherence should be routinely assessed. To this end, we aimed to identify patient-reported outcome instruments (PROs) used for measurement of patient adherence to inhaled maintenance medication in asthmatic adults and to report on the adherence stage that these instruments measured.

Appropriateness of Ticagrelor Use at Initiation: A Population-Based Cohort Study.

Purpose: Ticagrelor is recommended following an acute coronary syndrome if used appropriately. Its use has not yet been well described in the context of ambulatory clinical practice. The objective of this study was to assess the proportion of ticagrelor new users who initiated this medication appropriately and explore associated factors.

Transverse Myelitis and Guillain-Barré Syndrome Associated with Cat-Scratch Disease, Texas, USA, 2011.

We describe a case of coexisting transverse myelitis and Guillain-Barré syndrome related to infection with Bartonella henselae proteobacterium and review similar serology-proven cases. B. henselae infection might be emerging as a cause of myelitis and Guillain-Barré syndrome and should be considered as an etiologic factor in patients with such clinical presentations.

Performance of two differently designed permeable reactive barriers with sulfate and zinc solutions.

For the first time, this laboratory-scale study evaluates the feasibility of incorporating diffusive exchange in permeable reactive barriers. In order to do this, the performance of two permeable reactive barriers (PRB) with different internal substrate arrangements were compared during the administration of a sulfate solution without metals (for 163 days) and with metals (for 60 days), simulating groundwater contaminated with acid mine drainage (AMD). In order to simulate a traditional PRB, a homogeneous distribution was implemented in the first reactor and the other PRB reactor utilized diffusion-active technology (DAPRB).