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High patient volume in fellowship programs can affect learning, wellness, and patient outcomes. Training programs must find ways to mitigate high consultation volume to protect the learning environment. This survey describes average new consults and average censuses for infectious diseases training programs and strategies implemented to mitigate high volume. [ABSTRACT FROM AUTHOR]

Most Shiga toxin-producing E. coli (STEC) infections are sporadic. Routine enhanced surveillance questionnaires of confirmed STEC cases in England contained promising data to conduct a case-control study to identify non-food exposures linked to the risk of becoming infected with different STEC serotypes, including O157, O26 and all others; this study pulled eligible cases from the recorded enhanced surveillance data. Controls were recruited from the general population and answered a comparable postal questionnaire. Logistic regression was performed to identify risk factors associated with STEC infection for O157, O26 and other serotype cases. In adjusted models, travel outside of the U.K. and childcare occupations raised the risk of infection for all serotypes. Day trips within the UK, exposure to dogs and contact with soil were linked to lower infection risk. Resident region within England was often linked to decreased risk. Summer season was linked to O157 and O26, but not other STEC. Swimming in the sea was linked to increased risk of infection by O157, but not other types of STEC. Correlations between exposures and infection were similar when the analysis was repeated excluding participants with a history of foreign travel. As the first case-control study in England to include sporadic non-O157 STEC, the varying risk factors between O157 and non-O157 cases suggest there are potentially unique reservoirs for different serotypes. [ABSTRACT FROM AUTHOR]

Background Cryptococcal meningitis is an uncommon but serious infection with high mortality and morbidity. Classically described in immunocompromised patients, including those with solid organ transplants or HIV/AIDS, cryptococcosis has also been reported in young and otherwise healthy patients, albeit rarely. Methods We retrospectively searched for all cases of cryptococcal meningitis in young (≤50 years) and previously healthy patients with no known immunocompromising conditions from January 2015 to January 2022 at Indiana University Health (IU Health). Additionally, a PubMed literature review was performed with the keywords "cryptococcal meningitis" and "immunocompetent" from January 1988 to January 2022. Clinical courses, including outcomes and treatment regimens, were evaluated. Results We identified 4 local cases of cryptococcal meningitis in otherwise healthy patients age ≤50 years. Three cases were due to Cryptococcus neoformans, with 1 experiencing a postinfectious inflammatory response syndrome (PIIRS). The PubMed search identified 51 additional cases, with 32 (63%) being caused by Cryptococcus neoformans and 8 (17%) by Cryptococcus gattii. Of the 51 cases, only 2 resulted in death directly due to cryptococcosis. Fifteen (29%) had PIIRS, with steroid treatment documented in 11 of 15. Antifungal induction regimens and duration were varied but predominately consisted of amphotericin and flucytosine, with a mean induction duration of 5.0 weeks. Conclusions Cryptococcal meningitis in young, previously healthy patients is likely under-recognized. PIIRS (akin to immune reconstitution inflammatory syndrome observed in HIV/AIDS) with prolonged recovery should be of concern. Determining risk factors for cryptococcosis in these patients remains elusive. [ABSTRACT FROM AUTHOR]

The Infectious Diseases Society of America (IDSA) has set clear priorities in recent years to promote inclusion, diversity, access, and equity (IDA&E) in infectious disease (ID) clinical practice, medical education, and research. The IDSA IDA&E Task Force was launched in 2018 to ensure implementation of these principles. The IDSA Training Program Directors Committee met in 2021 and discussed IDA&E best practices as they pertain to the education of ID fellows. Committee members sought to develop specific goals and strategies related to recruitment, clinical training, didactics, and faculty development. This article represents a presentation of ideas brought forth at the meeting in those spheres and is meant to serve as a reference document for ID training program directors seeking guidance in this area. [ABSTRACT FROM AUTHOR]

Infectious intestinal disease (IID) studies conducted at different levels of the surveillance pyramid have found heterogeneity in the association of socioeconomic deprivation with illness. The aim of this study was to analyse the association between socioeconomic deprivation and incidence of IID by certain gastrointestinal pathogens reported to UKHSA. Data were extracted from 2015 to 2018 for Salmonella, Campylobacter, Shigella, Giardia species, and norovirus. Rates were calculated per 100,000 person-years by the index of multiple deprivation quintile, and an ecological analysis was conducted using univariant and multvariable regression models for each pathogen. Incidence of Campylobacter, and Giardia species decreased with increasing deprivation. Conversely, the incidence of norovirus, non-typhoidal Salmonella , Salmonella typhi /paratyphi , Shigella species increased with increasing deprivation. Multivariable analysis results showed that higher deprivation was significantly associated with higher odds of higher number of cases for Shigella flexneri , norovirus and S. typhi /paratyphi. Infections most associated with deprivation were those transmitted by person-to-person spread, and least associated were those transmitted by zoonotic contamination of the environment. Person-to-person transmission can be contained by implementing policies targeting over-crowding and poor hygiene. This approach is likely to be the most effective solution for the reduction of IID. [ABSTRACT FROM AUTHOR]

Laser collimation is required in many experiments based on lasers. Some laser experiments demand a high quality of collimation, e.g., the optical coherent processor, image transformer, and Fourier transform generator. A device is required to test the collimation of lasers in such experiments. We have suggested a modification in existing collimation testing techniques by which sensitivity can be improved. Theoretical analysis and experimental results demonstrate twice the improvement in sensitivity when used with previous techniques. OCIS codes: 120.1680, 120.4120, 080.0080, 120.0120, 350.0350.

Hospitalized patients with COVID-19 must have a safe discharge plan to prevent readmissions. We assessed patients with COVID-19 admitted to hospitals belonging to a single health system between April 2020 and June 2020. Demographics, vitals and laboratory data were obtained by electronic data query and discharge processes were reviewed by manual abstraction. Over the study period, 94 out of 912 (10.3%) patients were readmitted within 14 days of discharge. Readmitted patients were older and spent more time in the intensive care unit (p<0.01). Statistical differences were noted in discharge-day heart rates, temperatures, platelet counts, and neutrophil and lymphocyte percentages between the readmitted and non-readmitted groups. Readmitted patients were less likely to be discharged home and to receive complete discharge instructions or home oxygen (p<0.01). Age, duration of intensive care unit stay, disposition destinations other than home, incomplete discharge planning and no arrangement for home oxygen may be associated with 14-day readmissions in patients with COVID-19. Certain clinical parameters on discharge day, while statistically different, may not reach clinically discriminant thresholds. Structured discharge processes may improve outcomes. [ABSTRACT FROM AUTHOR]

Shiga toxin-producing Escherichia coli (STEC) serogroup O157 is a zoonotic, foodborne gastrointestinal pathogen of major public health concern. We describe the epidemiology of STEC O157 infection in England by exploring the microbiological and clinical characteristics, the demographic and geographical distribution of cases, and examining changes in environmental exposures over 11 years of enhanced surveillance. Enhanced surveillance data including microbiological subtyping, clinical presentations and exposures were extracted for all cases resident in England with evidence of STEC O157 infection, either due to faecal culture or serology detection. Incidence rates were calculated based on mid-year population estimates from the Office of National Statistics (ONS). Demographics, geography, severity and environmental exposures were compared across the time periods 2009–2014 and 2015–2019. The number of cases reported to national surveillance decreased, with the mean cases per year dropping from 887 for the period 2009–2014 to 595 for the period 2015–2019. The decline in STEC O157 infections appears to be mirrored by the decrease in cases infected with phage type 21/28. Although the percentage of cases that developed HUS decreased, the percentage of cases reporting bloody diarrhoea and hospitalisation remained stable. The number of outbreaks declined over time, although more refined typing methods linked more cases to each outbreak. Integration of epidemiological data with microbiological typing data is essential to understanding the changes in the burden of STEC infection, assessment of the risks to public health, and the prediction and mitigation of emerging threats. [ABSTRACT FROM AUTHOR]

In October 2019, public health surveillance systems in Scotland identified an increase in the number of reported infections of Shiga toxin-producing Escherichia coli (STEC) O26:H11 involving bloody diarrhoea. Ultimately, across the United Kingdom (UK) 32 cases of STEC O26:H11 stx1a were identified, with the median age of 27 years and 64% were male; six cases were hospitalised. Among food exposures there was an association with consuming pre-packed sandwiches purchased at outlets belonging to a national food chain franchise (food outlet A) [odds ratio (OR) = 183.89, P < 0.001]. The common ingredient identified as a component of the majority of the sandwiches sold at food outlet A was a mixed salad of Apollo and Iceberg lettuce and spinach leaves. Microbiological testing of food and environmental samples were negative for STEC O26:H11, although STEC O36:H19 was isolated from a mixed salad sample taken from premises owned by food outlet A. Contamination of fresh produce is often due to a transient event and detection of the aetiological agent in food that has a short-shelf life is challenging. Robust, statistically significant epidemiological analysis should be sufficient evidence to direct timely and targeted on-farm investigations. A shift in focus from testing the microbiological quality of the produce to investigating the processes and practices through the supply chain and sampling the farm environment is recommended. [ABSTRACT FROM AUTHOR]

In August 2019, public health surveillance systems in Scotland and England identified seven, geographically dispersed cases infected with the same strain (defined as isolates that fell within the same five single nucleotide polymorphism single linage cluster) of Shiga toxin-producing Escherichia coli O157:H7. Epidemiological analysis of enhanced surveillance questionnaire data identified handling raw beef and shopping from the same national retailer (retailer A) as the common exposure. Concurrently, a microbiological survey of minced beef at retail identified the same strain in a sample of minced beef sold by retailer A, providing microbiological evidence of the link. Between September and November 2019, a further four primary and two secondary cases infected with the same strain were identified; two cases developed haemolytic uraemic syndrome. None of the four primary cases reported consumption of beef from retailer A and the transmission route of these subsequent cases was not identified, although all four primary cases visited the same petting farm. Generally, outbreaks of STEC O157:H7 in the UK appear to be distinct, short-lived events; however, on-going transmission linked to contaminated food, animals or environmental exposures and person-to-person contact do occur. Although outbreaks of STEC caused by contaminated fresh produce are increasingly common, undercooked meat products remain a risk of infection. [ABSTRACT FROM AUTHOR]

The article offers 10 informative topics abou vaccination for adults. These include the need for influenza vaccine to be provided to all adults annually, the need for all pregnant women to receive vaccination against pertussis with Tdap in each pregnancy and the applicability of Varicella and Herpes Zoster vaccinations for patients without prior history.

This study presents a case report of a female patient with symptomatic refractory Trichomonas vaginalis infection who was not able to clear her infection with high-dose oral metronidazole, oral tinidazole, intra-vaginal zinc sulfate, intra-vaginal metronidazole, intra-vaginal tinidazole, and intra-vaginal boric acid. She was unable to tolerate intra-vaginal paromomycin. A combination of intravenous metronidazole, oral tinidazole liquid suspension, and intra-vaginal boric acid for 14 days subsequently achieved a complete symptomatic and laboratory cure. [ABSTRACT FROM AUTHOR]

Stable isotopes are powerful research tools in environmental sciences and their use in ecosystem research is increasing. Stable isotope measurements allow the study of evapotranspiration fluxes, soil evaporation and leaf transpiration phenomena. Soil water and leaf water are the sources of the evapotranspiration that transfers large quantities of water from land to the atmosphere; as a result the isotopic composition of water left in the leaves is modified towards enrichment. Evaporation also changes the isotopic composition of water bodies creating a natural isotopic signal. The isotopic identity of soil water affects the oxygen isotopic signature of leaf and stem water. In this paper we present the isotopic data of bulk leaf water, showing the enrichment in isotopic value of oxygen due to evapotranspiration from leaves in conjunction with the isotopic signal of rainwater and other environmental factors such as humidity and temperature. Results suggest that the variation in the values of δ18O of Eucalyptus citriodora, Dalbergia sissoo, Melia azedarach and Pinus roxburghii is due to the seasonal changes in the δ18O of the source water for plants, i. e. rain. It is further observed that leaf water δ18O values are depleted during the months of July, August and September. This occurs due to the following reasons: (a) the sampling areas receive about 50% of the average annual rain during these months, and (b) rainfalls during these months are isotopically depleted compared with winter rains. Citation Butt, S., Ali, M., Fazil, M. & Latif, Z. (2010) Seasonal variations in the isotopic composition of leaf and stem water from an arid region of Southeast Asia. Hydrol. Sci. J. 55(5), 844-848. [ABSTRACT FROM AUTHOR]

A painless progressive verrucous skin plaque in an endemic area should raise suspicion for blastomycosis resulting in prompt biopsy with fungal stains and culture. Skin is a common extrapulmonary site. Itraconazole is treatment of choice. [ABSTRACT FROM AUTHOR]

• Higher concentrations of elements in non-famous Basmati rice growing regions. • Higher δ13C values of Basmati rice growing regions compared to other regions. • PLS-DA was found to be effective in grouping rice samples from different regions. High-priced Basmati rice is vulnerable to deliberate mislabeling to increase profits. This type of fraud may lower consumers' confidence as inferior products can affect brand reputation. To address this problem, there is a need to devise a method that can efficiently distinguish Basmati rice grown in regions that are famous versus the regions that are not suitable for their production. Therefore, in this investigation, thirty-six samples of Basmati rice were collected from two zones of Punjab province (one known for Basmati rice) of Pakistan which is the major producer of Basmati rice. The elemental composition of rice samples was assessed using inductively coupled plasma-optical emission spectrometry and an organic elemental analyzer, whereas data on δ13C was acquired using isotopic ratio-mass spectrometry. Regional clustering of samples based on their respective cultivation zones was observed using multivariate data analysis techniques. Partial least squares-discriminant analysis was found to be effective in grouping rice samples from the different locations and identifying unknown samples belonging to these two regions. Further recommendations are presented to develop a better model for tracing the origin of unidentified rice samples. [ABSTRACT FROM AUTHOR]

The field of infectious diseases (ID) offers a rewarding career path and is widely viewed as an essential subspecialty in medicine. However, in recent years, these positive aspects have been overshadowed by concerns surrounding low fellowship match rates, undercompensation, and burnout. The Infectious Diseases Society of America Fellowship Training Program Directors Committee met in 2023, discussed the future of ID as a specialty, and sought to develop strategies to highlight the value and opportunities of ID for future generations, as well as underscore the importance of and provide tools for positive messaging to trainees about the subspecialty. This paper presents ideas generated at this meeting and is meant to serve as a reference for ID training program directors, as well as the wider ID community, in uplifting and shaping the future of the field., Competing Interests: Potential conflicts of interest. C.B. has received research grants to her institution from Gilead Sciences, Inc. and DNAe. She serves as a consultant to NDA Partners, LLC. M.A. serves as a consultant and on the DSMB for AbbVie. All other authors, no conflicts to report., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

High patient volume in fellowship programs can affect learning, wellness, and patient outcomes. Training programs must find ways to mitigate high consultation volume to protect the learning environment. This survey describes average new consults and average censuses for infectious diseases training programs and strategies implemented to mitigate high volume., Competing Interests: Potential conflicts of interest. All authors: No reported conflicts., (© The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America.)

Infections due to nontuberculous mycobacteria (NTM) continue to increase in prevalence, leading to problematic clinical outcomes. Omadacycline (OMC) is an aminomethylcycline antibiotic with FDA orphan drug and fast-track designations for pulmonary NTM infections, including Mycobacteroides abscessus (MAB). This multicenter retrospective study across 16 U.S. medical institutions from January 2020 to March 2023 examined the long-term clinical success, safety, and tolerability of OMC for NTM infections. The cohort included patients aged ≥18 yr, who were clinically evaluable, and` had been treated with OMC for ≥3 mo without a previous diagnosis of cystic fibrosis. The primary outcome was 3 mo clinical success, with secondary outcomes including clinical improvement and mortality at 6- and 12 mo, persistence or reemergence of infection, adverse effects, and reasons for OMC utilization. Seventy-five patients were included in this analysis. Most patients were female (48/75, 64.0%) or Caucasian (58/75, 77.3%), with a median (IQR) age of 59 yr (49-67). Most had NTM pulmonary disease (33/75, 44.0%), skin and soft tissue disease (19/75, 25.3%), or osteomyelitis (10/75, 13.3%), and Mycobacterium abscessus (60/75, 80%) was the most commonly isolated NTM pathogen. The median (IQR) treatment duration was 6 mo (4 - 14), and the most commonly co-administered antibiotic was azithromycin (33/70, 47.1%). Three-month clinical success was observed in 80.0% (60/75) of patients, and AEs attributable to OMC occurred in 32.0% (24/75) of patients, leading to drug discontinuation in 9.3% (7/75)., Competing Interests: A.E., T.M., K.L., M.G.T-O., R.V., C.W., Y.H., R.W.S., J.D.Z, A.J.W., A.S., C.L.C, M.M., V.E.U, S.B., K.C.M., M.T., E.A.K., J.B., T.W.G., C.H., M.G.C., D.J.H., J.J.F., M.B., A.O., J.S. have no conflicts of interest to disclose. S.A. is currently an employee of Aimmune Therapeutics, a Nestle Company. J.V.P. has been on advisory boards for Insmed, A2N, Paratek Pharmaceuticals, and Cipla Technologies, and has spoken for Insmed. M.P.V. received research funding from Paratek Pharmaceuticals, Cumberland Pharmaceuticals, Insmed, AN2, Spero, Hillrom, and Electromed. C.M-C. has consulted for HIVE Medical Inc, and has received grant funding from the CDC (CDC# 1U54CK000617-01-00). C.T.F. has spoken for Insmed. R.H. has consulted for and received research funding from Biofire Diagnostics. K.A.C. is currently employed by Janssen pharmaceutical companies of Johnson & Johnson and has received consulting fees from Insmed, Hillrom, Merck, and Microbion, and AN2, unrelated to the current investigation, and was supported by National Heart, Lung, and Blood Institute K08 HL1139994 and the Burroughs Welcome Fund Career Award for Medical Scientists. M.J.R. has received funds for research and consulting or participated in speaking bureaus for Abbvie, Baselia, Ferring, Melinta, Merck, Paratek Pharmaceuticals, Shionogi, Tetraphase, and T2 Biosystems and is partially supported by National Institute of Allergy and Infectious Diseases R21 AI163726. Conflicts that the editors considered relevant to the content of the manuscript have been disclosed.

In order to capture and separate CO 2 from the air or flue gas streams through nanoporous adsorbents, the influence of the humidity in these streams has to be taken into account as it hampers the capture process in two main ways: (1) water preferentially binds to CO 2 adsorption sites and lowers the overall capacity, and (2) water causes hydrolytic degradation and pore collapse of the porous framework. Here, we have used a water-stable polyimide covalent organic framework (COF) in N 2 /CO 2 /H 2 O breakthrough studies and assessed its performance under varying levels of relative humidity (RH). We discovered that at limited relative humidity, the competitive binding of H 2 O over CO 2 is replaced by cooperative adsorption. For some conditions, the CO 2 capacity was significantly higher under humid versus dry conditions ( e.g. , a 25% capacity increase at 343 K and 10% RH). These results in combination with FT-IR studies on equilibrated COFs at controlled RH values allowed us to assign the effect of cooperative adsorption to CO 2 being adsorbed on single-site adsorbed water. Additionally, once water cluster formation sets in, loss of CO 2 capacity is inevitable. Finally, the polyimide COF used in this research retained performance after a total exposure time of >75 h and temperatures up to 403 K. This research provides insight in how cooperative CO 2 -H 2 O can be achieved and as such provides directions for the development of CO 2 physisorbents that can function in humid streams.

Hospitalized patients with COVID-19 must have a safe discharge plan to prevent readmissions. We assessed patients with COVID-19 admitted to hospitals belonging to a single health system between April 2020 and June 2020. Demographics, vitals and laboratory data were obtained by electronic data query and discharge processes were reviewed by manual abstraction. Over the study period, 94 out of 912 (10.3%) patients were readmitted within 14 days of discharge. Readmitted patients were older and spent more time in the intensive care unit (p<0.01). Statistical differences were noted in discharge-day heart rates, temperatures, platelet counts, and neutrophil and lymphocyte percentages between the readmitted and non-readmitted groups. Readmitted patients were less likely to be discharged home and to receive complete discharge instructions or home oxygen (p<0.01). Age, duration of intensive care unit stay, disposition destinations other than home, incomplete discharge planning and no arrangement for home oxygen may be associated with 14-day readmissions in patients with COVID-19. Certain clinical parameters on discharge day, while statistically different, may not reach clinically discriminant thresholds. Structured discharge processes may improve outcomes., Competing Interests: Competing interests: None declared., (© American Federation for Medical Research 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

In October 2019, public health surveillance systems in Scotland identified an increase in the number of reported infections of Shiga toxin-producing Escherichia coli (STEC) O26:H11 involving bloody diarrhoea. Ultimately, across the United Kingdom (UK) 32 cases of STEC O26:H11 stx1a were identified, with the median age of 27 years and 64% were male; six cases were hospitalised. Among food exposures there was an association with consuming pre-packed sandwiches purchased at outlets belonging to a national food chain franchise (food outlet A) [odds ratio (OR) = 183.89, P < 0.001]. The common ingredient identified as a component of the majority of the sandwiches sold at food outlet A was a mixed salad of Apollo and Iceberg lettuce and spinach leaves. Microbiological testing of food and environmental samples were negative for STEC O26:H11, although STEC O36:H19 was isolated from a mixed salad sample taken from premises owned by food outlet A. Contamination of fresh produce is often due to a transient event and detection of the aetiological agent in food that has a short-shelf life is challenging. Robust, statistically significant epidemiological analysis should be sufficient evidence to direct timely and targeted on-farm investigations. A shift in focus from testing the microbiological quality of the produce to investigating the processes and practices through the supply chain and sampling the farm environment is recommended.

In August 2019, public health surveillance systems in Scotland and England identified seven, geographically dispersed cases infected with the same strain (defined as isolates that fell within the same five single nucleotide polymorphism single linage cluster) of Shiga toxin-producing Escherichia coli O157:H7. Epidemiological analysis of enhanced surveillance questionnaire data identified handling raw beef and shopping from the same national retailer (retailer A) as the common exposure. Concurrently, a microbiological survey of minced beef at retail identified the same strain in a sample of minced beef sold by retailer A, providing microbiological evidence of the link. Between September and November 2019, a further four primary and two secondary cases infected with the same strain were identified; two cases developed haemolytic uraemic syndrome. None of the four primary cases reported consumption of beef from retailer A and the transmission route of these subsequent cases was not identified, although all four primary cases visited the same petting farm. Generally, outbreaks of STEC O157:H7 in the UK appear to be distinct, short-lived events; however, on-going transmission linked to contaminated food, animals or environmental exposures and person-to-person contact do occur. Although outbreaks of STEC caused by contaminated fresh produce are increasingly common, undercooked meat products remain a risk of infection.

A modified snake method based on the novel idea of coordinate regeneration is presented and is tested on an object with complex concavities and on retinal images for locating the boundaries of optic discs, where the conventional snake methods fail. We have demonstrated that the use of conventional snake method with our proposed coordinate regeneration technique gives ultimate solution for finding the boundaries of complex objects. The proposed method requires a Gaussian blur of the object with a large kernel so that the snake can be initialised away from the object boundaries. In the second and third steps the blurring kernel size is reduced so that exact boundaries can be located. Coordinate regeneration is applied at each step which ultimately converges the snake (active contour) to exact boundaries. For complex objects like optic discs in retinal images, vessels act as snake distracters and some preimage processing is required before the proposed technique is applied. We are demonstrating this technique to find the boundary of optic discs in retinal images. In principle, this technique can be extended to find the boundary of any object in other modalities of medical imaging. Simulation results are presented to support the idea.