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Per- and polyfluoroalkyl substances (PFAS) are a large class of synthetic (man-made) chemicals widely used in consumer products and industrial processes. Thousands of distinct PFAS exist in commerce. The 2019 U.S. Environmental Protection Agency (U.S. EPA) Per- and Polyfluoroalkyl Substances (PFAS) Action Plan outlines a multiprogram national research plan to address the challenge of PFAS. One component of this strategy involves the use of systematic evidence map (SEM) approaches to characterize the evidence base for hundreds of PFAS.SEM methods were used to summarize available epidemiological and animal bioassay evidence for a set ofSystematic review methods were used to identify and screen literature using manual review and machine-learning software. The Populations, Exposures, Comparators, and Outcomes (PECO) criteria were kept broad to identify mammalian animal bioassay and epidemiological studies that could inform human hazard identification. A variety of supplemental content was also tracked, including information onMore than 40,000 studies were identified from scientific databases. Screening processes identified 44 animal and 148 epidemiology studies from the peer-reviewed literature and 95 animal and 50 epidemiology studies from gray literature that met PECO criteria. Epidemiological evidence (available for 15 PFAS) mostly assessed the reproductive, endocrine, developmental, metabolic, cardiovascular, and immune systems. Animal evidence (available for 40 PFAS) commonly assessed effects in the reproductive, developmental, urinary, immunological, and hepatic systems. Overall, 45 PFAS had evidence across animal and epidemiology data streams.Many of the

Objectives Emerging invasive fungal infections (IFI) have become a notable challenge. Apart from the more frequently described fusariosis, lomentosporiosis, mucormycosis, scedosporiosis, and certain dematiaceae or yeasts, little is known about extremely rare IFI. Methods Extremely rare IFI collected in the FungiScopeⓇ registry were grouped as Dematiaceae, Hypocreales, Saccharomycetales, Eurotiales, Dermatomycetes, Agaricales, and Mucorales. Results Between 2003 and June 2019, 186 extremely rare IFI were documented in FungiScopeⓇ. Dematiaceae (35.5%), Hypocreales (23.1%), Mucorales (11.8%), and Saccharomycetales (11.3%) caused most IFI. Most patients had an underlying malignancy (38.7%) with acute leukemia accounting for 50% of cancers. Dissemination was observed in 26.9% of the patients. Complete or partial clinical response rate was 68.3%, being highest in Eurotiales (82.4%) and in Agaricales (80.0%). Overall mortality rate was 29.3%, ranging from 11.8% in Eurotiales to 50.0% in Mucorales. Conclusions Physicians are confronted with a complex variety of fungal pathogens, for which treatment recommendations are lacking and successful outcome might be incidental. Through an international consortium of physicians and scientists, these cases of extremely rare IFI can be collected to further investigate their epidemiology and eventually identify effective treatment regimens.

Summary Objectives Methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI) are a major health care problem accounting for a large percentage of nosocomial infections. The aim of this study was to identify risk factors associated with 30-day mortality in patients with MRSA BSI. Methods This was a retrospective study performed in Southeast Michigan. Over a 9- year period, a total of 1,168 patients were identified with MRSA BSI. Patient demographics and clinical data were retrieved and evaluated using electronic medical health records. Results 30-day mortality during the 9-year study period was 16%. Significant risk factors for 30-day mortality were age, cancer, heart disease, neurologic disease, nursing home residence and Charlson score >3 with Odds Ratio (OR) of 1.03 (CI 1.02–1.04), 2.29 (CI 1.40–3.75), 1.78 (CI 1.20–2.63), 1.65 (CI 1.08–2.25), 1.66 (CI 1.02 − 2.70) and 1.86 (CI 1.18 − 2.95) correspondingly. Diabetes mellitus, peripheral vascular disease (PVD), and readmission were protective factors for 30-day mortality with OR of 0.53 (CI 0.36–0.78), 0.46 (CI 0.26–0.84) and 0.13 (CI0.05 − 0.32) respectively. Conclusions Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI. Interestingly, diabetes mellitus, PVD and readmission were protective effects on 30-day mortality. There was no statistically significant variability in 30-day mortality over the 9-year study period.

PurposeMethicillin-resistant Staphylococcus aureus (MRSA) pneumonia patients treated with current antibiotic therapies have exhibited poor outcomes, increased hospital length of stay, and higher costs of care. Twenty-eight-day mortality rate of 32% was reported with vancomycin therapy for MRSA hospi

We designed a professional development (PD) teacher-mentor program that used problem-based learning (PBL) to accomplish two goals. First, teachers explored how PBL could be used effectively in their classrooms to change the way they think about teaching to include literacy development in content areas. Second, PBL was the basis for PD training to help them improve their own knowledge of PBL, become mentors to other teachers, and implement PBL in their schools across content areas. Educators in the United States are challenged to teach linguistically and culturally diverse (LCD) students with differing literacy levels. The demographics of U.S. classrooms require a rigorous attempt to engage LCD students through collaborative, active learning opportunities (McGroarty, 1998; U.S. Department of Education, 2015). Research shows that literacy learning for all students improves in classroom settings that take a cooperative, student-centered approach (McGroarty, 1988, 1989; NCSS, 1991; Shumway, Saunders, Stewardson, & Reeve, 2001). PBL provides opportunities for students to engage in active learning and allows students with multiple learning styles to negotiate contextualized meaning through a variety of collaborative tasks. PBL has also been shown to be an effective method for teaching learners to be self-directed problemsolvers. However, in the absence of PD and ongoing support, teachers are often resistant to the implementation of PBL. In our program, we used PBL to help teachers learn more about literacy and PBL while providing opportunities for PD and support. As a result, the teacher reflections, discussions, presentations, and self-evaluations demonstrated how, by using PBL in their classrooms while immersing themselves in evidence-based content, they observed enhanced student collaboration. Teachers felt that they were better able to foster a learning environment in their classrooms that would allow students to develop literacy skills in a content-rich context both because of the incorporation of PBL and because of the support they provided for each other. This idea can be easily adapted to foster teacher development and mentoring programs in other fields.

In total, 718 consecutive clinical meticillin-resistant Staphylococcus aureus (MRSA) isolates from 2006 to 2010 and 417 clinical meticillin-susceptible S. aureus (MSSA) isolates from mid-2007 to 2010 were evaluated. Isolates were from blood cultures obtained from separate patients in Detroit, MI, and were tested for in vitro susceptibility trends to vancomycin and daptomycin by molecular strain type. The MRSA pulsed-field gel electrophoresis (PFGE) results showed that 290 (40.4%) were USA100, 296 (41.2%) were USA300 and the remaining isolates were non-USA100/300. Vancomycin minimum inhibitory concentrations (MICs) by Etest [mean±standard deviation (S.D.) 1.55±0.26mg/L] in MRSA isolates showed no significant change over the 5-year period within all strain types, whilst daptomycin MICs by Etest (mean±S.D. 0.51±0.25mg/L) showed a significant downward trend across time (r=-0.243; P0.001), with this trend occurring among all PFGE groups. For MSSA, a significant decrease in MICs to vancomycin was found by Etest (r=-0.160; P=0.001) and conversely a significant increase in daptomycin MICs by Etest was found (r=0.146; P=0.028). The results of this study showed that changes in MIC were not specific to strain molecular type. For vancomycin, there was no change in MRSA MICs and a decrease in MSSA MICs for blood isolates. For daptomycin, MICs decreased in MRSA and increased in MSSA blood isolates over the study period.

Methicillin-resistant Staphylococcus aureus (MRSA) hospital-acquired pneumonia (HAP) and healthcare-associated pneumonia (HCAP) patients treated with current antibiotic therapies have exhibited poor outcomes, increased hospital length of stay, and higher costs of care. The optimal management of these infections is undetermined; thus, it is critical to look at ways to improve outcomes in these patients. There is insufficient data on clinical efficacy in patients with MRSA HAP or HCAP infection treated with ceftaroline-fosamil. In a recent pilot study, nearly 90% of patients treated with ceftaroline-fosamil survived, despite the difficulties associated with administrating bactericidal antimicrobial therapy for this increasingly resistant pathogen. These data suggest a possible benefit in the use of ceftaroline-fosamil for MRSA pneumonia. Presently, we have identified cases over a two-year period treated with ceftaroline-fosamil, and will conduct a comparative analysis to controls (those treated with vancomycin and/or cefepime, and linezolid) to determine optimal therapeutic agents; these findings will have important implications for control of further spread of infection, recurrence, readmission, and mortality attributable to MRSA HAP and HCAP.

Tigecycline is one of the few remaining therapeutic options for extensively drug-resistant (XDR) Gram-negative bacilli (GNB). MICs of tigecycline to Acinetobacter baumannii have been reported to be elevated when determined by the Etest compared to determinations by the broth microdilution (BMD) method. The study aim was to compare the susceptibility of GNB to tigecycline by four different testing methods. GNB were collected from six health care systems (25 hospitals) in southeast Michigan from January 2010 to September 2011. Tigecycline MICs among A. baumannii , carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae , and susceptible Enterobacteriaceae isolates were determined by Etest, BMD, Vitek-2, and MicroScan. Nonsusceptibility was categorized as a tigecycline MIC of ≥4 μg/ml for both A. baumannii and Enterobacteriaceae . The study included 4,427 isolates: 2,065 ESBL-producing Enterobacteriaceae , 1,105 A. baumannii , 888 susceptible Enterobacteriaceae , and 369 CRE isolates. Tigecycline nonsusceptibility among A. baumannii isolates was significantly more common as determined by Etest compared to that determined by BMD (odds ratio [OR], 10.3; P < 0.001), MicroScan (OR, 12.4; P < 0.001), or Vitek-2 (OR, 9.4; P < 0.001). These differences were not evident with the other pathogens. Tigecycline MICs varied greatly according to the in vitro testing methods among A. baumannii isolates. Etest should probably not be used by laboratories for tigecycline MIC testing of A. baumannii isolates, since MICs are significantly elevated with Etest compared to those determined by the three other methods.

Rural areas across the U.S. are experiencing extremely tough economic times. As business layoffs continue, the economy of these rural communities will suffer more and more. One opportunity leaders in rural communities often overlook is health care. Rural leaders know the importance of medical facilities in providing health care but are often unaware of the economic impact and opportunities that health care has on their economic health. The overall objective of this paper is to illustrate and measure the economic impact of critical access hospitals on a medical service area, on a county and at the state level. The paper will discuss how the results can be used to enhance and expand health services at each governmental level. There are nine critical access hospital in Hawaii. Operational data, which include employment, wages and salaries, and revenue were collected from each hospital in 2008. Also, construction data, which reflects capital expenditures, were collected. Then the input-output model, using data from IMPLAN were used to measure the operational economic impact and construction impact at three government levels. These included impacts of a critical access hospital on a community (Hale Ho'ola Hamakua), impact of three critical access hospitals on Hawaii County, and impact of nine critical access hospitals on the state of Hawaii. This section will present economic impacts at each governmental level and discuss how this information can be used at each governmental level. Also included will be a discussion of the community or county engagement process, which provides the community or county leaders a format to assess health needs and gather support and input. From this process, medical services are often expanded or added and in turn, jobs are created. In summary, the provision of medical services in rural areas is critical. The economic impact is huge. Thus, if community leaders desire the provision of health services can be an economic engine. This paper shows how health research and extension professionals can assist rural leaders in enhancing the provision of health services in rural communities.