Revolutionising infection control: building the next generation of phage banks.

The escalating global burden of antimicrobial resistance (AMR) represents a critical public health challenge. This rise in antibiotic resistance is concomitant with heightened antibiotic consumption, with an estimated annual usage of 100,000 to 200,000 tons. A recent systematic review, which analysed data from 204 countries, reported that AMR was responsible for 4.95 million deaths in 2019 (Murray et al., 2022). The growing threat of AMR is imposing a significant financial burden on the global economy, with the CDC reporting an additional annual cost of $20 billion in the U.S. and €9 billion in Europe. The emerging field of bacteriophage therapy offers promising potential as a game-changer in the era of AMR. However, existing literature reveals numerous research gaps and technological challenges, including insufficient information on phage pharmacology, genomics, and a lack of preclinical and clinical data. In addition to conducting further research to address existing knowledge gaps, establishing phage banks in clinical facilities could be a transformative advancement in the fight against AMR.

Faith and vaccination: a scoping review of the relationships between religious beliefs and vaccine hesitancy.

BACKGROUND: Throughout history, vaccines have proven effective in addressing and preventing widespread outbreaks, leading to a decrease in the spread and fatality rates of infectious diseases. In a time where vaccine hesitancy poses a significant challenge to public health, it is important to identify the intricate interplay of factors exemplified at the individual and societal levels which influence vaccination behaviours. Through this analysis, we aim to shed new light on the dynamics of vaccine hesitancy among religious groups, contributing to the broader effort to promote vaccine uptake, dispel misunderstandings, and encourage constructive dialogue with these groups. METHODS: We used the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) using the 20-point checklist to guide this review. The inclusion criteria for our study were that the literature should be in English, concerned with vaccine hesitancy as the focus of study, study the impact religiosity or religious beliefs as either an outcome or control variable, concerning population levels, and be peer-reviewed. RESULTS: We analysed 14 peer-reviewed articles that included components related to religiosity or religious beliefs and their impact on vaccine hesitancy published until September 2023. All the articles were published in approximately the last decade between 2012 and 2023, with only 4 of the articles published before 2020. Out of the 14 studies included in our review, twelve utilized quantitative methods, while the remaining two employed qualitative approaches. Among the studies included in our analysis, we found various approaches to categorizing religious belief and identity. In most studies when religion is uniformly regarded as the sole determinant of vaccine hesitancy, it consistently emerges as a significant factor in contributing to vaccine hesitancy. All studies in our review reported sociodemographic factors to some degree related to vaccine hesitancy within their sample populations. Our analysis underscored the need for nuanced approaches to addressing vaccine hesitancy among religious groups. CONCLUSION: Vaccine hesitancy is a complex issue and driven by a myriad of individual and societal factors among which religious beliefs is commonly associated to be a driver of higher levels among populations.

Moral distress, coping mechanisms, and turnover intent among healthcare providers in British Columbia: a race and gender-based analysis.

BACKGROUND: This study explores intersectionality in moral distress and turnover intention among healthcare workers (HCWs) in British Columbia, focusing on race and gender dynamics. It addresses gaps in research on how these factors affect healthcare workforce composition and experiences. METHODS: Our cross-sectional observational study utilized a structured online survey. Participants included doctors, nurses, and in-home/community care providers. The survey measured moral distress using established scales, assessed coping mechanisms, and evaluated turnover intentions. Statistical analysis examined the relationships between race, gender, moral distress, and turnover intention, focusing on identifying disparities across different healthcare roles. Complex interactions were examined through Classification and Regression Trees. RESULTS: Racialized and gender minority groups faced higher levels of moral distress. Profession played a significant role in these experiences. White women reported a higher intention to leave due to moral distress compared to other groups, especially white men. Nurses and care providers experienced higher moral distress and turnover intentions than physicians. Furthermore, coping strategies varied across different racial and gender identities. CONCLUSION: Targeted interventions are required to mitigate moral distress and reduce turnover, especially among healthcare workers facing intersectional inequities.

Implementing community-based health program in conflict settings: documenting experiences from the Central African Republic and South Sudan.

BACKGROUND: The delivery of quality healthcare for women and children in conflict-affected settings remains a challenge that cannot be mitigated unless global health policymakers and implementers find an effective modality in these contexts. The International Committee of the Red Cross (ICRC) and the Canadian Red Cross (CRC) used an integrated public health approach to pilot a program for delivering community-based health services in the Central African Republic (CAR) and South Sudan in partnership with National Red Cross Societies in both countries. This study explored the feasibility, barriers, and strategies for context-specific agile programming in armed conflict affected settings. METHODS: A qualitative study design with key informant interviews and focus group discussions using purposive sampling was used for this study. Focus groups with community health workers/volunteers, community elders, men, women, and adolescents in the community and key informant interviews with program implementers were conducted in CAR and South Sudan. Data were analyzed by two independent researchers using a content analysis approach. RESULTS: In total, 15 focus groups and 16 key informant interviews were conducted, and a total of 169 people participated in the study. The feasibility of service delivery in armed conflict settings depends on well-defined and clear messaging, community inclusiveness and a localized plan for delivery of services. Security and knowledge gaps, including language barriers and gaps in literacy negatively impacted service delivery. Empowering women and adolescents and providing context-specific resources can mitigate some barriers. Community engagement, collaboration and negotiating safe passage, comprehensive delivery of services and continued training were key strategies identified for agile programming in conflict settings. CONCLUSION: Using an integrative community-based approach to health service delivery in CAR and South Sudan is feasible for humanitarian organizations operating in conflict-affected areas. For agile, and responsive implementation of health services in conflict-affected settings, decision-makers should focus on effectively engaging communities, bridge inequities through the engagement of vulnerable groups, collaborate and negotiate for safe passage for delivery of services, keep logistical and resource constraints in consideration and contextualize service delivery with the support of local actors.

Influences for Gender Disparity in the Radiology Societies in North America.

OBJECTIVE: The objective of our study was to outline the gender distribution in leadership positions in the North American radiology societies. MATERIALS AND METHODS: A review of North American radiology societies was conducted to identify committee members and those holding leadership positions. The Scopus database was queried for research productivity metrics of these individuals. Gender, university affiliation, and academic rank were identified from departmental websites. The chi-square test was used to assess for differences in gender distribution, and nonparametric analyses were applied to determine gender differences in continuous variables. RESULTS: Of 2826 radiology society committee members, men outnumbered women 67.4% (n = 1906) to 32.6% (n = 920). There were 696 society leadership positions, of which men held 501 (72.0%) and women held 195 (28.0%) (p < 0.003). Additionally, 26.3% of all men held leadership positions compared with 21.2% of all women (p = 0.0032). Overall, men had a higher median h-index (14 [range, 0-113] vs 11 [range, 0-73]), number of publications (52 [range, 2-1264] vs 35 [range, 2-428]), and number of citations (880 [range, 0-54,813] vs 483.5 [range, 0-17,332]) than women (p < 0.001). Across university academic ranks of assistant and associate professor, research productivity metrics were similar between genders, but interestingly, female representation decreased with increasing academic rank. A higher proportion of men held a university rank of professor than women (39.5% vs 33.4%; p = 0.0017) with parity at the levels of assistant and associate professors. CONCLUSION: Gender disparity exists in the leadership positions in North American radiology societies. We have attempted to study the relationship between gender, academic rank, and h-index with leadership roles in these societies.

The diagnostic utility of rib series in assessing rib fractures.

Rib series rarely add information to the posteroanterior (PA) film for the diagnosis of rib fractures. In this investigation, we evaluated the utility of rib X-rays using turnaround time (TAT), radiation exposure, and cost-efficiency as the key parameters. This investigation was conducted from January 2008 to December 2012. We included patients who had rib series performed for suspected rib fractures. TAT for patients was calculated from the time exam was ordered by the emergency department (ED) physician/staff to time the report was finalized by the attending radiologist. Effective radiation dose for rib series was calculated as a summation of radiation dose from the standard rib series images for each patient. Cost-efficiency was determined based on the number of interventions that took place as a result of a complicated study. Our investigation consisted of 422 patients, 208 females aged (57 ± 20.8) and 214 males aged (48 ± 17.3). A total of 74(17.5 %) abnormal findings were noted, out of which only 1(0.23 %) underwent management change. The mean turnaround time for patients undergoing rib series had a value of 133.5 (±129.8) min as opposed to a single chest PA of 61.8(± 64) min. Average effective radiation dose for a rib series was 0.105 (±0.04) mSv, whereas average effective radiation dose of a single chest PA was 0.02 mSv. Dedicated rib series has a low-yield diagnostic value as it pertains to management change. The overall impact on patient care based on our findings is small when compared to the risks associated with prolonged TAT, repeated exposure to radiation, and extensive medical costs.

Bacteriophage-based bioassays: an expected paradigm shift in microbial diagnostics.

Bacteriophages, as abundant and specific agents, hold significant promise as a solution to combat the growing threat of antimicrobial resistance. Their unique ability to selectively lyse bacterial cells without harming humans makes them a compelling alternative to traditional antibiotics and point-of-care diagnostics. The article reviews the current landscape of diagnostic technologies, identify gaps and highlight emerging possibilities demonstrates a comprehensive approach to advancing clinical diagnosis of microbial pathogens and covers an overview of existing phage-based bioassays. Overall, the provided data in this review effectively communicates the potential of bacteriophages in transforming therapeutic and diagnostic paradigms, offering a holistic perspective on the benefits and opportunities they present in combating microbial infections and enhancing public health.

Bacteriophages, a type of virus that infects bacteria, have a lot of potential to help us understand and detect bacteria that can cause disease. This review talks about how bacteriophages could be used in medicine and for testing for diseases, and for identifying disease-causing bacteria in easy-to-use diagnostic tools. This is important for not only population health, but also for animals and the protection of food supplies by stopping the spread of harmful bacteria in farming.

Equity Lens on Canada's COVID-19 Response: Review of the Literature.

BACKGROUND: A growing literature has documented how the secondary effects of the COVID-19 pandemic have compounded socioeconomic vulnerabilities already present in society, particularly across social categories such as gender, race, class, and socioeconomic status. Such effects demonstrate how pandemic response policies act as structural determinants of health to influence not only direct health outcomes but also intermediary outcomes, such as access to education or income. METHODS: This review aims to scope research that analyzes pandemic response policies in Canada from an equity perspective, to identify common themes, recommendations, and gaps. RESULTS: Fourteen studies were thematically analyzed, the majority being qualitative policy document analysis, applying critical frameworks and focused on effects on select priority populations. Analysis of economic and labour policies indicates a lack of consideration for the specific needs of priority populations, and those engaged in precarious, informal, and essential labour. Analysis of social policies illustrate the wide-ranging effects of school and service closures, particularly on women and children. Furthermore, these policies lacked consideration of populations marginalized during the pandemic, include older adults and their caregivers, as well as lack of consideration of the diversity of Indigenous communities. Recommendations proposed in this review call for developing policy responses that address persistent social and economic inequities, pandemic response policies tailored to the needs of priority populations and more meaningful consultation during policy development. CONCLUSION: The limited number of studies suggests there is still much scope for research recognizing policies as structural determinants of health inequities, including research which takes an intersectional approach.

Moral distress related to paid and unpaid care among healthcare workers during the COVID-19 pandemic.

While there is growing literature on experiences of healthcare workers and those providing unpaid care during COVID-19, little research considers the relationships between paid and unpaid care burdens and contributions. We administered a moral distress survey to healthcare workers in Canada, in 2022, collecting data on both paid and unpaid care. There were no significant differences in the proportion of participants providing unpaid care by gender, with both genders equally affected by certain responsibilities such as reduced contact with family/loved ones. However, men were significantly more distressed about specific unpaid care responsibilities. Unpaid care was not significantly associated with differences in intention to leave work. At work, women were significantly more concerned about patients unable to see family, while men were distressed by others mistreating COVID patients. This study enhances understanding of paid and unpaid care relationships, particularly during crises, and proposes an innovative method for assessing unpaid care burdens.

An Intersectional Analysis of Moral Distress and Intention to Leave Employment Among Long-Term Care Providers in British Columbia.

Objectives: In this study, we aimed to explore the relationship between intersectional inequities and moral distress among those working in Long-Term Care (LTC) in British Columbia, Canada. Methods: This was a cross-sectional and retrospective study. We assessed moral distress, of 1678 respondents, using a modified Moral Distress Scale, and an equivalent distress mitigation score, at the intersections of gender and racial/ethnic identity. Then, we explored which worker attributes were more predictive of intention to leave work. Results: We found notable difference in experiences of moral distress across intersecting identities, including high moral distress scores among Indigenous men and women, and white women. Significant differences in mitigation scores were also found by intersectional identities. Discussion: Moral distress was the most important predictor of intention to leave work. The differences across racial and gender identity groups suggest the need for tailored interventions to address moral distress among LTC providers.

Double Trouble: A Case of Two Simultaneous Thrombotic Events in a Patient With COVID-19.

Coronavirus disease 2019 (COVID-19) is known to primarily have respiratory tract involvement, but thromboembolic complications can occur as well, leading to increased overall mortality seen in these patients. We present a case of a patient infected with COVID-19 who then developed two simultaneous thrombotic events. Our patient is a 57-year-old male who presented to the emergency department with sudden onset dysarthria and left lower extremity weakness. Medical records indicated he recently tested positive for COVID-19 infection 10 days ago. Magnetic resonance imaging (MRI) of the brain revealed an acute right cerebellar infarction as well as acute bilateral thalamic infarcts. Later in the hospital course, computed tomography angiography (CTA) of the chest revealed a right lower lobe segmental pulmonary artery embolism. Patients with COVID-19 have been seen to develop a wide spectrum of thromboembolic manifestations, most commonly being venous thromboembolism. Arterial thrombosis and microvascular disease can be detected as well. Early diagnosis and treatment of clotting disease is essential and may decrease overall mortality in COVID-19-infected patients.

Sticky Floor and Glass Ceilings in Academic Medicine: Analysis of Race and Gender.

Purpose This paper examines the changes in the representation of women and racial minorities in academic medicine, compares the proportion of minorities in medicine and the general United States (US) population, and discusses potential explanations for observed trends. Methods A retrospective cross-sectional analysis of the Association of American Medical Colleges (AAMC) database was done and used to collect data on the gender and race of physicians in academic medicine. Data was collected for instructors, assistant professors, associate professors, full professors, and chairpersons from 2007 to 2018, and trends were presented. Results White physicians represented most academic physicians at every academic level, peaking in proportion at 82.74% of chairpersons and were lowest at the level of instructor at 59.30%. A similar distribution existed when gender was compared, with men comprising 84.67% of chairpersons and forming the majority at levels of full, associate, and assistant professors. However, most physicians at the level of instructors are women at 55.44%. Conclusions Though women and racial minorities have gained greater representation in academic medicine over the past decade, high-level academic positions are not as accessible to them. Existing efforts of advocacy for women and minority races have proven fruitful over the past decade, but much more work needs to be done.

Chronic steroid use: An overlooked impact on patients with inflammatory bowel disease.

Background and Aim: Steroids have long been used in inducing remission of inflammatory bowel disease (IBD). Chronic use, defined as therapy greater than 3 months, has been implicated in complications including increased hospital length of stay (LOS), infections, and even death. In our retrospective study, we aim to identify the complications of chronic steroid use in patients with IBD. Methods: The fourth quarter of 2015-2019 National Inpatient Sample (NIS) was used in this study. International Classification of Diseases (ICD-10) codes were used to identify patients with a diagnosis of IBD and chronic steroid use. Adverse outcomes of chronic steroid use in IBD patients were analyzed, such as osteoporosis, opportunistic infections, mortality rate, and LOS. Cohorts were weighted using an algorithm provided by the NIS allowing for accurate national estimates. Results: A total of 283 970 patients had a diagnosis of IBD. Of those, 18 030 patients had concurrent chronic steroid use. Racial disparities existed, with 77.4% White, 12.7% Black, and 6.0% Hispanic. Patients with a history of IBD and chronic steroid use were found to have higher odds of developing osteoporosis, opportunistic infections, and acute thromboembolic events but did not have higher odds of mortality. Conclusion: There is much controversy about whether IBD patients should be on chronic steroids for maintenance therapy and this study highlights the importance of this decision as patients on chronic steroid use had higher odds of developing adverse effects. These results stress the importance of monitoring patients on steroids and avoiding chronic use.

Racial and Gender Profile of Public Health Faculty in the United States of America.

Introduction In the context of shifting population demographics in the United States (US), a diverse workforce in the discipline of public health can improve outcomes for various populations through the provision of culturally competent public health policies and corresponding research. This study explored the academic, racial, and gender profile of public health faculty in the USA. Methods In this retrospective cross-sectional analysis, we analyzed the Association of American Medical Colleges (AAMC) annual report of faculty appointments at US medical schools. Descriptive data analysis was performed for chairperson, full professor, associate professor, assistant professor, instructor, and other positions from 2007 to 2018. Results There was a decrease in appointments at all academic ranks from 2007 to 2018 with an absolute change of -239. Overall, most academic positions were occupied by Whites compared to other races, especially in leadership ranks. However, year-by-year analysis showed a gradual decrease in the number of positions held by Whites. Over the last decade, there was a positive trend with a marginally greater number of minorities appointed at academic ranks, specifically Asians. Similarly, no significant change was seen in appointments for Hispanics. Additionally, females occupied a greater number of new positions as compared to their male counterparts except for the higher academic ranks. The data obtained from the AAMC were voluntarily reported and thus may not provide a complete picture of medical faculty in academic medicine. Conclusion Women have shown progress in public health faculty positions during our 12-year study period. However, racial and gender incongruity still exists at higher academic ranks and leadership positions. Further research is warranted to explore factors influencing faculty appointment and promotion, and strategies to reduce inequities.

Gender Differences in Faculty Rank and Leadership Positions Among Physician Biochemistry Faculty in North America: A Retrospective, Cross-Sectional Study.

Purpose This study sought to assess gender differences among physician faculty in medical biochemistry and genetics programs in North America. It compared the distribution of academic and leadership ranks, years of active research, number of citations and publications, and Hirsch-index (h-index) by gender. Variable associations with the h-index were assessed. Method This was a cross-sectional retrospective study for which data was collected from June 2019 to October 2019 on academic and administrative physician faculty members for medical biochemistry and genetics programs. The website of Fellowship and Residency Electronic Interactive Database, Canadian Resident Matching Service website, and the medical biochemistry profile from the Canadian Medical Association to identify relevant programs and SCOPUS was used to gather faculty data. Results The analyses included 147 faculty members. More male faculty held higher academic rank positions and first-in-command leadership positions than female faculty. Men had more median years of active research, citation numbers, publication numbers, and h-index than women across all academic ranks. Upon performing multivariable linear regression, female faculty showed 0.39 times the odds of having a higher h-index than male faculty, keeping all other variables constant (p<0.01).  Conclusions In our study, it was shown that male physician faculty surveyed had higher performance than female faculty in academic rank and research productivity. Certain barriers may be contributing factors, including lack of mentorship or flexible institutional policies, women choosing clinical educator tracks, or gender bias. Considering the low retention rates of women in academic research, there is a need to address barriers in order to achieve gender parity.

"Feeling the Blues": A Case of Calcium Channel Blocker Overdose Managed With Methylene Blue.

Amlodipine is a dihydropyridine calcium channel blocker (CCB) commonly used to treat hypertension. In the United States, approximately 9,500 cases of CCB intoxication due to deliberate or inadvertent overdose were reported to poison centers in 2002. We present a case of a patient who presented with CCB overdose complicated by acute respiratory distress syndrome (ARDS) and recalcitrant shock all of which resolved with methylene blue therapy. We present a case of a 56-year-old African American woman who presented to the emergency department (ED) after intentional ingestion of large amounts of multiple pills likely consisting of cyclobenzaprine, amlodipine, losartan, and ibuprofen following an argument with her boyfriend. Treatment included insulin drip, 10% dextrose, and norepinephrine drip which was titrated up. First insulin drip and 10% dextrose were titrated up; however, vasopressor-resistant hypotension persisted, and the decision was made to administer methylene blue. Over 9,500 cases of CCB toxicity were reported to poison centers in the US in 2002. Although no definitive treatment is outlined, first-line therapy consists of IV calcium, high-dose insulin, and vasopressor support with either norepinephrine or epinephrine. Traditionally, methylene blue is used for methemoglobinemia and in cardiothoracic ICUs for post coronary artery bypass vasoplegia. It acts by selectively inhibiting nitric oxide-activated cyclic guanylate cyclase leading to decreased vasodilation of arteriolar smooth muscles improving vascular tone and systemic vascular resistance. In severe amlodipine overdose, experimental models demonstrate methylene blue improves HR and mean arterial pressure (MAP), improving survival rate. With few adverse side effects (green-tinged discoloration of urine, saliva, tears, and bodily fluids), methylene blue should be explored and implemented in the treatment of CCB overdose with refractory hypotension and ARDS.

Impact of pulmonary hypertension in patients with acute exacerbation of chronic obstructive pulmonary disease and its effect on healthcare utilization.

We aim to study the impact of pulmonary hypertension on acutely exacerbated chronic obstructive pulmonary disease (AECOPD). We used the 2016 and 2017 National Readmission Database with an inclusion criterion of AECOPD as a primary and pulmonary hypertension as a secondary diagnosis using ICD 10-CM codes. Exclusion criteria were age under 18 years, non-elective admission, and discharge in December. The primary outcome was in-hospital mortality during the index admission. Secondary outcomes were 30-day readmission rate, resource utilization, and instrument utilization including intubation, prolonged invasive mechanical ventilation >96 h (PIMV), tracheostomy, chest tube placement, and bronchoscopy during the index admission. A total of 627,848 patients with AECOPD were included in the study, and 68,429 (10.90%) patients had a diagnosis of pulmonary hypertension. Pulmonary hypertension was more common among females (61.14%) with a mean age of 71 ± 11.66, Medicare recipients (79.5%), higher Charlson comorbidity index, and treatment in an urban teaching hospital. Pulmonary hypertension was associated with greater mortality (adjusted odds ratio (aOR) 1.89, p < 0.001), higher 30-day readmission (aOR 1.24, p < 0.001), higher cost (adjusted mean difference (aMD) $2785, p < 0.01), length of stay (aMD 1.09, p < 0.001), and higher instrument utilization including intubation (aOR 199, p < 0.001), PIMV (aOR 2.12, p < 0.001), tracheostomy (aOR 2.1, p < 0.001), bronchoscopy (aOR 1.46, p = 0.007), and chest tube placement (aOR 1.39 p < 0.004). We found that pulmonary hypertension is related to higher in-hospital mortality, length of stay, increased instrument utilization, readmission, and costs. Our study aims to shed light on the impact of pulmonary hypertension on AECOPD in hopes to improve future management.

Imaging of vascular pseudoaneurysms in the thorax and abdomen.

INTRODUCTION: This review article illustrates a spectrum of arterial pseudoaneurysms that may occur in various locations throughout the thoracoabdominal region. This article discusses the common etiologies and typical clinical presentations of arterial pseudoaneurysms as well as the imaging modalities employed in their diagnosis and potential treatment options. OBJECTIVE: The goal of this review article is to familiarize radiologists with the diagnosis of thoracoabdominal arterial pseudoaneurysms, the prompt identification and treatment of which are crucial in this patient population. CONCLUSION: In summary, a thorough understanding of the etiologies, imaging characteristics, and clinical implications of pseudoaneurysms can help optimize identification and management of this spectrum of disease.

Klippel-trénaunay syndrome with intracranial arteriovenous malformation: a rare presentation.

Klippel-Trénaunay syndrome (KTS) is a rare vascular congenital anomaly affecting less than 200,000 people in the United States. Vascular malformations associated with KTS tend to affect slow flow systems: venous, capillary, and lymphatic systems. The nature of the syndrome leads to a higher risk for the development of arteriovenous malformations. Our case presentation describes a patient with KTS and an associated rare presentation of intraventricular arteriovenous malformation (AVM).