The Community of Bilingual English-Spanish Speakers Exploring Issues in Science and Health: Experiences During the COVID-19 Pandemic.

Language diversity is increasing in the United States. This growth has implications for language preference, cost, quality, and client outcomes in health services settings. However, language diversity among medical and allied health professionals is lacking. Education pipeline programs are a mechanism to prepare bi- and multi-lingual diverse students to enter health careers. The Community of Bilingual English-Spanish Speakers Exploring Issues in Science and Health (CBESS) is one such program. Through peer mentorship from Leadership Trainees (LT), and a multicomponent 17-month education curriculum, CBESS was designed to increase interest in STEM careers among English-Spanish bilingual high school youth. In 2020, the COVID-19 pandemic interrupted high school students' education and forced programs to innovate. CBESS was no exception. The most significant modifications were to a) expectations of SRs for a successful Summer Virtual Research Program (SVRP), b) LT roles, and c) scope and delivery of summer science content. A preliminary evaluation was conducted from data collected through pre-post surveys, process data, and focus groups. Among the outcomes were a significant increase in science knowledge among SVRP youth participants as well as no significant differences between cohort 1 and 2 suggesting that changes did not impede program goals. LTs highlighted skills needed and role of mentors. Adaptations were successful and will continue with the 2021 cohort.

The use of fidaxomicin for treatment of relapsed Clostridium difficile infections in patients with cancer.

OBJECTIVES: To report our experience with the use of fidaxomicin (FDX), an oral macrocyclic antibiotic, in cancer patients with Clostridium difficile infection (CDI). METHODS: A single-center retrospective case series was conducted at The University of Texas MD Anderson Cancer Center. Patients with CDI treated with FDX from May 2011 to January 2013 were identified via the pharmacy database. Clinical response and recurrence after FDX initiation were evaluated. RESULTS: Twenty-two patients were included, most of whom were male (55%) with a mean age of 58 years (range: 20-83 yrs). The most common underlying malignancies were nine patients with lymphoma (41%), seven with leukemia (32%), and six with solid tumors (27%). Indications for FDX included recurrent CDI in 16 patients (72%) and failure of both metronidazole and oral vancomycin in 6 patients (28%). Nineteen patients (86%) were on concomitant antimicrobials during CDI treatment. Clinical response to FDX was 91%, and overall sustained clinical response was 82%. FDX was well tolerated with no major adverse events that were FDX related or discontinuations due to drug-related adverse events. CONCLUSION: In cancer patients, FDX is effective treatment for the first episode of CDI after failure of standard therapies and treatment of recurrent CDI. This was interesting given the large number of high-risk patients who continued to receive concomitant antimicrobial therapy, which is common in this immunocompromised patient population.

A clinician's guide to systematic reviews.

The purpose of this article is to discuss systematic reviews, how they are performed, and their associated strengths and limitations. A systematic review is an assessment of evidence involving exact methods to systematically identify, select, and critically evaluate all available literature on a particular topic. Unlike most narrative reviews, systematic reviews have defined methods established a priori for searching, evaluating, extracting, synthesizing, and reporting available evidence. Key characteristics differentiating systematic reviews from most narrative reviews include: clearly stated objectives, pre-defined inclusion/exclusion criteria, an explicit reproducible methodology, systematic exhaustive searches to identify all sources of evidence, an assessment of the validity for each included study, and a systematic presentation of the study characteristics/results. Though there are significant advantages to systematic reviews, there are also clear limitations such as: the quality of included evidence; heterogeneity and homogeneity of included studies; and publication bias. Even with these limitations, systematic reviews are beneficial to front line clinicians when the quantity of evidence is so substantial that reviewing and synthesizing it is not feasible, available evidence is conflicting, or when the robustness of available evidence is unknown.

The lack of predictors for rapid progression in prostate cancer patients receiving sipuleucel-T.

Sipuleucel-T is an immunotherapy indicated for the treatment of metastatic prostate cancer. It offers a new mechanism to treat prostate cancer without the side effects of hormone therapies and chemotherapies. In previous studies sipuleucel-T did not delay disease progression, but demonstrated an overall survival benefit compared to placebo. While clinical trials have evaluated the effects of sipuleucel-T on overall survival and progression, more studies are needed to evaluate its effectiveness and role in the management of prostate cancer. The objective of this study is to identify the incidence and possible predictors for disease progression in patients receiving sipuleucel-T. A retrospective review of patients who received sipuleucel-T between 1 September 2010 and 11 October 2011 was conducted (n = 36). Patients who changed therapy or died within 120 days were classified as experiencing rapid progression. Potential predictors of rapid progression were examined using logistic regression. Seven patients met criteria for rapid progression. Progression occurred in 72.2% of all patients. The median days to progression was 158. No significant predictors of rapid progression were identified. Currently no predictors have been found to be associated with rapid progression in prostate cancer patients on sipuleucel-T.

Improving Pediatric Adverse Drug Event Reporting through Clinical Pharmacy Services.

OBJECTIVES: The purpose of this study was to summarize adverse drug event (ADE) reporting and to characterize the type of healthcare practitioners involved in reporting over a 10-year period at a 120-bed university-affiliated children's hospital. METHODS: The University of Virginia Children's Hospital ADE database was analyzed for records involving pediatric patients. Data from patients <18 years of age who were admitted to the University of Virginia Children's Hospital between January 1, 2000, and December 31, 2009, were analyzed. Data collected included drug name and therapeutic class of the suspected causative agent, description of the event, severity, causality, outcome, and the type of healthcare practitioner reporting the event. RESULTS: A total of 863 ADEs were reported over the 10-year period. The 5 most common types reported were extravasation injury (10%), rash (8%), hypotension (5%), pruritus (5%), and renal failure (3%). A total of 196 (21%) cases were categorized as mild, 436 (47%) cases as moderate, and 296 (32%) cases as severe. Further characterization of extravasations was performed to identify trends relating to potential causes. In 45 (57%) reports, parenteral nutrition was identified as the causative agent. Full recovery was documented in 21 (47%) extravasations. Of the total events reported, 83% were reported by pharmacists, 16% by nurses, and <1% by other healthcare practitioners. CONCLUSIONS: Results of this study are consistent with those of previous studies involving ADE reporting in children's hospitals. This consistency is due in part to system design and use of unit-based pharmacists as the primary reporters.

Predicting the population dynamics of the house dust mite Dermatophagoides pteronyssinus (Acari: Pyroglyphidae) in response to a constant hygrothermal environment using a model of the mite life cycle.

A generalised model of the life cycle of a house dust mite, which can be tailored to any particular species of domestic mite, is presented. The model takes into account the effects of hygrothermal conditions on each life cycle phase. It is used in a computer simulation program, called POPMITE, which, by incorporating a population age structure, is able to predict population dynamics. The POPMITE simulation is adapted to the Dermatophagoides pteronyssinus (Acari: Pyroglyphidae) (DP) mite using published data on the egg development period, total development period, adult longevity, mortality during egg development, mortality during juvenile development, and fecundity of individual DP mites held at a range of constant hygrothermal conditions. An example is given which illustrates how the model functions under constant hygrothermal conditions. A preliminary validation of POPMITE is made by a comparison of the POPMITE predictions with published measurements of population growth of DP mites held at a range constant hygrothermal conditions for 21 days. The POPMITE simulation is used to provide predictions of population growth or decline for a wide range of constant relative humidity and temperature combinations for 30 and 60 days. The adaptation of the model to correctly take account of fluctuating hygrothermal conditions is discussed.

A simple model for predicting the effect of hygrothermal conditions on populations of house dust mite Dermatophagoides pteronyssinus (Acari: Pyroglyphidae).

A simple mite population index (MPI) model is presented which predicts the effect on house dust mite populations of any combination of temperature and relative humidity (RH). For each combination, the output is an index, or multiplication factor, such that 1.1 indicates 10% population growth and 0.9 indicates 10% population decline. To provide data for the model, laboratory experiments have been carried out using lab cultures of Dermatophagoides pteronyssinus. The population change was observed for mites held in steady-state conditions at different combinations of temperature and RH over 21 days. From the results, a best-fit equation has been derived which forms the basis of the MPI model. The results also enable a new term to be defined: the Population Equilibrium Humidity, PEH, the RH for a given temperature at which house dust mite populations neither grow nor decline. It is similar to Critical Equilibrium Humidity, the RH below which house dust mites are unable to maintain water balance, but relates to a population of mites (rather than a physiological phenomenon) and is more able to take account of the observed effects of extremes of temperature and RH. Compared with previous population models, the MPI model is potentially more accurate and comprehensive. It can be combined with other simple models (described in previous papers), such as BED, which simulates the average hygrothermal conditions in a bed, given room conditions, and Condensation Targeter II, which simulates room conditions given a range of easily obtainable inputs for climate, house type and occupant characteristics. In this way it is now possible, for any individual dwelling, to assess the most effective means of controlling mite populations by environmental means, such as by improving standards of ventilation and insulation, or by modifying the occupant behaviour that affects the hygrothermal environment within a dwelling. Although the MPI model requires further development and validation, it has already proved useful for understanding more clearly how the different hygrothermal conditions found in beds and bedrooms can affect mite populations. It has also demonstrated that there is considerable scope for controlling mites by environmental means in cold winter climates such as the UK.

Conservation of whole body nitric oxide metabolism in human alcoholic liver disease: implications for nitric oxide production.

OBJECTIVE: Patients with advanced liver diseases tend to develop a hyperdynamic circulation which complicates cirrhosis. Impairment of nitric oxide (NO) metabolism has been implicated in the pathogenesis of portal hypertension. The aim of this study was to determine nitric oxide synthase (NOS)-dependent whole body NO production in patients with decompensated liver cirrhosis and portal hypertension. MATERIAL AND METHODS: Ten patients with decompensated alcoholic liver disease and portal hypertension (Child-Pugh Classifications B and C with no signs of infection) and 10 age- and gender-matched control subjects received an intravenous infusion of L-[15N]2-arginine (50 micromol/min for 30 min). Urine and serum nitrite and nitrate concentrations were determined using ion chromatography-mass spectrometry. RESULTS: NOS-dependent whole body NO synthesis was estimated by the conversion of [15N]guanidino nitrogen of arginine to urine 15N-nitrite and 15N-nitrate. The amount of 15N-nitrite and 15N-nitrate in the urine of patients and control subjects was significantly correlated with the amount of urine nitrite and nitrate over 36 h (r=0.91 and 0.77, respectively, p<0.0001). However, neither a median of 12 h 15N-nitrite and 15N-nitrate nor nitrite and nitrate excretion in the urine was different between patients and control subjects, 46.4 (9.4-152.2) versus 98.7 (29.9-146.5) nmol/mmol creatinine and 20.6 (2.1-69.0) versus 40.0 (27.0-70.1) micromol/mmol creatinine, respectively. No differences were found in serum nitrite and nitrate concentrations and glomerular filtration rates between patients and control subjects, 111.4 (73.2-158.8) versus 109.3 (83.5-176.4) micromol/l. CONCLUSION: Our results contraindicate a greater basal NOS-dependent whole body NO production in patients with decompensated liver disease and portal hypertension.

High-performance liquid chromatography/inductively coupled plasma mass spectrometry and tandem mass spectrometry for the detection of carbon-containing compounds.

High-performance liquid chromatography (HPLC) combined with inductively coupled plasma mass spectrometry (ICPMS) has been studied as a means for the detection of carbon to provide a 'universal' method for detecting organic compounds in chromatographic eluents. Carbon is particularly difficult to ionise and the amount of carbon present in normal chromatographic systems leads to high backgrounds, making detection a challenge. Novel separation approaches were therefore employed, using either entirely aqueous eluents (at temperatures of 60 and 160 degrees C, dependent on the column used) to eliminate the organic modifier completely, or isotopically enriched solvents. For the aqueous eluents, detection limits for sulphanilamide were found to be 2.26 microg, corresponding to 1.13 micromol (0.47 micromol of carbon), injected on a conventional 4.6 mm i.d. column. The use of a narrow bore column with highly isotopically enriched 12C-methanol (99.95 atom%) as organic modifier for the mobile phase enabled the detection of 86 micromol for 13C-triple-labelled caffeine and 79 micromol for 13C-double-labelled phenacetin. The sensitive detection of 12C-compounds with 13C-enriched methanol as organic modifier proved impractical due to a lower level of isotopic enrichment (99 atom%) of this solvent, with the residual 12C-methanol resulting in significant interference.