Harlan Sayles

Evaluations of early exposure to the infectious diseases (ID) specialty typically focus on medical students and residents. Of 65 prehealth summer health professions program graduates surveyed, 21% showed at least fair interest in ID. Of 32 respondents interested in medicine, 10 considered internal medicine or pediatrics, which could lead to an ID career.

Background: In 2024, US hospitals were affected by the Becton Dickinson (BD) BACTEC blood culture bottle shortage with little time to respond and conserve supply. The extent of the impact of this shortage on clinical practice has not been explored. Methods: We developed a 7-question online poll with the Emerging Infections Network (EIN) exploring the extent to which facilities were impacted by the shortage, the geographic location and facility type of institutions affected, the actions taken to mitigate the shortage, and the impact on clinical management of fever and Staphylococcus aureus bacteremia. The link was sent to >3,100 EIN listserv members 3 times during September 2024. Descriptive and thematic analyses were performed on quantitative and qualitative responses. Results: Of 202 respondents from 39 states, 129 said their hospital had limited blood cultures available, 8 were unsure how their hospitals were affected, and 65 indicated their hospitals were not affected. Top mitigation strategies included publishing algorithms for best practice use, restricting follow-up blood cultures, using single blood culture sets, and implementing EMR-based alerts on blood culture orders. Important clinical themes identified by affected respondents included limitations on blood culture use, concerns with overall treatment and care, concerns with bacteremia management, and increased diagnostic stewardship opportunities. Conclusion: The BD BACTEC blood culture bottle shortage caused widespread clinical impact. The themes identified highlight the challenges placed on healthcare systems during times of shortage as well as the effects on patient care. Mitigation strategies implemented during the shortage may create future opportunities for diagnostic stewardship.

Objective: To characterize disease burden among adults with rheumatoid arthritis (RA) by both shared epitope (SE) and anticitrullinated protein antibody (ACPA) status, and to determine how their responses to abatacept, tumor necrosis inhibitors, and Janus kinase inhibitors may differ. Methods: Using data from 2 observational cohorts (FORWARD, Veterans Affairs RA [VARA]), individuals with RA were classified by SE/ACPA status. Outcomes included disease activity (Patient Activity Scale II [PAS-II], Routine Assessment of Patient Index Data 3 [RAPID3], Disease Activity Score in 28 joints), Rheumatic Disease Comorbidity Index (RDCI), lifetime disease-modifying antirheumatic drug (DMARD) exposure, and healthcare usage. Differences by SE/ACPA classification were determined with multiple linear regression. Response to DMARD initiation was assessed with linear regression for continuous measures of disease activity and logistic regression for achieving a change as large as the minimum clinically important difference. Results: A total of 3243 individuals were included (FORWARD, n = 917; VARA n = 2326). RDCI among ACPA-negative individuals was lower than in ACPA-positive individuals in both cohorts (β [95% CI]: FORWARD −0.35 [−0.65 to −0.05], P = 0.02; VARA −0.35 [−0.63 to −0.08], P = 0.01). In FORWARD, there were significant differences in disease burden, including lower disease activity (PAS-II −0.77 [−1.10 to −0.44], P < 0.001), lower healthcare usage (rheumatology visits −0.18 [−0.35 to 0.0], P = 0.046), and higher DMARD counts (0.43 [0.02 to 0.85], P = 0.04) among SE+/ACPA+ individuals. ACPA+ abatacept initiators were more likely to experience clinically important improvements in PAS-II and DAS28, but RAPID3 was not significantly associated with abatacept response. Conclusion: Our results highlight important differences in disease burden by SE/ACPA status and suggest that ACPA status, rather than correlative SE status, may be the stronger predictor of abatacept response among individuals with RA.

Recognizing the adverse effects of burnout on clinician well-being and patient care, there has been a surge in national interest in this subject. However, within the physical therapy profession, the extent of burnout has not been as deeply examined. This study aimed to 1) describe the frequency and severity of burnout of Nebraska physical therapists using the Maslach Burnout Inventory and 2) explore potential associations of burnout with sociodemographic and work environment characteristics. Using a cross-sectional design, 2057 licensed physical therapists in Nebraska were invited to complete a survey that included the Maslach Burnout Inventory, demographic information, work environment factors, and stressors. Burnout profiles were generated based on Maslach Burnout Inventory subscale scores and scores were compared to previously established cutoffs. Associations between burnout and sociodemographic and work environment factors were analyzed, and key stressors for each burnout profile were identified. The overall response rate was 23.5%. Approximately half of respondents exhibited engagement, while the remainder experienced at least one dimension of burnout, with 9.9% displaying a full burnout profile. Work environment factors, such as workload, autonomy, flexibility, time off, ethics, supervisor and coworker support, and professional judgment, contributed more significantly (p < .001) to burnout than sociodemographic characteristics (p < .05). The top stressors among participants with burnout were workload/productivity standards, hours worked per week, and student loan debt. These findings suggest that burnout, driven by emotional exhaustion, is a concern for Nebraska physical therapists. Addressing modifiable work environment factors could help reduce burnout and enhance workforce well-being.

Background: The first long-acting injectable antiretroviral therapy (LAI ART) for HIV was approved for commercial use in the United States in January 2021. Assessment of clinic characteristics and their associations with implementation outcomes and barriers is essential to developing strategies for equitable access to LAI ART. Methods: Using validated implementation measures—acceptability of intervention measure (AIM), intervention appropriateness measure (IAM), and feasibility of intervention measure (FIM)—we conducted a cross-sectional survey of Ryan White clinics in the United States. Additionally, we gathered information on the clinics’ population, LAI ART implementation status, and barriers to implementation. Data were analyzed using STATA, version 17. Open-ended responses were analyzed using an inductive thematic approach. Results: Forty-two clinics completed the survey, with 73% in an urban setting. Most clinics identified as either federally qualified health centers (39%) or academic medical centers (27%). The mean (SD) for each measure (maximum of 20) reflected higher AIM (17.7 [2.3]) and IAM (17.6 [2.4]) compared with FIM (16.4 [3.0]). There was a positive correlation between the percentage of patients on Medicaid and summative AIM and IAM scores. The greatest barriers were prior authorizations, drug procurement, and clinic cost of implementation. Conclusions: Despite high acceptability and appropriateness, clinics’ perceived feasibility of LAI ART implementation was low. Barriers to implementation include nonstandardization of prior authorizations, obtaining the medication, and cost of implementation. Clinics with a larger Medicaid-insured population reported higher acceptability and appropriateness of LAI ART, suggesting that public insurance might promote equitable access. Interventions that address structural barriers are needed to improve uptake.

There is a gap in autism research from Low- and Middle-Income Countries (LMIC) where most children with autism live. This has contributed to a lack of culturally validated diagnostic instruments for autism and is a major barrier to early diagnosis, intervention, and research. The Arabic Language Autism Diagnostic Inventory (ALADIN) was developed based on the DSM-5 criteria and adapted to Arabic language and culture using primary source data. The aim of this study was to validate the Arabic Language Autism Diagnostic Inventory for the diagnostic evaluation of autism. A case-control study design was used to test the instrument for sensitivity and specificity for diagnosis of autism in children 2-5 years of age. Parents of 48 children with autism and 152 neurotypical children in Jordan completed the ALADIN. Demographic information from the participants in each group was summarized, and a Receiver Operating Curve (ROC) was fit to the data. A total score of 24 on the ALADIN had 77% sensitivity and 98% specificity for autism. The area under the curve (AUC) was 0.976, indicating strong performance in identifying children with autism. The ALADIN is the first instrument created specifically for Arab populations and is informed by cultural and linguistic data from the target population. Initial validation shows it has high diagnostic specificity for autism. Culturally informed instruments can improve access to early diagnosis and intervention and enhance autism research to improve care and outcomes in global populations.

To quantify associations of serum alarmins with risk of rheumatoid arthritis-associated interstitial lung disease (RA-ILD). Using serum collected at enrolment, three alarmins (IL-33, thymic stromal lymphopoietin [TSLP] and IL-25) were measured in a multicentre prospective RA cohort. ILD was classified using systematic medical record review. Cross-sectional associations of log-transformed (IL-33, TSLP) or quartile (IL-25) values with RA-ILD at enrolment (prevalent RA-ILD) were examined using logistic regression, while associations with incident RA-ILD developing after enrolment were examined using Cox proportional hazards. Covariates in multivariate models included age, sex, race, smoking status, RA disease activity score and anti-cyclic citrullinated antibody positivity. Of 2835 study participants, 115 participants (4.1%) had prevalent RA-ILD at baseline and an additional 146 (5.1%) developed incident ILD. There were no associations between serum alarmin concentrations and prevalent ILD in unadjusted or adjusted logistic regression models. In contrast, there was a significant inverse association between IL-33 concentration and the risk of developing incident RA-ILD in unadjusted (hazard ratio [HR] 0.73 per log-fold increase; 95% CI: 0.57, 0.95; P = 0.018) and adjusted (HR 0.77; 95% CI: 0.59, 1.00; P = 0.047) models. No significant associations of TSLP or IL-25 with incident ILD were observed. In this study, we observed a significant inverse association between serum IL-33 concentration and the risk of developing incident RA-ILD, but no associations with prevalent ILD. Additional investigation is required to better understand the mechanisms driving this relationship and how serum alarmin IL-33 assessment might contribute to clinical risk stratification in patients with RA.

Antimalarial medications are recommended for chemoprevention as part of malaria control programs to decrease the morbidity and mortality related to more than 200 million infections each year. We sought to evaluate patient and provider acceptability of malaria chemoprevention in a long-acting formulation. We administered questionnaires to patients and providers in malaria endemic districts in Kenya and Zambia. Questions explored preferences and concerns around long-acting antimalarial formulations compared with oral formulations. We recruited 202 patient respondents (Kenya, n = 102; Zambia, n = 100) and 215 provider respondents (Kenya, n = 105; Zambia, n = 110). Long-acting injection was preferred to oral pills, whereas oral pills were preferred to implant or transdermal administration by patient respondents. Of 202 patient respondents, 80% indicated that they ‘definitely would try’ malaria chemoprevention offered by injection instead of oral pills. Of parents or guardians, 84% of 113 responded that they ‘definitely would’ have their child age < 12 years and 90% of 88 ‘definitely would’ have their child ≥12 years receive an injection for malaria prevention. Provider respondents indicated that they would be more likely to prescribe a long-acting injectable product compared with an oral product for malaria chemoprevention in adults (70%), adolescents ages 12 years and older (67%), and children <12 years (81%). Potential for prolonged adverse effects with long-acting products was the highest concern for patient respondents, while higher medication-related cost was cited as the most concerning barrier to implementation by providers. Overall, these findings indicate enthusiasm for the development of long-acting injectable antimalarials to provide individual delivery method options across age groups.