PURPOSE:Medical school dean transitions can be broadly disruptive. The authors explored deans' median length of tenure and organizational characteristics that may affect that tenure. METHOD:The authors analyzed Association of American Medical Colleges (AAMC) Council of Deans data to calculate the median tenure of all first-time deans at AAMC-member medical schools (July 1959 to June 2019; n = 1,166). They generated survival curves for all deans in the study period and for only first-time permanent deans, including interim deans who became permanent at the same institution (n = 869). The authors calculated median tenure as the median of the median of each 5-year cohort in the curves. Additionally, they examined length of tenure by organizational characteristics: public versus private, region, financial relationship to the university, and research intensity. RESULTS:The median length of tenure of all deans was 4.3 years, for first-time permanent deans (i.e., excluding interim-only deans) was 5.9 years, and for deans in the most recent 15 years was 6.0 years. Median length of tenure of deans at public institutions was shorter (3.9 years) than at private institutions (4.8 years); varied by region: Northeast = 5.3 years, Central = 4.8, South = 3.8, West = 3.8; was longer at institutions that are part of a university (4.8 years) versus freestanding (3.8 years); and at research-intensive (6.7 years) compared with non-research-intensive institutions (3.8 years). A histogram by year revealed a normal data distribution with a mode of 3 to 4 years. CONCLUSIONS:Length of tenure was stable over time for all dean types and when isolating for first-time permanent deans; however, the most common time for deans to leave was in 3 to 4 years. Additional research on factors related to turnover is needed, as are supportive resources and programs to improve dean development and success.

This clinical practice guideline for the diagnosis and treatment of acute bacterial arthritis (ABA) in children was developed by a multidisciplinary panel representing the Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with ABA, including specialists in pediatric infectious diseases and orthopedics. The panel's recommendations for the diagnosis and treatment of ABA are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of ABA in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation) (see Figure 1). A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.

Abstract Background Safe and effective respiratory syncytial virus (RSV) vaccines remain elusive. This was a phase I/II trial (NCT02927873) of ChAd155-RSV, an investigational chimpanzee adenovirus-RSV vaccine expressing 3 proteins (fusion, nucleoprotein, and M2-1), administered to 12–23-month-old RSV-seropositive children followed up for 2 years after vaccination. Methods Children were randomized to receive 2 doses of ChAd155-RSV or placebo (at a 1:1 ratio) (days 1 and 31). Doses escalated from 0.5 × 1010 (low dose [LD]) to 1.5 × 1010 (medium dose [MD]) to 5 × 1010 (high dose [HD]) viral particles after safety assessment. Study end points included anti–RSV-A neutralizing antibody (Nab) titers through year 1 and safety through year 2. Results Eighty-two participants were vaccinated, including 11, 14, and 18 in the RSV-LD, RSV-MD, and RSV-HD groups, respectively, and 39 in the placebo groups. Solicited adverse events were similar across groups, except for fever (more frequent with RSV-HD). Most fevers were mild (≤38.5°C). No vaccine-related serious adverse events or RSV-related hospitalizations were reported. There was a dose-dependent increase in RSV-A Nab titers in all groups after dose 1, without further increase after dose 2. RSV-A Nab titers remained higher than prevaccination levels at year 1. Conclusions Three ChAd155-RSV dosages were found to be well tolerated. A dose-dependent immune response was observed after dose 1, with no observed booster effect after dose 2. Further investigation of ChAd155-RSV in RSV-seronegative children is warranted. Clinical Trials Registration NCT02927873.

Academic medicine is evolving from the traditional model of a medical school and teaching hospital owned by the same entity to one with complex academic medical centers and health systems. This increased complexity is evident not only in the funding streams and organizational priorities of these growing health systems but also in the evolution of leadership roles toward more matrixed positions and more individuals who hold both medical school and health system roles. Given this changing landscape, the authors of this commentary raise the following questions: Will the levers of power remain in the hands of those in traditional academic roles? Or are they moving toward those in roles that are more aligned with the clinical enterprise and health system? Then, if this shift is occurring, what is needed to prepare women to be competitive candidates for these new roles? Because of the long history of and current gender imbalance in academic leadership roles, professional development programs have traditionally focused on preparing women to advance through the faculty ranks and for department chair and decanal roles. With the shift to more complicated health systems, the definitions, responsibilities, and types of leadership roles in academic medicine are also evolving to include nontraditional academic positions in the health system, such as c-suite and other senior executive roles. In parallel to the gender inequities in traditional roles, women are also underrepresented in health system leadership roles. Therefore, it is critical to explicitly identify emerging roles in health care leadership, address systemic barriers, and actively train and prepare women with the knowledge, skills, and experience required for these positions. Only with consistent attention to outcomes and the implementation of intentional systems to engage, prepare, and advance women will the gender gap be closed.

Influenza is associated with significant disease burden in the US. Influenza vaccination effectiveness (VE) is low due to several factors, including egg adaptations. Evidence for a relationship between egg-based manufacturing and influenza VE remains largely disassociated, except for two previous European consensuses. The aim of this study was to observe US expert consensus on the phenomenon. Ten US influenza experts assessed evidence for antigenic drift, egg adaptations, and manufacturing component principles of the research question in a novel two-stage online study design to observe proportional group awareness and consensus, known as the Jandhyala Method. US experts agreed that all component principles had a majority of strong or very strong supporting evidence (52–86%), similar to European results (70-90%). They agreed that global surveillance, WHO candidate vaccine virus selection, and manufacturing stages involving eggs were the most likely to impact influenza VE. There was unanimous agreement for a mechanistic basis for reduced influenza VE due to egg-based manufacturing. There is now US and European expert agreement for the increased risk of reduced influenza VE resulting from egg-based manufacturing techniques. Increasing the use of non-egg-based manufacturing that avoids egg-adaptations is a currently available strategy that may improve influenza VE.

There are limited data on precision medicine in infectious diseases and vaccines; however, precise management of infectious diseases plays a critical role in trust for government, health-care organizations, science, and pharma. The improvement in biomedical technologies, availability of large clinical and -omic data and appropriate application of artificial intelligence may allow precision in vaccines and public health and restore trust. This is an invited editorial on the role of precision medicine in infectious diseases and vaccines.

The threat of drug-resistant infections has been mounting the past two decades, making new antibiotic development to treat those infections increasingly important. National organizations pushed to make new antibiotic availability a priority. Since 2010, there have been 16 new antibiotics brought to market, all of which cover emerging, threatening, and/or drug-resistant pathogens. The legislative and funding changes resulting from the focus on making combating drug resistance a priority made this possible. This chapter provides information on each of the new antibiotics including mechanism of action, dosing, adverse effects, uses, and key studies associated with their approval.

Measles, or rubeola, is a highly contagious viral disease most commonly seen in young children who are unvaccinated against it. It is caused by a single-stranded, negative-sense, nonsegmented, enveloped RNA virus. In the pre-vaccine era, annual seasonal epidemics (lasting 3–4 months) superimposed upon longer epidemic cycles were seen, with regular outbreaks every 2–5 years. Measles virus is highly contagious, with nonimmune exposed persons having a > 90% secondary attack rate in close contact settings. Following infection via the respiratory route, measles has an incubation period of about 10–14 days. A prodromal phase with fever and the “3 Cs” (cough, conjunctivitis and coryza) initially occurs. Measles rash is maculopapular and erythematous, beginning on the face and back of the ears, then spreading downward and outward. The rash may desquamate and fades about 5 days later in the same order as it appeared. Complications occur in up to 40% of patients including pneumonia, encephalitis, and death. Viral tests are used to confirm infection. RT-PCR has replaced viral culture for diagnosis. Primary treatment of measles is supportive care. Vitamin A supplementation is recommended by the World Health Organization to be administered orally to children with measles. Airborne transmission precautions should be used for hospitalized patients. Vaccination with live-attenuated vaccines is the best method to prevent measles. As humans are the only host for the measles virus, eradication may be possible.

Influenza is a highly contagious, viral respiratory tract infection that causes epidemics annually during winter months in temperate zones and periodic worldwide pandemics. It manifests as an acute febrile illness with variable degrees of symptoms and severity, ranging from mild fatigue, fever and cough, to respiratory failure and death. Laboratory testing is available to confirm the diagnosis of influenza. Most patients will recover with supportive care, but specific antiviral therapy is recommended for individuals with underlying medical conditions that place them at high risk for poor outcomes of influenza infection, as well as patients with severe disease. Annually, regular annual influenza vaccination is suggested for all persons aged ≥ 6 months who do not have a contraindication.

Purpose: Women comprise almost one-third of academic medicine faculty 60 years of age and older. Gender disparities have been documented across many measures in medicine, including salary, promotion rates, and leadership positions and may impact long-term career and retirement decisions. The authors sought to describe gender differences in retirement decisions among late-career, full-time medical school faculty. Materials and Methods: The authors conducted a secondary analysis of cross-sectional survey data from a 2017 survey of faculty 55 years of age and older at 14 U.S. Medical Schools. Responses were compared for differences by gender using bivariate and multivariable analyses. Results: Among the 2,126 respondents (41% response rate), the majority were male (67%) and the average age was 62. Less than half (45%) had current plans to retire and 50% reported that they would consider working part time. Women faculty were less likely to be professors or on a tenure track and more likely to be single and report past and current caregiving responsibilities. Women differed from men in the personal and professional factors influencing retirement decisions with women more likely to identify health insurance, sense of burnout, lack of access to career advancing resources and opportunities, feeling devalued at work, and caregiving responsibilities as important issues. Conclusions: Women late-career faculty report unique and salient factors influencing retirement plans that may reflect cumulative gender-based career differences and disparities. Institutions should be aware of these differences and work to support women during late career and retirement transitions, including creating opportunities for faculty to remain engaged in meaningful work during retirement transitions if they desire to do so.

Despite efforts to improve parity in the biomedical workforce, gender bias persists related to equitable pay, promotion, speaking opportunities, journal editorial positions, research funding, and leadership positions. This bias becomes more prominent for women of color and women with other intersectional identities who come from underrepresented groups. It is critical to understand the barriers that women face and why the pathway is especially challenging for women of color. In this commentary, the authors cite research related to the effects of institutional gender bias in academic medicine, including research on bias against women of color. As academic leaders who come from underrepresented groups, the authors are aware that traditional approaches to reducing this bias have not worked well, and they instead highlight promising strategies aimed at filling the pathway to leadership with women of color who are qualified and ready to take the helm. They address solutions to ensure the academic pathway is supportive. They also provide several recommendations, including: offering more opportunities for mentorship and sponsorship, improving access to formal leadership programming, modeling successful upstander initiatives, recognizing the growing role of minority-based medical societies, implementing early-career education, increasing journal editorial board representation, and expanding promotion criteria. Appropriate training, education, and partnership with internal and external stakeholders are necessary to advance leadership equity for women of color in academic medicine.

To the Editor: We read with interest Jagsi and colleagues’ study titled “Women’s Representation Among Members and Leaders of National Medical Specialty Societies,”1 which found that in 30 major medical specialties, the percentages of women who were among the highest-ranking elected society leaders between 2000 and 2015 ranged from 0% to 37.5%. A low proportion of women serving on governing boards (0%–47.6%) likely contributed to this finding. Although representation in some societies has improved, in others, it has stayed the same or regressed. Those findings complement prior research2 that showed that women are underrepresented, frequently at zero or near-zero levels, in presidential leadership positions within influential physician-focused medical societies. Over a 10-year span (2008–2017), 10 societies had no women presidential leaders. For all of the societies studied, men served as presidents for 82.6% of the cumulative years across all societies (322 of 390 years) and women for only 17.4% of those years (68 of 390 years). To our knowledge, data surrounding challenges for women from groups underrepresented in medicine in elected leadership positions have not been evaluated, but we presume that the underrepresentation issues would be intensified in these groups. One question follows naturally: “Why are women underrepresented in high-ranking elected leadership positions?” A survey study3 of more than 1,200 women physicians found that they are less likely to run for elected positions after graduating from medical school, despite the fact that a majority of women surveyed believed there should be more women in leadership.3 Although 43.2% of women considered running for office, only 16.7% actually ran. Barriers cited were lack of protected time, work support, experience, and mentorship. Fewer than 1 out of 3 respondents were previously encouraged to run for elected office by someone else, and only 8.3% of respondents were encouraged to run by a supervisor. This study highlights an opportunity to provide additional resources to encourage and support women physicians in their pursuit of leadership positions. As Jagsi and colleagues1 suggest, women in medicine face significant disparities regarding leadership. It is now time to focus on how more highly talented and qualified women physicians and scientists can be elected to top leadership positions, especially in professional medical societies. These societies significantly impact every aspect of academic medicine, and it has never been more crucial to close gender-related leadership gaps.

This clinical practice guideline for the diagnosis and treatment of acute hematogenous osteomyelitis (AHO) in children was developed by a multidisciplinary panel representing Pediatric Infectious Diseases Society (PIDS) and the Infectious Diseases Society of America (IDSA). This guideline is intended for use by healthcare professionals who care for children with AHO, including specialists in pediatric infectious diseases, orthopedics, emergency care physicians, hospitalists, and any clinicians and healthcare providers caring for these patients. The panel's recommendations for the diagnosis and treatment of AHO are based upon evidence derived from topic-specific systematic literature reviews. Summarized below are the recommendations for the diagnosis and treatment of AHO in children. The panel followed a systematic process used in the development of other IDSA and PIDS clinical practice guidelines, which included a standardized methodology for rating the certainty of the evidence and strength of recommendation using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. A detailed description of background, methods, evidence summary and rationale that support each recommendation, and knowledge gaps can be found online in the full text.

We thank Esparza and colleagues for their comments on our article that quantified women’s representation among members and leaders of 30 national medical specialty societies. We share the authors’ concern that women are underrepresented and that in some societies, representation has not improved or has even worsened with time. We agree that intersectional analyses that look at characteristics such as race, ethnicity, gender identity, and sexual orientation are important subjects for future studies of women’s underrepresentation. We suspect that barriers to attaining these influential positions will be amplified for those with multiple marginalized identities. A study cited by the authors 1 suggests that women are less likely to run for office due to differences in sponsorship, mentorship, protected time, and experience. These findings help to identify interventions that might succeed in promoting greater diversity of leadership of professional societies in the future. Ensuring transparency about the pathways to leadership within specialty societies is critical. 2 Moreover, recognition of the gendered division of domestic responsibilities in our society is important; this should motivate policies that ensure that women have access to the funds and support necessary to participate fully in society events. 3 Societies that have had greater experience with creating an environment conducive to the success of women should share promising practices about innovative initiatives such as implicit bias training of nomination committee members, women’s networking centers at annual meetings, and on-site childcare to ensure equitable opportunities for participation. 4 Recent events, including the COVID-19 pandemic and heightened awareness of the Black Lives Matter movement, have illuminated the influence of specialty societies in shaping professional norms and policies. Robust evidence suggests that greater diversity in leadership will optimize the ability of these organizations to deliver on their worthy missions of service to the profession and society. 5

Respiratory syncytial virus (RSV) is a major cause of hospitalizations due to pneumonia and bronchiolitis. Substantial morbidity and socioeconomic burden are associated with RSV infection worldwide. Populations with higher susceptibility to developing severe RSV include premature infants, children with chronic lung disease of prematurity (CLDP) or congenital heart disease (CHD), elderly individuals aged > 65 years, and immunocompromised individuals. In the pediatric population, RSV can lead to long-term sequelae such as wheezing and asthma, which are associated with increased health care costs and reduced quality of life. Treatment for RSV is mainly supportive, and general preventive measures such as good hygiene and isolation are highly recommended. Although vaccine development for RSV has been a global priority, attempts to date have failed to yield a safe and effective product for clinical use. Currently, palivizumab is the only immunoprophylaxis (IP) available to prevent severe RSV in specific high-risk pediatric populations. Well-controlled, randomized clinical trials have established the efficacy of palivizumab in reducing RSV hospitalization (RSVH) in high-risk infants including moderate- to late-preterm infants. However, the American Academy of Pediatrics (AAP), in its 2014 policy, stopped recommending RSV IP use for >= 29 weeks' gestational age infants. Revisions to the AAP policy for RSV IP have largely narrowed the proportion of pediatric patients eligible to receive RSV IP and have been associated with an increase in RSVH and morbidity. On the other hand, after reviewing the recent evidence on RSV burden, the National Perinatal Association, in its 2018 clinical practice guidelines, recommended RSV IP use for a wider pediatric population. As the AAP recommendations drive insurance reimbursements for RSV IP, they should be revised to help further mitigate RSV disease burden.

Purpose Individuals 55 or older constitute 28.5% of the U.S. population but 32% of full-time faculty at U.S. medical schools accredited by the Liaison Committee on Medical Education (LCME). The academic medicine community knows little about the policies, programs, and resources for faculty in pre- and post-retirement stages. The authors sought to inventory the range of institutional resources for late-career faculty development and retirement planning in U.S. LCME-accredited medical schools. Method The authors surveyed 138 medical school faculty affairs deans and leaders in May 2017 to ascertain (1) priorities around retirement, succession planning, and workforce development/support; (2) retirement policies; (3) late-career and retirement resources; and (4) perceived factors impacting faculty retirement. Results Of those invited, 84 (60.9%) responded to the survey, and of these, 44 (52.4%) disagreed or strongly disagreed that retirement planning and support was a top priority in their offices. Less than half (n = 35 [41.7%]) reported that their institution had a retirement policy. The 5 most common late-career and retirement-related resources offered were emeriti or honorific appointments, academic benefits for retirees, phased retirement, retirement counseling, and financial planning. More than half the respondents noted that the following factors impact faculty retirements: physician burnout (43/75 respondents [57.3%]), decreased grant funding (42/75 [56.0%]), and changes in productivity requirements (38/75 [50.7%]). Conclusions These data highlight a distinct, startling gap between the needs of a fast-growing population of late-career faculty and the priorities of their institutions. Faculty affairs/faculty development offices must meet these growing needs.