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Syphilis Incidence Rate Continues to Increase and Shows Rising Trend Over Several Years

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Syphilis Incidence Rate Continues to Increase and Shows Rising Trend Over Several Years


The Centers for Disease Control and Prevention (CDC) released its annual report, Sexually Transmitted Infections (STI) Surveillance, 2022, which showed primary and secondary syphilis—the most infectious stages of the disease—increased 10 percent in 2022 alone and 68 percent since 2018.1

According to the report, syphilis cases (all stages and congenital syphilis) have increased 80 percent in the past five years. More than 3700 congenital syphilis cases were reported in 2022, reflecting a 937% increase in the past decade.1

Overall, there was 2,505,027 total cases of STI in the United States in 2022, which was a very slight decrease of 1% from 2021. Over 5 years, the total number of cases remained steady with a 1.9% increase.1

“The 2022 STI Surveillance report underscores the severity of the ongoing surge in syphilis and STI cases, presenting a critical public health concern,” National Association of County and City Health Officials (NACCHO) CEO Lori Tremmel Freeman, said in a statement.2

In contrast, the incidence rate for chlamydia was flat with a 0.3% increase for 2022 vs 2021—although the number of cases overall remained high with 1,649,716. However, the 5 year percentage decreased by 6.2%. The highest number of cases occurred in 2019 with 1,808,703.1

Gonorrhea saw a 8.7% decrease year-over-year, from 710,151 in 2021 to 648,056 cases in 2022, but saw an 11.1% increase over the 5-year period. (See the table below for all the statistics.)1

Table. Latest STI statistics.

Table courtesy: CDC

Both CDC and NAACHO see the significance of the ongoing STI issues, and know this will take a number of public health initiatives over the course of years to reverse these findings. “There are no shortcuts, and we have to meet people where they are. Some people face tremendous barriers to STI prevention and health services. So, the most important work is often outside the clinic, whether it be reaching out to communities with testing, interviewing patients to offer services to their partners, or delivering treatment directly to someone,” Laura Bachmann, MD, MPH, acting director, CDC’s Division of STD Prevention, said in a statement.1

For its part, NACCHO is a large public health organization that supports over 3300 local health departments and their initiatives. They are currently supporting local and tribal health department projects to partner with local pharmacies and jails to expand STI testing and treatment, do community engagement to develop syphilis reduction action plans, and conduct syphilis awareness media campaigns. 2

Additionally, the organization continues to work for increased STI funding and to bring awareness to the impact of continued drug shortages on treating syphilis in pregnant people. NACCHO is also engaged with the Federal Syphilis Taskforce and is working with partners to convene a separate taskforce to address congenital syphilis disparities among American Indian and Alaska Native Communities.2

“With an 80% increase of syphilis since 2018, the STI epidemic continues to escalate, impacting the lives of millions of people and placing many more—including babies—at risk. An immediate coordinated response is needed that involves pushing for more testing, prioritizing immediate treatment, and forming solid community partnerships to ensure accessibility. Focusing on these efforts is critical to minimizing the spread and impact of this disturbing trend,” Freeman said.2

Doxy-PEP
In previous reporting, Contagion has discussed a potential preventative strategy to reduce infections. Last year, a study published in the New England Journal of Medicine showed that doxycycline prevented the acquisition of STI among men who have sex with men (MSM) and transgender women who took the medication within 72 hours of having condomless sex.3

This approach, termed doxy-PEP (post-exposure prophylaxis), resulted in a two-thirds reduction in the incidence of syphilis, gonorrhea, and chlamydia among the study participants, all of whom reported having an STI within the previous year.3

Participants were randomly assigned in a 2:1 ratio to take 200 mg of doxycycline within 72 hours after condomless sex (doxycycline postexposure prophylaxis) or receive standard care without doxycycline. STI testing was performed quarterly. The primary end point was the incidence of at least one STI per follow-up quarter.3

“In the PrEP cohort, an STI was diagnosed in 61 of 570 quarterly visits (10.7%) in the doxycycline group and 82 of 257 quarterly visits (31.9%) in the standard-care group, for an absolute difference of −21.2 percentage points and a relative risk of 0.34 (95% confidence interval [CI], 0.24 to 0.46; P<0.001),” the investigators wrote.3

Conversely, in another study using doxy-PEP the investigators did not see the same results for women, partially, because of poor adherence rates. Although the results were not what they wanted to see, it is an opportunity to see how to redress the approach to women, says one public health official.

“Although the findings are disappointing, the trial provides a needed opportunity to reconsider how to strategically inform the design and conduct of biomedical intervention trials involving women of reproductive age,” Jeanne Marrazzo, MD, MPH, director, National Institute of Allergy and Infectious Diseases (NIAID), Bethesda, Maryland, said in an accompanying commentary of the study.4

References

1. CDC’s 2022 STI Surveillance Report underscores that STIs must be a public health priority. CDC announcement. January 30, 2024. Accessed January 30, 2024. https://www.cdc.gov/std/statistics/2022/default.htm

2. NACCHO Urges More Testing and Immediate Preventative Treatment Amidst New CDC Report on Alarming Rise in STI Cases. NACCHO press release. January 30, 2024. Accessed January 30, 2024.
https://www.naccho.org/communications/newsroom/releases

3. Luetkemeyer AF, Donnell D, Dombrowski JC, et al. Postexposure Doxycycline to Prevent Bacterial Sexually Transmitted Infections. N Engl J Med. 2023;388(14):1296-1306. doi:10.1056/NEJMoa2211934

4. Marrazzo J. Doxycyline postexposure prophylaxis for STIS in women—uncertain benefit, urgent need. N Engl J Med 2023; 389:2389-2390.



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Chicken and Wild Rice Casserole Recipe

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Chicken and Wild Rice Casserole Recipe


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Chicken and wild rice casserole is an easy, comforting meal that the whole family will enjoy! You just can’t go wrong with tender chicken and wild rice in a creamy sauce, and topped off with buttery breadcrumbs. It’s a hearty, flavorful dinner that will be a new favorite!

A good homemade casserole is just the best, and this recipe is a definite winner! After you’ve made this one, go ahead and try some of our other tried and true casseroles like this Cowboy Casserole, Crack Chicken Casserole or this yummy Broccoli and Rice Chicken Casserole. You will love them all!

Top-down view of chicken and wild rice casserole in a black baking dish.

Chicken and Wild Rice Casserole Recipe

This chicken and wild rice casserole will be the star of your dinner table! It has easily become one of my family’s favorite meals. Made with juicy chicken, hearty wild rice, a creamy sauce, and crispy topping, it’s going to have everyone wanting seconds.

Casseroles are one of my favorite meals to prepare for my family. They are just so warm, cozy and always taste amazing! They’re also really convenient to serve because everything bakes in one big dish. You can easily transport them to potlucks and family gatherings and clean up is fuss-free. Try this incredible breakfast casserole, this popular pizza casserole, or my favorite taco casserole. You will LOVE them all!

Ingredients Needed

All of the ingredients needed to make this chicken and wild rice casserole recipe are simple and easy to find at your local grocery store. Everything comes together for total comfort food! Find the measurements below in the recipe card.

  • Wild Rice Mix: You will cook this up before mixing it in with all of the other ingredients.
  • Butter: Cooking the chicken and veggies in unsalted butter will add richness to the casserole. You will also need butter for the perfect golden, flavorful breadcrumb topping.
  • Yellow Onion: Adds wonderful savoriness without overwhelming the dish.
  • Chicken Breasts: Dice the chicken into 1-inch cubes for bite-sized pieces.
  • Garlic: A must in any savory casserole!
  • Baby Bella Mushrooms: For an earthy, savory taste that complements all of the other ingredients.
  • Seasonings: A blend of dried thyme, parsley, basil, salt and pepper to bring all of the flavors together.
  • Cream of Mushroom Soup: You can use store-bought or you can try making this delicious homemade cream of mushroom soup.
  • Sour Cream: Adds creaminess and the perfect tangy flavor.
  • Parmesan Cheese: Flavors the creamy sauce.
  • Panko Breadcrumbs: Mixed with melted butter and parsley for a golden brown crisp topping.
  • Fresh Parsley: Gives the dish a pop of color.

How to Make Wild Rice Casserole

This chicken and rice casserole is something that anyone can make! There’s just a few simple steps, and everything turns out so tasty every time. Your friends and family won’t be able to resist the creamy, hearty goodness.

  1. Prep: Preheat the oven to 350 degrees Fahrenheit and prepare a 9×13-inch baking dish by spraying it with nonstick cooking spray.
  2. Wild Rice: Cook the wild rice mix according to the package directions and then set aside.
  3. Sauté the Onion and Chicken: Heat the butter in a large skillet over medium high heat and add in the onion and chicken breasts. Sauté until the chicken breasts have been seared on all sides but aren’t quite cooked through, about 3-5 minutes.
  4. Cook the Other Seasonings and Veggies: To the skillet add the garlic, mushrooms, thyme, parsley basil, salt and pepper and sauté another 5 minutes, until everything has come together and the mushrooms have cooked down a bit.
  5. Stir in the Soup, Sour Cream and Cheese: Remove the skillet from heat and then stir in the cream of mushroom soup, sour cream, parmesan cheese, and cooked wild rice mix. Stir to mix well. Then pour the mixture into the prepared baking dish.
  6. Bake: In a medium bowl whisk together the breadcrumbs, butter, and parsley. Pour the topping over the casserole and bake uncovered for 20-30 minutes, until the topping is golden brown.
  7. Cool and Serve: Remove the casserole from the oven, let it stand at room temperature at least 5 minutes before serving.
4-photo collage of the wild rice being mixed with a creamy sauce and topped with breadcrumbs.

Tips and Variations

This chicken and rice casserole is so tasty as-is, but if you want to cook it more often, you can easily switch a few things up and make it taste fresh and new every time! Here are a few ideas!. 

  • Vegetables: Try adding in other vegetables that you like! Carrots, peas, green beans or broccoli would be great! Just make sure that you adjust the amounts. For example, if you add in carrots, add less mushrooms. You want 2 cups of veggies total. 
  • Rice: You can switch the wild rice out for white or brown rice, if you’d prefer. It will change the taste a bit but it will still be delicious. Make sure to follow the directions on the rice that you are using because cook times vary depending on the type!
  • Make it Vegetarian: If you’re wanting a meatless meal, you can bulk up on the vegetables instead of using the chicken.
  • Bake Until Golden Brown: This casserole is done when the topping is golden brown and bubbly. If the topping is still pale, let it bake for a few more minutes.
  • Rest After Baking: This allows the flavors to meld and the casserole to set slightly. Let it rest for at least 45 minutes.

Closeup of a scoop of chicken and wild rice casserole.

Storing and Reheating Leftovers

This chicken and wild rice casserole makes incredible leftovers! The flavors get even tastier the next day. Follow my instructions below for storing and reheating leftovers. 

  • In the Refrigerator: Stored in the refrigerator, this casserole will last for 5 days. Store leftovers in an airtight container for the best results!
  • To Reheat: To rewarm, you can heat the casserole in the oven for 15 to 20 minutes or until warmed through at 350 degrees Fahrenheit, or you can microwave individual slices in 15 to 30-second cooking intervals.

A serving of the casserole in a gray stoneware dish.

Looking for More Casserole Recipes?

Enjoy these other family-friendly casserole recipes that are so easy to make! They are the absolute best comfort food! For more dinner inspo, find my full list of casseroles here!

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  • Preheat the oven to 350 degrees fahrenheit and prepare a 9X13 inch baking dish by spraying it with nonstick cooking spray.

  • Cook the wild rice mix according to the package directions and set aside.

  • Heat the butter in a large skillet over medium high heat and add in the onion and chicken breasts. Saute until the chicken breasts have been seared on all sides but aren’t quite cooked through, about 3-5 minutes.

  • To the skillet add the garlic, mushrooms, thyme, parsley basil, salt and pepper and saute another 5 minutes, until everything has come together and the mushrooms have cooked down a bit.

  • Remove the skillet from heat and stir in the cream of mushroom soup, sour cream, parmesan cheese, and cooked wild rice mix. Stir to mix well. Pour the mixture into the prepared baking dish.

  • In a medium bowl whisk together the breadcrumbs, butter, and parsley. Pour the topping over the casserole and bake uncovered for 20-30 minutes, until the topping is golden brown.

  • Remove the casserole from the oven, let it stand at room temperature at least 5 minutes before serving.

Calories: 405kcalCarbohydrates: 15gProtein: 26gFat: 27gSaturated Fat: 15gPolyunsaturated Fat: 2gMonounsaturated Fat: 7gTrans Fat: 1gCholesterol: 114mgSodium: 1114mgPotassium: 798mgFiber: 1gSugar: 3gVitamin A: 820IUVitamin C: 4mgCalcium: 297mgIron: 1mg

Nutrition information is automatically calculated, so should only be used as an approximation.





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Beat the deadline! Open Enrollment ends in 1 month

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Beat the deadline! Open Enrollment ends in 1 month


Act now — don’t miss the January 16 deadline to apply for, re-enroll in, or change 2024 health insurance. This holiday season, give yourself the peace of mind that comes with taking care of your health.

A woman with glasses smiling and typing on laptop with text "Act Now! Open enrollment ends January 16.

Important deadlines to know

  • January 16, 2024: Deadline to apply for and enroll in 2024 coverage.
  • February 1, 2024: Coverage starts.

Apply & enroll now

Don’t miss your chance!

If you miss the deadline, you may have to wait until next year to get coverage. You can only enroll in or change your health plan for 2024 after January 16 if you qualify for a Special Enrollment Period. 

Get help now if you have questions or need help applying. 



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Can Medicine Integrate Spiritual and Religious Practice?

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Can Medicine Integrate Spiritual and Religious Practice?


Traditional Western medicine hasn’t typically concerned itself with spiritual well-being. But that might be changing as a growing body of evidence shows spiritual and religious practice can have profound health effects, especially in regard to mental health. 

Higher levels of spirituality and religiousness are associated with lower levels of depression, suicide, and substance misuse in any number of studies. Sustained spiritual practice (going to church, praying, meditating, helping others) may also guard against posttraumatic stress disorder and boost psychological growth after a stressful situation, research shows. 

These practices can help you feel “loved and held” during times of despair, says Lisa Miller, PhD, founder of the Spirituality Mind Body Institute at Teachers College, Columbia University. 

People who find meaning and purpose through their spirituality often emerge from hard times feeling better prepared to handle the next horrible thing that might happen, she says.

And it’s not simply mental health. People who regularly attend religious services are less likely to end up in the hospital for any reason. And when they do, they’re hospitalized for less time, studies show. Even the sickest among us can benefit. Among people with cancer, no matter how severe, those with a spiritual practice report a better quality of life. 

In some cases, scientists can see changes in the brain. 

For example, certain regions of the brain linked to emotion, insight, and self-image light up when people have religious or spiritual experiences or think back on them, says Miller. 

And parts of the brain that shrink when people are chronically depressed can actually thicken when people who say spirituality is important to them engage in spiritual practices during and after recovery, she says. 

It may be these brain changes themselves buffer against certain mental health problems, Miller says, but the research is not yet clear. What is clear, says Miller, is that simple belief is not enough. It’s important to maintain a spiritual practice to reap the full benefits. (In this way it is similar to other behavioral interventions, such as cognitive behavioral therapy, for which consistent practice is key.)

One study looked at people who remained spiritual for 8 years. In that study, those who had a “spiritual awakening” through things like self-reflection, prayer, meditation, or service and maintained the practice were less likely to get depressed down the road, she says. 

Your spirituality doesn’t have to be overtly religious, says Miller. It can simply be a connection to “a higher power” or to “the transcendent.” Some people think of it simply as “something greater than yourself.” This can range from a traditional conception of God to connection with the universe, artworks, nature, or even other people, according to studies. 

“This natural spiritual awareness has a universal neural pathway,” Miller says. “So, it doesn’t matter if I’m spiritual but not religious or if I’m Christian, Catholic, Muslim, Jewish, Hindu. We all have the same spiritual brains, which is beautiful.” 

It could just mean, “I’m not a robot and I have deep emotions, and I care about humanity and the planet,” says Brandon Vaidyanathan, PhD, associate professor and chair of sociology at The Catholic University of America in Washington D.C.

Formal beliefs and practices aren’t required. You can practice gratitude and compassion, volunteer in your community, or spend time in nature. If you’re moved by music, poetry, or watching a sunset, then do more of that, he says. 

Or tap into the spirituality of scientists and marvel at the beauty and wonder in the natural world around you.

“Astronomers might be the first people to see the light of a particular star, and that is a profoundly important moment that can be a spiritual experience,” Vaidyanathan says. “Just as somebody watching a protein under a microscope might be in awe of this phenomenon of life that they’re seeing unfolding in front of them.” 

“Some of the language around spirituality can be very individualistic,” Vaidyanathan says. “But we are social creatures. We need other people. We need a place to belong.” 

That may be why religiousness seems to have a more robust effect on well-being compared to spirituality alone. At least that’s what Vaidyanathan and his colleagues found when they surveyed a group of scientists about their mental health during the COVID-19 pandemic.     

 “When you go to a temple or a mosque or a church and you’re together with people, there’s a sense of belonging, which is kind of the antidote to loneliness,” Vaidyanathan says. “And just sitting and meditating in a room by yourself isn’t going to give you that.” 

Joining a meditation group or other non-religious spiritual community might accomplish the same thing, though more research is needed to be sure, he says. 

It’s important to note that not everyone’s experience with religious or spiritual community is positive. Studies show you may have more anxiety, depression, or overall stress and distress if you feel guilty, abandoned, or punished by your God or your community.

“And if you’re in a religious community where there’s a lot of politics, a lot of tension, and a lot of infighting and backbiting,” Vaidyanathan says, “I guarantee you’ll find higher levels of stress and anxiety in those populations.” 

Some practitioners already fold individual religious or spiritual practice into cognitive behavioral therapy (CBT). Studies show this can be an effective way to manage a variety of mental health problems, particularly addiction, chronic depression, and trauma. 

But It’s not always easy to find this kind of treatment. 

“There’s definitely an unmet need, especially when it comes to things like depression and mental health,” says psychiatrist Anna Yusim, MD, a clinical assistant professor at Yale School of Medicine. Yusim is helping develop the forthcoming Center for Mental Health and Spirituality, which will be “a bridge between Yale Medical School and Yale Divinity School,” she says. 

Yusim integrates various religious and spiritual practices in her treatment protocols for patients.

If it’s part of their core beliefs, she’ll integrate prayer, sacred texts, or religious services into treatment. For those without a particular religious conviction, she uses other approaches such as meditation, yoga, and breath work, which have proven “very powerful and transformative” in her practice, Yusim says.

“Spiritual needs are a very core and integral part of one’s being,” Yusim says. “And that part has to be engaged in order for the person to feel whole and complete. It’s not the only thing that needs to be there, but it certainly is one of those things.” 



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The World Health Organization’s Use of Firstline: Pushing Antimicrobial Stewardship Forward

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The World Health Organization’s Use of Firstline: Pushing Antimicrobial Stewardship Forward


In this article the World Health Organization’s adoption of Firstline as a platform to support antimicrobial stewardship is discussed

Interviewee: Jason Buck

Interviewer: Timothy P. Gauthier, Pharm.D., BCPS, BCIDP

Article posted 9 August 2023

The battle against antimicrobial resistant microbes is a global one that we are all in together. Over the last few years many antimicrobial stewards from around the world have shared their perspectives and advice here on this blog, weighing in on with their experiences waging this war. This includes people from Nigeria, India, Bangladesh, Uganda, Thailand, Japan, Costa Rica, Australia, New Zealand, Canada, Spain, Turkey, and the United Kingdom. Reflecting on the naturally emerging theme of common ground, here are several quotes from the interviews…

  • “The best advice I can leave you with is to develop your team, make new links within and outside your organisation, be in it for the long haul, rest, and most of all, enjoy it!”
    • Tariq Azamgarhi, MRPharmS, PGDip Clin Pharm, PG CEPIP, United Kingdom
  • ‘I have learned two fundamental lessons regarding antimicrobial stewardship… First, maintain humility… Secondly, much remains to be done in this field.’
    • Eduardo Clot Silla, Pharm.D., Ph.D., Spain
  • “One main challenge… is to increase the impact and sustainability of our interventions. This will mean embracing behavioural, implementation, and social sciences.”
    • Bradley J. Langford, BScPhm, ACPR, PharmD, BCPS, Canada
  • “The greatest lesson I have learnt is that in order to win the fight for antimicrobial resistance there is a need to build systems for effective workflow”
    • Winnie Nambatya, M.Pharm, Uganda
  • “There is a great opportunity for antimicrobial stewardship pharmacists across the world to learn from each other about strategies to improve antimicrobial use and how to overcome implementation barriers.”
  • “I think that is very important that we work together and support each other, so that we have good practices and as soon as possible we can have a standard level of work.”
    • José Pablo Díaz Madriz, Pharm.D, Costa Rica
  • If you work hard, have patience, ambition and enthusiasm, then you can achieve your goals even if you initially know very little about what you are trying to do.
    • Md Jahidul Hasan, M.Pharm., Bangladesh

As demonstrated by these comments, we all have clear and common opportunities in the area of antimicrobial stewardship. At the core of these includes teamwork, communication, and resources. This is why many governments and organizations are now putting forth initiatives to fight against antimicrobial resistance and it includes utilizing antimicrobial stewardship tools.

A very neat collaboration that has recently come to my attention is between the Canada-based technology company Firstline and the World Health Organization (WHO). One of the things they have collaborated on is the AWaRe Antibiotic book. This open-access book provides information on infectious syndromes in primary care, hospital-based infections, so-called reserve antibiotics, and antibiotic dosing guidance.  If you have not yet checked it out, it’s worth at least a few minutes to familiarize yourself with this free resource. It is going to serve as a springboard to enable localized guidance on antimicrobial stewardship and it’s something to be very excited about for advancing global antimicrobial stewardship.

I was recently able to connect with Jason Buck who is the Chief Strategy Officer at Firstline. We were able to have a discussion about how Firstline is collaborating with WHO and that enabled the production of the following text which I am grateful to share here with you today…

1. How did you get involved in the field of antimicrobial stewardship? 

My fascination with the intersection of technology and healthcare sparked an interest in antimicrobial stewardship.

As a technologist, I am acutely aware of the power that technology has to change the landscape of healthcare, particularly in tackling challenges like antimicrobial resistance. My journey at Firstline has led from designing and building our platform technology, through to becoming Chief Strategy Officer. I am now focused on applying our technology through initiatives with strategic partners and approaches to global health.

2. What is your role in the connection between WHO and Firstline?

Firstline’s partnership with the WHO required two main ingredients: information design for point of care guidance, and distribution of that guidance to providers’ mobile and web devices.

These play right to the core strengths of Firstline’s clinical and technical teams. But the complexities of working with the WHO as a United Nations agency, meant we also required Canadian government support, as Firstline is based out of Canada. My role was primarily steering the parties and the process to enable those Firstline core strengths to be best used.

The end result is the AWaRe Antibiotic Book, which is not only a tremendous piece of work, it provides for real and immediate action on global antimicrobial stewardship.

3. At a high-level, what is the primary goal for the WHO-Firstline collaboration? 

The primary goal of the partnership is to make gold standard antibiotic knowledge accessible to every healthcare professional, anywhere in the world. By empowering all healthcare providers to make informed, evidence-based decisions on antibiotic usage, we can counter the rise of antimicrobial resistance.

By distributing the guidance electronically on Firstline, the WHO has provided the foundation on which national and local antimicrobial stewardship teams can build their own stewardship guidance. The AWaRe book is easily localized on the electronic Firstline platform to make adjustments for clinical, behavioral or cultural factors. This enables stewardship teams anywhere to quickly create and deploy locally applicable prescribing guidance.

In Italy, where we are shortly launching a national implementation, clinical leaders are utilizing our platform to calibrate the WHO’s AWaRe guidance to the local specificities of Italian outpatient and pediatric prescribing. This is a great case-study for the benefits of building on top of global-strength clinical guidance, being able to make essential local adaptations, and rapidly delivering actionable guidance to the point of care.

The significance of this partnership is immense – far beyond distributing a single version of guidance. It is about creating a sophisticated practice tool that is always up to date, easily deployable anywhere, and enthusiastically adopted by clinicians everywhere.

4.  In what way is Firstline able to help make critical resources available at the point of care? 

Firstline delivers actionable guidance right to the point of care through mobile and the web. We know that healthcare professionals are often short of time and need to make quick decisions. Therefore, the challenge is not just about making resources available; it is about crafting those resources so they become super easy for busy individuals to follow in real-time clinical decision-making.

That means no pinching and zooming of PDFs that were originally designed for use on a desktop, for example. Firstline’s meticulous information design, combined with an intuitive user experience, really sets it far apart.

The clarity and ease of use fosters better concordance with guidance, encouraging behavioral change in prescribing practices, and consequently promotes optimal antibiotic use. Our goal is to bridge the gap between guidance and practice, turning optimal antibiotic use from an aspiration to an everyday reality.

5. Implementation science has been a hot topic in antimicrobial stewardship, how is the WHO-Firstline collaboration helping with this? 

The issue of implementation gaps in healthcare is neither new nor unique to our fight against antimicrobial resistance. Almost two decades ago, researchers called for “more effective ways of promoting the uptake of evidence-based interventions,” a need that still resonates today across all facets of healthcare. However, this is particularly acute in the context of drug resistance, where poor practices in any part of the globe can cause problems everywhere.

The first challenge in any implementation is always access, and distribution of the WHO AWaRe guidance is pioneering in several ways. It is the first time ever that the WHO has produced guidance on the use of antibiotics in the treatment of the most common infections – not just drug information. Moreover, access to evidence-based guidance is a challenge in many parts of the world. The availability of Firstline on low-powered Android devices, and low-data connections or even offline, is a vital innovation.

Secondly, adoption and implementation are tremendously significant challenges for stewardship programmes. The ability of any organization to use Firstline to easily and quickly adopt and adapt the WHO AWaRe guidance according to local factors is an important innovation. It frees organizations to devote increased focus to applying locally appropriate behavioral cues that encourage appropriate prescribing, and to building an engaged movement of providers behind the stewardship initiative.

This is an aspect of stewardship programmes we have developed a wealth of experience in, and are now using a Firstline implementation framework to support stewardship teams.

The less antimicrobial stewardship programs need to reinvent the wheel on evidence-based guidelines, the more they can focus on the most significant challenges – adoption and engagement.

6. Who can use the Firstline resources from the WHO collaboration?

The AWaRe guidance on Firstline is available free to all, in every country.

It is a global tool designed for use everywhere – including high-income countries with the most sophisticated healthcare systems. If prescribers do not have localized stewardship guidance available, they should use the WHO’s AWaRe guidance.

7. The relationship between WHO and Firstline is just budding today, what are you excited about that the future may hold? 

What excites us most is the potential for the Firstline platform to serve as a conduit for the fast and free flow of antimicrobial stewardship resources worldwide.

It currently enables national and local healthcare organizations to lean on the evidence-based guidance of the world’s apex healthcare organization. This prospect – combining authoritative global guidance with local relevance and specificity – is one we find particularly promising for future stewardship efforts.

By combining WHO’s gold standard guidance with Firstline’s capability to localize and distribute guidance into the hands of clinicians, we have been able to create a hugely positive initial impact, and we are excited to see this impact increase as it becomes more globally adopted.

About the Interviewee

Jason Buck – Chief Strategy Officer

Jason leads Firstline’s product development team and leans on over 20 years of commercial experience to coordinate Firstline’s non-organic growth including through intellectual property and partnerships with government and international organizations.

Prior to Firstline, Jason led an e-commerce venture for 15 years, creating and evolving partnerships with some of the most respected corporations in the UK.

Disclosure: The views and opinions in this article are that of the author and do not necessarily reflect the opinion or policy of any former, current, or potential future employer.

Interviewer’s note: I would like to express my utmost gratitude to Jason for taking the time out of his busy schedule to complete this article and to also thank him for his contributions to the field, as the world needs people like him to advance antimicrobial stewardship!

RECOMMENDED TO YOU



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1-Bowl Banana Buckwheat Muffins (Vegan + GF)

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1-Bowl Banana Buckwheat Muffins (Vegan + GF)


Two banana buckwheat muffins on a paper liner with the first one partially eaten to show the fluffy crumb texture

The goal: portable, delicious, and a bit nutritious! And so banana buckwheat muffins were born! These nutty, wholesome muffins are vegan, gluten-free, naturally sweetened, and easy to make with just 1 bowl and 10 ingredients required. 

They’re great for after-school snacks, on-the-go breakfasts, and more! Grab your mixing bowl, let’s make muffins!

Potato starch, almond flour, buckwheat flour, water, cocout sugar, walnuts, vanilla, salt, baking soda, banana, and flaxseed meal

These 1-bowl buckwheat muffins begin with the wet ingredients: a flax egg, mashed banana, coconut sugar, a little oil, and vanilla.

Buckwheat can have a strong flavor on its own (and a dense texture), so it’s not always our go-to gluten-free flour. But when paired with another strong flavor like banana? This low glycemic, gluten-free nutrient powerhouse seed is going in our muffins!

Using a fork to mash a banana in a bowl with flax egg

Then it’s on to the dry ingredients: gluten-free flours, salt, and baking soda. To balance the denser texture of the buckwheat flour, we include almond flour and potato starch. The result? A wholesome, not-too-heavy muffin with a perfect crumb texture!

Using a spoon to add muffin batter to a lined muffin tin

The final step before baking: deciding whether these will be banana muffins or banana nut muffins. Adding walnuts gets our vote! But if you’re not a fan, no one will be mad if you leave them out. And they definitely won’t be mad if you go rogue and throw in some chocolate chips.

Stack of vegan gluten-free banana buckwheat muffins

We hope you LOVE these banana buckwheat muffins! They’re:

Nutty
Wholesome
Perfectly banana-y
A little sweet
Easy to make
& SO delicious!

These sturdy muffins are perfect for on-the-go breakfasts, brunch gatherings, after-school snacks, and so much more! Our Cinnamon Vanilla Dandelion Tea Latte and Easy Masala Chai would be delicious pairings.

More Wholesome Muffin Recipes

If you try this recipe, let us know! Leave a comment, rate it, and don’t forget to tag a photo @minimalistbaker on Instagram. Cheers, friends!

Two vegan gluten-free banana buckwheat muffins on a plate

Prep Time 25 minutes

Cook Time 35 minutes

Total Time 1 hour

Servings 10 (Muffins)

Course Breakfast, Snack

Cuisine Gluten-Free, Vegan

Freezer Friendly 1 month

Does it keep? 3-4 Days

Prevent your screen from going dark

  • 1 Tbsp flaxseed meal (to make flax egg)
  • 2 ½ Tbsp water (to make flax egg)
  • 2 medium ripe bananas
  • 1/2 cup coconut sugar*
  • 2 Tbsp avocado oil or melted coconut oil (or other neutral oil)
  • 1 tsp vanilla extract
  • 1/3 cup buckwheat flour (homemade or store-bought)
  • 1/4 cup potato starch (NOT potato flour)
  • 1/4 cup almond flour* (we like Wellbee’s)
  • 3/4 tsp baking soda
  • 1/4 tsp sea salt
  • 1/2 cup chopped walnuts (optional)

  • Preheat your oven to 350 degrees F (176 C) and line a standard-size muffin pan with paper liners. Set aside.

  • To a medium mixing bowl, add flaxseed meal and water. Stir to combine and let gel for 5 minutes.

  • Add the bananas to the flax mixture and mash well with a fork until only little chunks of banana remain. We prefer them to be pretty smooth! Next add coconut sugar, oil, and vanilla extract. Whisk well to combine. Add buckwheat flour, potato starch, almond flour, baking soda, and sea salt. Whisk until no flour streaks remain. If using walnuts, fold them into the batter at this point.

  • Divide the batter evenly between 10 muffin liners (or 12 if including walnuts // adjust if altering batch size) and bake for 35-40 minutes or until a toothpick inserted into the center comes out with only a few crumbs.

  • Once cooked, let the muffins cool for 10 minutes in the muffin pan before transferring to a wire rack to cool completely before enjoying. Leftovers can be stored lightly covered at room temperature for up to 3-4 days or frozen for 1 month!

*We haven’t tested this recipe with eggs, but it would likely work to replace the flaxseed meal + water with 1 egg if not vegan/egg-free. Let us know in the comments if you try it!
*If you tend to prefer less-sweet treats, you can use half the amount of coconut sugar with success. Make sure to let the muffins cool fully for best texture.
*Both homemade and store-bought buckwheat flour work well in this recipe. Store-bought will be a bit more dry and homemade a bit more moist.
*Almond flour keeps these muffins a little moist with a crumb-like texture. If you need to make them almond-free, cashew flour would be the next best option. If nut-free, you could try sunflower seed meal, but it may give your muffins a green-tinted color because of the way the seed meal reacts with baking soda.
*Nutrition information is a rough estimate calculated without optional ingredients.

Serving: 1 muffin Calories: 131 Carbohydrates: 22.6 g Protein: 1.5 g Fat: 4.6 g Saturated Fat: 0.5 g Polyunsaturated Fat: 0.9 g Monounsaturated Fat: 2.9 g Trans Fat: 0 g Cholesterol: 0 mg Sodium: 154 mg Potassium: 137 mg Fiber: 1.5 g Sugar: 12.8 g Vitamin A: 2 IU Vitamin C: 2 mg Calcium: 12 mg Iron: 0.3 mg





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Supplier Diversity is a Key Ingredient to Business Success

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Supplier Diversity is a Key Ingredient to Business Success


The Value of the IBX Networking Group

“One of the great things we’ve been able to achieve with Independence Blue Cross is the development of the IBX Networking Group. The group is an ecosystem of diverse professionals and minority-owned businesses that empowers and strengthens members professionally through mentorship and comradery,” Waddy shares. “It’s a way to pay it forward. We’re not in this game alone — we have to work together. IBX provides the environment for that ecosystem to grow.”

The IBX Networking Group participants look for ways to help each other create and expand opportunities. As of August 2023, the diverse businesses that are part of the IBX Networking Group have generated more than $30 million in pipeline opportunities with regional companies that can be directly attributed to their networking activities.

A Workforce that Resembles the Community it Serves

Waddy appreciates the way Independence Blue Cross recognizes the importance of strengthening and empowering a workforce — and a supplier base — that is representative of the region.

“The demographics of the country are changing, and more and more Black and Brown people are becoming economically empowered. Thriving, diverse businesses fuel that growth in a variety of ways,” Waddy explains.

“We must also focus on diverse-ownership culture. As an owner, you have skin in the game and a vested interest in the community around you. For me, that personal stake makes me constantly think about how to give back. It’s not just about legacy. It’s not just about money. It’s about the greater ecosystem. That’s important to me, and IBX understands that importance as well.”

IBX’s Supplier Diversity Program

IBX’s Supplier Diversity Program launched more than 30 years ago. Each year it helps create thousands of jobs while generating millions of dollars toward local, state, and federal economies.

“Once you say that you’re a supplier at Independence Blue Cross, people take notice, because if you can do it with them, you have a proven track record,” Waddy says. “Due to our relationship with IBX, we have closed and acquired at least three additional contracts with other Fortune 500 companies.”

“Working with Gene and his teams has been seamless,” added Stefanosky. “Gene came to us with a solution to onboard contractors that was a win for both of our organizations. He has been an incredible partner.”

Relationships that Matter

After almost two decades as a successful entrepreneur, Waddy has learned that it’s not just about the dollars and cents. What matters most is the help that can be offered to others.

“We all have a superpower, and we need a safe and nurturing place to learn how to use it. That’s what Independence Blue Cross offers,” Waddy shares. “They take the time to get to know their suppliers. That way, when they need something, they don’t have to be reactive. They know their partners. They’re proactive. It’s something that makes them really special.”

“Effective suppliers understand that impactful relationships are key to our shared success. I consider Gene to be a trusted advisor, and he frequently asks me what he can do for IBX,” continued Stefanosky. “In addition to the work that his company performs for Independence Blue Cross, he is one of my ‘go-to’ sources to find other best-in-class, high-performing, diverse suppliers. Everyone needs a person like Gene as a trusted advisor.”



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Chocolate Meringue Cookies

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Chocolate Meringue Cookies


Healthy chocolate is never a bad choice when it comes to dessert (or a midday snack!). These chocolate meringue cookies have a unique texture with a chewy center and a crispy outside. They’re great for holidays, Christmas, or whenever you want to add a little fancy touch.

Chocolate Meringue Cookies

Unlike other cookies that have a base of flour, sugar, and butter, these rely on foamy egg whites instead. If you’ve ever had the fluffy dessert pavlova or lemon meringue pie, then you’ll recognize the texture. They have a little protein thanks to the eggs, plus they’re gluten-free and dairy-free. And instead of refined sugar, I use maple syrup which is rich in manganese, riboflavin, and antioxidants.

The cream of tartar helps stiffen the egg whites so they don’t deflate in the oven and adds a decent amount of potassium. For the chocolate flavor, I use regular unsweetened cocoa powder, but you could also use Dutch-processed cocoa. They have a light, sweet, and slightly chocolatey taste, but you can add some chocolate chips if you want even more chocolate flavor.

These cookies taste really good on their own, but you can add some more flavor if preferred. Add extract or espresso powder with the maple syrup. If you want to add some chocolate chips or nuts, then gently fold these in after the meringue forms stiff peaks.

Chocolate_Meringue_Cookies

Chocolate Meringue Cookies Recipe

These chewy meringues are naturally gluten-free with a crunchy outside. Full of chocolate flavor they’ll melt in your mouth!

  • Preheat the oven to 200°F and line a baking sheet with parchment paper.

  • Add 3 large egg whites to the bowl of a stand mixer and whisk with the whisk attachment on low speed until fluffy and soft peaks form. You can also use a mixing bowl with a hand mixer.

  • Slowly add the maple syrup and cream of tartar to the whipped egg whites. Increase the speed to medium-high and whisk until stiff peaks form, about 5 minutes. Add the cocoa powder and whisk for another 30 seconds until thoroughly blended.

  • Put the mixture into a piping bag with a star tip.

  • Pipe about 1 tablespoon of the meringue onto the cookie sheet for each chocolate meringue cookie. If you don’t have a piping bag you can spoon a moundful of the mixture onto the tray.

  • Bake for 90 minutes to 2 hours, or until the meringues start to turn golden brown and are crispy on the outside.

  • Remove from the oven and let them cool for 5-10 minutes before removing them from the tray.

Nutrition Facts

Chocolate Meringue Cookies Recipe

Amount Per Serving (1 cookie)

Calories 17

% Daily Value*

Fat 0.02g0%

Saturated Fat 0.01g0%

Polyunsaturated Fat 0.001g

Monounsaturated Fat 0.01g

Sodium 8mg0%

Potassium 27mg1%

Carbohydrates 4g1%

Fiber 0.05g0%

Sugar 3g3%

Protein 1g2%

Calcium 6mg1%

Iron 0.03mg0%

* Percent Daily Values are based on a 2000 calorie diet.

Store any leftovers in an airtight container at room temperature. 

How to Use the Egg Yolks

You’ll have some leftover egg yolks after making this recipe. I like to save them and mix them into scrambled eggs or omelets the next morning. Here are a few other recipe ideas for using up egg yolks:

Troubleshooting Meringue

If it’s your first time making meringue there are a few tips for success. Start with a clean, dry bowl that’s either glass or metal. Plastic mixing bowls can absorb oils, food, and odors that affect the meringue taste. Plus plastic isn’t great for you anyways!

Pick a dry day to make meringues. If it’s really humid outside or in your kitchen the meringues can absorb too much moisture and won’t set right.

And lastly, if you have difficulty getting the egg whites to foam and whip, try using room-temperature eggs. If the egg whites are too cold they won’t whip up as high. Also, try to make sure there aren’t any egg yolk pieces in your meringue, as too much can prevent it from whipping.

More Cookie Recipes

In the mood for cookies? Here are a few more yummy ideas!

Have you ever made meringue before? Did you add anything to your chocolate meringue cookies or eat them as is? Leave a comment and let us know!



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Differences in Central Line Associated Bloodstream Infections Prior to and During the Pandemic

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Differences in Central Line Associated Bloodstream Infections Prior to and During the Pandemic


Data has shown central line associated bloodstream infections (CLABSI) increased during the COVID-19 pandemic. However, a greater understanding of what the determinants were for this activity were not widely studied or understood.

As such, a group of investigators associated with Charlotte, NC-based Advocate Health evaluated what factors including whether race impacted risk for development of CLABSI prior to and during the COVID-19 pandemic in patients with indwelling central venous catheter (CVC).

Specifically, they conducted a retrospective cohort study across 11 acute care hospitals in the southeastern US during a study period between 2019-2021. Within this period, there was the pre-pandemic period from 1/1/2019 – 2/29/2020, and the pandemic period defined as 3/1/2020 – 12/31/2021. The data collected included demographic factors including self-reported race and ethnicity, comorbidities, COVID-19 status and central line characteristics. The primary outcome was the first CLABSI that was diagnosed during the admission.

“Of the 46,259 patients with central lines, 313 developed a CLABSI during the study period (109 pre- and 204 during- pandemic, a significant proportional increase), the investigators wrote. “Risk factors for CLABSI in the pre-pandemic period included cancer diagnosis, receipt of total peripheral nutrition (TPN) during hospital stay, intensive care unit encounter, and longer length of stay and average line days.”

Coinvestigator Catherine Passaretti, MD, vice president, Southeast Region epidemiologist, Advocate Health, and clinical professor of infectious diseases, Wake Forest University, says they witnessed differences in CLABSI between black and white patients during COVID-19. “Black patients had a higher risk of CLABSI during the pandemic that we did not see before…that difference between black and white patients really stood out for patients without COVID.”

In fact, Black patients without COVID-19 were 1.6 times (95% CI 1.09, 2.41) more likely to develop CLABSI compared to White patients, the investigators note. There were other risk factors for infection including Medicare insurance (OR 1.68), presence of a dialysis catheter (OR 1.57, or higher body mass index (OR 1.01).

Does Stress Play a Role as a Risk Factor?
In addition, the stressors placed on health care during the pandemic may have contributed to risk factors as clinicians were challenged to care for a surging public health issue.

“Health care was very different at the height of the pandemic when the study took place. So certainly, care delivery and stressors on health care, potentially contributed,” Passaretti said. “So how do we better prepare for stress in healthcare settings? How do we make sure that care provided for infection prevention, even during times of stress is equivalent across the board so we don’t lose ground?”

Passaretti believes creating best practices during these periods may be a solution to consider.

“[We need to understand] how do stress and burnout play into health care behavior, and then making sure we hardwire basic practices in even during times of stress.”



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Creamy Sausage and Potato Soup

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Creamy Sausage and Potato Soup


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Buttery yellow potatoes and flavorful Italian sausage cooked together in a creamy, herb-filled soup base. The perfect hearty recipe to warm you up from the inside-out!

Nothing compares to enjoying a warm bowl of soup when it’s chilly outside! Especially when the soup is homemade, hearty, and packed with flavor. This creamy sausage and potato soup is the perfect recipe to make, but I’ll leave these other recipes here just in case you need more tasty soups in your life. Crack chicken soup, cheeseburger soup, and 8-can taco soup!

A serving of sausage and potato soup in a stoneware bowl.

Potato and Sausage Soup

I’m a sucker for potato soup. Loaded baked potato soup, zuppa toscana, you name it! This creamy sausage and potato soup is the best addition to the list and is SO delicious. It’s nice and creamy without being too rich or heavy, and the flavor is out of this world.

The broth is chock full of fresh herbs, garlic, red pepper flakes, and parmesan cheese. If you’re not already convinced, then it has chunks of buttery petite yellow potatoes, tender carrots, and juicy Italian sausage in each bite. You need this soup in your life.

Ingredient List

This is everything that you’ll need for the most hearty, savory broth and mouthwatering texture. I know you’re going to love this creamy sausage and potato soup as much as I do, and want to have it on repeat!

  • Italian Sausage: Any type of ground Italian sausage will work! Sweet, mild, or hot, depending on your desired spice level.
  • Minced Yellow Onion: Adds sweetness and flavor.
  • Minced Garlic: So the soup has that mouthwatering savory flavor.
  • Chopped Carrots: For some extra texture and heartiness.
  • Chopped Kale: This leafy green adds a vitamin boost and extra texture.
  • Italian Seasoning: A blend of herbs like oregano, basil, and thyme for classic Italian flavor.
  • Fresh Parsley: Chopped to add herby flavor to the sausage and potato soup.
  • Red Pepper Flakes: Adjust amount for desired heat level.
  • Salt and Pepper: Season to your preference.
  • Chicken Broth: Forms the base of the soup.
  • Heavy Cream: Creates a rich and creamy texture. You can also use half and half if you’d like.
  • Petite Yellow Potatoes: These are also called baby gold potatoes. Chopped small, they add bits of hearty texture to the soup. I love their creamy, buttery texture so much!
  • Grated Parmesan: Melts into the soup for a pop of salty flavor.

How to Make Creamy Sausage and Potato Soup

Grab your soup pot and get ready to make some of this hearty, meaty goodness! It only takes 20 minutes for it all to cook up, making it a great choice for a weeknight dinner.

  1. Cook Sausage: Heat a large heavy bottom pot over medium high heat, add the italian sausage and onion and saute until the sausage is cooked through.
  2. Add Seasonings: Add in the garlic, Italian seasoning, fresh parsley, and red pepper flakes and saute for just another minute until the garlic becomes fragrant.
  3. Add Chicken Broth and Vegetables: Quarter the potatoes and add them to the pot along with the chicken broth, carrots, salt and pepper.
  4. Simmer: Bring everything to a boil then reduce the heat to low, cover and simmer until the potatoes are fork tender, about 15 minutes.
  5. Mix In Cream and Cheese: Add the heavy cream and parmesan cheese to the pot and stir, cook the kale until it wilts, about 5 minutes. Remove the soup from heat and then serve fresh!
4-photo collage of the creamy sausage and potato soup being prepared.

Cooking Tips

You know I’m all about ease and using ingredients that you already have in the fridge, so here are a few ways to customize your sausage and potato soup!

  • Other Veggies: Swap the kale for spinach or add chopped zucchini, celery, bell peppers, or broccoli for extra color and nutrients.
  • Use Half and Half: You can use half and half in place of the heavy cream. It won’t be quite as rich but still creamy! This is a great option to make your soup a little lighter.
  • More Toppings: For more flavor and texture, add chopped green onions or crumbled bacon to your sausage and potato soup.

Serve With These For Dipping!

Other Cooking Methods

  • Instant Pot: Brown the sausage and saute the veggies as usual, then toss in everything else except the cream and cheese. Pressure cook on high for 10 minutes, let the pressure release naturally, then stir in the cream and cheese.
  • Slow Cooker: Brown the sausage in a separate pan if you like, then toss it in your Crockpot with all the other ingredients (except the cream and cheese). Cover and cook on low for 6 hours. When you’re ready to eat, simply stir in the cream and cheese and serve.

Creamy sausage and potato soup in a large pot, being scooped up with a ladle.

Storing Leftover Sausage and Potato Soup

Store leftovers in the fridge in an airtight container for up to 4 days.

Reheat individual portions in the microwave for one minute intervals until warmed through, or over the stove on medium heat.

Closeup of a serving of soup.

More Tried & True Soup Recipes

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  • Heat a large heavy bottom pot over medium high heat, add the italian sausage and onion and saute until the sausage is cooked through.

  • Add in the garlic, Italian seasoning, fresh parsley, and red pepper flakes and saute for just another minute until the garlic becomes fragrant.

  • Quarter the potatoes and add them to the pot along with the chicken broth, carrots, salt and pepper.

  • Bring everything to a boil then reduce the heat to low, cover and simmer until the potatoes are fork tender, about 15 minutes.

  • Add the heavy cream and parmesan cheese to the pot and stir, cook the kale until it wilts, about 5 minutes. Remove the soup from heat and serve fresh!

Calories: 589kcalCarbohydrates: 8gProtein: 17gFat: 55gSaturated Fat: 28gPolyunsaturated Fat: 4gMonounsaturated Fat: 19gCholesterol: 155mgSodium: 1164mgPotassium: 401mgFiber: 1gSugar: 4gVitamin A: 4800IUVitamin C: 5mgCalcium: 196mgIron: 2mg

Nutrition information is automatically calculated, so should only be used as an approximation.





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