To describe antimicrobial use in Tennessee from 2017 to 2023.

Retrospective analysis of antimicrobial use using data from the National Healthcare Safety Network (NHSN) Antimicrobial Use (AU) Option.

Acute care and critical access facilities in Tennessee.

From 2017 to 2023, 97 facilities in Tennessee submitted data to the NHSN AU Option. The number of reporting facilities increased from 25 to 95. During this time, the statewide average antimicrobial use significantly rose from 593 days of therapy (DOT)/1000 days present (DP) to 621 DOT/1000 DP (P = .0478). The All-Antibacterial Standardized Antimicrobial Administration Ratio (SAAR) values remained near 1.0, indicating overall use was as predicted. However, the All-Antibacterial SAAR values, particularly in small facilities, revealed that they utilized antibiotic agents more than predicted during the study period. Additionally, the SAAR trends varied by patient care locations, with the oncology unit (ONC) experiencing a significant increase from 0.73 to 1.12 (P-value<.0001). West Tennessee had the highest antimicrobial use rate at 736 DOT per 1000 DP, and an All-Antibacterial SAAR of 1.21. The top antimicrobial agents—vancomycin, ceftriaxone, piperacillin/tazobactam, cefepime, and cefazolin—accounted for 54% of the total antimicrobial use.

This statewide analysis of AU and SAAR trends identifies areas where additional antimicrobial stewardship efforts may be targeted to improve antimicrobial use. Facilities of different sizes and geographic locations have unique demographics that can affect antimicrobial use, requiring specialized antimicrobial stewardship techniques.

Patients with posttraumatic stress disorder (PTSD) exhibit smaller regional brain volumes in commonly reported regions including the amygdala and hippocampus, regions associated with fear and memory processing. In the current study, we have conducted a voxel-based morphometry (VBM) meta-analysis using whole-brain statistical maps with neuroimaging data from the ENIGMA-PGC PTSD working group.

T1-weighted structural neuroimaging scans from 36 cohorts (PTSD n = 1309; controls n = 2198) were processed using a standardized VBM pipeline (ENIGMA-VBM tool). We meta-analyzed the resulting statistical maps for voxel-wise differences in gray matter (GM) and white matter (WM) volumes between PTSD patients and controls, performed subgroup analyses considering the trauma exposure of the controls, and examined associations between regional brain volumes and clinical variables including PTSD (CAPS-4/5, PCL-5) and depression severity (BDI-II, PHQ-9).

PTSD patients exhibited smaller GM volumes across the frontal and temporal lobes, and cerebellum, with the most significant effect in the left cerebellum (Hedges’ g = 0.22, pcorrected = .001), and smaller cerebellar WM volume (peak Hedges’ g = 0.14, pcorrected = .008). We observed similar regional differences when comparing patients to trauma-exposed controls, suggesting these structural abnormalities may be specific to PTSD. Regression analyses revealed PTSD severity was negatively associated with GM volumes within the cerebellum (pcorrected = .003), while depression severity was negatively associated with GM volumes within the cerebellum and superior frontal gyrus in patients (pcorrected = .001).

PTSD patients exhibited widespread, regional differences in brain volumes where greater regional deficits appeared to reflect more severe symptoms. Our findings add to the growing literature implicating the cerebellum in PTSD psychopathology.

The macro-social and environmental conditions in which people live, such as the level of a country’s development or inequality, are associated with brain-related disorders. However, the relationship between these systemic environmental factors and the brain remains unclear. We aimed to determine the association between the level of development and inequality of a country and the brain structure of healthy adults.

We conducted a cross-sectional study pooling brain imaging (T1-based) data from 145 magnetic resonance imaging (MRI) studies in 7,962 healthy adults (4,110 women) in 29 different countries. We used a meta-regression approach to relate the brain structure to the country’s level of development and inequality.

Higher human development was consistently associated with larger hippocampi and more expanded global cortical surface area, particularly in frontal areas. Increased inequality was most consistently associated with smaller hippocampal volume and thinner cortical thickness across the brain.

Our results suggest that the macro-economic conditions of a country are reflected in its inhabitants’ brains and may explain the different incidence of brain disorders across the world. The observed variability of brain structure in health across countries should be considered when developing tools in the field of personalized or precision medicine that are intended to be used across the world.

To estimate the cost-effectiveness of methicillin-resistant Staphylococcus aureus (MRSA) nares poymerase chain reaction (PCR) use in pediatric pneumonia and tracheitis.

We built a cost-effectiveness model based on MRSA prevalence and probability of empiric treatment for MRSA pneumonia or tracheitis, with all parameters varied in sensitivity analyses. The hypothetical patient cohort was <18 years of age and hospitalized in the pediatric intensive care unit for community-acquired pneumonia (CAP) or tracheitis. Two strategies were compared: MRSA nares PCR-guided antibiotic therapy versus usual care. The primary measure was cost per incorrect treatment course avoided. Length of stay and hospital costs unrelated to antibiotic costs were assumed to be the same regardless of PCR use. Both literature data and expert estimates informed sensitivity analysis ranges.

When estimating the health care system willingness-to-pay threshold for PCR testing as $140 (varied in sensitivity analyses) per incorrect treatment course avoided, reflecting estimated additional costs of MRSA targeted antibiotics, and MRSA nares PCR true cost as $64, PCR testing was generally favored if empiric MRSA treatment likelihood was >52%. PCR was not favored in some scenarios when simultaneously varying MRSA infection prevalence and likelihood of MRSA empiric treatment. Screening becomes less favorable as MRSA PCR cost increased to the highest range value of the parameter ($88). Individual variation of MRSA colonization rates over wide ranges (0% – 30%) had lesser effects on results.

MRSA nares PCR use in hospitalized pediatric patients with CAP or tracheitis was generally favored when empiric MRSA empiric treatment rates are moderate or high.

Cash transfer programmes (CTPs) provide financial support to alleviate poverty and promote economic stability. The Bolsa Família Programme (BFP), a Brazilian initiative and the world’s largest CTP by number of beneficiaries, aims to improve living conditions. While poverty is closely linked to poor mental health, evidence regarding the specific effects of CTPs on young adults’ mental health remains limited, underscoring the need for further research.

To understand the meaning attributed to the BFP by young adults regarding their future aspirations and mental health, as well as perspectives from providers.

This qualitative study was conducted at the outskirts of São Paulo city, involving 12 in-depth interviews with young adults aged 18–24 years and 2 focus groups comprising 17 health and social assistance professionals.

Thematic analysis identified four themes according with interviews and focus groups: (a) perceptions about poverty (hopelessness and lack of opportunities); (b) impact of poverty on mental health (anxiety, unpredictability and hopelessness as consequences of living in poverty); (c) young adults’ needs and aspirations (job opportunities as the main expectation for a better future); and (d) BFP limitations and opportunities for improvement (BFP perceived as just one of the survival strategies but not impacting life opportunities for young adults).

The BFP was valued as essential for meeting poor families’ basic needs. Employment opportunities were central to young adults’ expectations, often causing anguish and anxiety. Expanding the BFP to include employment and income-generation policies could better support the mental health and life opportunities of vulnerable youth.

This study evaluated Medicaid claims (MC) data as a valid source for outpatient antimicrobial stewardship programs (ASPs) by comparing it to electronic medical record (EMR) data from a single academic center.

This retrospective study compared pediatric patients’ MC data with EMR data from the Marshall Health Network (MHN). Claims were matched to EMR records based on patient Medicaid ID, service date, and provider NPI number. Demographics, antibiotic choice, diagnosis appropriateness, and guideline concordance were assessed across both data sources.

The study was conducted within the MHN, involving multiple pediatric and family medicine outpatient practices in West Virginia, USA.

Pediatric patients receiving care within MHN with Medicaid coverage.

MC and EMR data showed >90% agreement in antibiotic choice, gender, and date of service. Discrepancies were observed in diagnoses, especially for visits with multiple infectious diagnoses. MC data demonstrated similar accuracy to EMR data in identifying inappropriate prescriptions and assessing guideline concordance. Additionally, MC data provided timely information, enhancing the feasibility of impactful outpatient ASP interventions.

MC data is a valid and timely resource for outpatient ASP interventions. Insurance providers should be leveraged as key partners to support large-scale outpatient stewardship efforts.

To understand the scenarios where health care worker (HCW) masking is most impactful for preventing nosocomial transmission.

A mathematical agent-based model of nosocomial spread with masking interventions. Masking adherence, community prevalence, disease transmissibility, masking effectiveness, and proportion of breakroom (unmasked) interactions were varied. The main outcome measure is the total number of nosocomial infections in patients and HCW populations over a simulated three-month period.

HCW masking around patients and universal HCW masking reduces median patient nosocomial infections by 15% and 18%, respectively. HCW-HCW interactions are the dominant source of HCW infections and universal HCW masking reduces HCW nosocomial infections by 55%. Increasing adherence shows a roughly linear reduction in infections. Even in scenarios where a high proportion of interactions are unmasked “breakroom” interactions, masking is still an effective tool assuming adherence is high outside of these areas. The optimal scenarios where masking is most impactful are those where community prevalence is at a medium level (around 2%) and transmissibility is high.

Masking by HCWs is an effective way to reduce nosocomial transmission at all levels of mask effectiveness and adherence. Increases in adherence to a masking policy can provide a small but important impact. Universal HCW masking policies are most impactful should policymakers wish to target HCW infections. The more transmissible a variant in circulation is, the more impactful HCW masking is for reducing infections. Policymakers should consider implementing masking at the point when community prevalence is optimum for maximum impact.