Inappropriate urine cultures (UCs) are common and lead to inappropriate antimicrobial use. Urinalyses (UAs) have been increasingly incorporated into diagnostic stewardship interventions, but the impact of these interventions nationally has not been assessed. We describe UA and UC utilization practices using a nationwide dataset of patients admitted to acute care hospitals.

Design, Setting and Participants: We performed a retrospective cohort study of index UCs and their associated UAs performed for adult patients (age ≥ 18 years) admitted in U.S. acute care hospitals, participating in the PINC AI™ Healthcare Database (PHD) from January 1, 2017, through December 31, 2020. A positive UA was defined as >10 leukocytes per high power field, positive leukocyte esterase, or positive nitrite.

The overall rate of UCs in this study was 124.7 per 1000 discharges and annual UC rates decreased from 2017 (129.2) to 2020 (120.0). The proportion of UCs that had a positive UA increased from 60.5% in 2017 to 68.1% in 2020; UCs without a UA decreased from 19.3% to 10.5%, and UCs with a negative UA did not significantly change (20.2% to 21.5%). A multivariate multinomial logistic regression model identified male sex, age <65, and a diagnosis of cancer to be predictors of having a UC with a negative UA or no UA.

UC utilization decreased over the study period. The proportion of UCs with a positive UA increased. This may suggest a positive impact of diagnostic stewardship practices at the national level although further progress is needed.

Children with CHD are at risk of neurodevelopmental impairment. Modifiable risk factors associated with hospitalisation that could impact neurodevelopment include being left alone for long periods of time with minimal interaction or opportunity to engage in developmentally appropriate play. Volunteers are an underutilised resource to help the medical team and families support neurodevelopment in cardiac care. Our Cardiac Inpatient Neurodevelopmental Care Optimization or CINCO team aimed to develop a volunteer programme specific to paediatric cardiac inpatient units.

CINCO volunteers were recruited from the hospital volunteer pool and, in 2022, partnered with the University of Colorado to recruit health profession-interested students from under-represented backgrounds. All underwent hospital volunteer orientation and CINCO-specific training with cardiac child life, including education and shadowing. Volunteers completed an activity log and provided qualitative feedback.

Between September 2021 and October 2024, 43 volunteers were onboarded and worked a total of 754 shifts. There were 2310 patient interactions, with an average of 3 patients seen per shift. Volunteers held patients 1231 times, played with patients 1230 times, and read to patients 780 times.

A dedicated cardiac volunteer programme is a feasible, low-cost, and low-risk way to enhance neurodevelopmental care for inpatient children with CHD. When parents or caregivers are not present, volunteers participate as therapy extenders and may offset the care burden for nurses. Furthermore, allowing parents breaks may support their mental health, and increasing neurodevelopmental stimulation through volunteer interactions may mitigate disadvantageous aspects of a hospitalisation for neurodevelopment.

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.

Medicare claims are frequently used to study Clostridioides difficile infection (CDI) epidemiology. However, they lack specimen collection and diagnosis dates to assign location of onset. Algorithms to classify CDI onset location using claims data have been published, but the degree of misclassification is unknown.

We linked patients with laboratory-confirmed CDI reported to four Emerging Infections Program (EIP) sites from 2016–2021 to Medicare beneficiaries with fee-for-service Part A/B coverage. We calculated sensitivity of ICD-10-CM codes in claims within ±28 days of EIP specimen collection. CDI was categorized as hospital, long-term care facility, or community-onset using three different Medicare claims-based algorithms based on claim type, ICD-10-CM code position, duration of hospitalization, and ICD-10-CM diagnosis code presence-on-admission indicators. We assessed concordance of EIP case classifications, based on chart review and specimen collection date, with claims case classifications using Cohen’s kappa statistic.

Of 12,671 CDI cases eligible for linkage, 9,032 (71%) were linked to a single, unique Medicare beneficiary. Compared to EIP, sensitivity of CDI ICD-10-CM codes was 81%; codes were more likely to be present for hospitalized patients (93.0%) than those who were not (56.2%). Concordance between EIP and Medicare claims algorithms ranged from 68% to 75%, depending on the algorithm used (κ = 0.56–0.66).

ICD-10-CM codes in Medicare claims data had high sensitivity compared to laboratory-confirmed CDI reported to EIP. Claims-based epidemiologic classification algorithms had moderate concordance with EIP classification of onset location. Misclassification of CDI onset location using Medicare algorithms may bias findings of claims-based CDI studies.

Cognitive reserve and health-related fitness are associated with favorable cognitive aging, but Black/African American older adults are underrepresented in extant research. Our objective was to explore the relative contributions and predictive value of cognitive reserve and health-related fitness metrics on cognitive performance at baseline and cognitive status at a 4-year follow up in a large sample of Black/African American older adults.

Participants aged 65 years and older from the Health and Retirement Study (HRS) who identified as Black/African American and completed baseline and follow-up interviews (including physical, health, and cognitive assessments) were included in the study. The final sample included 321 Black/African American older adults (mean age = 72.8; sd = 4.8; mean years of education = 12.3; sd = 2.9; mean body mass index (BMI) = 29.1; sd = 5.2; 60.4% identified as female). A cross-sectional analysis of relative importance – a measure of partitioned variance controlling for collinearity and model order – was first used to explore predictor variables and inform the hierarchical model order. Next, hierarchical multiple regression was used to examine cross-sectional relationships between cognitive reserve (years of education), health-related fitness variables (grip strength, lung capacity, gait speed, BMI), and global cognition. Multiple logistic regression was used to examine prospective relationships between predictors and longitudinal cognitive status (maintainers versus decliners). Control variables in all models included age, gender identity, and a chronic disease index score.

Cross-sectional relative importance analyses identified years of education and gait speed as important predictors of global cognition. The cross-sectional hierarchical regression model explained 33% of variance in baseline global cognition. Education was the strongest predictor of cognitive performance (β = 0.48, p < 0.001). Holding all other variables constant, gait speed was significantly associated with baseline cognitive performance and accounted for a significant additional amount of explained variance (ΔR = 0.01, p = 0.032). In a prospective analysis dividing the sample into cognitive maintainers and decliners, a single additional year of formal education increased chances of being classified as a cognitive maintainer (OR = 1.30, 95% CI = 1.17-1.45). There were no significant relationships between rate of change in health-related fitness and rate of change in cognition.

Education, a proxy for cognitive reserve, was a robust predictor of global cognition at baseline and was associated with increased odds of maintaining cognitive ability at 4-year follow up in Black/African American older adults. Of the physical performance metrics, gait speed was associated with cognitive performance at baseline. The lack of observed association between other fitness variables and cognition may be attributable to the brief assessment procedures implemented in this large-scale study.

The current study had two primary objectives: 1) To assess the dose-response relationship between acute bouts of aerobic exercise intensity and performance in multiple cognitive domains (episodic memory, attention, and executive function) and 2) To replicate and extend the literature by examining the dose-response relationship between aerobic exercise intensity and pattern separation.

18 young adults (mean age = 21.6, sd = 2.6; mean education = 13.9, sd = 3.4; 50% female) were recruited from The Ohio State University and surrounding area (Columbus, OH). Participants completed control (no exercise), light intensity, and vigorous intensity exercise conditions across three counterbalanced appointments. For each participant, all three appointments occurred at approximately the same time of day with at least 2 days between appointments. Following the rest or exercise conditions and after an approximately 7 minute delay, participants completed a Mnemonic Similarity Task (MST; Stark et al., 2019) to assess pattern separation. This task was always administered first as we attempted to replicate previous studies and further clarify the relationship between acute bouts of aerobic exercise and pattern separation by implementing an exercise stimulus that varied in intensity. After the MST, three brief cognitive tasks (roughly 5 min each) were administered in a counterbalanced order: a gradual-onset continuous performance task (gradCPT; Esterman et al., 2013), the flanker task from the NIH toolbox, and a face-name episodic memory task. Here we report results from the gradCPT, which assesses sustained attention and inhibitory control. Heart rate and ratings of perceived exertion were collected to validate the rest and exercise conditions. Repeated-measures ANOVAs were used to assess the relationship between exercise condition and dependent measures of sustained attention and inhibitory control and pattern separation.

One-way repeated-measures ANOVAs revealed a main effect of exercise condition on gradCPT task performance for task discrimination ability (d') and commission error rate (p’s < .05). Pairwise comparisons revealed task discrimination ability was significantly higher following the light intensity exercise condition versus the control condition. Commission error rate was significantly lower for both the light and vigorous exercise conditions compared to the control condition. For the MST, two-way repeated-measures ANOVAs revealed an expected significant main effect of lure similarity on task performance; however, there was not a significant main effect of exercise intensity on task performance (or a significant interaction).

The current study indicated that acute bouts of exercise improve both sustained attention and inhibitory control as measured with the gradCPT. We did not replicate previous work reporting that acute bouts of exercise improve pattern separation in young adults. Our results further indicate that vigorous exercise did not detrimentally impact or improve pattern separation performance. Our results indicate that light intensity exercise is sufficient to enhance sustained attention and inhibitory control, as there were no significant differences in performance following light versus vigorous exercise.

To identify the relative contributions and importance of modifiable fitness and demographic variables to cognitive performance in a cohort of healthy older adults.

Metrics of modifiable fitness (gait speed, respiratory function, grip strength, and body mass index (BMI)) and cognition (executive function, episodic memory, and processing speed) were assessed in 619 older adults from the Health and Retirement Study 2016 wave (mean age = 74.9, sd = 6.9; mean education = 13.4 years, sd = 2.6; 42% female). General linear models were employed to assess the contribution of modifiable fitness variables in predicting three domains of cognition: executive function, episodic memory, and processing speed. Demographics (age, sex, education, time between appointments, and a chronic disease score) were entered as covariates for each model. Relative importance metrics were computed for all variables in each model using Lindeman, Merenda, and Gold (lmg) analysis, a technique which decomposes a given model’s explained variance to describe the average contribution of each predictor variable, independent of its position in the linear model.

When all variables were entered into the general linear model, demographic and modifiable fitness variables explained 35%, 24%, and 26% of the variance in executive function, episodic memory, and processing speed, respectively (all three models were significant, p <0.001). Age, education, respiratory function, and walking speed had higher relative importance values (all lmgs > 1.8) compared to BMI, grip strength, and other covariates in all three models (all lmgs < 1.3). Gender was also relatively important in the executive function (lmg = 4.2) and episodic memory models (lmg = 5.0). Of the modifiable fitness variables, walking speed and respiratory function had the greatest lmg values (5.8 and 6.4 respectively) in the executive function model, similar to demographic variables age (lmg = 6.0) and education (lmg = 8.9). When demographic variables were entered as covariates, modifiable fitness variables collectively accounted for an additional 9.7%, 6.3%, and 6.0% variance in the executive function, episodic memory, and processing speed models respectively (all three models were significant, p <0.001).

Our findings indicate that walking speed and respiratory function are of similar importance compared to “traditional” demographic variables such as age and education in predicting cognitive performance in a cohort of healthy older adults. Moreover, modifiable fitness variables accounted for unique variance in executive function, episodic memory, and processing speed after accounting for age and education. Modifiable fitness variables explained the most unique variance in executive function. These results extend the current literature by demonstrating that modifiable fitness variables, even when assessed with brief and relatively coarse measures of physical performance, may be useful in predicting cognitive function. Moreover, the results highlight the need to assess metrics of cognitive reserve, such as education, as well as modifiable fitness variables and their respective roles in accounting for cognitive performance. The data further suggest that relative contributions of physical performance metrics may vary by cognitive domain in healthy older adults.

On February 24, 2022, Russia invaded Ukraine, resulting in Europe’s largest refugee crisis since World War II. More than six million Ukrainians fled the country—half of these to Poland—and one-third of the population was internally displaced.

Border points became bottlenecks where fatalities were reported—people risked their lives in long queues and subzero temperatures.

This presentation focuses on experiential information obtained during a 17-week deployment of EMT Type 1 both at border points (fixed) and in northwestern Ukraine (mobile). Quantitative and qualitative data were obtained after deployment by online survey with 75 medical, logistical and interpreter volunteers.

Initial teams experienced extremely fluid demands and numerous challenges with security, team adherence to COVID-19 protocols, behavioral issues with less experienced volunteers, and collaboration with novel governmental and non-governmental partners to achieve objectives.

1. Deployment to a conflict setting requires adherence to the Incident Command System, with daily security briefings and structured handover between teams at the beginning of each deployment.

2. Strict adherence to well-defined protocols for the prevention and management of emerging infectious risks such as COVID-19 is necessary, along with contingency plans to isolate infected team members.

3. There is a need for standardized pre-deployment vetting, training and orientation of all volunteers—particularly team leaders.

4. Identification of international partners should start pre-deployment and remain a continuous process during deployment.

Children with CHD are at risk for neurodevelopmental delays, and length of hospitalisation is a predictor of poorer long-term outcomes. Multiple aspects of hospitalisation impact neurodevelopment, including sleep interruptions, limited holding, and reduced developmental stimulation. We aimed to address modifiable factors by creating and implementing an interdisciplinary inpatient neurodevelopmental care programme in our Heart Institute.

In this quality improvement study, we developed an empirically supported approach to neurodevelopmental care across the continuum of hospitalisation for patients with CHD using three plan-do-study-act cycles. With input from multi-level stakeholders including parents/caregivers, we co-designed interventions that comprised the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) programme. These included medical/nursing orders for developmental care practices, developmental kits for patients, bedside developmental plans, caregiver education and support, developmental care rounds, and a specialised volunteer programme. We obtained data from the electronic health record for patients aged 0–2 years admitted for at least 7 days to track implementation.

There were 619 admissions in 18 months. Utilisation of CINCO interventions increased over time, particularly for the medical/nursing orders and caregiver handouts. The volunteer programme launch was delayed but grew rapidly and within six months, provided over 500 hours of developmental interaction with patients.

We created and implemented a low-cost programme that systematised and expanded upon existing neurodevelopmental care practices in the cardiac inpatient units. Feasibility was demonstrated through increasing implementation rates over time. Key takeaways include the importance of multi-level stakeholder buy-in and embedding processes in existing clinical workflows.

Assessing performance validity is imperative in both clinical and research contexts as data interpretation presupposes adequate participation from examinees. Performance validity tests (PVTs) are utilized to identify instances in which results cannot be interpreted at face value. This study explored the hit rates for two frequently used PVTs in a research sample of individuals with and without histories of bipolar disorder (BD).

As part of an ongoing longitudinal study of individuals with BD, we examined the performance of 736 individuals with BD and 255 individuals with no history of mental health disorder on the Test of Memory Malingering (TOMM) and the California Verbal Learning Test forced choice trial (CVLT-FC) at three time points.

Undiagnosed individuals demonstrated 100% pass rate on PVTs and individuals with BD passed over 98% of the time. A mixed effects model adjusting for relevant demographic variables revealed no significant difference in TOMM scores between the groups, a = .07, SE = .07, p = .31. On the CVLT-FC, no clinically significant differences were observed (ps < .001).

Perfect PVT scores were obtained by the majority of individuals, with no differences in failure rates between groups. The tests have approximately >98% specificity in BD and 100% specificity among non-diagnosed individuals. Further, nearly 90% of individuals with BD obtained perfect scores on both measures, a trend observed at each time point.