objective. To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated.design. Multicenter retrospective study.setting. Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds).patients. Patients ≥18 years of age with culture-proven Gram-negative bacteremia.intervention. Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results.results. We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P < .001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P < .001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P < .001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P = .04).conclusion. This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.

Currently, there are more than 4.5 million Americans under some form of community supervision. Much of the experience of traditional community supervision relies on face-to-face interactions. Individuals on supervision often require treatment or services typically delivered in face-to-face settings. However, the COVID-19 pandemic has forced community corrections' agencies to quickly rethink how they do business, with limited existing research on how to adapt supervision protocols in the midst of a global pandemic. Using surveys of directors of community corrections' agencies across the United States, the goal of the current study was to examine how community corrections' agencies have adapted traditional supervision processes to address disease prevention and containment in addition to supporting client needs and community safety as a result of COVID-19. Changes implemented during the pandemic may have implications for the future landscape of community supervision. Understanding how and what agencies prioritize in a time of global crisis can provide a foundation for identifying sustainable changes as well as understanding future impacts on system and client-level outcomes.

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The emergence of COVID-19 placed immediate pressure on the juvenile justice system to adapt to changes in case processing and decision-making practices. Juvenile probation agencies were tasked with quickly altering their policies and practice to abide by local public health measures. As probation supervision is the most common disposition in the juvenile justice system, there is both an empirical and practical need to understand the impact that COVID-19 has on a variety of issues surrounding the supervision and provision of services for juveniles. Using self-report survey data from juvenile probation directors across the United States, the current study examines (a) the biggest challenges faced by juvenile probation agencies during the pandemic, (b) the strategies implemented in response to these challenges, and (c) the most pressing issues currently facing the field of juvenile community corrections. Results have the potential to inform future agency decision-making when adjusting juvenile probation policy and practice.

Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries. The World Health Organization estimates that more than 1.4 billion adults are obese. Although the prevalence of obesity is increasing over the last decades, pharmacokinetic evaluations are still conducted in individuals with a body weight of approximately 70 kg. Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. There are currently no specific dosing recommendations for antibiotics in obese patients, making dosing suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states. Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in the obese population.