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Count data are common in many fields such as public health. Hurdle models have been developed to model count data when the zero count could be either inflated or deflated. However, when data are repeatedly collected over time and spatially correlated, it is very challenging to model the data appropriately. For example, to study health professional shortage areas, the number of primary care physicians along with other demographic characteristics are collected at the county level in the USA and over different years. Since the data are repeatedly collected over time, counties are nested within the state, and adjacent counties are geographically correlated, the dependence structure of the data is very complex. We develop a Bayesian hurdle model with multilayered random effects to incorporate this complex structure. We use a time-varying random effect for each state to capture the time effect at the state level, and a temporal thin plate spline to capture the spatiotemporal correlation across different counties. We use STAN to obtain samples for inference from the posterior distribution. By using the model proposed, we can identify the important factors which impact health professional shortage areas. Simulation studies also confirm the effectiveness of the model.

Background Delta granule storage pool deficiency (δ‐SPD) is a rare platelet disorder in which a deficiency of platelet granules leads to poor aggregation, resulting in varying clinical bleeding phenotypes. Children with δ‐SPD have variable laboratory results, making the proper diagnosis and evaluation controversial. Objectives To describe the demographic and laboratory trends of this population and to assess the value of electron microscopy in diagnostic evaluation and its correlation to bleeding symptoms. Methods We performed a retrospective review of 109 pediatric patients diagnosed with δ‐SPD. We collected demographic information and bleeding scores using a validated bleeding assessment tool. A descriptive and exploratory analysis was performed. Results The majority of patients were female, with an average age at diagnosis of 11.61 years. Females were diagnosed at a significantly older age presenting most often with menorrhagia, while males presented most commonly with epistaxis. The majority showed normal lumiaggregometry, the mean platelet electron microscopy (PEM) value was 2.37, and the mean bleeding score was 6. Bleeding assessment tool and PEM had a significantly weak correlation. Conclusions Patients with more dense granules per platelet had higher bleeding scores than those with fewer dense granules per platelet. The current body of evidence does not favor the use of PEM in routine clinical practice, and results are difficult to interpret. In patients with severe mucocutaneous bleeding symptoms and normal platelet aggregation studies, consideration should be given to an alternative diagnosis and further evaluation is warranted.

Cefdinir is frequently prescribed for pediatric infections despite lack of first-line indications. We reviewed Kentucky Medicaid claims from 2012 through 2016. Cefdinir prescriptions and spending significantly increased over the study period. Upper respiratory infections accounted for the majority of use. Inappropriate cefdinir use should be a priority for stewardship efforts.