Tennessee Department of Health

Driven by structural violence experienced during forced migration, including asylum-deterrence policies, asylum-seeking women face health and social inequities related to experiences of pregnancy and motherhood. Little is known about the intersecting relationships between forced migration and motherhood and their respective health consequences. This study examined the interplay between the structural constraints and the individual agency on pregnant and parenting asylum-seeking women's sexual, reproductive, and mental health and migration experiences. Qualitative. As part of a community-academic partnership, we thematically analyzed 38 qualitative, semi-structured interviews conducted in Spanish or Haitian Creole with pregnant and parenting asylum-seeking women at the Mexico-US border (July 2022 to April 2023). Structural violence and agency intersected to affect migrant women's experiences of pregnancy and motherhood. The structural violence experienced during forced migration, including political, legal, and economic violence, constrained women's sexual, reproductive, and mental health during pregnancy and motherhood via barriers to family planning; reduced/delayed access to perinatal care; food, housing, and economic insecurity; and psychosocial stressors (e.g., anxiety around family separation). Concomitantly, women's identity as mothers was a source of agency and resilience amidst forced migration, leading to shifts in migration trajectories and strengthened resolve to build a safer life for their children. Asylum-seeking women faced barriers to healthy pregnancy and motherhood during migration, influenced by structural constraints during forced migration and tempered by their strength and resilience as mothers. There is a need for removal of restrictive immigration policies to address the harmful socio-structural contexts that perpetuate adverse health outcomes among women and their families during forced migration, alongside humanitarian and health services for asylum-seeking women that acknowledge the impacts of structural violence amid current migration policies.

Abstract Background Infection Control Assessment and Response (ICAR) visits utilize a series of CDC-developed modules to evaluate a healthcare facility’s infection prevention programs. The ICAR Module 10 focuses on a facility’s antimicrobial stewardship programs and core element achievement. ICAR visits are typically performed by infection preventionists (IPs) with varying degrees of antimicrobial stewardship assessment experience. Methods The Tennessee Department of Health (TDH) developed an initiative to increase the uptake of preventative ICARs in long-term care facilities (LTCF). Due to the number of LTCFs requesting a module 10 review a TDH pharmacist developed training on stewardship assessments and developed follow-up questions and activity explanations. After the module 10 interview, IPs sent ICAR results and their feedback to the pharmacist for review. Feedback reports included summaries of programs’ strengths and weaknesses with suggestions and resources for improvement. Data were collected using REDCap electronic data capture tools hosted at TDH. All data analysis were completed using SAS Enterprise Guide 7.1. Results Forty-five LTCFs participated from April–September 2024. The top stewardship activities that LTCFs implemented were having a stewardship policy (86.7%), assessing penicillin allergy (80%), and stopping unnecessary antibiotics in new Clostridium difficile infection cases (75.6%). Antibiotic use tracking was performed in 100% of LTCFs and most achieved by using electronic health data (86.7%). Individuals responsible for the management and outcomes of their facility’s stewardship program are IPs and directors of nursing (100%). Percent of time dedicated to stewardship was 50% or less in 89.7% of facilities. Conclusion Antibiotic stewardship assessments at LTCFs using the ICAR Module 10 tool revealed that stewardship responsibilities primarily fall to IPs/DONs who often have their duties split between stewardship and other programs. Most facilities had at minimum a policy in place for antimicrobial stewardship, however, there remains room for improvement. This reinforces the need for additional resources and initiatives for LTCFs to improve stewardship and optimize antibiotic use. Disclosures All Authors: No reported disclosures

A working knowledge of theory requires theory translation within and outside the nursing discipline to guide practice and inform generative epistemic nursing knowledge. However, theory focused content for application to practice is scarce in many Doctor of Nursing (DNP) education programs. Communication between faculty and students regarding the use of theory to guide practice is an important action that is not well understood. The terminology to describe this process is nursing theory conversance (NTC). However, NTC has not been defined within the literature. We provide a tentative definition of NTC and explore its importance in DNP education.

Abstract Background Azole-based antifungals are the first-line therapy for many common mycoses and are increasingly used prophylactically to protect immunocompromised patients. Due to variability in their metabolism and bioavailability, therapeutic drug monitoring is crucial to avoid toxicity while ensuring maximum efficacy. Methods Sample preparation involved protein precipitation with a methanol and internal standard mixture, followed by centrifugation. Isotope-labeled analogues for each analyte served as internal standards. Chromatographic separation was performed using an ACQUITY UPLC BEH C18 Column (30 mm x 2.1 mm, 1.7 µm) with a BEH C18 VanGuard Pre-column (2.1 mm x 5 mm, 1.7 µm) on an ACQUITY UPLC I-Class System. Gradient elution was achieved with Mobile phase A and B consisting of 2 mM ammonium acetate in 0.1% formic acid in H2O and methanol, respectively, at a flow rate of 0.8 mL/min. Azoles were detected using a triple-stage quadrupole mass spectrometer in selected reaction monitoring mode with positive heated electrospray ionization, within a runtime of 3.00 minutes. Results Linearity and calibration ranges for all azoles were verified from 0.05 to 10 µg/mL, with a limit of quantitation at 0.05 µg/mL. Within-run and between-run precisions ranged from 0.6% to 6.7% for all azoles. Accuracy was assessed by comparing results with a reference lab, showing high correlation with an average slope of 1.06, intercept of 0.06, and R value of 0.99. Comparison between two instrument systems also demonstrated similar results, with an R value of 0.99. Dilution was verified by reduced volume injection at a 1:2 dilution, extending reportable ranges up to 20 µg/mL. Carryover studies, conducted by interspersing high concentration and negative samples, passed the EP Evaluator protocol. Matrix-induced ion suppression/enhancement studies revealed no interference from the EDTA plasma matrix, except for hydroxyitraconazole. Consequently, hydroxyitraconazole results are not reported when itraconazole is undetectable, as hydroxyitraconazole was enhanced by over 30% of the spiked concentration due to the sample matrix. Whole blood stability was assessed at 8 hours at room temperature before centrifugation, with results acceptable based on a 20% total allowable error. Conclusion A simple yet reliable liquid chromatography-tandem mass spectrometry method was validated that enables quantification of azoles in EDTA plasma across therapeutic ranges. These new assays have significantly improved result turnaround time and have been successfully implemented in our therapeutic drug monitoring service, making them suitable for routine monitoring of antifungal therapy, especially in severely ill patients.

BackgroundCryptosporidiosis is a leading cause of zoonotic illness. We aimed to describe cryptosporidiosis illnesses in Tennessee by species and molecular subtypes, and explore epidemiological risk factors.MethodsCryptosporidium is a reportable condition in Tennessee. Cases are investigated and molecular subtyping is performed. Collected data includes patient demographics, risk factors, laboratory results, and Cryptosporidium species and subtype. We described Tennessee residents with cryptosporidiosis during 2018–2023. To explore risk factors, we used binomial probabilities to compare exposure frequencies with the Foodborne Diseases Active Surveillance Network (FoodNet) Population Survey.ResultsDuring 2018–2023, Tennessee recorded 1174 cryptosporidiosis cases. Of those, 282 (24%) had species information and 214 (18%) had genotype information. Of 802 laboratory-confirmed cases without species information, 664 (83%) did not have a specimen submitted for molecular subtyping. Most frequently identified species were C. parvum (n = 183, 65%) and C. hominis (n = 60, 21%) with most frequently identified subtypes being C. parvum subtypes IIaA15G2R1 (n = 80) and IIaA15G2R2 (n = 15), and C. hominis subtype IfA12G1R5 (n = 15). C. felis (n = 8), C. ubiquitum (n = 5), C. meleagridis (n = 3), C. canis (n = 2), and C. deer mouse subtypes (n = 2) were also identified. Rates were higher for C. parvum in rural counties and C. hominis in urban counties. Persons with C. parvum infections more often reported contact with goats, cows, or sheep compared to the population (39% vs. 6%, P <.001). Persons with C. hominis infections more often reported contact with natural (22% vs. 9%, P =.003) and treated (32% vs. 12%, P <.001) water, and having contact with another person with diarrheal illness (28% vs. 15%, P =.013).ConclusionsMolecular cryptosporidiosis surveillance can facilitate more detailed understanding of cryptosporidiosis risk factors and prevention measures. To best use this tool, a greater proportion of specimens need to be submitted for molecular subtyping.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12879-025-11364-w.

ABSTRACT The application of high-pressure processing is gaining importance and momentum in the food industry. In this hurdle validation study, strain mixtures of Escherichia coli O157:H7 (STEC) and non-O157 serogroups (nSTEC) were used in three phenotypes of wild-type, rifampicin-resistant, and pressure-stressed. After a 48-hour habituation, elevated hydrostatic pressure of 300–600 MPa was tested. While 300 MPa treatments at 4.4°C resulted in 0.45 log reduction (P < 0.05) of STEC after 5 min, the same treatment resulted in 4.26 and 6.02 log reductions (P < 0.05) with the addition of malic acid and citricidalTM, respectively. Results of our study illustrate that application of selected antimicrobials could, to a great extent, augment the decontamination efficacy of pressure-based treatments. Additionally, we observed that the STEC and nSTEC serogroups of the pathogen have comparable sensitivity to elevated hydrostatic pressure and the antimicrobials. Thus, a validated treatment plan against STEC serogroups is most probably equally effective against nSTEC serogroups as well.