Digital Commons Network^™

Predicting Lymph Node Metastasis In Non-Small Cell Lung Cancer: Prospective External And Temporal Validation Of The Hal And Homer Models, Gabriela Martinez-Zayas, Francisco A Almeida, Lonny Yarmus, Daniel Steinfort, Donald R Lazarus, Michael J Simoff, Timothy Saettele, Septimiu Murgu, Tarek Dammad, D Kevin Duong, Lakshmi Mudambi, Joshua J Filner, Sofia Molina, Carlos Aravena, Jeffrey Thiboutot, Asha Bonney, Adriana M Rueda, Labib G Debiane, D Kyle Hogarth, Harmeet Bedi, Mark Deffebach, Ala-Eddin S Sagar, Joseph Cicenia, Diana H Yu, Avi Cohen, Laura Frye, Horiana B Grosu, Thomas Gildea, David Feller-Kopman, Roberto F Casal, Michael Machuzak, Muhammad H Arain, Sonali Sethi, George A Eapen, Louis Lam, Carlos A Jimenez, Manuel Ribeiro, Laila Z Noor, Atul Mehta, Juhee Song, Humberto Choi, Junsheng Ma, Liang Li, David E Ost

Faculty, Staff and Students Publications

BACKGROUND: Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in patients with non-small cell lung cancer (NSCLC) as determined by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to prospectively externally validate both models at multiple centers.

RESEARCH QUESTION: Are the HAL and HOMER models valid across multiple centers?

STUDY DESIGN AND METHODS: This multicenter prospective observational cohort study enrolled consecutive patients with PET-CT clinical-radiographic stages T1-3, N0-3, M0 NSCLC undergoing EBUS-TBNA staging. …

Whole-Genome Association Analyses Of Sleep-Disordered Breathing Phenotypes In The Nhlbi Topmed Program, Brian E Cade, Jiwon Lee, Tamar Sofer, Heming Wang, Man Zhang, Han Chen, Sina A Gharib, Daniel J Gottlieb, Xiuqing Guo, Jacqueline M Lane, Jingjing Liang, Xihong Lin, Hao Mei, Sanjay R Patel, Shaun M Purcell, Richa Saxena, Neomi A Shah, Daniel S Evans, Craig L Hanis, David R Hillman, Sutapa Mukherjee, Lyle J Palmer, Katie L Stone, Gregory J Tranah, Gonçalo R Abecasis, Eric A Boerwinkle, Adolfo Correa, L Adrienne Cupples, Robert C Kaplan, Deborah A Nickerson, Kari E North, Bruce M Psaty, Jerome I Rotter, Stephen S Rich, Russell P Tracy, Ramachandran S Vasan, James G Wilson, Xiaofeng Zhu, Susan Redline

Faculty, Staff and Student Publications

BACKGROUND: Sleep-disordered breathing is a common disorder associated with significant morbidity. The genetic architecture of sleep-disordered breathing remains poorly understood. Through the NHLBI Trans-Omics for Precision Medicine (TOPMed) program, we performed the first whole-genome sequence analysis of sleep-disordered breathing.

METHODS: The study sample was comprised of 7988 individuals of diverse ancestry. Common-variant and pathway analyses included an additional 13,257 individuals. We examined five complementary traits describing different aspects of sleep-disordered breathing: the apnea-hypopnea index, average oxyhemoglobin desaturation per event, average and minimum oxyhemoglobin saturation across the sleep episode, and the percentage of sleep with oxyhemoglobin saturation < 90%. We adjusted for age, sex, BMI, study, and family structure using MMSKAT and EMMAX mixed linear model approaches. Additional bioinformatics analyses were performed with MetaXcan, GIGSEA, and ReMap.

RESULTS: We identified a …

Art As Protest: How Creative Activism Shaped “Black Lives Matter” In Richmond, Virginia, Anaheed Mobaraki

The Yale Undergraduate Research Journal

Unrest spurred by the resurgence of the Black Lives Matter movement in the United States has flowed throughout the city of Richmond, Virginia. Unique forms of protest have proliferated across the city, encompassing several artistic tactics such as graffiti art, oral storytelling, graphic design, and movement art. This paper will explore the effectiveness of art as protest by analyzing its impacts on several foundational aspects of social movements. Combining my personal observations, scholarly literature, and research on other social movements, I have developed my own findings regarding the use of art in Richmond’s Black Lives Matter movement. I posit that …

Barriers To The Diagnosis Of Dyslexia In Children, Maria Cunningham

The Yale Undergraduate Research Journal

Dyslexia is a learning disability that impairs reading, writing, and spelling and is estimated to affect 5-20% of people (Shaywitz, 1998; Shaywitz, 2003). Although dyslexia is a life-long disability that has no cure, evidence-based treatments are available for struggling students (Shaywitz, 2003). The earlier these interventions are implemented, the better the student outcomes (Alexander & Slinger-Constant, 2004). However, despite the very high prevalence of dyslexia and time-sensitive need for treatment, many affected individuals slip through the cracks and go undiagnosed until adolescence or adulthood – most never get diagnosed at all (Shaywitz, 2003). This paper addresses potential barriers that contribute …

A Silent Injustice: Air Pollution As A Contributing Factor Of Covid-19 Health Disparities, Spencer Johnson

The Yale Undergraduate Research Journal

COVID-19, the disease caused by SARS-CoV-2 has had a disproportionate impact on Black communities throughout the United States. This paper suggests that air pollution may be a factor for why Black individuals experience markedly poorer health outcomes after contracting COVID-19. It establishes that not only are Black Americans exposed to disproportionate amounts of air pollution, but also that many air pollution-related ailments are the exact ones that have been clinically proven to make COVID-19 more fatal. AV Whe UniWed SWaWeV diVcXVVeV ZhaW a ³neZ noUmal´ entails for healthcare practice and public health policy, this paper makes the case for why …

Operationalizing Culture: Refugees, Migration, And Mental Health In The Wake Of The Vietnam War, Helena Bui

The Yale Undergraduate Research Journal

!e end of the Vietnam War led to the migration of hundreds of thousands of Vietnamese refugees to the United States a"er political and economic upheaval. As another result, the refugees’ years of warfare, trauma, death, and injury began to manifest as unprecedented mental health issues that American physicians and researchers sought to understand. In this paper, I argue that American medical professionals— in good faith—operationalized [Vietnamese] culture to help themselves and their colleagues understand the mental health issues of Vietnamese refugees. Yet this operationalization acted as a double-edged sword. Viewing Western mental health discourse through the lens of Vietnamese …

Immunity As An Integral Aspect Of Tribal Sovereignty: An Analysis Of The Supreme Court Case Michigan V. Bay Mills Indian Community, Meghanlata Gupta

The Yale Undergraduate Research Journal

While Native nations in the United States have tribal sovereignty—that is, the inherent freedom and authority to govern themselves without outside control—non-Native actors have often challenged this institution within legal and political spaces. The United States court system, starting with the Marshall Court, has often attempted to define aspects of Indigenous sovereignty and federal-tribal relationships. The 2014 US Supreme Court case Michigan v. Bay Mills Indian Community is no exception, raising questions of sovereign immunity in the context of Indian gaming, tribal-state relationships, and land trusts. This paper first provides a general context for the case, identifying relevant historical events …

Rheumatic Heart Disease In The United States: Forgotten But Not Gone: Results Of A 10 Year Multicenter Review., Sarah R De Loizaga, Lindsay Arthur, Bhawna Arya, Brian Beckman, Wubishet Belay, Cole Brokamp, Nak Hyun Choi, Sean Connolly, Soham Dasgupta, Tavenner Dibert, Marylou M Dryer, Lakshmi R Gokanapudy Hahn, Elizabeth Anne Greene, Daphney Kernizan, Omar Khalid, Jennifer Klein, Ryan Kobayashi, Subhrajit Lahiri, Raymond P Lorenzoni, Andrea Otero Luna, Jennifer Marshall, Theodore Millette, Lily Moore, Babu Muhamed, Meghna Murali, Kinjal Parikh, Amy Sanyahumbi, Divya Shakti, Elizabeth Stein, Sanket Shah, Hannah Wilkins, Mcallister Windom, Scott Wirth, Meghan Zimmerman, Andrew F Beck, Nicholas Ollberding, Craig Sable, Andrea Beaton

Pediatrics Research and Scholarship

Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty-two US pediatric institutions participated in a 10-year review (2008-2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract-based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial antibiotic prescription according to community …

Rheumatic Heart Disease In The United States: Forgotten But Not Gone: Results Of A 10 Year Multicenter Review., Sarah R. De Loizaga, Lindsay Arthur, Bhawna Arya, Brian Beckman, Wubishet Belay, Cole Brokamp, Nak Hyun Choi, Sean Connolly, Soham Dasgupta, Tavenner Dibert, Marylou M. Dryer, Lakshmi R. Gokanapudy Hahn, Elizabeth Anne Greene, Daphney Kernizan, Omar Khalid, Jennifer Klein, Ryan Kobayashi, Subhrajit Lahiri, Raymond P. Lorenzoni, Andrea Otero Luna, Jennifer A. Marshall, Theodore Millette, Lily Moore, Babu Muhamed, Meghna Murali, Kinjal Parikh, Amy Sanyahumbi, Divya Shakti, Elizabeth Stein, Sanket Shah, Hannah Wilkins, Mcallister Windom, Scott Wirth, Meghan Zimmerman, Andrew F. Beck, Nicholas Ollberding, Craig Sable, Andrea Beaton

Manuscripts, Articles, Book Chapters and Other Papers

Background Recent evaluation of rheumatic heart disease (RHD) mortality demonstrates disproportionate disease burden within the United States. However, there are few contemporary data on US children living with acute rheumatic fever (ARF) and RHD. Methods and Results Twenty-two US pediatric institutions participated in a 10-year review (2008-2018) of electronic medical records and echocardiographic databases of children 4 to 17 years diagnosed with ARF/RHD to determine demographics, diagnosis, and management. Geocoding was used to determine a census tract-based socioeconomic deprivation index. Descriptive statistics of patient characteristics and regression analysis of RHD classification, disease severity, and initial antibiotic prescription according to community …

Favorable Outcomes With Reduced Steroid Use In Juvenile Dermatomyositis, Amir B Orandi, Lampros Fotis, Jamie Lai, Hallie Morris, Andrew J White, Anthony R French, Kevin W Baszis

2020-Current year OA Pubs

BACKGROUND: High-intensity glucocorticoid regimens are commonly used to induce and maintain remission in Juvenile Dermatomyositis but are associated with several adverse side-effects. Evidence-based treatment guidelines from North American and European pediatric rheumatology research societies both advocate induction with intravenous pulse steroids followed by high dose oral steroids (2 mg/kg/day), which are then tapered. This study reports the time to disease control with reduced glucocorticoid dosing.

METHODS: We retrospectively reviewed the records at a single tertiary-care children's hospital of patients diagnosed with Juvenile Dermatomyositis between 2000 and 2014 who had a minimum of 2 years of follow-up. The primary outcome measure …

Chagas Disease In Hiv-Infected Patients: It’S Time To Consider The Diagnosis, Melissa Nolan Ph.D., Mph, Natasha S. Hochberg

Faculty Publications

No abstract provided.

Temporal Trends Of Covid-19 Mortality And Hospitalisation Rates: An Observational Cohort Study From The Us Department Of Veterans Affairs, Miao Cai, Benjamin Bowe, Yan Xie, Ziyad Al-Aly

Open Access Publications

OBJECTIVES: To investigate the temporal trends of 30-day mortality and hospitalisation in US Veterans with COVID-19 and 30-day mortality in hospitalised veterans with COVID-19 and to decompose the contribution of changes in the underlying characteristics of affected populations to these temporal changes.

DESIGN: Observational cohort study.

SETTING: US Department of Veterans Affairs.

PARTICIPANTS: 49 238 US veterans with a positive COVID-19 test between 20 March 2020 and 19 September 2020; and 9428 US veterans hospitalised with a positive COVID-19 test during the same period.

OUTCOME MEASURES: 30-day mortality rate and hospitalisation rate.

RESULTS: Between 20 March 2020 and 19 September …

Digital Equity Is An Environmental Justice Issue, Courtney B. Cooper

Master's Projects and Capstones

Digital equity has evolved into a more critical area of focus due to the novel coronavirus (COVID-19) pandemic. The COVID-19 pandemic exacerbated the existing digital divide, or the divide that exists between those who have access to the internet and those that do not, by moving many important services and resources online to reduce the spread of the virus. This shift has created more challenges for communities who either lack or have inadequate access to the internet. Furthermore, it is likely that internet utilization will only increase as we continue to recognize its capabilities. A lack of or inadequate access …

Year 1 Of The Bundled Payments For Care Improvement-Advanced Model, Karen E Joynt Maddox, E John Orav, Jie Zheng, Arnold M Epstein

Open Access Publications

BACKGROUND: The Center for Medicare and Medicaid Innovation launched the Medicare Bundled Payments for Care Improvement-Advanced (BPCI-A) program for hospitals in October 2018. Information is needed about the effects of the program on health care utilization and Medicare payments.

METHODS: We conducted a modified segmented regression analysis using Medicare claims and including patients with discharge dates from January 2017 through September 2019 to assess differences between BPCI-A participants and two control groups: hospitals that never joined the BPCI-A program (nonjoining hospitals) and hospitals that joined the BPCI-A program in January 2020, after the conclusion of the intervention period (late-joining hospitals). …

Compounding Hazards And Intersecting Vulnerabilities: Experiences And Responses To Extreme Heat During Covid-19, Olga V. Wilhelmi, Peter D. Howe, Mary H. Hayden, Cassandra R. O'Lenick

Environment and Society Faculty Publications

Extreme heat is a major threat to human health worldwide. The COVID-19 pandemic, with its complexity and global reach, created unprecedented challenges for public health and highlighted societal vulnerability to hazardous hot weather. In this study, we used data from a three-wave nationally representative survey of 3036 American adults to examine how the COVID-19 pandemic affected extreme heat vulnerability during the summer of 2020. We used mixed effects models to examine the roles of socio-demographic characteristics and pandemic-related factors in the distribution of negative heat effects and experiences across the United States. The survey findings show that over a quarter …

Census Tract Patterns And Contextual Social Determinants Of Health Associated With Covid-19 In A Hispanic Population From South Texas: A Spatiotemporal Perspective, Cici Bauer, Kehe Zhang, Miryoung Lee, Susan Fisher-Hoch, Esmeralda Guajardo, Joseph Mccormick, Isela De La Cerda, Maria E Fernandez, Belinda Reininger

Faculty, Staff and Student Publications

BACKGROUND: Previous studies have shown that various social determinants of health (SDOH) may have contributed to the disparities in COVID-19 incidence and mortality among minorities and underserved populations at the county or zip code level.

OBJECTIVE: This analysis was carried out at a granular spatial resolution of census tracts to explore the spatial patterns and contextual SDOH associated with COVID-19 incidence from a Hispanic population mostly consisting of a Mexican American population living in Cameron County, Texas on the border of the United States and Mexico. We performed age-stratified analysis to identify different contributing SDOH and quantify their effects by …

Pulmonary Function Decline In Amyotrophic Lateral Sclerosis, Terry D. Heiman-Patterson, Ossama Khazaal, Daohai Yu, Michael E. Sherman, Edward J. Kasarskis, Carlayne E. Jackson, Peg Niv Study Group

Neurology Faculty Publications

Background: There has been no comprehensive longitudinal study of pulmonary functions (PFTS) in ALS determining which measure is most sensitive to declines in respiratory muscle strength. Objective: To determine the longitudinal decline of PFTS in ALS and which measure supports Medicare criteria for NIV initiation first. Methods: Serial PFTs (maximum voluntary ventilation (MVV), maximum inspiratory pressure measured by mouth (MIP) or nasal sniff pressure (SNIP), maximum expiratory pressure (MEP), and Forced Vital Capacity (FVC)) were performed over 12 months on 73 ALS subjects to determine which measure showed the sentinel decline in pulmonary function. The rate of decline for each …

The Age Presents Introduction To Geroscience Video Lecture Series., Alessandro Bitto, Mitchell B Lee, Cristal M Hill, Ron Korstanje, Matt Kaeberlein

Faculty Research 2021

The AGE Presents Introduction to Geroscience video lecture series is a collection of high-quality didactic video lectures and associated teaching materials focused on foundational topics in aging biology. The videos are made freely available on YouTube and are targeted toward an audience familiar with concepts learned in the first year of a college undergraduate biology/biomedical major. Members of the American Aging Association also receive the original lecture slides and lecture notes, with additional course materials to be developed in the future. We expect that these lectures will enhance understanding of geroscience among the general public while also providing tools that …

How The World's Largest Economies Regulate Data Privacy: Drawbacks, Benefits, & Proposed Solutions, Alexander J. Pantos

Indiana Journal of Global Legal Studies

National data privacy regimes are quickly gaining traction and ubiquity around the globe. Moving forward, countries will face a range of difficult decisions surrounding how best to engage internationally in cross border data flow, particularly in the context of personal information (PI).

This article takes a bird's-eye view of the current state of data privacy regimes in the world's four highest GDP regions. In part, this article hopes to provide a succinct analysis of these data privacy regimes, with a focus on the balance they strike between granting individuals rights in their data and placing responsibilities on businesses that deal …

Overcoming The Limitations Of 'Accident' As A Manner Of Death For Drug Overdose Mortality: Case For A Death Certificate Checkbox, Ian R H Rockett, Eric D. Caine, Hilary S. Connery, Kurt B. Nolte

Pathology Research and Scholarship

Collectively, the epidemic increases in the United States of opioid-related deaths and suicides during the first two decades of the 21st century have exposed shortcomings in current forensic and epidemiological approaches for determining and codifying manner of death-a vital function fulfilled by medical examiners, coroners and nosologists-the foundation for the National Violent Death Reporting System (NVDRS), an incident-based surveillance system providing individual-level information on decedent characteristics, manner, cause and circumstances of suicide, homicide and other violent injury deaths. Drug intoxication deaths are generally classified as 'accidents' or unintentional, a fundamental mischaracterisation; most arose from repetitive self-harm behaviours related to substance …

Judicial Biography In The British Empire, Victoria Barnes, Emily Whewell

Indiana Journal of Global Legal Studies

This article adds to the biographic ''turn" in legal studies. While there is a large body of scholarship examining judges in the United States and the United Kingdom, comparatively little is written on their legal counterparts in the common law world. What can judicial biographies offer for comparative law? Do these studies generate useful information about the movement of law? What can be gained by a better awareness of the lives of those at the top of the colonial legal profession? This article shows that within the common law world, judges, like those in the United States and the United …

Debt Expansion As "Relief And Rescue" At The Time Of The Covid-19 Pandemic: Insights From The Legal Theory Of Finance, Iris Hse-Yu Chiu, Andreas Kokkinis, Andrea Miglionico

Indiana Journal of Global Legal Studies

In Section II, we discuss the relief and rescue policies in the US, UK, and EU and show how they have been advanced by legal elasticity in suspensions from normal private and regulatory law. Crucially, such legal elasticity is intended to facilitate an increased debt burden for corporations and households as a means of relief and rescue. We argue that this policy choice, which is startlingly similar in these developed jurisdictions, has been influenced by the contexts of financialization in these jurisdictions and the perception of temporary duration by policy makers. However, there is a need to critically interrogate the …

Us-China Transnational Law In A Time Of Trade Crisis, Carrie Shang

Indiana Journal of Global Legal Studies

Growing transnational business activities have resulted in more rapid transnationalization of American laws. In an era of deglobalization, the way the Trump administration moved away from multilateralism has both gravely impacted international law ordering and triggered responsive (or adaptive) law-making in some of the United States' major trade partners, in particular, China. The recently concluded US-China Trade War has driven up the speed of transnational norm-making and hastened incorporation of American legal principles into Chinese domestic laws. As diplomatic tension between the United States and China intensify, Chinese companies are increasingly becoming targets of sanctions and regulatory enforcement actions led …

Zero Sympathy: Unaccompanied Minors' Rights In The Us Immigration System, Mahrukh Ali

Indiana Journal of Global Legal Studies

This note analyzes the US Government's approach to unaccompanied minors and the webs they must navigate when they are apprehended by the US immigration system. More importantly, this note calls for reformative approaches to children's rights through acknowledging the differences between adults and children while simultaneously taking their vulnerability and autonomy into account. After explaining the migrant crisis along with its implications and examining the underlying reasons fostering this movement, this note discusses the legal options available for unaccompanied minors. It draws on the shortcomings of the immigration system as the system labels unaccompanied minors as dependent children, but also …

Calling The Shots: Balancing Parental And Child Rights In The Age Of Anti-Vax, Mahrukh Badar

Indiana Journal of Global Legal Studies

Vaccinations have become a contentious issue in recent times. Although there has always been opposition to vaccines, the internet has made it possible for pseudoscience and false information to spread like never before. This has led to alarming declines in vaccine confidence and adherence rates globally. High-income countries have seen the sharpest drop in vaccine confidence rates. Factors such as the complacency effect and religious objections likely explain this decline. Most countries have attempted to raise vaccine confidence levels by enacting laws that make vaccinations for children compulsory, with strict penalties for parents who refuse to comply. In addition to …

One Child Town: The Health Care Exceptionalism Case Against Agglomeration Economies, Elizabeth Weeks

Utah Law Review

This Article offers an extended rebuttal to the suggestion to move residents away from dying communities to places with greater economic promise. Rural America, arguably, is one of those dying places. A host of strategies aim to shore up those communities and make them more economically viable. But one might ask, “Why bother?” In a similar vein, David Schleicher’s provocative 2017 Yale Law Journal article, Stuck! The Law and Economics of Residential Stagnation, recommended dismantling a host of state and local government laws that operate as barriers to migration by Americans from failing economies to robust agglomeration economies. But Schleicher …

Guidance Note For Fund Staff On The Treatment And Use Of Sdr Allocations, International Monetary Fund (Imf)

Documents

No abstract provided.

Musculoskeletal Injuries In Us Air Force Security Forces, January 2009 To December 2018, Julia N Sundstrom, Bryant J Webber, George L Delclos, John R Herbold, David Gimeno Ruiz De Porras

Faculty, Staff and Student Publications

OBJECTIVE: to determine the incidence, types, and risk factors of musculoskeletal injuries in a military security forces population.

METHODS: Demographic and diagnostic data were retrieved on enlisted US Air Force security forces personnel who served on active duty between January 2009 and December 2018. Incidence rates and ratios were calculated using Poisson regression.

RESULTS: During 251,787 person-years of exposure, 62,489 personnel served on active duty. Of these, 40,771 (65.2%) were diagnosed with at least one musculoskeletal injury. The majority (60.1%) of the 164,078 unique musculoskeletal injuries were inflammation and pain secondary to overuse. After adjusting for other factors, women had …

Nurses' Pandemic Lives: A Mixed-Methods Study Of Experiences During Covid-19., Kathleen Gray, Paulette Dorney, Lori Hoffman, Albert Crawford

College of Nursing Faculty Papers & Presentations

BACKGROUND: The US healthcare settings and staff have been stretched to capacity by the COVID-19 pandemic. While COVID-19 continues to threaten global healthcare delivery systems and populations, its impact on nursing has been profound.

OBJECTIVES: This study aimed to document nurses' immediate reactions, major stressors, effective measures to reduce stress, coping strategies, and motivators as they provided care during COVID-19.

DESIGN: Mixed-methods, cross sectional design. Participants responded to objective and open-ended questions on the COVID-19 Nurses' Survey.

PARTICIPANTS: The survey, was sent to nurses employed in health care settings during the pandemic; 110 nurses participated.

RESULTS: Immediate reactions of respondents …

Progress Towards Antibiotic Use Targets In Eight High-Income Countries, Bryony Simmons, Koya Ariyoshi, Norio Ohmagari, Celine Pulcini, Benedikt Huttner, Sumanth Gandra, Giovanni Satta, Lorenzo Moja, Michael Sharland, Nicola Magrini, Marisa Miraldo, Graham Cooke

2020-Current year OA Pubs

OBJECTIVE: To compare antibiotic sales in eight high-income countries using the 2019 World Health Organization (WHO) Access, Watch and Reserve (AWaRe) classification and the target of 60% consumption of Access category antibiotics.

METHODS: We analysed data from a commercial database of sales of systemic antibiotics in France, Germany, Italy, Japan, Spain, Switzerland, United Kingdom of Great Britain and Northern Ireland, and United States of America over the years 2013-2018. We classified antibiotics according to the 2019 AWaRe categories: Access, Watch, Reserve and Not Recommended. We measured antibiotic sales per capita in standard units (SU) per capita and calculated Access group …