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Successfully educating urgent care patients on appropriate use and risks of antibiotics can be challenging. We assessed the conscious and subconscious impact various educational materials (informational handout, priming poster, and commitment poster) had on urgent care patients’ knowledge and expectations regarding antibiotics.
Design:
Stratified Block Randomized Control Trial.
Setting:
Urgent care centers (UCCs) in Colorado, Florida, Georgia, and New Jersey.
Participants:
Urgent care patients.
Methods:
We randomized 29 UCCs across six study arms to display specific educational materials (informational handout, priming poster, and commitment poster). The primary intention-to-treat (ITT) analysis evaluated whether the materials impacted patient knowledge or expectations of antibiotic prescribing by assigned study arm. The secondary as-treated analysis evaluated the same outcome comparing patients who recalled seeing the assigned educational material and patients who either did not recall seeing an assigned material or were in the control arm.
Results:
Twenty-seven centers returned 2,919 questionnaires across six study arms. Only 27.2% of participants in the intervention arms recalled seeing any educational materials. In our primary ITT analysis, no difference in knowledge or expectations of antibiotic prescribing was noted between groups. However, in the as-treated analysis, the handout and commitment poster were associated with higher antibiotic knowledge scores.
Conclusions:
Educational materials in UCCs are associated with increased antibiotic-related knowledge among patients when they are seen and recalled; however, most patients do not recall passively displayed materials. More emphasis should be placed on creating and drawing attention to memorable patient educational materials.
This article uses a prosopographical methodology and new dataset of 1,558 CEOs from Britain’s largest public companies between 1900 and 2009 to analyze how the role, social background, and career pathways of corporate leaders changed. We have four main findings. First, the designation of CEO only prevailed in the 1990s. Second, the proportion of socially elite CEOs was highest before 1940, but they were not dominant. Third, most CEOs did not have a degree before the 1980s, or professional qualification until the 1990s. Fourth, liberal market reforms in the 1980s were associated with an increase in the likelihood of CEO dismissal by a factor of three.
To determine whether removal of default duration, embedded in electronic prescription (e-script), influenced antibiotic days of therapy.
Design:
Interrupted time-series analysis.
Setting:
The study was conducted across 2 community hospitals, 1 academic hospital, 3 emergency departments, and 86 ambulatory clinics.
Patients:
Adults prescribed a fluoroquinolone with a duration <31 days.
Interventions:
Removal of standard 10-day fluoroquinolone default duration and addition of literature-based duration guidance in the order entry on December 19, 2017. The study period included data for 12 months before and after the intervention.
Results:
The study included 35,609 fluoroquinolone e-scripts from the preintervention period and 31,303 fluoroquinolone e-scripts from the postintervention period, accounting for 520,388 cumulative fluoroquinolone DOT. Mean durations before and after the intervention were 7.8 (SD, 4.3) and 7.7 (SD, 4.5), a nonsignificant change. E-scripts with a 10-day duration decreased prior to and after the default removal. The inpatient setting showed a significant 8% drop in 10-day e-scripts after default removal and a reduced median duration by 1 day; 10-day scripts declined nonsignificantly in ED and ambulatory settings. In the ambulatory settings, both 7- and 14-day e-script durations increased after default removal.
Conclusion:
Removal of default 10-day antibiotic durations did not affect overall mean duration but did shift patterns in prescribing, depending on practice setting. Stewardship interventions must be studied in the context of practice setting. Ambulatory stewardship efforts separate from inpatient programs are needed because interventions cannot be assumed to have similar effects.
We studied how patient beliefs regarding the need for antibiotics, as measured by expectation scores, and antibiotic prescribing outcome affect patient satisfaction using data from 2,710 urgent-care visits. Satisfaction was affected by antibiotic prescribing among patients with medium–high expectation scores but not among patients with low expectation scores.
Mixed flora in urine cultures usually occur due to preanalytic contamination. In our outpatient urology clinic, we detected a high prevalence of mixed flora (46.2%), which was associated with female sex and older age. Patient education did not influence the rate of mixed flora. Future efforts should target high-risk patients.
This study aimed to explore effects of adjunctive minocycline treatment on inflammatory and neurogenesis markers in major depressive disorder (MDD). Serum samples were collected from a randomised, placebo-controlled 12-week clinical trial of minocycline (200 mg/day, added to treatment as usual) for adults (n = 71) experiencing MDD to determine changes in interleukin-6 (IL-6), lipopolysaccharide binding protein (LBP) and brain derived neurotrophic factor (BDNF). General Estimate Equation modelling explored moderation effects of baseline markers and exploratory analyses investigated associations between markers and clinical outcomes. There was no difference between adjunctive minocycline or placebo groups at baseline or week 12 in the levels of IL-6 (week 12; placebo 2.06 ± 1.35 pg/ml; minocycline 1.77 ± 0.79 pg/ml; p = 0.317), LBP (week 12; placebo 3.74 ± 0.95 µg/ml; minocycline 3.93 ± 1.33 µg/ml; p = 0.525) or BDNF (week 12; placebo 24.28 ± 6.69 ng/ml; minocycline 26.56 ± 5.45 ng/ml; p = 0.161). Higher IL-6 levels at baseline were a predictor of greater clinical improvement. Exploratory analyses suggested that the change in IL-6 levels were significantly associated with anxiety symptoms (HAMA; p = 0.021) and quality of life (Q-LES-Q-SF; p = 0.023) scale scores. No other clinical outcomes were shown to have this mediation effect, nor did the other markers (LBP or BDNF) moderate clinical outcomes. There were no overall changes in IL-6, LBP or BDNF following adjunctive minocycline treatment. Exploratory analyses suggest a potential role of IL-6 on mediating anxiety symptoms with MDD. Future trials may consider enrichment of recruitment by identifying several markers or a panel of factors to better represent an inflammatory phenotype in MDD with larger sample size.
Approximately, 1.7 million individuals in the United States have been infected with SARS-CoV-2, the virus responsible for the novel coronavirus disease-2019 (COVID-19). This has disproportionately impacted adults, but many children have been infected and hospitalised as well. To date, there is not much information published addressing the cardiac workup and monitoring of children with COVID-19. Here, we share the approach to the cardiac workup and monitoring utilised at a large congenital heart centre in New York City, the epicentre of the COVID-19 pandemic in the United States.
Historians have used a number of political, social, and other factors to explain the controversy surrounding elementary education in Victorian Britain. This article underscores the importance of religious motivations. The Act of 1870 – a significant extension of state responsibility – did not end debates about the purpose of education and the pros and cons of government involvement and religious instruction. Prominent among voluntaryists and anti-secularists was A. J. Beresford Hope, whose position offers useful insights into the educational agencies of the Church and the manner in which churchmen responded to new circumstances. This article explains Hope’s attitude and uses it to explore some of the causes and consequences of the Act of 1870. What type of schooling best suited the British people? Should it have a basis in something other than religion? How could the Church and its supporters meet the challenges posed by education reform?
This study evaluated in a rigorous 18-month randomized controlled trial the efficacy of an enhanced vocational intervention for helping individuals with a recent first schizophrenia episode to return to and remain in competitive work or regular schooling.
Methods
Individual Placement and Support (IPS) was adapted to meet the goals of individuals whose goals might involve either employment or schooling. IPS was combined with a Workplace Fundamentals Module (WFM) for an enhanced, outpatient, vocational intervention. Random assignment to the enhanced integrated rehabilitation program (N = 46) was contrasted with equally intensive clinical treatment at UCLA, including social skills training groups, and conventional vocational rehabilitation by state agencies (N = 23). All patients were provided case management and psychiatric services by the same clinical team and received oral atypical antipsychotic medication.
Results
The IPS–WFM combination led to 83% of patients participating in competitive employment or school in the first 6 months of intensive treatment, compared with 41% in the comparison group (p < 0.005). During the subsequent year, IPS–WFM continued to yield higher rates of schooling/employment (92% v. 60%, p < 0.03). Cumulative number of weeks of schooling and/or employment was also substantially greater with the IPS–WFM intervention (45 v. 26 weeks, p < 0.004).
Conclusions
The results clearly support the efficacy of an enhanced intervention focused on recovery of participation in normative work and school settings in the initial phase of schizophrenia, suggesting potential for prevention of disability.
Interstate rights-of-way may serve as weed host reservoirs for the tarnished plant bug, an insect pest of cotton. Management of these rights-of-way may have an impact upon cotton pest management. In a 3-yr study, time of mowing, frequency of mowing, and sulfometuron methyl applied against overwintering rosettes influenced the cover of annual fleabane and wild carrot, which harbor tarnished plant bugs.
Yellow starthistle is an annual that is dependent on achene production, dispersal, and germination for stand renewal. Our purpose in this study was to determine the temperature relations for germination of achenes of this species. Germination temperature profiles were developed for achenes of yellow starthistle collected from 15 sites in California, Nevada, and Oregon. Each profile consisted of achene germination at 55 constant or alternating temperatures from 0 through 40 C. A total of 85 germination temperature profiles were developed by using the germination data to construct quadratic response surfaces through regression analysis. For most profiles, germination occurred at all the temperature regimes except a constant 40 C. This includes a constant 0 C and 0 alternating with 40 C. Rarely, there was no germination at 35 C and 35 C alternating with 40 C. The only evidence of afterripening requirements for achenes of yellow starthistle that we noted occurred at very cold temperature regimes. At those temperatures, the germination of dark-colored achenes without pappus increased 3 mo after harvest, and decreased for light-colored achenes with a pappus. No single temperature regime always supported optimum germination when all the profiles were combined. The most frequent optima was 2/20 C. Comparing all profiles for the Davis, CA, accession, there were 5 regimes (5 and 10 C cold periods alternating with 15 through 25 C warm periods) that always supported optimum germination. Light-colored achenes with pappus tended to have optimal germination at colder temperatures, and the dark-colored achenes at higher temperatures when seeds were tested immediately after harvest.
The last interglacial, commonly understood as an interval with climate as warm or warmer than today, is represented by marine isotope stage (MIS) 5e, which is a proxy record of low global ice volume and high sea level. It is arbitrarily dated to begin at approximately 130,000 yr B.P. and end at 116,000 yr B.P. with the onset of the early glacial unit MIS 5d. The age of the stage is determined by correlation to uranium–thorium dates of raised coral reefs. The most detailed proxy record of interglacial climate is found in the Vostok ice core where the temperature reached current levels 132,000 yr ago and continued rising for another two millennia. Approximately 127,000 yr ago the Eemian mixed forests were established in Europe. They developed through a characteristic succession of tree species, probably surviving well into the early glacial stage in southern parts of Europe. After ca. 115,000 yr ago, open vegetation replaced forests in northwestern Europe and the proportion of conifers increased significantly farther south. Air temperature at Vostok dropped sharply. Pulses of cold water affected the northern North Atlantic already in late MIS 5e, but the central North Atlantic remained warm throughout most of MIS 5d. Model results show that the sea surface in the eastern tropical Pacific warmed when the ice grew and sea level dropped. The essentially interglacial conditions in southwestern Europe remained unaffected by ice buildup until late MIS 5d when the forests disappeared abruptly and cold water invaded the central North Atlantic ca. 107,000 yr ago.
Tall ironweed is a troublesome perennial weed that infests cool-season grass pastures in Kentucky. Field experiments were conducted in 2000 through 2003 to evaluate the efficacy of fall-applied herbicides on established tall ironweed following a midsummer mowing. Triclopyr-containing treatments showed the greatest suppression of tall ironweed 12 mo after treatment (MAT), across all years. With triclopyr at 0.56 and 0.63 kg/ha, tall ironweed control was 80% or greater in 2 of the 3 yr. Dicamba initially provided 87% control 8 MAT in 2 of 3 yr and declined to less than 60% 12 MAT. Tall ironweed shoot density was also reduced 66% or more 12 MAT with fall-applied triclopyr-containing treatments. In contrast, tall ironweed density increased approximately twofold in dicamba-treated plots between 8 to 12 MAT in all 3 yr. The impact of herbicide treatment on dry matter (DM) yield of spring-seeded red clover (Trifolium pratense L.), tall ironweed, and forage grasses was also evaluated. Red clover DM yield in the herbicide-treated plots in 2002 showed no significant differences from the untreated control. However, red clover DM yield in 2003 was lowest for the two triclopyr + clopyralid treatments, indicating a decrease in DM production compared with that of the nontreated control. Results indicated that fall-applied triclopyr-containing herbicides following a midsummer mowing is an effective program for removing tall ironweed from grass pastures, but further research is needed to evaluate the establishment of red clover following herbicide treatment.
Objectives: Good glycemic control is an important goal of diabetes management. Late adolescents with type 1 diabetes (T1D) are at risk for poor glycemic control as they move into young adulthood. For a subset of these patients, this dysregulation is extreme, placing them at risk for life-threatening health complications and permanent cognitive declines. The present study examined whether deficiency in emotional decision making (as measured by the Iowa Gambling Task; IGT) among teens with T1D may represent a neurocognitive risk factor for subsequent glycemic dysregulation. Methods: As part of a larger longitudinal study, a total of 241 high-school seniors (147 females, 94 males) diagnosed with T1D underwent baseline assessment that included the IGT. Glycated hemoglobin (HbA1c), which reflects glycemic control over the course of the past 2 to 3 months, was also assessed at baseline. Of the 241,189 (127 females, 62 males, mean age=17.76, mean HbA1c=8.11) completed HbA1c measurement 1 year later. Results: Baseline IGT performance in the impaired range (per norms) was associated with greater dysregulation in glycemic control 1 year later, as evidenced by an average increase in HbA1c of 2%. Those with normal IGT scores (per norms) exhibited a more moderate increase in glycemic control, with an HbA1c increase of 0.7%. Several IGT scoring approaches were compared, showing that the total scores collapsed across all trials was most sensitive to change in glycemic control. Conclusions: IGT assessment offers promise as a tool for identifying late adolescents at increased risk for glycemic dysregulation. (JINS, 2017, 23, 204–213)
To provide accurate estimates of the commencement time, duration and dosage of folic acid (FA) supplementation taken by Irish women in the periconceptional period. The study also aimed to establish the factors associated with optimal FA supplementation practices.
Design
Cross-sectional observational study. Women’s clinical and sociodemographic details were computerised. Maternal weight and height were measured before calculating BMI. Detailed FA supplementation questionnaires were completed under the supervision of a trained researcher.
Setting
A large university maternity hospital, Republic of Ireland, January 2014–April 2016.
Subjects
Women (n 856) recruited at their convenience in the first trimester.
Results
While almost all of the women (97 %) were taking FA at enrolment, only one in four women took FA for at least 12 weeks preconceptionally (n 208). Among the 44 % of women who were supplementing with FA preconceptionally, 44 % (162/370) reported taking FA for less than the 12 weeks required to achieve optimal red-blood-cell folate levels for prevention of neural tube defects. On multivariate analysis, only planned pregnancy and nulliparity were associated with taking FA for at least 12 weeks preconceptionally. Among women who only took FA postconceptionally, almost two-thirds commenced it after day 28 of their pregnancy when the neural tube had already closed.
Conclusions
As the timing of FA was suboptimal both before and after conception, we recommend that current national FA guidelines need to be reviewed.
Objectives: Treatments for childhood brain tumors (BT) confer substantial risks to neurological development and contribute to neuropsychological deficits in young adulthood. Evidence suggests that individuals who experience more significant neurological insult may lack insight into their neurocognitive limitations. The present study compared survivor, mother, and performance-based estimates of executive functioning (EF), and their associations with treatment intensity history in a subsample of young adult survivors of childhood BTs. Methods: Thirty-four survivors (52.9% female), aged 18 to 30 years (M=23.5; SD=3.4), 16.1 years post-diagnosis (SD=5.9), were administered self-report and performance-based EF measures. Mothers also rated survivor EF skills. Survivors were classified by treatment intensity history into Minimal, Average/Moderate, or Intensive/Most-Intensive groups. Discrepancies among survivor, mother, and performance-based EF estimates were compared. Results: Survivor-reported and performance-based measures were not correlated, although significant associations were found between mother-reported and performance measures. Survivors in the Intensive/Most-Intensive treatment group evidenced the greatest score discrepancies, reporting less executive dysfunction relative to mother-reported F(2,31)=7.81, p<.01, and performance-based measures F(14,50)=2.54, p<.05. Conversely, survivors in the Minimal treatment group reported greater EF difficulties relative to mothers t(8)=2.82, p<.05, but not performance-based estimates (ps>.05). Conclusions: There may be a lack of agreement among survivor, mother, and performance-based estimates of EF skills in young adult survivors of childhood BT, and these discrepancies may be associated with treatment intensity history. Neuropsychologists should use a multi-method, multi-reporter approach to assessment of EF in this population. Providers also should be aware of these discrepancies as they may be a barrier to intervention efforts. (JINS, 2016, 22, 900–910)