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More than 80% of antibiotics are prescribed in the outpatient setting, of which 30% are inappropriate. The National Action Plan for Combating Antimicrobial Resistance called for a 50% decrease in outpatient antibiotic use by 2020. Inappropriate antibiotics are associated with adverse reactions and Clostridioides difficile infection, especially among older adults.
Before and after study.
We performed a quality improvement initiative at the University of Colorado Seniors Clinic. Providers received education on antibiotic guidelines, electronic antibiotic order sets were introduced with standardized stop dates. Antibiotic use data were collected for 6 months before and 6 months after the intervention, from December to May to avoid seasonal variation. Descriptive statistics and linear mixed-effects regression models were used for this comparison.
Total antibiotic prescriptions for acute respiratory conditions decreased from 137 prescriptions before the intervention (December 1, 2017, to May 31, 2018) to 112 prescriptions after the intervention (December 1, 2018, to May 31, 2019), driven primarily by decreases in antibiotic prescriptions for pneumonia, sinusitis, and bronchitis. Prescriptions for broad-spectrum antibiotics declined following the intervention including decreases in levofloxacin from 12 (9%) to 3 (3%) and amoxicillin-clavulanate from 15 (12%) to 7 (7%). We detected significant reductions in prescribed antibiotic durations (days) after the intervention for sinusitis (estimate, −2.0; 95% CI, −3.1 to −1.0; P = .0003), pharyngitis (estimate, −2.5; 95% CI, −4.6 to −0.5; P = .018), and otitis (−3.2; 95% CI, −5.2 to −1.3; P = .008).
Low-cost interventions were initially successful in changing patterns of antibiotic use and decreasing overall antibiotic prescribing among older patients in the outpatient setting. Long-term follow-up studies are needed to determine the sustainability and clinical impact of these interventions.
To examine awareness and recall of healthy eating public education campaigns in five countries.
Data were cross-sectional and collected as part of the 2018 International Food Policy Study. Respondents were asked whether they had seen government healthy eating campaigns in the past year; if yes (awareness), they were asked to describe the campaign. Open-ended descriptions were coded to indicate recall of specific campaigns. Logistic models regressed awareness of healthy eating campaigns on participant country, age, sex, ethnicity, education, income adequacy and BMI. Analyses were also stratified by country.
Participants were Nielsen panelists aged ≥18 years in Australia, Canada, Mexico, UK and the USA (n 22 463).
Odds of campaign awareness were higher in Mexico (50·9 %) than UK (18·2 %), Australia (17·9 %), the USA (13·0 %) and Canada (10·2 %) (P < 0·001). Awareness was also higher in UK and Australia v. Canada and the USA, and the USA v. Canada (P < 0·001). Overall, awareness was higher among males v. females and respondents with medium or high v. low education (P < 0·001 for all). Similar results were found in stratified models, although no sex difference was observed in Australia or UK (P > 0·05), and age was associated with campaign awareness in UK (P < 0·001). Common keywords in all countries included sugar/sugary drinks, fruits and vegetables, and physical activity. The top five campaigns recalled were Chécate, mídete, muévete (Mexico), PrevenIMSS (Mexico), Change4Life (UK), LiveLighter® (Australia), and Actívate, Vive Mejor (Mexico).
In Mexico, UK and Australia, comprehensive campaigns to promote healthy lifestyles appear to have achieved broad, population-level reach.
Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.
A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.
Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).
Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
OBJECTIVES/GOALS: Lung transplant (LTx) candidates benefit from use of non-ideal donor organs. Each organ procurement organization (OPO) defines “acceptable” donor organs introducing unmeasured variation in donor pursuit. We characterized non-ideal donor pursuit among OPOs to identify drivers of risk aversion in LTx. METHODS/STUDY POPULATION: We queried the UNOS registry for adult donors who donated ≥1 organ for transplantation from 12/2007-12/2018. Non-ideal donors were those with any of age>50, smoking history ≥20 pack-years, PaO2/FiO2 (P/F) ratio<350, donation after cardiac death (DCD) status, or CDC increased risk (IRD) status. Non-ideal donor pursuit rate was defined as the proportion of non-ideal donors at each OPO from whom consent for lung donation was requested with lower numbers indicating increased risk aversion. We estimated the correlation between non-ideal and overall donor pursuit using a Spearman correlation coefficient. Adjusted non-ideal donor pursuit rates were estimated using multivariable logistic regression. RESULTS/ANTICIPATED RESULTS: Overall, 18,333 deceased donors were included and classified as ideal or non-ideal. Among 58 OPOs, rates of non-ideal donor pursuit ranged from 0.24-1.00 Figure). Of 5 non-ideal characteristics, DCD and IRD status were associated with the most and least risk aversion, respectively. Non-ideal donor pursuit was strongly correlated with overall donor pursuit (r = 0.99). On adjusted analysis, older age (OR 0.15, 95% CI 0.13-0.16), smoking history (OR 0.38, 95% CI 0.34-0.44), low P/F ratio (OR 0.12, 95% CI 0.11-0.14), and DCD status (OR 0.04, 95% CI 0.03-0.04) were all independently associated with significant risk aversion, corresponding to decreased rates of donor pursuit. DISCUSSION/SIGNIFICANCE OF IMPACT: OPOs differ in their levels of risk aversion in LTx and risk aversion is not uniform across selected categories of non-ideal lung donor. Consideration of new OPO performance metrics that encourage the pursuit of non-ideal lung donors is warranted.
There is a growing body of evidence highlighting the presence of a single general dimension of psychopathology that can account for multiple associations across mental and substance use disorders. However, relatively little evidence has emerged regarding the validity of this model with respect to a range of factors that have been previously implicated across multiple disorders. The current study utilized a cross-sectional population survey of adolescents (n = 2,003) to examine the extent to which broad psychopathology factors account for specific associations between psychopathology and key validators: poor sleep, self-harm, suicidality, risky sexual behavior, and low self-esteem. Confirmatory factor models, latent class models, and factor mixture models were estimated to identify the best structure of psychopathology. Structural equation models were then estimated to examine the broad and specific associations between each psychopathology indicator and the validators. A confirmatory factor model with three lower-order factors, representing internalizing, externalizing, and psychotic-like experiences, and a single higher-order factor evidenced the best fit. The associations between manifest indicators of psychopathology and validators were largely nonspecific. However, significant and large direct effects were found between several pairwise associations. These findings have implications for the identification of potential targets for intervention and/or tailoring of prevention programs.
Special educator attrition is a major problem in the United States (US) and in many countries worldwide. In the present study, we investigated the experiences of 5 highly successful special education teachers serving students with autism spectrum disorder in the central Florida area of the US with particular attention to factors associated with teacher retention. A phenomenological research design was employed to identify factors leading participants to persevere where others have not. A representative sample was included of multiple teachers in classrooms of varying grade levels and school districts across central Florida as part of a funded project by the Office of Special Education Services and the U.S. Department of Education. Findings include that teachers of students with ASD who are involved in extracurricular activities may show a lowered burnout rate.
The paper analyses the policy process which enabled the successful adoption of Australia's National Aboriginal and Torres Strait Islander Health Plan 2013–2023 (NATSIHP), which is grounded in an understanding of the Social Determinants of Indigenous Health (SDIH). Ten interviews were conducted with key policy actors directly involved in its development. The theories we used to analyse qualitative data were the Advocacy Coalition Framework, the Multiple Streams Approach, policy framing and critical constructionism. We used a complementary approach to policy analysis. The NATSIHP acknowledges the importance of Aboriginal and Torres Strait Islander (hereafter, Aboriginal) culture and the health effects of racism, and explicitly adopts a human-rights-based approach. This was enabled by a coalition campaigning to ‘Close the Gap’ (CTG) in health status between Aboriginal and non-Aboriginal Australians. The CTG campaign, and key Aboriginal health networks associated with it, operated as an effective advocacy coalition, and policy entrepreneurs emerged to lead the policy agenda. Thus, Aboriginal health networks were able to successfully contest conventional problem conceptions and policy framings offered by government policy actors and drive a paradigm shift for Aboriginal health to place SDIH at the centre of the NATSIHP policy. Implications of this research for policy theory and for other policy environments are considered along with suggestions for future research.
OBJECTIVES/SPECIFIC AIMS: To create a searchable public registry of all Quality Improvement (QI) projects. To incentivize the medical professionals at UF Health to initiate quality improvement projects by reducing startup burden and providing a path to publishing results. To reduce the review effort performed by the internal review board on projects that are quality improvement Versus research. To foster publication of completed quality improvement projects. To assist the UF Health Sebastian Ferrero Office of Clinical Quality & Patient Safety in managing quality improvement across the hospital system. METHODS/STUDY POPULATION: This project used a variant of the spiral software development model and principles from the ADDIE instructional design process for the creation of a registry that is web based. To understand the current registration process and management of quality projects in the UF Health system a needs assessment was performed with the UF Health Sebastian Ferrero Office of Clinical Quality & Patient Safety to gather project requirements. Biweekly meetings were held between the Quality Improvement office and the Clinical and Translational Science – Informatics and Technology teams during the entire project. Our primary goal was to collect just enough information to answer the basic questions of who is doing which QI project, what department are they from, what are the most basic details about the type of project and who is involved. We also wanted to create incentive in the user group to try to find an existing project to join or to commit the details of their proposed new project to a data registry for others to find to reduce the amount of duplicate QI projects. We created a series of design templates for further customization and feature discovery. We then proceed with the development of the registry using a Python web development framework called Django, which is a technology that powers Pinterest and the Washington Post Web sites. The application is broken down into 2 main components (i) data input, where information is collected from clinical staff, Nurses, Pharmacists, Residents, and Doctors on what quality improvement projects they intend to complete and (ii) project registry, where completed or “registered” projects can be viewed and searched publicly. The registry consists of a quality investigator profile that lists contact information, expertise, and areas of interest. A dashboard allows for the creation and review of quality improvement projects. A search function enables certain quality project details to be publicly accessible to encourage collaboration. We developed the Registry Matching Algorithm which is based on the Jaccard similarity coefficient that uses quality project features to find similar quality projects. The algorithm allows for quality investigators to find existing or previous quality improvement projects to encourage collaboration and to reduce repeat projects. We also developed the QIPR Approver Algorithm that guides the investigator through a series of questions that allows an appropriate quality project to get approved to start without the need for human intervention. RESULTS/ANTICIPATED RESULTS: A product of this project is an open source software package that is freely available on GitHub for distribution to other health systems under the Apache 2.0 open source license. Adoption of the Quality Improvement Project Registry and promotion of it to the intended audience are important factors for the success of this registry. Thanks goes to the UW-Madison and their QI/Program Evaluation Self-Certification Tool (https://uwmadison.co1.qualtrics.com/SE/?SID=SV_3lVeNuKe8FhKc73) used as example and inspiration for this project. DISCUSSION/SIGNIFICANCE OF IMPACT: This registry was created to help understand the impact of improved management of quality projects in a hospital system. The ultimate result will be to reduce time to approve quality improvement projects, increase collaboration across the UF Health Hospital system, reduce redundancy of quality improvement projects and translate more projects into publications.
Photogrammetry provides an accessible, cost-effective means of creating a
high-resolution, digital 3D record of archaeological artefacts. The
methodology has been widely adopted, but a number of issues remain,
especially in relation to model variability, and to misalignments that
result in gaps in the models generated. Two new approaches are presented
here that have been shown to increase standardisation during data capture
and processing routines. This ensures that models are seamless and
Adieu to Albums – for a great while, I said when I came here, and had not been fixed two days but my Landlord's daughter … requested me to write in her female friend's, and in her own; if I go to — thou art there also, O all pervading album! All over the Leeward Islands, in Newfoundland, and the Back Settlements, I understand there is no other reading. They haunt me.
Writing to Bernard Barton late in 1827, after a modest relocation from suburban Islington to comparatively rustic Enfield, Charles Lamb jokingly associates his decision to flee literary London with the nuisance of being solicited for poems for albums; but albums were at the peak of their popularity in the late 1820s, and there is no escape even in Enfield. Lamb presents this cultural ubiquity in geographical terms, through a catalogue of remote locations: a Caribbean island group, the extreme northeast coast of Canada and the American Back Settlements. Chosen because they are both names of specific places and symbolically resonant (for Lamb) of the furthest reaches of civilization, the locations simultaneously figure the album as a symbol of culture and of cultural debasement, since it constitutes ‘literature’ in comparatively uncultivated settlements. More than a year later Lamb repeats the story of his failed flight from ‘Albumean persecution’ in a letter to Bryan Waller Procter, claiming that ‘If I take the wings of the morning and fly unto the uttermost parts of the earth, there will Albums be.
Entry into graduate programmes is highly competitive. Although careers advisors working within higher education do their best to prepare students for engagement with these programmes; anecdotal reports suggest many graduates remain unsure what it is these employers are seeking, and how it is assessed. Our study examines both selection criteria profiles and practices, drawing comprehensive data from 20 New Zealand firms and finds that regardless of a firm's characteristics, most seek a very similar graduate profile, with the concepts of candidate ‘well roundedness’ and ‘fit’ considered most vital. Selection practices employed are tightly connected to this graduate profile. These findings shed some much needed light for graduates on what is, but also what is not, highly sought after by employers in the recruitment and selection process. They should also be of benefit to universities by assisting them to better prepare their graduates for successful transition into the employment market.
FracTracker is a participatory geographic information system (PGIS) and website that was designed to address concerns surrounding the process of unconventional natural gas development (UNGD) by enabling registered users to make visual connections by using raw data and mapping technologies. An electronic survey (n = 147) and case studies (n = 3) of registered users were conducted in 2011–12 to better understand FracTracker's usage, outcomes, and barriers. Results indicate that PGISs like FracTracker, while difficult for some users to operate, can effectively provide information about UNGD to engaged nonexperts—or regular users. User contributions via volunteered geographic information or crowdsourcing remain limited on FracTracker, but are a barrier that could be overcome with targeted training, by facilitation of a user intermediary, and by diversifying site features. Future PGIS research should assess individuals' concept of space, investigate the interaction between PGIS and digital discourse, and search for the proper balance between the system's technological capacities and ease of use.
This study examined seed ultrastructure in relation to germination of North American dandelion seeds. Based on laboratory rearing observations, it was thought that the design of the pappus acts as a conduit facilitating water entry into the seed. It was hypothesized that seeds without a pappus would yield fewer seedlings and require more time to germinate than seeds with an intact pappus. Seed ultrastructure was investigated using scanning electron microscopy, while relative humidity and fungal association were explored as factors that may confer an advantage to intact seeds. Results indicate that germination for seeds lacking a pappus is 31% lower than control seeds (with an intact pappus) and that the seeds lacking a pappus require more time to germinate. Relative humidity did not differentially affect germination, and while a fungus Cladosporium cladosporioides was recovered internally, its presence neither enhanced germination nor decreased time to germination when tested by antimycotic removal. Electron micrographs revealed that (1) the pappus is hollow and (2) the pericarp of the fruit fuses with and partially encloses the pappus. Fusion of the pappus with the fruit suggests that this structure acts as a device to regulate seed hydration.
Writing to Virginia Woolf in 1912, Lytton Strachey tried, and failed, to imagine a time when we would love the Victorians, or at least find an acceptable way of condescending to them:
Is it prejudice, do you think, that makes us hate the Victorians, or is it the truth of the case? They seem to me to be a set of mouthing bungling hypocrites; but perhaps really there is a baroque charm about them which will be discovered by our great-great-grandchildren, as we have discovered the charm of Donne, who seemed intolerable to the 18th century. Only I don't believe it[.]
The power of metaphor allows us to think of Matthew Sweet, author of Inventing the Victorians (2001), as Strachey's great-great-grandchild, affirming that
Victorian culture was as rich and difficult and complex and pleasurable as our own; that the Victorians shaped our lives and sensibilities in countless unacknowledged ways; that they are still with us, walking our pavements, drinking in our bars, living in our houses, reading our newspapers, inhabiting our bodies.
The three stages of Sweet's argument take us from equivalence ('as rich and difficult and complex and pleasurable as our own'), through influence ('shaped our lives and sensibilities'), to confluence ('inhabiting our bodies').
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