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To evaluate the effect of templated microbiology reporting comments on antifungal utilization in patients with candiduria.
In this retrospective, quasi-experimental study, we evaluated a preimplementation cohort (June 2018–January 2019) compared with a postimplementation cohort (June 2019–January 2020).
A multisite health system including 1 academic hospital and 4 community hospitals.
Patients were aged ≥18 years, were hospitalized, and had candiduria documented at least once during their admission. The study included 156 patients in the preimplementation period and 141 patients in the postimplementation period.
In June 2019, Saint Luke’s Health System implemented the use of templated comments for urine cultures with Candida spp growth. When Candida is isolated, the following comment appears in the microbiology result section: “In the absence of symptoms, Candida is generally considered normal flora. No therapy indicated unless high risk (pregnant, neonate, or neutropenic) or undergoing urologic procedure. If Foley catheter present, remove or replace when able.” The primary outcome was rate of antifungal prescribing.
Antifungal administration within 72 hours of a culture identifying a Candida spp occurred in 75 patients in the preimplementation group and 48 patients in the postimplementation group (48.1% vs 34.0%; P = .02). We did not detect a difference between groups in antifungal administration between 73 and 240 hours (1.3% vs 3.5%; P = .26), nor did we detect a difference in median antifungal duration (4 vs 3 days; P = .43).
Using a templated comment with urine cultures reduced antifungal prescription rates in hospitalized patients with candiduria. This strategy is a low-resource technique to improve antimicrobial stewardship.
When children tell stories, they gesture; their gestures can predict how their narrative abilities will progress. Five-year-olds who gestured from the point of view of a character (CVPT gesture) when telling stories produced better-structured narratives at later ages (Demir, Levine, & Goldin-Meadow, 2014). But does gesture just predict narrative structure, or can asking children to gesture in a particular way change their narratives? To explore this question, we instructed children to produce CVPT gestures and measured their narrative structure. Forty-four kindergarteners were asked to tell stories after being trained to produce CVPT gestures, gestures from an observer’s viewpoint (OVPT gestures), or after no instruction in gesture. Gestures were coded as CVPT or OVPT, and stories were scored for narrative structure. Children trained to produce CVPT gestures produced more of these gestures, and also had higher narrative structure scores compared to those who received the OVPT training. Children returned for a follow-up session one week later and narrated the stories again. The training received in the first session did not impact narrative structure or recall for the events of the stories. Overall, these results suggest a brief gestural intervention has the potential to enhance narrative structure. Due to the fact that stronger narrative abilities have been correlated with greater success in developing writing and reading skills at later ages, this research has important implications for literacy and education.
The rapid sol–gel synthesis of macroscopic quantities of nanodiamond aerogel (NDAG) is reported at standard temperature and pressure using acid-catalyzed covalent crosslinking of air-oxidized detonation nanodiamond (DND) nanocrystals. Acetonitrile acts as a polar, aprotic solvent both to form a colloidal dispersion of DND particles and to conduct acid-catalyzed polycondensation reactions between resorcinol and formaldehyde (RF) small molecule precursors. Several characterization techniques show that nanodiamond grains are connected via covalent bonding with RF molecules to form a porous, three-dimensional network. Solvent exchange into liquid carbon dioxide and subsequent supercritical drying of NDAGs are used to recover low-density (151 mg/cm3), three-dimensional monolithic aerogels that exhibit surface areas in excess of 589 m2/g. The large accessible pore volume from the rapidly synthesized, macroscopic NDAG materials suggests a range of potential applications in catalysis, sensing, energy storage, as well as inert excipients for small-molecule pharmaceuticals.
The assessment of multiracial status in U.S. health research is fraught with challenges that limit our ability to enumerate and study this population. This paper reconceptualizes the assessment of multiracial status through the development of a model with three dimensions: mixed ancestry multiracial status, self-identified multiracial status, and socially assigned multiracial status. We present challenges to studying multiracial populations and provide recommendations for improving the assessment of multiracial status in health research.
The Department of Agricultural and Resource Economics began deliberating upon rural development in early 1970. At that time the President's Commission on Rural Development issued its report, A New Life for the Country, and the Congress was considering various bills in support of better life for non-metropolitan residents. Two circumstances drew our attention.
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