Adult Acute Sinusitis Antimicrobial Stewardship Program in a Primary Care Setting

BACKGROUND: Inappropriate antibiotic prescribing is a well-documented global health crisis (Centers for Disease Control, CDC, 2013). Antimicrobial stewardship (AS) is the purposeful selection of the correct drug, dose, route and duration of antimicrobial treatment to decrease microbial resistance, adverse drug effects and cost while improving patient outcomes (Dellit et al., 2007; CDC, 2016). Antimicrobial Stewardship Programs (ASP) are multidisciplinary programs designed to improve AS. PURPOSE: To describe baseline prescribing patterns and evaluate the effect of an antimicrobial stewardship program (ASP) for adult acute sinusitis on provider knowledge and antibiotic prescribing practice. among primary care providers in an internal medicine clinic in an academic medical center in Kentucky METHODS: In this pre/post-test quasi-experimental design study a baseline chart audit was conducted to determine baseline prescribing practices. An evidence based ASP was developed and implemented to assess pre/post provider knowledge as determined by changes survey scores after the education based ASP. Following the ASP, a focus group structured on the Health Belief Model was conducted to elicit perceived barriers to deliver guideline recommended care. RESULTS: The sample contained 22 patient chats for the baseline chart audit. The chart audits revealed that care was concordant the majority (59.1%) of the time, the lowest scoring component of the chart audit was timing (50%) and was significantly different between concordant and unconcordant care. Eleven providers completed the pretest and participated in the ASP and focus group 9 of the 11 providers completed the post-test 1 week after the ASP. Overall knowledge increased from after the ASP (M = 52.27, SD =26.11) vs. (M = 55.56, SD = 24.3). Concordant care was delivered in 59.1% of cases. Providers reported a desire for support in appropriate prescribing and in educating patients on appropriate antibiotic use. CONCLUSION: Care was concordant the majority (59.1%) of the time, and correct antibiotic selection occurred 100%. Key areas for improvement include waiting for long enough symptom duration … correct symptom duration. The ASP was feasible to implement and was well received by attendees. Future ASP sessions should include a multidisciplinary team, multiple sessions which include active participation, and communication skills. Future studies should identify specific provider, clinical and patient components that influence the effectiveness of outpatient stewardship programs

Programmers' performance on structured versus nonstructured function definitions

A control-flow model for functional programs is used in an experimental comparison of the performance of programmers on structured versus nonstructured Miranda function definitions. The performance is taken as a measure of the comprehensibility of functional programs. The experimental set-up is similar to the Scanlan study (1989). However, in the present study, a two-factor repeated measures design is used in the statistical analysis. The control-flow model appears to be useful in the shaping of the experiment. A significantly better performance has been found for structured function definitions on both dependent variables: the time needed to answer questions about the function definitions and the proportion correct answers. Moreover, for structured function definitions, a counter-intuitive result has been obtained: there are significantly fewer errors in larger definitions than in smaller ones

A Pattern Language for High-Performance Computing Resilience

High-performance computing systems (HPC) provide powerful capabilities for modeling, simulation, and data analytics for a broad class of computational problems. They enable extreme performance of the order of quadrillion floating-point arithmetic calculations per second by aggregating the power of millions of compute, memory, networking and storage components. With the rapidly growing scale and complexity of HPC systems for achieving even greater performance, ensuring their reliable operation in the face of system degradations and failures is a critical challenge. System fault events often lead the scientific applications to produce incorrect results, or may even cause their untimely termination. The sheer number of components in modern extreme-scale HPC systems and the complex interactions and dependencies among the hardware and software components, the applications, and the physical environment makes the design of practical solutions that support fault resilience a complex undertaking. To manage this complexity, we developed a methodology for designing HPC resilience solutions using design patterns. We codified the well-known techniques for handling faults, errors and failures that have been devised, applied and improved upon over the past three decades in the form of design patterns. In this paper, we present a pattern language to enable a structured approach to the development of HPC resilience solutions. The pattern language reveals the relations among the resilience patterns and provides the means to explore alternative techniques for handling a specific fault model that may have different efficiency and complexity characteristics. Using the pattern language enables the design and implementation of comprehensive resilience solutions as a set of interconnected resilience patterns that can be instantiated across layers of the system stack.Comment: Proceedings of the 22nd European Conference on Pattern Languages of Program

Building an IDE for the Calculational Derivation of Imperative Programs

In this paper, we describe an IDE called CAPS (Calculational Assistant for Programming from Specifications) for the interactive, calculational derivation of imperative programs. In building CAPS, our aim has been to make the IDE accessible to non-experts while retaining the overall flavor of the pen-and-paper calculational style. We discuss the overall architecture of the CAPS system, the main features of the IDE, the GUI design, and the trade-offs involved.Comment: In Proceedings F-IDE 2015, arXiv:1508.0338

VLSI Architecture and Design

Integrated circuit technology is rapidly approaching a state where feature sizes of one micron or less are tractable. Chip sizes are increasing slowly. These two developments result in considerably increased complexity in chip design. The physical characteristics of integrated circuit technology are also changing. The cost of communication will be dominating making new architectures and algorithms both feasible and desirable. A large number of processors on a single chip will be possible. The cost of communication will make designs enforcing locality superior to other types of designs. Scaling down feature sizes results in increase of the delay that wires introduce. The delay even of metal wires will become significant. Time tends to be a local property which will make the design of globally synchronous systems more difficult. Self-timed systems will eventually become a necessity. With the chip complexity measured in terms of logic devices increasing by more than an order of magnitude over the next few years the importance of efficient design methodologies and tools become crucial. Hierarchical and structured design are ways of dealing with the complexity of chip design. Structered design focuses on the information flow and enforces a high degree of regularity. Both hierarchical and structured design encourage the use of cell libraries. The geometry of the cells in such libraries should be parameterized so that for instance cells can adjust there size to neighboring cells and make the proper interconnection. Cells with this quality can be used as a basis for "Silicon Compilers"

What is the method in applying formal methods to PLC applications?

The question we investigate is how to obtain PLC applications with confidence in their proper functioning. Especially, we are interested in the contribution that formal methods can provide for their development. Our maxim is that the place of a particular formal method in the total picture of system development should be made very clear. Developers and customers ought to understand very well what they can rely on or not, and we see our task in trying to make this explicit. Therefore, for us the answer to the question above leads to the following questions: Which parts of the system can be treated formally? What formal methods and tools can be applied? What does their successful application tell (or does not) about the proper functioning of the whole system

A Multimedia Interactive Environment Using Program Archetypes: Divide-and-Conquer

As networks and distributed systems that can exploit parallel computing become more widespread, the need for ways to teach parallel programming effectively grows as well. Even though many colleges and universities provide courses on parallel programming [1], most of those courses are reserved for graduate students and advanced undergraduates. There is a demand for ways to teach fundamental parallel programming concepts to people with just a working knowledge of programming. By using the idea of a software archetype, and providing a learning environment that teaches both concept and coding, we hope to satisfy this need. This paper presents an overview of the multimedia approach we took in teaching parallel programming and offers Divide-and-Conquer as an example of its use