A potential cost savings analysis of a penicillin de-labeling program

IntroductionOver 95% of patients documented as penicillin allergic can tolerate a penicillin without a reaction. Inaccurate documentation of penicillin allergy leads to more expensive alternative antibiotic prescriptions and an increased incidence of resistant infections.ObjectiveTo understand the potential drug cost savings of a penicillin de-labeling program to a healthcare system.MethodsWe evaluated patient visits with documented penicillin allergy who presented to the pediatric Emergency Department (PED) and 22 associated primary care clinics. Patients were included if they were discharged home with a non-penicillin antibiotic when the first-line treatment for the diagnosis would have been a penicillin. The potential cost savings were the sum of all visit-level cost differences between the non-penicillin prescription(s) and a counterfactual penicillin prescription. To factor in a 95% successful patient de-labeling rate, we repeatedly sampled 95% from the patients with the eligible visits 10,000 times to produce an estimate of the potential cost savings.ResultsOver the 8-year period, 2,034 visits by 1,537 patients to the PED and 12,349 visits by 6,073 patients to primary care clinics satisfied eligibility criteria. If 95% of the patients could have been successfully de-labeled, it would have generated a cost saving of $618,653 (95$618,617—$618,689) for all the corresponding payers in the system.ConclusionsImplementing a penicillin de-labeling program across a healthcare system PED and its associated primary care clinics would bring significant cost savings. Healthcare systems should rigorously evaluate optimal methods to de-label patients with reported penicillin allergy

Discrimination of benign from malignant breast lesions in dense breasts with model-based analysis of regions-of-interest using directional diffusion-weighted images.

BACKGROUND: There is an increasing interest in non-contrast-enhanced magnetic resonance imaging (MRI) for detecting and evaluating breast lesions. We present a methodology utilizing lesion core and periphery region of interest (ROI) features derived from directional diffusion-weighted imaging (DWI) data to evaluate performance in discriminating benign from malignant lesions in dense breasts. METHODS: We accrued 55 dense-breast cases with 69 lesions (31 benign; 38 cancer) at a single institution in a prospective study; cases with ROIs exceeding 7.50 cm RESULTS: The region-growing algorithm for 3D lesion model generation improved inter-observer variability over hand drawn ROIs (DSC: 0.66 vs 0.56 (p \u3c 0.001) with substantial agreement (DSC \u3e 0.8) in 46% vs 13% of cases, respectively (p \u3c 0.001)). The overall classifier improved discrimination over mean ADC, (ROC- area under the curve (AUC): 0.85 vs 0.75 and 0.83 vs 0.74 respectively for the two readers). CONCLUSIONS: A classifier generated from directional DWI information using lesion core and lesion periphery information separately can improve lesion discrimination in dense breasts over mean ADC and should be considered for inclusion in computer-aided diagnosis algorithms. Our model-based ROIs could facilitate standardization of breast MRI computer-aided diagnostics (CADx)

The Benefits and Challenges of Preconsent in a Multisite, Pediatric Sickle Cell Intervention Trial

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/133619/1/pbc26013.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/133619/2/pbc26013_am.pd

Diabetic foot complications among Indigenous peoples in Canada: a scoping review through the PROGRESS-PLUS equity lens

IntroductionIndigenous peoples in Canada face a disproportionate burden of diabetes-related foot complications (DRFC), such as foot ulcers, lower extremity amputations (LEA), and peripheral arterial disease. This scoping review aimed to provide a comprehensive understanding of DRFC among First Nations, Métis, and Inuit peoples in Canada, incorporating an equity lens.MethodsA scoping review was conducted based on Arksey and O’Malley refined by the Joanna Briggs Institute. The PROGRESS-Plus framework was utilized to extract data and incorporate an equity lens. A critical appraisal was performed, and Indigenous stakeholders were consulted for feedback. We identified the incorporation of patient-oriented/centered research (POR).ResultsOf 5,323 records identified, 40 studies were included in the review. The majority of studies focused on First Nations (92%), while representation of the Inuit population was very limited populations (< 3% of studies). LEA was the most studied outcome (76%). Age, gender, ethnicity, and place of residence were the most commonly included variables. Patient-oriented/centered research was mainly included in recent studies (16%). The overall quality of the studies was average. Data synthesis showed a high burden of DRFC among Indigenous populations compared to non-Indigenous populations. Indigenous identity and rural/remote communities were associated with the worse outcomes, particularly major LEA.DiscussionThis study provides a comprehensive understanding of DRFC in Indigenous peoples in Canada of published studies in database. It not only incorporates an equity lens and patient-oriented/centered research but also demonstrates that we need to change our approach. More data is needed to fully understand the burden of DRFC among Indigenous peoples, particularly in the Northern region in Canada where no data are previously available. Western research methods are insufficient to understand the unique situation of Indigenous peoples and it is essential to promote culturally safe and quality healthcare.ConclusionEfforts have been made to manage DRFC, but continued attention and support are necessary to address this population’s needs and ensure equitable prevention, access and care that embraces their ways of knowing, being and acting.Systematic review registrationOpen Science Framework https://osf.io/j9pu7, identifier j9pu7

Redox agent enhanced chemical mechanical polishing of thin film diamond

The chemical nature of the chemical mechanical polishing of diamond has been examined by adding various redox agents to the alkaline SF1 polishing slurry. Three oxidizing agents namely, hydrogen peroxide, potassium permanganate and ferric nitrate, and two reducing agents, oxalic acid and sodium thiosulfate, were added to the SF1 slurry. Oxalic acid produced the fastest polishing rate while hydrogen peroxide had very little effect on polishing, probably due to its volatile nature. X-ray photoelectron spectroscopy (XPS) reveals little difference in the surface oxygen content on the polished samples using various slurries. This suggests that the addition of redox agents do not increase the density of oxygen containing species on the surface but accelerates the process of attachment and removal of Si or O atoms within the slurry particles to the diamond surface

The Maunakea Spectroscopic Explorer Book 2018

(Abridged) This is the Maunakea Spectroscopic Explorer 2018 book. It is intended as a concise reference guide to all aspects of the scientific and technical design of MSE, for the international astronomy and engineering communities, and related agencies. The current version is a status report of MSE's science goals and their practical implementation, following the System Conceptual Design Review, held in January 2018. MSE is a planned 10-m class, wide-field, optical and near-infrared facility, designed to enable transformative science, while filling a critical missing gap in the emerging international network of large-scale astronomical facilities. MSE is completely dedicated to multi-object spectroscopy of samples of between thousands and millions of astrophysical objects. It will lead the world in this arena, due to its unique design capabilities: it will boast a large (11.25 m) aperture and wide (1.52 sq. degree) field of view; it will have the capabilities to observe at a wide range of spectral resolutions, from R2500 to R40,000, with massive multiplexing (4332 spectra per exposure, with all spectral resolutions available at all times), and an on-target observing efficiency of more than 80%. MSE will unveil the composition and dynamics of the faint Universe and is designed to excel at precision studies of faint astrophysical phenomena. It will also provide critical follow-up for multi-wavelength imaging surveys, such as those of the Large Synoptic Survey Telescope, Gaia, Euclid, the Wide Field Infrared Survey Telescope, the Square Kilometre Array, and the Next Generation Very Large Array.Comment: 5 chapters, 160 pages, 107 figure

Parameters controlling octadecyl phosphonic acid self-assembled monolayers on titanium dioxide for anti-fouling biomedical applications

Octadecylphosphonic acid (ODPA) self-assembled monolayers (SAMs) have demonstrated potential for deterring bacterial attachment to titanium, however the coating process is time consuming and uses toxic solvents. In this study, ODPA SAM quantity, quality, and structure were evaluated on titanium quartz crystal microbalance (QCM) sensors by varying solvent type (anisole or cyclopentyl methyl ether (CPME), environmentally friendly non-polar solvents); ODPA concentration (0.5 mM or 1 mM); and temperature (21 °C or 60 °C). Surfaces were characterised using QCM frequency and dissipation measurements and Sauerbrey mass calculations; X-ray photoelectron spectroscopy; water contact angle measurements; and temperature-programmed desorption mass spectrometry (TPD-MS). Anti-fouling ability was established against Staphylococcus aureus. Incubation in 0.5 mM ODPA in CPME at 21 °C rapidly formed uniform rigid ODPA SAMs as demonstrated by high Sauerbrey mass (≈285-290 ng/cm2), viscoelastic modelling, high atomic percentage surface phosphorus (1.1 %) and high water contact angles (117.6 ± 2.5°), consistent across the entire sample surface. High temperatures or the use of anisole resulted in suspected multilayer formation, which reduced bacterial attachment. TPD-MS confirmed covalent bonding of ODPA SAMs on TiO2 at ≈ 110–120 °C and thermal stability below 300 °C. This study demonstrates the key parameters that control ODPA SAM formation on titanium and their future potential for biomedical applications

The determinants of electronic traceability adoption: a firm-level analysis of French agribusiness

International audienceThis paper aims to understand what factors influence firms to adopt electronic traceability systems (ETS) and notably the respective effects of the firm's internal characteristics, its vertical relations and its external environment. Traceability systems based on information and communication technologies (ICT) allow firms to collect, track, stock and transfer information on a range of product attributes. This study contributes to further understand traceability adoption by applying ICT adoption models to the case of ETS, and by using an original dataset, the 2002 ICT Survey, representative of all French agribusiness. The results suggest that a firm's degree of complexity (growing size, belonging to a group) and the development of its information system play a significant role in its adoption behavior. Moreover, they show that ETS adoption is more driven by a firm's narrow relations with specialized suppliers and downstream processors than by retailers