Primary hyperhidrosis in children: A review of therapeutics

Primary hyperhidrosis, an idiopathic disease that commonly affects the palms, soles, axillae, or craniofacial region, is characterized by perspiration in excess of what is required for physiologic cooling. This disease begins in childhood or adolescence and negatively impacts emotional, physical, and psychologic well‐being. This review explores current therapeutic options for primary hyperhidrosis in the pediatric population, including topical therapies, oral therapies, non‐surgical and procedural interventions, and adjunctive therapies. In addition, this review identifies new and emerging treatments and highlights the need for further research and therapeutic options for this impactful disease

Factors Affecting Faculty Participation in Online Development at a Higher Education Institution

Faculty development continues to be a significant component of higher education institutions. The purpose of this phenomenological case study was to understand the faculty experience surrounding participation in online professional development, thereby discovering the complex structures that influence participation and impact completion of formal online offerings. The research was supported through systems theory, and the iceberg model was used to conclude the findings. Full-time instructional faculty at a tier-one university in the southern United States who registered for a university-sponsored accessibility and universal design for learning training were recruited to participate in semi-structured interviews to discuss their online faculty development experiences. The findings of the study indicate that the factors that influence faculty to participate in online faculty development, such as an institutional mandate, are often the same regardless if they complete the training or not. Additionally, faculty who complete online faculty development may have similar but fewer barriers to completion than faculty who do not complete. Systematic implications for lowering barriers and increasing support for faculty in online professional development are presented, and further research recommendations are discussed

Diagnosis-Specific Readmission Risk Prediction Using Electronic Health Data: a Retrospective Cohort Study

Background: Readmissions after hospital discharge are a common occurrence and are costly for both hospitals and patients. Previous attempts to create universal risk prediction models for readmission have not met with success. In this study we leveraged a comprehensive electronic health record to create readmission-risk models that were institution- and patient- specific in an attempt to improve our ability to predict readmission. Methods: This is a retrospective cohort study performed at a large midwestern tertiary care medical center. All patients with a primary discharge diagnosis of congestive heart failure, acute myocardial infarction or pneumonia over a two-year time period were included in the analysis. The main outcome was 30-day readmission. Demographic, comorbidity, laboratory, and medication data were collected on all patients from a comprehensive information warehouse. Using multivariable analysis with stepwise removal we created three risk disease-specific risk prediction models and a combined model. These models were then validated on separate cohorts. Results: 3572 patients were included in the derivation cohort. Overall there was a 16.2% readmission rate. The acute myocardial infarction and pneumonia readmission-risk models performed well on a random sample validation cohort (AUC range 0.73 to 0.76) but less well on a historical validation cohort (AUC 0.66 for both). The congestive heart failure model performed poorly on both validation cohorts (AUC 0.63 and 0.64). Conclusions: The readmission-risk models for acute myocardial infarction and pneumonia validated well on a contemporary cohort, but not as well on a historical cohort, suggesting that models such as these need to be continuously trained and adjusted to respond to local trends. The poor performance of the congestive heart failure model may suggest that for chronic disease conditions social and behavioral variables are of greater importance and improved documentation of these variables within the electronic health record should be encouraged

Oviposition Cues for a Specialist Butterfly–Plant Chemistry and Size

The oviposition choice of an insect herbivore is based on a complex set of stimuli and responses. In this study, we examined the effect of plant secondary chemistry (the iridoid glycosides aucubin and catalpol) and aspects of size of the plant Plantago lanceolata, on the oviposition behavior of the specialist butterfly Melitaea cinxia. Iridoid glycosides are known to deter feeding or decrease the growth rate of generalist insect herbivores, but can act as oviposition cues and feeding stimulants for specialized herbivores. In a previous observational study of M. cinxia in the field, oviposition was associated with high levels of aucubin. However, this association could have been the cause (butterfly choice) or consequence (plant induction) of oviposition. We conducted a set of dual- and multiple-choice experiments in cages and in the field. In the cages, we found a positive association between the pre-oviposition level of aucubin and the number of ovipositions. The association reflects the butterfly oviposition selection rather than plant induction that follows oviposition. Our results also suggest a threshold concentration below which females do not distinguish between levels of iridoid glycosides. In the field, the size of the plant appeared to be a more important stimulus than iridoid glycoside content, with bigger plants receiving more oviposition than smaller plants, regardless of their secondary chemistry. Our results illustrate that the rank of a cue used for oviposition may be dependent on environmental context

Primary Hyperhidrosis in Children: A Review of Therapeutics

Primary hyperhidrosis, an idiopathic disease that commonly affects the palms, soles, axillae, or craniofacial region, is characterized by perspiration in excess of what is required for physiologic cooling. This disease begins in childhood or adolescence and negatively impacts emotional, physical, and psychologic well‐being. This review explores current therapeutic options for primary hyperhidrosis in the pediatric population, including topical therapies, oral therapies, non‐surgical and procedural interventions, and adjunctive therapies. In addition, this review identifies new and emerging treatments and highlights the need for further research and therapeutic options for this impactful disease

Demonstration of the Weighted-Incidence Syndromic Combination Antibiogram: An Empiric Prescribing Decision Aid

Healthcare providers need a better empiric antibiotic prescribing aid than the traditional antibiogram, which supplies no information on the relative frequency of organisms recovered in a given infection and which is uninformative in situations where multiple antimicrobials are used or multiple organisms are anticipated. We aimed to develop and demonstrate a novel empiric prescribing decision aid. This is a demonstration involving more than 9,000 unique encounters for abdominal-biliary infection (ABI) and urinary tract infection (UTI) to a large healthcare system with a fully integrated electronic health record (EHR). We developed a novel method of displaying microbiology data called the weighted-incidence syndromic combination antibiogram (WISCA) for 2 clinical syndromes, ABI and UTI. The WISCA combines simple diagnosis and microbiology data from the EHR to (1) classify patients by syndrome and (2) determine, for each patient with a given syndrome, whether a given regimen (1 or more agents) would have covered all the organisms recovered for their infection. This allows data to be presented such that clinicians can see the probability that a particular regimen will cover a particular infection rather than the probability that a single drug will cover a single organism. There were 997 encounters for ABI and 8,232 for UTI. A WISCA was created for each syndrome and compared with a traditional antibiogram for the same period. Novel approaches to data compilation and display can overcome limitations to the utility of the traditional antibiogram in helping providers choose empiric antibiotics