Promoting Adherence to Influenza Vaccination Recommendations in Pediatric Practice.

OBJECTIVES: In the United States, nonadherence to seasonal influenza vaccination guidelines for children and adolescents is common and results in unnecessary morbidity and mortality. We conducted a quality improvement project to improve vaccination rates and test effects of 2 interventions on vaccination guidelines adherence. METHODS: We conducted a cluster randomized control trial with 11 primary care practices (PRACTICE) that provided care for 11 293 individual children and adolescents in a children\u27s health care system from September 2015 through April 2016. Practice sites (with their clinicians) were randomly assigned to 4 arms (no intervention [Control], computerized clinical decision support system [CCDSS], web-based training [WBT], or CCDSS and WBT [BOTH]). RESULTS: During the study, 55.8% of children and adolescents received influenza vaccination, which improved modestly during the study period compared with the prior influenza season ( P = .009). Actual adherence to recommendations, including dosing, timeliness, and avoidance of missed opportunities, was 46.4% of patients cared for by the PRACTICE. The WBT was most effective in promoting adherence with vaccination recommendations with an estimated average odds ratio = 1.26, P \u3c .05, to compare between preintervention and intervention periods. Over the influenza season, there was a significantly increasing trend in odds ratio in the WBT arm ( P \u3c .05). Encouraging process improvements and providing longitudinal feedback on monthly rate of vaccination sparked some practice changes but limited impact on outcomes. CONCLUSIONS: Web-based training at the start of influenza season with monthly reports of adherence can improve correct dose and timing of influenza vaccination with modest impact on overall vaccination rate

Quintessential inflation with canonical and noncanonical scalar fields and Planck 2015 results

We investigate two classes of models of quintessential inflation, based upon canonical as well as noncanonical scalar fields. In particular, introducing potentials steeper than the standard exponential, we construct models that can give rise to a successful inflationary phase, with signatures consistent with Planck 2015 results. Additionally, using nonminimal coupling of the scalar field with massive neutrino matter, we obtain the standard thermal history of the Universe, with late-time cosmic acceleration as the last stage of evolution. In both cases, inflation and late-time acceleration are connected by a tracker solution.Comment: 13 pages, 18 figures, minor clarifications added and refs updated, to appear in PR