The celebrity entrepreneur on television: profile, politics and power

This article examines the rise of the ‘celebrity entrepreneur’ on television through the emergence of the ‘business entertainment format’ and considers the ways in which regular television exposure can be converted into political influence. Within television studies there has been a preoccupation in recent years with how lifestyle and reality formats work to transform ‘ordinary’ people into celebrities. As a result, the contribution of vocationally skilled business professionals to factual entertainment programming has gone almost unnoticed. This article draws on interviews with key media industry professionals and begins by looking at the construction of entrepreneurs as different types of television personalities and how discourses of work, skill and knowledge function in business shows. It then outlines how entrepreneurs can utilize their newly acquired televisual skills to cultivate a wider media profile and secure various forms of political access and influence. Integral to this is the centrality of public relations and media management agencies in shaping media discourses and developing the individual as a ‘brand identity’ that can be used to endorse a range of products or ideas. This has led to policy makers and politicians attempting to mobilize the media profile of celebrity entrepreneurs to reach out and connect with the public on business and enterprise-related issues

The Nursing Home Pneumonia Risk Index: A Simple, Valid MDS-Based Method of Identifying 6-Month Risk for Pneumonia and Mortality

Background Pneumonia is the leading infectious cause of hospitalization and death for nursing home (NH) residents; however, diagnosis is often delayed because classic signs of infection are not present. We sought to identify NH residents at high risk for pneumonia, to identify persons to target for more intensive surveillance and preventive measures. Methods Based on a literature review, we identified key risk factors for pneumonia and compiled them for use as prediction tool, limiting risk factors to those available on the Minimum Data Set (MDS). Next, we tested the tool's ability to predict 6-month pneumonia incidence and mortality rates in a sample of 674 residents from 7 NHs, evaluating it both as a continuous and a dichotomous variable, and applying both logistic regression and survival analysis to calculate estimates. Results NH Pneumonia Risk Index scores ranged from −1 to 6, with a mean of 2.1, a median of 2, and a mode of 2. For the outcome of pneumonia, a 1-point increase in the index was associated with a risk odds ratio of 1.26 (P =.038) or a hazard ratio of 1.24 (P =.037); using it as a dichotomous variable (≤2 vs ≥3), the corresponding figures were a risk odds ratio of 1.78 (P =.045) and a hazard ratio of 1.82 (P =.025). For the outcome of mortality, a 1-point increase in the NH Pneumonia Risk Index was associated with a risk odds ratio of 1.58 (P =.002) and a hazard ratio of 1.45 (P =.013); using the index as a dichotomous variable, the corresponding figures were a risk odds ratio of 3.71 (P <.001) and a hazard ratio of 3.29 (P =.001). Conclusions The NH Pneumonia Risk Index can be used by NH staff to identify residents for whom to apply especially intensive preventive measures and surveillance. Because of its strong association with mortality, the index may also be valuable in care planning and discussion of advance directives

Current Prescribing Practices for Skin and Soft Tissue Infections in Nursing Homes

Objectives Antibiotic stewardship has been called for across all sites of health care, including nursing homes (NHs). Skin and soft tissue infections (SSTIs) are the third most common indication for antibiotics in the NH, and so should be a focus of stewardship. This study audited medical records to identify signs and symptoms of SSTIs treated with antibiotics in relation to the McGeer criteria for surveillance, the Loeb minimum criteria for antibiotic initiation, and prescribing recommendations of the Infectious Disease Society of America. Design Cross-sectional study. Setting Thirty-one NHs in Southeastern United States. Measurements Chart data from a random sample of 161 antibiotic prescriptions for SSTIs were abstracted. To meet the McGeer criteria, pus was present at a suspected SSTI site, or at least four of the following findings were documented as present at the site: new or worsening warmth, redness, swelling, tenderness, serous drainage, or a constitutional finding. The Loeb minimum criteria for initiating antibiotics included findings of new or increasing purulent drainage at a suspected SSTI site or at least two of the following findings: fever or new or worsening redness, tenderness, warmth, or swelling at the suspected site. Audits also collected the name, route, and duration of the associated antibiotic. Analyses calculated the types of diagnoses and evaluated associations between published criteria and prescribing. Results Cellulitis, skin/soft tissue injury with infection, and abscess were diagnosed in 37% (N = 59), 18% (N = 29), and 16% (N = 26) of cases, respectively; 27% (N = 43) had less specific diagnoses. The McGeer criteria were met in 25% (N = 40), and the Loeb minimum criteria were met in 48% (N = 77) of cases. Doxycycline was the most frequently prescribed antibiotic. The mean treatment length was 9.6 days (standard deviation, 5.6), and the median length of treatment was 8.5 days (range, 3-45). Conclusion SSTIs are not routinely diagnosed or treated according to recommended standards of care, and prescriptions for systemic antibiotics appear to be frequently initiated without regard to recommended definitions of infection or therapies for the associated diagnoses. These findings indicate that SSTIs present various opportunities to improve antibiotic stewardship

Urine culture testing in community nursing homes: Gateway to antibiotic overprescribing

OBJECTIVE To describe current practice around urine testing and identify factors leading to overtreatment of asymptomatic bacteriuria in community nursing homes (NHs) DESIGN Observational study of a stratified random sample of NH patients who had urine cultures ordered in NHs within a 1-month study period SETTING 31 NHs in North Carolina PARTICIPANTS 254 NH residents who had a urine culture ordered within the 1-month study period METHODS We conducted an NH record audit of clinical and laboratory information during the 2 days before and 7 days after a urine culture was ordered. We compared these results with the urine antibiogram from the 31 NHs. RESULTS Empirical treatment was started in 30% of cases. When cultures were reported, previously untreated cases received antibiotics 89% of the time for colony counts of ≥100,000 CFU/mL and in 35% of cases with colony counts of 10,000-99,000 CFU/mL. Due to the high rate of prescribing when culture results returned, 74% of these patients ultimately received a full course of antibiotics. Treated and untreated patients did not significantly differ in temperature, frequency of urinary signs and symptoms, or presence of Loeb criteria for antibiotic initiation. Factors most commonly associated with urine culture ordering were acute mental status changes (32%); change in the urine color, odor, or sediment (17%); and dysuria (15%). CONCLUSIONS Urine cultures play a significant role in antibiotic overprescribing. Antibiotic stewardship efforts in NHs should include reduction in culture ordering for factors not associated with infection-related morbidity as well as more scrutiny of patient condition when results become available

Baffin Island Expedition, 1953: A Preliminary Field Report

Contains description and brief summaries of results of the second Baffin Island Expedition of the Arctic Institute of North America, May-Sept. 1953. The 13-man party carried out a program in the Penny Highland region of Cumberland Peninsula, centering on Pangnirtung Pass. Glaciological work on the Penny Icecap and Highway Glacier included studies of glacier physics, seismic work, and meteorological observations on bedrock geology and structure are given. Corrie formation and the geomorphology of Pangnirtung Pass were studied. Specimens of local fauna were collected and biological studies of some species were made. Comparisons of the vegetation of Penny Highland and East and North Greenland were made through extensive plant collections. Eight peaks were climbed and their altitudes determined. A list of 17 new names approved by the Canadian Board on Geographical Names is appended

Can Sepsis Be Detected in the Nursing Home Prior to the Need for Hospital Transfer?

Objectives: To determine whether and to what extent simple screening tools might identify nursing home (NH) residents who are at high risk of becoming septic. Design: Retrospective chart audit of all residents who had been hospitalized and returned to participating NHs during the study period. Setting and Participants: A total of 236 NH residents, 59 of whom returned from hospitals with a diagnosis of sepsis and 177 who had nonsepsis discharge diagnoses, from 31 community NHs that are typical of US nursing homes overall. Measures: NH documentation of vital signs, mental status change, and medical provider visits 0–12 and 13–72 hours prior to the hospitalization. The specificity and sensitivity of 5 screening tools were evaluated for their ability to detect residents with incipient sepsis during 0–12 and 13–72 hours prior to hospitalization: The Systemic Inflammatory Response Syndrome criteria, the quick Sequential Organ Failure Assessment (SOFA), the 100-100-100 Early Detection Tool, and temperature thresholds of 99.0°F and 100.2°F. In addition, to validate the hospital diagnosis of sepsis, hospital discharge records in the NHs were audited to calculate SOFA scores. Results: Documentation of 1 or more vital signs was absent in 26%–34% of cases. Among persons with complete vital sign documentation, during the 12 hours prior to hospitalization, the most sensitive screening tools were the 100-100-100 Criteria (79%) and an oral temperature >99.0°F (51%); and the most specific tools being a temperature >100.2°F (93%), the quick SOFA (88%), the Systemic Inflammatory Response Syndrome criteria (86%), and a temperature >99.0°F (85%). Many SOFA data points were missing from the record; in spite of this, 65% of cases met criteria for sepsis. Conclusions: NHs need better systems to monitor NH residents whose status is changing, and to present that information to medical providers in real time, either through rapid medical response programs or telemetry

Pneumonia identification using nursing home records

Pneumonia is a leading cause of death among nursing home residents; consequently, prevention and treatment are important for quality improvement. To be pragmatic, quality improvement depends on sensitive case identification using nursing home records; however, no studies have examined the reliability of different methods of pneumonia case finding from records. The current authors compared three established strategies for defining pneumonia using records from 1,119 residents across 16 nursing homes: recorded diagnosis of pneumonia, modified McGeer criteria (chest x-ray infiltrate plus specified signs/symptoms), and antibiotic prescription plus pneumonia-specific signs. Chart diagnosis detected 107 cases, modified McGeer criteria detected 84 cases, and antibiotic prescription detected 47 cases. Diagnosis included all cases identified by the McGeer criteria and all but one case identified by antibiotic use. Based on findings, recorded diagnosis of pneumonia is a highly sensitive and pragmatic method to ascertain pneumonia in nursing homes, and is recommended for use in quality improvement and research

Evaluation and Management of the Nursing Home Resident With Respiratory Symptoms and an Equivocal Chest X-Ray Report

Objectives Pneumonia is a leading cause of morbidity and mortality in nursing home (NH) residents. Chest x-ray evidence is considered a key diagnostic criterion for pneumonia by the Infectious Disease Society of America (IDSA) diagnostic guidelines, the modified McGeer diagnostic criteria, and the Loeb criteria for initiating antibiotics; however, x-ray interpretation is often equivocal. We conducted chart audits of patients in NHs who had chest x-rays for new respiratory symptoms to determine the degree of ambiguity in the radiology reports and their relationship to antibiotic prescription decisions. Design Cross-sectional study. Setting Thirty-one NHs in North Carolina. Participants Two hundred twenty-six NH residents who had a chest x-ray. Methods Medical charts were abstracted to record (1) the patient's clinical presentation when a chest x-ray was ordered, (2) the verbatim report of the chest x-ray, and (3) the patient's course during the subsequent 7 days. To standardize the radiologist reports, a seven-category coding system was developed, which was further aggregated into three groups based on the radiologist's description of the likelihood of pneumonia. Results Of the 226 chest x-rays, 118 (52%) identified a very low likelihood of pneumonia, 67 (30%) indicated that pneumonia was present or highly likely, and the remaining 41 (18%) used a variety of terms to describe uncertainty regarding the presence of pneumonia. NH medical providers tended to treat ambiguous chest x-ray reports similarly to positive x-ray reports, prescribing antibiotic therapy to 71% of patients with ambiguous reports and 78% of positive reports. Also notable is that 40 (34%) of the 118 patients with a very low likelihood of pneumonia based on chest x-ray results were prescribed antibiotics, the majority of whom failed to meet criteria for a clinical diagnosis of pneumonia or chronic obstructive pulmonary disease exacerbation. Conclusion The moderate rate of ambiguous x-ray interpretations in NH residents is likely a combination of the poor quality of portable x-rays, a high prevalence of chronic lung conditions, and conservative (ie, cautious) decision making by radiologists whose interpretation is based on little clinical information and a suboptimal quality film. As a result, data suggest that chest x-rays obtained in NHs may unnecessarily encourage antibiotic prescribing because a majority of readings are ambiguous or show a low likelihood of pneumonia, yet more than half of the patients are still treated. From an antibiotic stewardship standpoint, the apparent solution is to more closely rely on clinical signs and symptoms for diagnosis of pneumonia and to place less emphasis on the role of the chest x-ray given the high number of unclear readings

A 2-Year Pragmatic Trial of Antibiotic Stewardship in 27 Community Nursing Homes

OBJECTIVES: To determine if antibiotic prescribing in community nursing homes (NHs) can be reduced by a multicomponent antibiotic stewardship intervention implemented by medical providers and nursing staff and whether implementation is more effective if performed by a NH chain or a medical provider group. DESIGN: Two-year quality improvement pragmatic implementation trial with two arms (NH chain and medical provider group). SETTING: A total of 27 community NHs in North Carolina that are typical of NHs statewide, conducted before announcement of the US Centers for Medicare and Medicaid Services antibiotic stewardship mandate. PARTICIPANTS: Nursing staff and medical care providers in the participating NHs. INTERVENTION: Standardized antibiotic stewardship quality improvement program, including training modules for nurses and medical providers, posters, algorithms, communication guidelines, quarterly information briefs, an annual quality improvement report, an informational brochure for residents and families, and free continuing education credit. MEASUREMENTS: Antibiotic prescribing rates per 1000 resident days overall and by infection type; rate of urine test ordering; and incidence of Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) infections. RESULTS: Systemic antibiotic prescription rates decreased from baseline by 18% at 12 months (incident rate ratio [IRR] = 0.82; 95% confidence interval [CI] = 0.69-0.98) and 23% at 24 months (IRR = 0.77; 95% CI = 0.65-0.90). A 10% increase in the proportion of residents with the medical director as primary physician was associated with a 4% reduction in prescribing (IRR = 0.96; 95% CI = 0.92-0.99). Incidence of C. difficile and MRSA infections, hospitalizations, and hospital readmissions did not change significantly. No adverse events from antibiotic nonprescription were reported. Estimated 2-year implementation costs per NH, exclusive of medical provider time, ranged from $354 to$3653. CONCLUSIONS: Antibiotic stewardship programs can be successfully disseminated in community NHs through either NH administration or medical provider groups and can achieve significant reductions in antibiotic use for at least 2 years. Medical director involvement is an important element of program success

An in situ transmission electron microscopy study of the ion irradiation induced amorphisation of silicon by He and Xe

Transmission electron microscopy with in situ ion irradiation has been used to examine the ionbeam-induced amorphisation of crystalline silicon under irradiation with light (He) and heavy (Xe) ions at room temperature. Analysis of the electron diffraction data reveal the heterogeneous amorphisation mechanism to be dominant in both cases. The differences in the amorphisation curves are discussed in terms of intra-cascade dynamic recovery, and the role of electronic and nuclear loss mechanisms