Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01] - study protocol and baseline practice and provider characteristics

Background: Inappropriate antibiotic prescribing for nonbacterial infections leads to increases in the costs of care, antibiotic resistance among bacteria, and adverse drug events. Acute respiratory infections (ARIs) are the most common reason for inappropriate antibiotic use. Most prior efforts to decrease inappropriate antibiotic prescribing for ARIs (e.g., educational or informational interventions) have relied on the implicit assumption that clinicians inappropriately prescribe antibiotics because they are unaware of guideline recommendations for ARIs. If lack of guideline awareness is not the reason for inappropriate prescribing, educational interventions may have limited impact on prescribing rates. Instead, interventions that apply social psychological and behavioral economic principles may be more effective in deterring inappropriate antibiotic prescribing for ARIs by well-informed clinicians. Methods/design The Application of Behavioral Economics to Improve the Treatment of Acute Respiratory Infections (BEARI) Trial is a multisite, cluster-randomized controlled trial with practice as the unit of randomization. The primary aim is to test the ability of three interventions based on behavioral economic principles to reduce the rate of inappropriate antibiotic prescribing for ARIs. We randomized practices in a 2 × 2 × 2 factorial design to receive up to three interventions for non-antibiotic-appropriate diagnoses: 1) Accountable Justifications: When prescribing an antibiotic for an ARI, clinicians are prompted to record an explicit justification that appears in the patient electronic health record; 2) Suggested Alternatives: Through computerized clinical decision support, clinicians prescribing an antibiotic for an ARI receive a list of non-antibiotic treatment choices (including prescription options) prior to completing the antibiotic prescription; and 3) Peer Comparison: Each provider’s rate of inappropriate antibiotic prescribing relative to top-performing peers is reported back to the provider periodically by email. We enrolled 269 clinicians (practicing attending physicians or advanced practice nurses) in 49 participating clinic sites and collected baseline data. The primary outcome is the antibiotic prescribing rate for office visits with non-antibiotic-appropriate ARI diagnoses. Secondary outcomes will examine antibiotic prescribing more broadly. The 18-month intervention period will be followed by a one year follow-up period to measure persistence of effects after interventions cease. Discussion The ongoing BEARI Trial will evaluate the effectiveness of behavioral economic strategies in reducing inappropriate prescribing of antibiotics. Trials registration ClinicalTrials.gov: NCT0145494

Medication Therapy Management, Challenges: The Pharmacist’s Emerging Role

The pharmacist\u27s role on the healthcare team has received much attention lately as the new Affordable Care Act (ACA) healthcare legislation creates opportunities for pharmacists. lnterprofessional collaboration will transform the way pharmacists deliver health services to patients with respect to their medications. In the community, pharmacist-provided services have been moving away from the traditional role of dispensing to cognitive services that maximize the patient\u27s safe and effective use of medications. The current movement in medical care within the United States is to adopt a model that is patient-centric. The Patient-Centered Primary Care Collaborative (PCPCC) recognizes that patient-centric systems are evolving, in which the patient\u27s well-being and responsibility for his or her own good health are defining treatment and operational policies

Improved flexural behaviour of reinforced concrete beam strengthened using stainless steel wire mesh

The paper presents an experimental investigation of the flexural behaviour of reinforced concrete (RC) beam elements strengthened externally with stainless steel wire mesh (SSWM). SSWM has the potential to be an alternative composite material in place of Carbon Fiber Reinforced Polymer (CFRP) and Glass Fiber Reinforced Polymer (GFRP) because of advantages such as being cost-effective, having more fire-resistance and corrosion resistance, good bond behaviour with concrete, improve the strength of members, leaving minimal effects on structural aesthetics as it has less thickness and ease in availability. In the present study, SSWM has been wrapped externally over the beams having three different wrapping patterns, including fully wrapped vertical SSWM strips over the beam, partial wrapping of vertical SSWM strips in between the stirrups of the beam and partial wrapping of vertical SSWM strips above the stirrups of the beam, and control beam with no wrapping, each configuration having two test specimens. Results of experimental investigation in terms of cracking load, ultimate load, corresponding deflection, ductility, initial stiffness and energy absorption capacity of different wrapping patterns have been obtained and compared with those of control beam specimens. From the results obtained, it has been demonstrated that the fully wrapped SSWM strip wrapping pattern enhanced the flexural strength of the beam and showed the highest strength gain compared to the other wrapping patterns

Are state laws granting pharmacists authority to vaccinate associated with HPV vaccination rates among adolescents?

We explored whether state laws allowing pharmacists to administer human papillomavirus (HPV) vaccinations to adolescents are associated with a higher likelihood of HPV vaccine uptake

Parents' Support for School-Entry Requirements for Human Papillomavirus Vaccination: A National Study

The number of states proposing school-entry requirements for human papillomavirus (HPV) vaccination has increased over the last decade. However, data are currently limited regarding parents' support of such laws. We sought to obtain the first national estimates of parents' support of HPV vaccination school-entry requirements

Messages to Motivate Human Papillomavirus Vaccination: National Studies of Parents and Physicians

Physician communication about human papillomavirus (HPV) vaccine is a key determinant of uptake. To support physician communication, we sought to identify messages that would motivate HPV vaccination

Numerical Optimization of a Premixer for an Internal Combustion Engine using Producer Gas as a Fuel

269-275Gasification seems to be one of the sustainable green energy solutions to fulfill the current and future energy needs. For efficient utilization of producer gas on existing IC Engines, carburetor/premixer needs to be carefully designed and developed to achieve uniform mixing quality. A long radius nozzle type premixer has been designed for natural gas engine to be operated on producer gas as an alternate fuel. Different configurations of T – Type premixers with single air entry and twin air entry with different throat diameters and hole sizes are numerically analysed using ANSYS® CFX. Turbulence is modelled using RNG k - ε closure model. Mixer performance is compared in terms of constituents’ mass fraction, flow Uniformity Index (UI) and pressure penalty. Numerical analysis reveals that throat diameter, air entry type and air hole diameter governs mixing and pressure drop. Out of all configurations, twin air entry type premixer provides better mixing of producer gas and air. The optimized design of premixer shows that the absolute deviation in mass fraction of individual constituent lies in the range of ± 1.73% with respect to the actual mass fractions obtained. The average absolute deviation calculated is 1.37% with Uniformity Index 0.958 at the exit plane while the pressure drop across the premixer is 951 Pa

Provider communication and HPV vaccination: The impact of recommendation quality

Receiving a healthcare provider’s recommendation is a strong predictor of HPV vaccination, but little is known empirically about which types of recommendation are most influential. Thus, we sought to investigate the relationship between recommendation quality and HPV vaccination among U.S. adolescents

Parametric Optimization of Producer Gas fuelled Spark Ignition Engine through Thermodynamic Modelling

374-383Development of alternative fuel has become a necessity to quench the current/rising future energy demands and alarming environmental pollution. Producer gas/syngas has potential to be most favorite alternative fuel substitution whose performance characteristics are lower whereas emission characteristics of carbon monoxide (CO), carbon dioxide (CO2) and hydrocarbons are better than petrol/diesel. Looking at these facts, the present work focuses on thermodynamic modelling and parametric studies on a real-life engine using producer gas as fuel to study its performance and emission characteristics. Simulated program is validated with published literature and results are found within ± 9% in terms of power and efficiency. The model is then used to study the effect of Spark advance (10°–30°), valve timing and combustion duration (40°–80°), fuel-air ratio, stroke to bore ratio and connecting rod length to crank radius to study their impact on emission and performance of real-life engine. The optimum engine performance parameters while also considering emission of nitric oxide (NO) and CO operated at stoichiometric fuel-air ratio turns out to be L/D as 1.0, Spark advance as 20° BTDC (before top dead center), combustion duration as 50°, inlet valve closing as 30° ATDC and exhaust valve opening as 10° BBDC (before bottom dead center). The efficiency, specific fuel consumption, power, CO and NO with these optimal parameters are of the order of 19.58%, 1.23 kg/kWh, 67.0 kW, 0.65 ppm and 0.017 ppb, respectively. It is believed that present work offers optimal design and operating parameters through actual thermodynamic cycle analysis which may be used as a reference for design and development of producer gas-fuelled Spark Ignition (SI) engines