The Associations of Autonomy Support and Conceptual Press with Engaged Reading and Conceptual Learning from Text

This study examined the associations of autonomy support and conceptual press, with reading engagement and conceptual learning from text. When students perceive their teacher to be supporting autonomy, it means that student choice, ownership, and personal goals are emphasized. When students perceive their teacher to be supporting conceptual press, it means that the teacher (a) promotes understanding of the substantial principles of a domain; (b) helps students use information integration strategies during reading, such as concept mapping, and (c) promotes persistence on moderately challenging tasks. Based on the self-process model of motivation (Connell & Wellborn, 1990) and an engagement perspective of reading (Baker, Dreher & Guthrie, 2000), it was hypothesized that as students perceived their instruction to be motivating, their reading engagement would increase. In turn, as engaged reading increases, conceptual learning from text would increase. For this investigation, 244 fourth- and fifth-grade students reported their perceptions of their teachers' use of conceptual press and autonomy support in reading instruction. Multifaceted components of reading engagement were measured. Reading engagement was defined as the manifestations of affective, behavioral, and cognitive processes during reading. In addition, participants completed a reading performance assessment in the domain of science designed to measure prior knowledge, strategic reading, and conceptual learning from text. Structural equation modeling was used to compare alternative theoretical models depicting the relations among motivated reading instruction, engaged reading, and conceptual learning from text. The direct effects model had a direct path connecting motivating reading instruction with conceptual learning from text whereas the hypothesized indirect effects model contained an indirect path from motivating reading instruction to conceptual learning from text via engaged reading. Results confirmed the hypothesis that the model including an indirect effect of motivating reading instruction on conceptual learning from text through engaged reading explained the data more fully than a direct effect model. This is consistent with the self-process model of motivation (Connell & Wellborn, 1990). These results have implications for theories of the role of social contexts in engagement and achievement, particularly in the domain of reading, and also suggest ways by which teachers might foster reading engagement among students

Barriers to guideline-concordant antibiotic use among inpatient physicians: A case vignette qualitative study

BACKGROUND: Greater adherence to antibiotic-prescribing guidelines may promote more judicious antibiotic use, which could benefit individual patients and society at large. OBJECTIVE: To assess physician knowledge and acceptance of antibiotic-prescribing guidelines through the use of case vignettes. DESIGN: We conducted semistructured interviews with 30 inpatient physicians. Participants were asked to respond to 3 hypothetical case vignettes: (1) a skin and soft tissue infection (SSTI), (2) suspected hospital-acquired pneumonia (HAP), and (3) asymptomatic bacteriuria (ASB). All participants received feedback according to guidelines from the Infectious Diseases Society of America (IDSA) and were asked to discuss their level of comfort with following these guidelines. SETTING: Two acute care teaching hospitals for adult patients. INTERVENTION: None. MEASUREMENTS: Data from transcribed interviews were analyzed using emergent thematic analysis. RESULTS: Participants were receptive to guidelines and believed they were useful. However, participants' responses to the case vignettes demonstrated that IDSA guideline recommendations were not routinely followed for SSTI, HAP, and ASB. We identified 3 barriers to guideline-concordant care: (1) physicians' lack of awareness of specific guideline recommendations; (2) tension between adhering to guidelines and the desire to individualize patient care; and (3) skepticism of certain guideline recommendations. CONCLUSIONS: Case vignettes may be useful tools to assess physician knowledge and acceptance of antibiotic-prescribing guidelines. Using case vignettes, we identified 3 barriers to following IDSA guidelines. Efforts to improve guideline-concordant antibiotic prescribing should focus on reducing such barriers at the local level

Aplicación de un modelo de productividad en el sector de la comercialización de madera tratada en la ciudad de Ambato. Empresa de estudio: Súper Tableros

El trabajo de investigación realizado en este trabajo de titulación se lo ha realizado en la empresa SUPERTABLEROS, ubicada en la ciudad de Ambato. El objetivo de este análisis fue la de determinar qué modelo de productividad es el que mejor se aplica y se adapta a las características en el sector de madera tratada, para ello se estudiaron ocho modelos de los cuales se escogió uno para su implementación debido a que es el que mejor cumplía con los factores que la empresa desea analizar. Se escogió el modelo estructural de Kurosawa. Para llegar a esta conclusión se empezó por hacer el levantamiento del proceso productivo y posteriormente medir los tiempos de cada una de las actividades dentro de dicho proceso. Se procedió a recopilar dentro de la empresa todos los datos necesarios para el cálculo de cada uno de los ocho modelos de productividad. El modelo estructural de Kurosawa es bastante minucioso, sin embargo es muy práctico ya que mide los tiempos y movimientos de los trabajadores dentro del proceso productivo considerando el tiempo efectivamente trabajado. Además de medir la eficiencia global de la empresa. Dentro del análisis interno realizado se pudo observar que la empresa cuenta con una posición consolidada en el mercado, tiene indicadores favorables de rentabilidad y existen ciertas barreras de entrada para potenciales competidores como una considerable inversión inicial de capital, conseguir buenos proveedores internacionales y crear canales de distribución eficientes. Esto hace que SUPERTABLEROS esté en una posición óptima para la implementación de un modelo productivo que le permita manejarse de una manera más eficaz y eficiente en el corto, mediano y largo plazo

Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists.

BackgroundMany US hospitals lack infectious disease (ID) specialists, which may hinder antibiotic stewardship efforts. We sought to compare patient-level antibiotic exposure at Veterans Health Administration (VHA) hospitals with and without an on-site ID specialist, defined as an ID physician and/or ID pharmacist.MethodsThis retrospective VHA cohort included all acute-care patient admissions during 2016. A mandatory survey was used to identify hospitals' antibiotic stewardship processes and their access to an on-site ID specialist. Antibiotic use was quantified as days of therapy per days present and categorized based on National Healthcare Safety Network definitions. A negative binomial regression model with risk adjustment was used to determine the association between presence of an on-site ID specialist and antibiotic use at the level of patient admissions.ResultsEighteen of 122 (14.8%) hospitals lacked an on-site ID specialist; there were 525 451 (95.8%) admissions at ID hospitals and 23 007 (4.2%) at non-ID sites. In the adjusted analysis, presence of an ID specialist was associated with lower total inpatient antibacterial use (odds ratio, 0.92; 95% confidence interval, .85-.99). Presence of an ID specialist was also associated with lower use of broad-spectrum antibacterials (0.61; .54-.70) and higher narrow-spectrum β-lactam use (1.43; 1.22-1.67). Total antibacterial exposure (inpatient plus postdischarge) was lower among patients at ID versus non-ID sites (0.92; .86-.99).ConclusionsPatients at hospitals with an ID specialist received antibiotics in a way more consistent with stewardship principles. The presence of an ID specialist may be important to effective antibiotic stewardship

Seasonal and Temperature-Associated Increases in Gram-Negative Bacterial Bloodstream Infections among Hospitalized Patients

BACKGROUND: Knowledge of seasonal trends in hospital-associated infection incidence may improve surveillance and help guide the design and evaluation of infection prevention interventions. We estimated seasonal variation in the frequencies of inpatient bloodstream infections (BSIs) caused by common bacterial pathogens and examined associations of monthly BSI frequencies with ambient outdoor temperature, precipitation, and humidity levels. METHODS: A database containing blood cultures from 132 U.S. hospitals collected between January 1999 and September 2006 was assembled. The database included monthly counts of inpatient blood cultures positive for several clinically important Gram-negative bacteria (Acinetobacter spp, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) and Gram-positive bacteria (Enterococcus spp and Staphylococcus aureus). Monthly mean temperature, total precipitation, and mean relative humidity in the postal ZIP codes of participating hospitals were obtained from national meteorological databases. RESULTS: A total of 211,697 inpatient BSIs were reported during 9,423 hospital-months. Adjusting for long-term trends, BSIs caused by each gram-negative organism examined were more frequent in summer months compared with winter months, with increases ranging from 12.2% for E. coli (95% CI 9.2-15.4) to 51.8% for Acinetobacter (95% CI 41.1-63.2). Summer season was associated with 8.7% fewer Enterococcus BSIs (95% CI 11.0-5.8) and no significant change in S. aureus BSI frequency relative to winter. Independent of season, monthly humidity, monthly precipitation, and long-term trends, each 5.6°C (10°F) rise in mean monthly temperature corresponded to increases in gram-negative bacterial BSI frequencies ranging between 3.5% for E. coli (95% CI 2.1-4.9) to 10.8% for Acinetobacter (95% CI 6.9-14.7). The same rise in mean monthly temperature corresponded to an increase of 2.2% in S. aureus BSI frequency (95% CI 1.3-3.2) but no significant change in Enterococcus BSI frequency. CONCLUSIONS: Summer season and higher mean monthly outdoor temperature are associated with substantially increased frequency of BSIs, particularly among clinically important gram-negative bacteria

Implementation of antimicrobial stewardship policies in U.S. hospitals: findings from a national survey.

OBJECTIVE: To describe the use of antimicrobial stewardship policies and to investigate factors associated with implementation in a national sample of acute care hospitals. DESIGN: Cross-sectional survey. PARTICIPANTS: Infection Control Directors from acute care hospitals participating in the National Healthcare Safety Network (NHSN). METHODS: An online survey was conducted in the Fall of 2011. A subset of hospitals also provided access to their 2011 NHSN annual survey data. RESULTS: Responses were received from 1,015 hospitals (30% response rate). The majority of hospitals (64%) reported the presence of a policy; use of antibiograms and antimicrobial restriction policies were most frequently utilized (83% and 65%, respectively). Respondents from larger, urban, teaching hospitals and those that are part of a system that shares resources were more likely to report a policy in place (P CONCLUSION: This study provides a snapshot of the implementation of antimicrobial stewardship policies in place in U.S. hospitals and suggests that statewide efforts in California are achieving their intended effect. Further research is needed to identify factors that foster the adoption of these policies

Incidence and Outcomes Associated With Clostridium difficile Infections: A Systematic Review and Meta-analysis

Importance: An understanding of the incidence and outcomes of Clostridium difficile infection (CDI) in the United States can inform investments in prevention and treatment interventions. Objective: To quantify the incidence of CDI and its associated hospital length of stay (LOS) in the United States using a systematic literature review and meta-analysis. Data Sources: MEDLINE via Ovid, Cochrane Library Databases via Wiley, Cumulative Index of Nursing and Allied Health Complete via EBSCO Information Services, Scopus, and Web of Science were searched for studies published in the United States between 2000 and 2019 that evaluated CDI and its associated LOS. Study Selection: Incidence data were collected only from multicenter studies that had at least 5 sites. The LOS studies were included only if they assessed postinfection LOS or used methods accounting for time to infection using a multistate model or compared propensity score-matched patients with CDI with control patients without CDI. Long-term-care facility studies were excluded. Of the 119 full-text articles, 86 studies (72.3%) met the selection criteria. Data Extraction and Synthesis: Two independent reviewers performed the data abstraction and quality assessment. Incidence data were pooled only when the denominators used the same units (eg, patient-days). These data were pooled by summing the number of hospital-onset CDI incident cases and the denominators across studies. Random-effects models were used to obtain pooled mean differences. Heterogeneity was assessed using the I2 value. Data analysis was performed in February 2019. Main Outcomes and Measures: Incidence of CDI and CDI-associated hospital LOS in the United States. Results: When the 13 studies that evaluated incidence data in patient-days due to hospital-onset CDI were pooled, the CDI incidence rate was 8.3 cases per 10 000 patient-days. Among propensity score-matched studies (16 of 20 studies), the CDI-associated mean difference in LOS (in days) between patients with and without CDI varied from 3.0 days (95% CI, 1.44-4.63 days) to 21.6 days (95% CI, 19.29-23.90 days). Conclusions and Relevance: Pooled estimates from currently available literature suggest that CDI is associated with a large burden on the health care system. However, these estimates should be interpreted with caution because higher-quality studies should be completed to guide future evaluations of CDI prevention and treatment interventions