Reducing inappropriate antibiotics prescribing: The role of online commentary on physical examination findings

Objective: This study investigates the relationship of ‘online commentary’(contemporaneous physician comments about physical examination [PE] findings) with (i) parent questioning of the treatment recommendation and (ii) inappropriate antibiotic prescribing. Methods: A nested cross-sectional study of 522 encounters motivated by upper respiratory symptoms in 27 California pediatric practices (38 pediatricians). Physicians completed a post-visit survey regarding physical examination findings, diagnosis, treatment, and whether they perceived the parent as expecting an antibiotic. Taped encounters were coded for ‘problem’ online commentary (PE findings discussed as significant or clearly abnormal) and ‘no problem’ online commentary (PE findings discussed reassuringly as normal or insignificant). Results: Online commentary during the PE occurred in 73% of visits with viral diagnoses (n = 261). Compared to similar cases with ‘no problem’ online commentary, ‘problem’ comments were associated with a 13% greater probability of parents uestioning a non-antibiotic treatment plan (95% CI 0-26%, p = .05,) and a 27% (95% CI: 2-52%, p < .05) greater probability of an inappropriate antibiotic prescription. Conclusion: With viral illnesses, problematic online comments are associated with more pediatrician-parent conflict over non-antibiotic treatment recommendations. This may increase inappropriate antibiotic prescribing. Practice implications: In viral cases, physicians should consider avoiding the use of problematic online commentary

Scaffold searching: automated identification of similar ring systems for the design of combinatorial libraries

Rigid ring systems can be used to position receptor-binding functional groups in 3D space and they thus play an increasingly important role in the design of combinatorial libraries. This paper discusses the use of shape-similarity methods to identify ring systems that are structurally similar to, and aligned with, a user-defined target ring system. These systems can be used as alternative scaffolds for the construction of a combinatorial library

Chromosome Abnormalities and Repeated Abortion: A Preliminary Report

In view of the increased frequency of chromosome rearrangements demonstrated in these couples and the importance of counseling for future pregnancies, it would be wise to consider cytogenetic evaluation when all other probable causes for recurrent abortion have been ruled out

Topographic, Hydraulic, and Vegetative Controls on Bar and Island Development in Mixed Bedrock‐Alluvial, Multichanneled, Dryland Rivers

We investigate processes of bedrock‐core bar and island development in a bedrock‐influenced anastomosed reach of the Sabie River, Kruger National Park (KNP), eastern South Africa. For sites subject to alluvial stripping during an extreme flood event (~4470‐5630 m3 s‐1) in 2012, pre‐ and post‐flood aerial photographs and LiDAR data, 2D morphodynamic simulations, and field observations reveal that the thickest surviving alluvial deposits tend to be located over bedrock topographic lows. At a simulated peak discharge (~4500 m3 s‐1), most sediment (sand, fine gravel) is mobile but localized deposition on bedrock topographic highs is possible. At lower simulated discharges (<1000 m3 s‐1), topographic highs are not submerged, and deposition occurs in lower elevation areas, particularly in areas disconnected from the main channels during falling stage. Field observations suggest that in addition to discharge, rainwash between floods may redistribute sediments from bedrock topographic highs to lower elevation areas, and also highlight the critical role of vegetation colonization in bar stability, and in trapping of additional sediment and organics. These findings challenge the assumptions of preferential deposition on topographic highs that underpin previous analyses of KNP river dynamics, and are synthesized in a new conceptual model that demonstrates how initial bedrock topographic lows become topographic highs (bedrock core‐bars and islands) in the latter stages of sediment accumulation. The model provides particular insight into the development of mixed bedrock‐alluvial anastomosing along the KNP rivers, but similar processes of bar/island development likely occur along numerous other bedrock‐influenced rivers across dryland southern Africa and farther afield

FAST CARS: Engineering a Laser Spectroscopic Technique for Rapid Identification of Bacterial Spores

Airborne contaminants, e.g., bacterial spores, are usually analyzed by time consuming microscopic, chemical and biological assays. Current research into real time laser spectroscopic detectors of such contaminants is based on e.g. resonant Raman spectroscopy. The present approach derives from recent experiments in which atoms and molecules are prepared by one (or more) coherent laser(s) and probed by another set of lasers. The connection with previous studies based on "Coherent Anti-Stokes Raman Spectroscopy" (CARS) is to be noted. However generating and utilizing maximally coherent oscillation in macromolecules having an enormous number of degrees of freedom is much more challenging. This extension of the CARS technique is called FAST CARS (Femtosecond Adaptive Spectroscopic Techniques for Coherent Anti-Stokes Raman Spectroscopy), and the present paper proposes and analyses ways in which it could be used to rapidly identify pre-selected molecules in real time.Comment: 43 pages, 21 figures; replacement with references added. Submitted to the Proceedings of National Academy of Science

Paraphrases and summaries: A means of clarification or a vehicle for articulating a preferred version of student accounts?

The use of group discussions as a means to facilitate learning from experiences is well documented in adventure education literature. Priest and Naismith (1993) assert that the use of the circular discussion method, where the leader poses questions to the participants, is the most common form of facilitation in adventure education. This paper draws on transcripts of facilitation sessions to argue that the widely advocated practice of leader summaries or paraphrases of student responses in these sessions functions as a potential mechanism to control and sponsor particular knowledge(s). Using transcripts from recorded facilitation sessions the analysis focuses on how the leader paraphrases the students’ responses and how these paraphrases or ‘formulations’ function to modify or exclude particular aspects of the students’ responses. I assert that paraphrasing is not simply a neutral activity that merely functions to clarify a student response, it is a subtle means by which the leader of the session can, often inadvertently or unknowingly, alter the student’s reply with the consequence of favouring particular knowledge(s). Revealing the subtle work that leader paraphrases perform is of importance for educators who claim to provide genuine opportunities for students to learn from their experience

Actions in Practice: On details in collections

Several of the contributions to the Lynch et al. Special issue make the claim that conversation- analytic research into epistemics is ‘routinely crafted at the expense of actual, produced and constitutive detail, and what that detail may show us’. Here, we seek to address the inappositeness of this critique by tracing precisely how it is that recognizable actions emerge from distinct practices of interaction. We begin by reviewing some of the foundational tenets of conversation-analytic theory and method – including the relationship between position and composition, and the making of collections – as these appear to be primary sources of confusion for many of the contributors to the Lynch et al. Special Issue. We then target some of the specific arguments presented in the Special Issue, including the alleged ‘over-hearer’s’ writing of metrics, the provision of so- called ‘alternative’ analyses and the supposed ‘crafting’ of generalizations in epistemics research. In addition, in light of Lynch’s more general assertion that conversation analysis (CA) has recently been experiencing a ‘rapprochement’ with what he disparagingly refers to as the ‘juggernaut’ of linguistics, we discuss the specific expertise that linguists have to offer in analyzing particular sorts of interactional detail. The article as a whole thus illustrates that, rather than being produced ‘at the expense of actual, produced and constitutive detail’, conversation-analytic findings – including its work in epistemics – are unambiguously anchored in such detail. We conclude by offering our comments as to the link between CA and linguistics more generally, arguing that this relationship has long proven to be – and indeed continues to be – a mutually beneficial one

Spectral Line-by-Line Pulse Shaping of an On-Chip Microresonator Frequency Comb

We report, for the first time to the best of our knowledge, spectral phase characterization and line-by-line pulse shaping of an optical frequency comb generated by nonlinear wave mixing in a microring resonator. Through programmable pulse shaping the comb is compressed into a train of near-transform-limited pulses of \approx 300 fs duration (intensity full width half maximum) at 595 GHz repetition rate. An additional, simple example of optical arbitrary waveform generation is presented. The ability to characterize and then stably compress the frequency comb provides new data on the stability of the spectral phase and suggests that random relative frequency shifts due to uncorrelated variations of frequency dependent phase are at or below the 100 microHertz level.Comment: 18 pages, 4 figure