Knowledge, attitudes, and reported practices among obstetrician-gynecologists in the USA regarding antibiotic prescribing for upper respiratory tract infections.

BACKGROUND: Knowledge, attitudes, and practices regarding antibiotic prescribing for upper respiratory tract infections (URIs) have not been well described among obstetrician-gynecologists (OB/GYNs). This information is useful for determining whether an OB/GYN-specific program promoting appropriate antibiotic use would significantly contribute to the efforts to decrease inappropriate antibiotic use among primary care providers. METHODS: An anonymous questionnaire asking about the treatment of URIs was sent to 1031 obstetrician-gynecologists. RESULTS: The overall response rate was 46%. The majority of respondents (92%) were aware of the relationship between antibiotic use and antibiotic resistance, and respondents estimated that 5% of their patients had URI symptoms at their office visits. Overall, 56% of respondents reported that they would prescribe an antibiotic for uncomplicated bronchitis and 43% for the common cold. OB/GYNs with the fewest years of experience were less likely than those with the most years of experience to report prescribing for uncomplicated bronchitis (Odds ratio (OR) 0.46, 95% confidence interval (CI) 0.23 to 0.91) or the common cold (OR 0.44, CI 0.22 to 0.89). The majority of respondents (60%) believed that most patients wanted an antibiotic for URI symptoms, with male OB/GYNs being more likely than female OB/GYNs (OR 2.1, CI 1.2 to 3.8) to hold this belief. Both male OB/GYNs (OR 1.9, CI 1.1 to 3.4) and rural practitioners (OR 2.1, CI 1.1 to 4.0) were more likely to believe that it was hard to withhold antibiotics for URI symptoms because other physicians prescribe antibiotics for these symptoms. OB/GYNs who believed that postgraduate training prepared them well for primary care management were more likely than those who did not (OR 2.1, CI 1.1 to 4.2) to believe that they could reduce antibiotic prescribing without reducing patient satisfaction. CONCLUSION: Multiple demographic factors affect attitudes and reported practices regarding antibiotic prescribing. However, in view of the low proportion of office visits for URIs, an OB/GYN-specific program is not warranted

Turning product design into public service

Thesis (S.B.)--Massachusetts Institute of Technology, Dept. of Mechanical Engineering, 2010.Statement of responsibility on t.p. reads: Laura E. Aust, Zachary W. Rose, Ariadne G. Smith, Amrita Saigal. Each student submitted a title page and vita. Cataloged from PDF version of thesis.Includes bibliographical references (p. 87-89 ([i.e. p. [99]-[101])).Every mechanical engineering student at MIT takes the same courses: 2.009 being one of them. In our capstone product design course at MIT, most students glean an incredible amount from their teams, mentors, and projects, then focus their efforts on slightly more pressing issues, such as graduating and finding jobs and grad school. But what if the project you found was bigger than just a course, and had the potential of improving the lives of those less fortunate than you? The Komera project creates affordable sanitary protection for women in developing countries from the locally available and all-natural fiber from banana plants. In doing so, the initiative not only empowers girls by allowing them to attend school during their periods, but also creates employment and income within their communities. Our first initial iterations of the machine to fabricate pads were created in 2.009. Previous mechanical solutions to this problem are inefficient and labor-intensive. With our prototype, we seek to reduce the labor involved and increase pad output by twofold. However, we didn't want out work to stop there. Over the course of the semester, we continued to expand the Komera project twofold: by working on the mechanical design of the product and by expanding our scope to transform the product into a public service initiative. This thesis discusses the trials and tribulations of both directions. We explore the differences and challenges in designing for the developing world within a 1 st-world product design context - paying attention to manufacturing, materials, cost, and usability. We also offer a guide through the creation of an initiative: how we took a product and turned it into an IDEAS-winning public service project. It has been an incredibly rewarding experience for us, and we hope that we can inspire others to work on international development products as well.by Laura E. Aust ... [et al.].S.B

Multiple Imputation of Missing Race and Ethnicity in CDC COVID-19 Case-Level Surveillance Data

The COVID-19 pandemic has resulted in a disproportionate burden on racial and ethnic minority groups, but incompleteness in surveillance data limits understanding of disparities. CDC’s case-based surveillance system contains most COVID-19 cases in the United States. Data analyzed in this paper contain COVID-19 cases with case-level information through September 25, 2020, which represent 70.9% of all COVID-19 cases reported to CDC during the period. Case-level surveillance data are used to investigate COVID-19 disparities by race/ethnicity, sex, and age. However, demographic information on race and ethnicity is missing for a substantial percentage of COVID-19 cases (e.g., 35.8% and 47.2% of cases analyzed were missing race and ethnicity information, respectively). Our goal in this study was to impute missing race and ethnicity to derive more accurate incidence and incidence rate ratio (IRR) estimates for different racial and ethnic groups, and evaluate the results from imputation compared to complete case analysis, which involves removing cases with missing race/ethnicity information from the analysis. Two multiple imputation (MI) models were developed. Model 1 imputes race using six binary race variables, and Model 2 imputes race as a composite multinomial variable. Our evaluation found that compared with complete case analysis, MI reduced biases and improved coverage on incidence and IRR estimates for all race/ethnicity groups, except for the Non-Hispanic Multiple/other group. Our research highlights the importance of supplementing complete case analysis with additional methods of analysis to better describe racial and ethnic disparities. When race and ethnicity data are missing, multiple imputation may provide more accurate incidence and IRR estimates to monitor these disparities in tandem with efforts to improve the collection of race and ethnicity information for pandemic surveillance

Clinical stakeholders' opinions on the use of selective decontamination of the digestive tract in critically ill patients in intensive care units : an international Delphi study

Peer reviewedPublisher PD

Keeping an eye on decellularized corneas: a review of methods, characterization and applications

The worldwide limited availability of suitable corneal donor tissue has led to the development of alternatives, including keratoprostheses (Kpros) and tissue engineered (TE) constructs. Despite advances in bioscaffold design, there is yet to be a corneal equivalent that effectively mimics both the native tissue ultrastructure and biomechanical properties. Human decellularized corneas (DCs) could offer a safe, sustainable source of corneal tissue, increasing the donor pool and potentially reducing the risk of immune rejection after corneal graft surgery. Appropriate, human-specific, decellularization techniques and high-resolution, non-destructive analysis systems are required to ensure reproducible outputs can be achieved. If robust treatment and characterization processes can be developed, DCs could offer a supplement to the donor corneal pool, alongside superior cell culture systems for pharmacology, toxicology and drug discovery studies

Determining the Feasibility of Milk Vending Machines to Improve Calcium Intake Among College Students

Calcium intake declines from late adolescence to young adulthood, in part, due to decreases in accessibility to milk and dairy products. While milk vending has shown demonstrated success in secondary schools, no studies have examined whether milk vending improves calcium intake among college students. We hypothesized that milk and calcium intake would be higher among college students given access to milk vending in their dormitory (milk vending consumers) compared to those lacking access in their dormitory (non-milk vending consumers). Milk vending machines were installed in two dormitories, and two dormitories having non-milk beverage vending served as comparison sites. Students completed a calcium intake questionnaire at the point of milk (n = 73) or non-milk (n = 79) beverage vending purchases. Mean total calcium intake was higher in milk vending consumers (1245 + 543 mg/d) compared to non-milk vending consumers (1042 + 447 mg/d) (p = 0.01). Adjusting for gender and milk vending consumer status, there was a positive association between past month milk vending purchases and daily calcium intake from milk (p \u3c 0.001). Fiftyseven students without in-dormitory access to milk vending reported an interest in milk vending if made available. Milk vending may serve as a novel approach

Integrated Refrigeration and Storage of LNG for Compositional Stability

Growing interest in liquefied natural gas (LNG) as a rocket fuel necessitates a greater technical understanding of the compositional changes due to preferential boil-off (or weathering) that occurs during long duration storage. The purity of methane in LNG can range from 90 to 98%, and is subject to preferential boil-off due to its low boiling point compared to other constituents despite the use of high-performance thermal insulation systems. Active heat extraction (i.e. refrigeration) is required to completely eliminate weathering. For future operational safety and reliability, and to better understand the quality and efficiency of the LNG as a cryofuel, a 400-liter Cryostat vessel was designed and constructed to measure the composition and temperatures of the LNG at a number of different liquid levels over long durations. The vessel is the centerpiece of a custom-designed lab-scale integrated refrigeration and storage (IRaS) system employing a pulse tube cryocooler capable of roughly 50 W of lift at 100 K. Instrumentation includes ten temperature sensors mounted on a vertical rake and five liquid sample tubes corresponding to five liquid levels. Two modes of operation are studied. The first is without refrigeration in order to determine a baseline in the change in composition, and to study stratification of the LNG. The second is performed with the cryocooler active to determine the operational parameters of the IRaS system for eliminating the weathering as well as stratification effects in the bulk liquid. The apparatus design and test method, as well as preliminary test results are presented in this paper. As a bonus in cost-saving and operational efficiency, the capability of the IRaS system to provide zero-loss capabilities such as zero boil-off (ZBO) keeping of the LNG and zero-loss filling/transfer operations are also discussed

The use of innovative scaffolds in the development of corneal stroma-derived stem cell therapies for future corneal regeneration strategies [Abstract]

The use of innovative scaffolds in the development of corneal stroma-derived stem cell therapies for future corneal regeneration strategies [Abstract

Reflections and Experiences of a Co-Researcher involved in a Renal Research Study

Background Patient and Public Involvement (PPI) is seen as a prerequisite for health research. However, current Patient and public involvement literature has noted a paucity of recording of patient and public involvement within research studies. There have been calls for more recordings and reflections, specifically on impact. Renal medicine has also had similar criticisms and any reflections on patient and public involvement has usually been from the viewpoint of the researcher. Roles of patient and public involvement can vary greatly from sitting on an Advisory Group to analysing data. Different PPI roles have been described within studies; one being a co-researcher. However, the role of the co-researcher is largely undefined and appears to vary from study to study. Methods The aims of this paper are to share one first time co-researcher's reflections on the impact of PPI within a mixed methods (non-clinical trial) renal research study. A retrospective, reflective approach was taken using data available to the co-researcher as part of the day-to-day research activity. Electronic correspondence and documents such as meeting notes, minutes, interview thematic analysis and comments on documents were re-examined. The co-researcher led on writing this paper. Results This paper offers a broad definition of the role of the co-researcher. The co-researcher reflects on undertaking and leading on the thematic analysis of interview transcripts, something she had not previously done before. The co-researcher identified a number of key themes; the differences in time and responsibility between being a coresearcher and an Advisory Group member; how the role evolved and involvement activities could match the co-researchers strengths (and the need for flexibility); the need for training and support and lastly, the time commitment. It was also noted that it is preferable that a co-researcher needs to be involved from the very beginning of the grant application. Conclusions The reflections, voices and views of those undertaking PPI has been largely underrepresented in the literature. The role of co-researcher was seen to be rewarding but demanding, requiring a large time commitment. It is hoped that the learning from sharing this experience will encourage others to undertake this role, and encourage researchers to reflect on the needs of those involved.Peer reviewedFinal Published versio

Balancing Selection at the Tomato RCR3 Guardee Gene Family Maintains Variation in Strength of Pathogen Defense

Coevolution between hosts and pathogens is thought to occur between interacting molecules of both species. This results in the maintenance of genetic diversity at pathogen antigens (or so-called effectors) and host resistance genes such as the major histocompatibility complex (MHC) in mammals or resistance (R) genes in plants. In plant-pathogen interactions, the current paradigm posits that a specific defense response is activated upon recognition of pathogen effectors via interaction with their corresponding R proteins. According to the''Guard-Hypothesis,'' R proteins (the ``guards'') can sense modification of target molecules in the host (the ``guardees'') by pathogen effectors and subsequently trigger the defense response. Multiple studies have reported high genetic diversity at R genes maintained by balancing selection. In contrast, little is known about the evolutionary mechanisms shaping the guardee, which may be subject to contrasting evolutionary forces. Here we show that the evolution of the guardee RCR3 is characterized by gene duplication, frequent gene conversion, and balancing selection in the wild tomato species Solanum peruvianum. Investigating the functional characteristics of 54 natural variants through in vitro and in planta assays, we detected differences in recognition of the pathogen effector through interaction with the guardee, as well as substantial variation in the strength of the defense response. This variation is maintained by balancing selection at each copy of the RCR3 gene. Our analyses pinpoint three amino acid polymorphisms with key functional consequences for the coevolution between the guardee (RCR3) and its guard (Cf-2). We conclude that, in addition to coevolution at the ``guardee-effector'' interface for pathogen recognition, natural selection acts on the ``guard-guardee'' interface. Guardee evolution may be governed by a counterbalance between improved activation in the presence and prevention of auto-immune responses in the absence of the corresponding pathogen