Trends in broad-spectrum antibiotic prescribing for children with acute otitis media in the United States, 1998–2004

<p>Abstract</p> <p>Background</p> <p>Overuse of broad-spectrum antibiotics is associated with antibiotic resistance. Acute otitis media (AOM) is responsible for a large proportion of antibiotics prescribed for US children. Rates of broad-spectrum antibiotic prescribing for AOM are unknown.</p> <p>Methods</p> <p>Analysis of the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 1998 to 2004 (N = 6,878). Setting is office-based physicians, hospital outpatient departments, and emergency departments. Patients are children aged 12 years and younger prescribed antibiotics for acute otitis media. Main outcome measure is percentage of broad-spectrum antibiotics, defined as amoxicillin/clavulanate, macrolides, cephalosporins and quinolones.</p> <p>Results</p> <p>Broad-spectrum prescribing for acute otitis media increased from 34% of visits in 1998 to 45% of visits in 2004 (P < .001 for trend). The trend was primarily attributable to an increase in prescribing of amoxicillin/clavulanate (8% to 15%; P < .001 for trend) and macrolides (9% to 15%; P < .001 for trend). Prescribing remained stable for amoxicillin and cephalosporins while decreasing for narrow-spectrum agents (12% to 3%; P < .001 for trend) over the study period. Independent predictors of broad-spectrum antibiotic prescribing were ear pain, non-white race, public and other insurance (compared to private), hospital outpatient department setting, emergency department setting, and West region (compared to South and Midwest regions), each of which was associated with lower rates of broad-spectrum prescribing. Age and fever were not associated with prescribing choice.</p> <p>Conclusion</p> <p>Prescribing of broad-spectrum antibiotics for acute otitis media has steadily increased from 1998 to 2004. Associations with non-clinical factors suggest potential for improvement in prescribing practice.</p

Comparison between IRI and preliminary Swarm Langmuir probe measurements during the St. Patrick storm period

Preliminary Swarm Langmuir probe measurements recorded during March 2015, a period of time including the St. Patrick storm, are considered. Specifically, six time periods are identified: two quiet periods before the onset of the storm, two periods including the main phase of the storm, and two periods during the recovery phase of the storm. Swarm electron density values are then compared with the corresponding output given by the International Reference Ionosphere (IRI) model, according to its three different options for modelling the topside ionosphere. Since the Swarm electron density measurements are still undergoing a thorough validation, a comparison with IRI in terms of absolute values would have not been appropriate. Hence, the similarity of trends embedded in the Swarm and IRI time series is investigated in terms of Pearson correlation coefficient. The analysis shows that the electron density representations made by Swarm and IRI are different for both quiet and disturbed periods, independently of the chosen topside model option. Main differences between trends modelled by IRI and those observed by Swarm emerge, especially at equatorial latitudes, and at northern high latitudes, during the main and recovery phases of the storm. Moreover, very low values of electron density, even lower than 2 × 10^4 cm−3, were simultaneously recorded in the evening sector by Swarm satellites at equatorial latitudes during quiet periods, and at magnetic latitudes of about ±60° during disturbed periods. The obtained results are an example of the capability of Swarm data to generate an additional valuable dataset to properly model the topside ionosphere

Diversification of brackishwater aquaculture in Indonesia: tilapia culture in Aceh

Traditional brackishwater aquaculture in Indonesia focuses on production of shrimp and milkfish. However, since the 1990’s production of shrimp, particularly Penaeus monodon, has become problematic because ofthe prevalence of white-spot disease. Crop losses due to white-spot disease have limited production of P. monodon in traditional tambak throughout Indonesia. Because of this, many tambak have fallen into disuse, or their use islimited. In response, we are developing and trialling diversification options for tambak farmers in Aceh and South Sulawesi. Alternative production options that we are evaluating include Nile tilapia (ikan nila) and soft-shell crab(kepiting lunak) in Aceh, and Nile tilapia, swimming crab (rajungan) and rabbitfish (baronang) in South Sulawesi. In Aceh our main focus has been on Nile tilapia (Oreochromis niloticus) culture, either alone or co-cultured with milkfish (Chanos chanos). We have undertaken trials with farmers in Samalanga and Jangka (Kab. Bireuen) and Banda Mulia (Kab. Aceh Tamiang). Overall, our trials have shown that tilapia will grow and survive well at salinities below 20 ppt. Above 20 ppt, growth rate is reduced and the fish are prone to bacterial disease. At salinities above 20 ppt, milkfish (bandeng) perform better in ponds than tilapia. Our trials in Aceh have demonstrated that Nile tilapia can provideincome to farmers comparable with shrimp culture. Out of a total of 22 trials to date, 9 ponds (41%) have met or exceeded our reference profitability of IDR 1–5 million per hectare per crop. Fourteen ponds (64%) have been‘profitable’, i.e. have generated positive economic returns. This figure is similar to the profitability figure for traditional shrimp ponds (64–73%), indicating that Nile tilapia culture in brackishwater ponds provides economic returns similar to traditional shrimp culture. Based on these results, we recommend Nile tilapia culture to farmers whose ponds are 20 ppt. This provides a profitable production option for farmers in areas subject to low salinities, or during the rainy season when salinities are depressed. Because outbreaks of white-spot disease are particularly common and severe during the rainy season, Nile tilapia culture provides a viable option for income generation for Acehnese tambak farmers under conditions where shrimp culture is too risk

Simple methods for enhancing patient outcome in routine care: Measuring, monitoring, and feedback

While highly effective, psychotherapy outcome studies suggest 5?14% of clients worsen while in treatment and that therapists are unable to identify a substantial portion of such cases. Methods to systematically track client mental health functioning over the course of treatment and adjust treatment through the use of problem-solving tools are described. We summarize meta-analyses of the effects of a feedback system indicating that the number of psychotherapy patients who deteriorate can be cut in half. We conclude with a series of practice implications, including that clinicians seriously consider making formal methods of collecting client feedback a routine part of their daily practice

Individual Differences in Adolescents’ Civic Engagement: The Role of Civic Discussions with Parents and Environmental Sensitivity

The main goal of the current study was to examine the direct and moderating effects of civic dis-cussions with parents and environmental sensitivity using both the total score and its specific di-mensions (i.e., Aesthetic Sensitivity, AES; Ease of Excitation, EOE; Low Sensitivity Threshold, LST) on youth civic engagement (attitudes and behaviours). The empirical analysis relied on a ques-tionnaire-based survey conducted on a sample of 438 adolescents (30% males), aged between 14 and 18 years (M = 16.50, SD = 1.36). We used a structural equation model (SEM) with latent vari-ables and the latent moderated structural equation (LMS) method to test our hypotheses. Our re-sults showed that civic discussions with parents were positively and significantly associated with general environmental sensitivity and with AES and predicted both civic attitudes and civic be-haviours; EOE was negatively and significantly related to civic behaviours; AES was positively and significantly related to civic attitudes; and LST was not significantly related to either civic attitudes or behaviours. Contrary to our expectations, environmental sensitivity did not moderate the rela-tionship between civic discussions with parents and civic engagement. Our study further high-lights the relevance that parents have in shaping their children’s civic engagement and makes a novel contribution regarding how differences in perceiving and processing environmental stimuli can affect beliefs and behaviours toward community issues among young individual

Viabilidad de Mezclas Supercríticas en Ciclos Brayton Acoplados a Plantas de Energía Solar Concentrada

In this work it is promoted to study the viability of the use of mixtures based on supercritical CO2 that can lead to thermal yields in Brayton cycles higher than those obtained with the standard fluid (pure s-CO2). The recommended settings to analyze are Recompression and Recompression with intercooling in the main compressor, which may include more than one superheat. These configurations are very transcendental because in terms of efficiency they are the ones with the highest values and, in addition, their total costs per net installed capacity are the lowest compared to other configurations.En este trabajo se promueve estudiar la viabilidad del uso de mezclas basadas en CO2 supercrítico que pueda conducir a rendimientos térmicos en los ciclos Brayton más altos que los obtenidos con el fluido estándar (s-CO2 puro). Las configuraciones que se recomienda analizar son las de Recompresión y Recompresión con enfriamiento intermedio en el compresor principal que pueden incluir más de un recalentamiento. Estas configuraciones son muy transcendentales debido a que en términos de eficiencia son las que mayores valores presentan y, además, sus costos totales por capacidad neta instalada son los más bajos en comparación con otras configuraciones

Giving in Chicago

The report examines the patterns of charitable giving by households and corporations in the region for 2013 and the characteristics of grantmaking by foundations in the same region for 2012 (the latest year with available data). Findings from the study offer a better picture of the philanthropic landscape in the Chicago metro area and how it compares to the national philanthropic environment