Impact of Positive Feedback on Antimicrobial Stewardship in a Pediatric Intensive Care Unit: A Quality Improvement Project.

Unlabelled: We hypothesized that antimicrobial stewardship (AMS) could be enhanced through positive feedback for the behaviors of healthcare professionals. This project aimed to reduce antimicrobial consumption in a Pediatric Intensive Care Unit (PICU) by >5%, with secondary aims to reduce broad-spectrum antimicrobial consumption, and processes related to AMS. Learning from Excellence is a positive feedback initiative conceptualized at our institution.

Broad scope hydrofunctionalization of styrene derivatives using iron-catalyzed hydromagnesiation.

The highly regioselective iron-catalyzed formal hydrofunctionalization of styrene derivatives with a diverse range of electrophiles has been developed using a single, operationally simple hydromagnesiation procedure and only commercially available, bench-stable reagents. Using just 0.5 mol % FeCl2·4H2O and N,N,N',N'-tetramethylethylenediamine, hydromagnesiation and electrophilic trapping have been used to form new carbon-carbon bonds (13 examples) and carbon-heteroatom bonds (5 examples) including the products of formal cross-coupling reactions, hydroboration, hydroamination, hydrosilylation, and hydrofluorination.

Ligand bite angle-dependent palladium-catalyzed cyclization of propargylic carbonates to 2-alkynyl azacycles or cyclic dienamides.

The regioselectivity of the palladium-catalyzed cyclization of propargylic carbonates with sulfonamide nucleophiles is critically dependent on the bite angle of the bidentate phosphine ligand. Ligands with small bite angles favor attack on the central carbon atom of an allenylpalladium intermediate to afford cyclic dienamide products, whereas the use of those with large bite angles leads to alkynyl azacycles, with high stereoselectivity. A computational analysis of the reaction pathway is also presented.

U.S. alcohol affordability and real tax rates, 1950-2011.

Background: The affordability of alcoholic beverages, determined by the relationship of prices to incomes, may be an important factor in relation to heavy drinking, but little is known about how affordability has changed over time.

Purpose: To calculate real prices and affordability measures for alcoholic beverages in the U.S.

What U.S. data should be used to measure the price elasticity of demand for alcohol?

This paper examines how estimates of the price elasticity of demand for beer vary with the choice of alcohol price series examined. Our most important finding is that the commonly used ACCRA price data are unlikely to reliably indicate alcohol demand elasticities-estimates obtained from this source vary drastically and unpredictably. As an alternative, researchers often use beer taxes to proxy for alcohol prices.

Model safety-net programs could care for the uninsured at one-half the cost of Medicaid or private insurance.

Because the reforms under the Affordable Care Act of 2010 will leave an estimated twenty million or more people still uninsured, some Americans will continue to seek care at low or no cost through existing safety-net systems. To identify appropriate care models, this comparative case study assessed the costs of care provided by four large, well-structured, comprehensive safety-net programs for the uninsured in Colorado, Michigan, North Carolina, and Texas. The average monthly resource cost-including the value of referred, donated, and in-kind services-in these model programs was $141-$209 per adult in 2008.

Multi-dimensional risk factor patterns associated with non-use of highly active antiretroviral therapy among human immunodeficiency virus-infected women.

Objectives: Relationships between non-use of highly active antiretroviral therapy (HAART), race/ethnicity, violence, drug use, and other risk factors are investigated using qualitative profiles of five risk factors (unprotected sex, multiple male partners, heavy drinking, crack, cocaine or heroin use, and exposure to physical violence) and association of the profiles and race/ethnicity with non-use of HAART over time.

Methods: A hidden Markov model was used to summarize risk factor profiles and changes in profiles over time in a longitudinal sample of HIV-infected women enrolled in the Women's Interagency HIV Study with follow-up from 2002 to 2005 (n = 802).

Results: Four risk factor profiles corresponding to four distinct latent states were identified from the five risk factors.

Complex behavioral patterns and trajectories of domestic violence offenders.

Evidence-based practice within the criminal justice system has relied primarily on cumulative reports of reassaults or rearrests, especially in evaluating effectiveness of domestic violence (DV) interventions. We use a longitudinal sample of DV offenders arrested and referred to DV offender programs in four cities to examine complex multi-outcome patterns of violent and abusive behavior and trajectories between patterns over time. Offenders and their partners were surveyed at program intake and followed for 15 months (N = 550).

North Carolina tobacco farmers' changing perceptions of tobacco control and tobacco manufacturers.

Purpose: To examine tobacco farmers' attitudes toward tobacco control, public health, and tobacco manufacturers in order to determine the extent to which rapidly changing economic conditions have influenced North Carolina tobacco farmer attitudes in ways that may provide tobacco control advocates with new opportunities to promote tobacco control policies in tobacco-dependent US communities.

Methods: We used data from a longitudinal sample of North Carolina tobacco farmers across 5 waves of data collection (1997-2005) (baseline N = 749 farmers). Generalized linear mixed models were used to examine changes in attitudes toward tobacco control and tobacco manufacturers, controlling for economic dependence on tobacco, and demographic factors.

Tobacco farmers and tobacco manufacturers: implications for tobacco control in tobacco-growing developing countries.

Assisting tobacco farmers to transition to non-tobacco alternatives is a key element of comprehensive tobacco control's end-game strategy and specifically required by the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC). We examine the historical relationship between tobacco manufacturers and tobacco farmers in the United States, where the duration of the relationship has been longest and use information obtained to inform possible end-game strategies for tobacco control advocates working with tobacco farmers in developing countries. Tobacco Documents obtained under the Master Settlement Agreement (MSA) provide evidence of conflicts between tobacco manufacturers and tobacco farmers.

Health-care costs associated with amputation or reconstruction of a limb-threatening injury.

Background: Recent reports have suggested that functional outcomes are similar following either amputation or reconstruction of a severely injured lower extremity. The goal of this study was to compare two-year direct health-care costs and projected lifetime health-care costs associated with these two treatment pathways.

Methods: Two-year health-care costs were estimated for 545 patients with a unilateral limb-threatening lower-extremity injury treated at one of eight level-I trauma centers.

The relationship between patient's perceived waiting time and office-based practice satisfaction.

Background: The amount of waiting time a patient experiences in a primary care or specialty care outpatient setting may have an effect on patient satisfaction and may depend on other visit characteristics. We sought to investigate and quantify the association between waiting time and satisfaction outcomes in clinics belonging to the Wake Forest University Baptist Medical Center and assess how this relationship varies by time spent with the provider.

Methods: Cross-sectional survey data was collected at point of care from 18 primary and specialty care clinics at the Center Overall satisfaction with provider care, the office ratings, and willingness to return were each rated on a 0-to-10-point scale.

Maternal alcohol abuse/dependence, children's behavior problems, and home environment: estimates from the National Longitudinal Survey of Youth using propensity score matching.

Objective: Propensity score (PS) matching was used to investigate the relationship between maternal alcohol abuse (AA) and alcohol dependence (AD), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and three child outcomes: child behavior problems and two characteristics of the child's home environment as measured by the Home Observation and Measurement of the Environment-Short Form, cognitive stimulation and emotional support.

Method: A cohort of children (N = 2,193; 49% female) whose mothers were drawn from the 1994 National Longitudinal Survey of Youth were stratified by gender and matched on maternal propensity to exhibit AA or AD.

Results: After matching, sons of mothers with AA/AD had higher behavior problem scores (p < or = .

Funding of North Carolina tobacco control programs through the Master Settlement Agreement.

Changing political and economic forces in 1 tobacco-dependent state, North Carolina, demonstrate how the interplay between these forces and public health priorities has shaped current allocation of Master Settlement Agreement funds. Allocation patterns demonstrate lawmakers' changing priorities in response to changes in the economic climate; some of the agreement's funds targeted to tobacco farmers appear to reflect objectives favored by tobacco manufacturers. Funds earmarked for health have underfunded youth tobacco prevention and tobacco control initiatives, and spending for tobacco farmers in North Carolina has not lived up to the rhetoric that accompanied the original agreement.

When practices, promises, profits, and policies outpace hard evidence: the post-menopausal hormone debate.

Currently, there is widespread controversy regarding the risks and benefits of hormone therapy for women over 50. The history of hormone therapy provides an excellent example of how different constituencies with competing objectives can produce health practices and policies of questionable benefit. We examine this history from the perspectives of women who now live longer, expecting higher quality of life throughout their later years, healthcare providers who are influenced by the real and perceived needs of their patients as well as information provided by drug manufacturers, the pharmaceutical industry which seeks to identify and promote drugs that offer the most promise for both patients and shareholders, and medical researchers--including the National Institutes of Health and the Federal Drug Administration.

Long-term costs of intimate partner violence in a sample of female HMO enrollees.

Objectives: To compare costs associated with intimate partner violence (IPV) overall and for selected physical health problems in a non-poor, privately insured sample.

Methods: We compared 185 women aged 21-55 who were physically and/or sexually abused between 1989 and 1997 and enrolled in a multisite metropolitan health maintenance organization (HMO) to 198 never abused women enrolled in the same plan who had been matched using propensity score stratification. Costs associated with HMO visits, hospital stays, referrals, and emergency room (ER) visits, prescriptions, and radiology are based on the Medicare Resource-Based Relative Value System, expressed in 2005 dollars.

Domestic violence in the military: women's policy preferences and beliefs concerning routine screening and mandatory reporting.

Objectives: This study describes active duty military (ADM) women's beliefs and preferences concerning domestic violence (DV) policy in the military.

Methods: Telephone interviews were completed with 474 ADM women from all services, 119 of whom had experienced DV during their military service.

Results: A majority (57%) supported routine screening.

Causal effects of alcoholism on earnings: estimates from the NLSY.

Propensity score matching is used to investigate the causal relationship between alcoholism and earnings in a young cohort of males and females drawn from the 1989 and 1994 National Longitudinal Survey of Youth (NLSY) in order to investigate productivity losses attributed to alcoholism and to quantify these effects. Results suggest that there are productivity losses attributable to alcoholism; that they become more pronounced over the life cycle; and that they differ between men and women. Ways in which estimates from propensity score matching may or may not improve on instrumental variables estimates are discussed.

Assessing the effect of batterer program completion on reassault using propensity scores.

Recent experimental evaluations have suggested little or no effect of batterer programs on reassault but are compromised by methodological and analytical issues. This study assesses program effect using propensity score analysis with a quasi-experimental sample in an attempt to address these issues. The sample consisted of 633 batterers and their partners from three geographically dispersed batterer programs and a 15-month follow-up with their female partners.

Intimate partner violence and physical health consequences.

Background: Domestic violence results in long-term and immediate health problems. This study compared selected physical health problems of abused and never abused women with similar access to health care.

Methods: A case-control study of enrollees in a multisite metropolitan health maintenance organization sampled 2535 women enrollees aged 21 to 55 years who responded to an invitation to participate; 447 (18%) could not be contacted, 7 (0.