A National Quality Improvement Collaborative to Improve Antibiotic Use in Pediatric Infections.

Background: Nearly 25% of antibiotics prescribed to children are inappropriate or unnecessary, subjecting patients to avoidable adverse medication effects and cost.

Methods: We conducted a quality improvement initiative across 118 hospitals participating in the American Academy of Pediatrics Value in Inpatient Pediatrics Network 2020 to 2022. We aimed to increase the proportion of children receiving appropriate: (1) empirical, (2) definitive, and (3) duration of antibiotic therapy for community-acquired pneumonia, skin and soft tissue infections, and urinary tract infections to ≥85% by Jan 1, 2022.

Documentation of Trauma-Informed Care Elements for Young People Hospitalized After Assault Trauma.

Introduction: Violent traumatic injury, including firearm violence, can adversely impact individual and community health. Trauma-informed care (TIC) can promote resilience and prevent future violence in patients who have experienced trauma. However, few protocols exist to facilitate implementation of TIC for patients who survive traumatic injury.

Perceptions on use of insecticide-treated bed nets to prevent malaria: a qualitative assessment in two rural districts of Zambézia province in Mozambique.

Background: Malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. The insecticide-treated bed nets (ITNs) are one of the malaria control strategies that, due to their cost effectiveness, are largely used in the country. Data on the actual coverage and usage of bed nets is unreliable, as it is based only on administrative data from distributed ITNs.

Inequalities in early marriage, childbearing and sexual debut among adolescents in sub-Saharan Africa.

Background: Adolescent sexual and reproductive health (ASRH) is a major public health concern in sub-Saharan Africa (SSA). However, inequalities in ASRH have received less attention than many other public health priority areas, in part due to limited data. In this study, we examine inequalities in key ASRH indicators.

Comparing Patterns of Care for Febrile Infants at Community and University-Affiliated Hospitals.

Objectives: Most children in the United States receive treatment in community hospitals, but descriptions of clinical practice patterns in pediatric care in this setting are lacking. Our objectives were to compare clinical practice patterns primarily between community and university-affiliated hospitals and secondarily by number of pediatric beds before and during participation in a national practice standardization project.

Methods: We performed a retrospective secondary analysis on data from 126 hospitals that participated in the American Academy of Pediatrics' Value in Inpatient Pediatrics Reducing Excessive Variability in the Infant Sepsis Evaluation project, a national quality improvement project conducted to improve care for well-appearing febrile infants aged 7 to 60 days.

Training Hospital Personnel in Trauma-Informed Care: Assessing an Interprofessional Workshop With Patients as Teachers.

Objective: Trauma-informed care (TIC) and violence intervention programs (VIPs) facilitate psychosocial healing and reduce injury recidivism for children and families affected by community violence. To integrate a VIP into 2 Level 1 Pediatric Trauma Centers, an educational initiative was developed and co-taught by pediatricians and former patients. The primary aim was to increase provider-driven patient referrals to the VIP.

Qualitative Assessment of Health and Care-Seeking Behaviors among Hiv-Infected Adults and Health Care Providers in Mozambique.

Background: From 2009 to 2014, the prevalence of HIV among adults in Mozambique increased from 11.5% to 13.2%.

Obstacles to advancing women's health in Mozambique: a qualitative investigation into the perspectives of policy makers.

Background: Despite substantial investment in women's health over the past two decades, and enthusiastic government support for MDG 5 and SDG 3, health indicators for women in Mozambique remain among the lowest in the world. Maternal mortality stayed constant from 2003 to 2011, with an MMR of 408; the estimated HIV prevalence for women of 15-24 years is over twice that for men; and only 12.1% of women are estimated to be using modern contraception.

Projecting the lives saved by continuing the historical scale-up of child and maternal health interventions in Mozambique until 2030.

Background: Over the past 20 years, Mozambique has achieved substantial reductions in maternal, neonatal, and child mortality. However, mortality rates are still high, and to achieve the Sustainable Development Goals (SDGs) for maternal and child health, further gains are needed. One technique that can guide policy makers to more effectively allocate health resources is to model the coverage increases and lives saved that would be achieved if trends continue as they have in the past, and under differing alternative scenarios.

A Low-Diversity Microbiota Inhabits Extreme Terrestrial Basaltic Terrains and Their Fumaroles: Implications for the Exploration of Mars.

A major objective in the exploration of Mars is to test the hypothesis that the planet hosted life. Even in the absence of life, the mapping of habitable and uninhabitable environments is an essential task in developing a complete understanding of the geological and aqueous history of Mars and, as a consequence, understanding what factors caused Earth to take a different trajectory of biological potential. We carried out the aseptic collection of samples and comparison of the bacterial and archaeal communities associated with basaltic fumaroles and rocks of varying weathering states in Hawai'i to test four hypotheses concerning the diversity of life in these environments.

Reaching substantive female representation among decision-makers: A qualitative research study of gender-related experiences from the health sector in Mozambique.

Background: Achieving significant female representation in government at decision-making levels has been identified as a key step towards achieving gender equality. In 2015, women held 39.6% of parliamentary seats in Mozambique, which is above the benchmark of 30% that has been suggested as the turning point for minority representation to move from token status to having a sizable impact.

Economic and Clinical Outcomes Resulting From the Stage 4 Chronic Kidney Disease Case Management Quality Improvement Initiative.

Purpose Of Study: Chronic kidney disease (CKD) is a costly and burdensome public health concern. The goal of this study was to evaluate the impact on outcomes and utilization of a pilot program to identify and engage beneficiaries with CKD at risk for progression from Stage 4 to Stage 5.

Primary Practice Settings: A quality improvement initiative was conducted to assess the impact of case management on costs and outcomes among 7,720 Cigna commercial medical beneficiaries with Stage 4 CKD enrolled in the United States between January 2012 and October 2012.

Spatial and temporal distribution, environmental drivers and community structure of mosquitoes in the Kaipara Harbour, New Zealand.

Mosquito communities across the globe frequently comprise a mix of native and cosmopolitan species. New Zealand's mosquito communities are no exception. Here we describe the abundance, distribution and phenological patterns for a community of six mosquito taxa resident across the Kaipara Harbour region of northern New Zealand.

Vector competence of New Zealand mosquitoes for selected arboviruses.

New Zealand (NZ) historically has been free of arboviral activity with the exception of Whataroa virus (Togaviridae: Alphavirus), which is established in bird populations and is transmitted by local mosquitoes. This naive situation is threatened by global warming, invasive mosquitoes, and tourism. To determine the threat of selected medically important arboviruses to NZ, vector competence assays were conducted using field collected endemic and introduced mosquito species.

Rural public dental practice in Australia: perspectives of Tasmanian government-employed dentists.

Objective: This study sought to describe the perspectives of dentists providing public dental care in the Australian rural state of Tasmania. It sought information on a range of subjects, such as interactions with patients, as a component of baseline studies to improve models of public dental clinical services. It was conducted through a unique partnership between the University of Tasmania (Department of Rural Health) and the State government.

The implications and management of acute odontogenic infection in association with Down and Eisenmenger syndromes and schizophrenia in a rural setting.

Background: This report describes the case management of a 32 year old special needs patient with life-threatening odontogenic infection. The combination of schizophrenia, Down and Eisenmenger syndromes presented significant challenges to managing his oral health, particularly within the rural context. In this case, dental treatment was limited to a full dental clearance during a high risk general anaesthesia session.

Microsatellites and 16S sequences corroborate phenotypic evidence of trans-Andean variation in the parasitoid Microctonus hyperodae (Hymenoptera: Braconidae).

Eight South American geographical populations of the parasitoid Microctonus hyperodae Loan were collected in South America (Argentina, Brazil, Chile and Uruguay) and released in New Zealand for biological control of the weevil Listronotus bonariensis (Kuschel), a pest of pasture grasses and cereals. DNA sequencing (16S, COI, 28S, ITS1, beta-tubulin), RAPD, AFLP, microsatellite, SSCP and RFLP analyses were used to seek markers for discriminating between the South American populations. All of the South American populations were more homogeneous than expected.

Developing primary health clinical teams for public oral health services in Tasmania.

This paper reviews the problem of socio-economic health inequalities and highlights the relevance of these issues for the delivery of public oral health services in the Australian island State of Tasmania. It contends that unless there is reform of existing public oral health systems, inequities in oral health care linked to socio-economic factors and geographic location will remain. The challenge is, firstly, to understand the current situation and why it has occurred.

Understanding childhood asthma in focus groups: perspectives from mothers of different ethnic backgrounds.

Background: Diagnosing childhood asthma is dependent upon parental symptom reporting but there are problems in the use of words and terms. The purpose of this study was to describe and compare understandings of childhood 'asthma' by mothers from three different ethnic backgrounds who have no personal experience of diagnosing asthma. A better understanding of parents' perceptions of an illness by clinicians should improve communication and management of the illness.

Parents' interpretations of children's respiratory symptoms on video.

Aims: To investigate how parents report children's respiratory sounds on video compared to a clinical "gold standard".

Methods: Five clinicians agreed on 10 video clips of children with audible breathing. These responses were the "gold standard".

What do parents of wheezy children understand by "wheeze"?

Background: Reported wheeze is the cornerstone of asthma diagnosis.

Aims: To determine what parents understand by wheeze.

Methods: Two studies were undertaken: (1) Parents of clinic attendees with reported wheeze (n=160) were asked by questionnaire what they understood by "wheeze" and how they knew their child was wheezy.

Unplanned endotracheal extubation in the intensive care unit.

Study Objective: To identify the frequency, outcome, and factors associated with unplanned endotracheal extubation (UE) in the intensive care unit (ICU).

Design: Prospective study.

Setting: An urban, university trauma-surgical ICU.

Head turning in brain death.

Criteria for determination of brain death in adults have been defined. Spinal cord reflexes may persist after brain death. We present the case of a brain dead patient who had a complex spinal automatism resulting in head shaking and arm extension.