Reducing Antibiotic Use in Pediatric Upper Respiratory Infection: A Multifaceted Parent-Clinician Approach

The goal of this QI initiative was to decrease inappropriate antibiotic for the treatment of pediatric upper respiratory infection (URI) in the retail clinic setting. The approach included the use of a protocol to treat viral upper respiratory illness, a visual aid decision-making tool for guideline adherence, prescription pad for nonprescription remedies, and shared decision-making techniques for providers to involve patients and parents in management plans regarding nonprescription remedies, supportive treatment, and signs and symptoms that would warrant a return visit. An improvement trend during the first 3 months of the initiative showed a shift in antibiotic avoidance from a baseline avoidance rate of 66% to a post intervention rate of 82%. The antibiotic avoidance initiative proved to be an effective approach in reducing the rate of inappropriate antibiotic treatment for pediatric viral upper respiratory conditions

Are UK SMEs with active websites more likely to achieve both innovation and growth?

Purpose: This paper examines the impact of developing more active Websites and increasing E-commerce on the relationship between innovation and growth performance in SMEs. Using the existing literature and empirical analysis the study considers the potential of engagement with the Internet to achieve the often hard to attain ambition of both innovation and growth. Design/methodology/approach: In order to examine the relationship, data is drawn from the Federation of Small Businesses (FSB) 'Lifting the Barriers to Growth Survey'. In order to establish whether the use of more sophisticated Websites is associated with being an innovative high performance business, whilst controlling for other firm and entrepreneurial characteristics, multivariate approaches in the form of multinominal logits and discriminant function analysis are utilised. Findings: The results suggest that although theoretically Websites with tools allowing interaction with customers or suppliers could benefit SMEs through a reduction in transaction costs and wider access to information, enabling them to jointly experience innovation and growth, in practice there is less evidence that this occurs. If anything those firms with active websites are more likely to be innovative, but no more likely to be both innovative and achieving growth. Implications: These results suggest that further work must be undertaken to establish whether SMEs should be encouraged to make such investments and if so what additional help is required to ensure that investments in this digital infrastructure achieves an appropriate return on investment. Originality/Value: The results are of importance to both SMEs and policy makers providing insight into the nature of potential benefits from Website development using a large dataset. A clear need to investigate further how more innovative SMEs can benefit from company Websites and ecommerce to grow is identified

Nonmethane hydrocarbon measurements in the North Atlantic Flight Corridor during the Subsonic Assessment Ozone and Nitrogen Oxide Experiment

Mixing ratios of nonmethane hydrocarbons (NMHCs) were not enhanced in whole air samples collected within the North Atlantic Flight Corridor (NAFC) during the fall of 1997. The investigation was conducted aboard NASA's DC-8 research aircraft, as part of the Subsonic Assessment (SASS) Ozone and Nitrogen Oxide Experiment (SONEX). NMHC enhancements were not detected within the general organized tracking system of the NAFC, nor during two tail chases of the DC-8's own exhaust. Because positive evidence of aircraft emissions was demonstrated by enhancements in both nitrogen oxides and condensation nuclei during SONEX, the NMHC results suggest that the commercial air traffic fleet operating in the North Atlantic region does not contribute at all or contributes negligibly to NMHCs in the NAFC. Copyright 2000 by the American Geophysical Union

On the Prior Sensitivity of Thompson Sampling

The empirically successful Thompson Sampling algorithm for stochastic bandits has drawn much interest in understanding its theoretical properties. One important benefit of the algorithm is that it allows domain knowledge to be conveniently encoded as a prior distribution to balance exploration and exploitation more effectively. While it is generally believed that the algorithm's regret is low (high) when the prior is good (bad), little is known about the exact dependence. In this paper, we fully characterize the algorithm's worst-case dependence of regret on the choice of prior, focusing on a special yet representative case. These results also provide insights into the general sensitivity of the algorithm to the choice of priors. In particular, with $p$ being the prior probability mass of the true reward-generating model, we prove $O(\sqrt{T/p})$ and $O(\sqrt{(1-p)T})$ regret upper bounds for the bad- and good-prior cases, respectively, as well as \emph{matching} lower bounds. Our proofs rely on the discovery of a fundamental property of Thompson Sampling and make heavy use of martingale theory, both of which appear novel in the literature, to the best of our knowledge.Comment: Appears in the 27th International Conference on Algorithmic Learning Theory (ALT), 201

Vibronic Structure in Room Temperature Photoluminescence of the Halide Perovskite Cs3Bi2Br9

We report a study on the optical properties of the layered polymorph of vacancy-ordered triple perovskite Cs3Bi2Br9. The electronic structure, determined from density functional theory calculations, shows the top of the valence band and bottom of the conduction band minima are, unusually, dominated by Bi s and p states, respectively. This produces a sharp exciton peak in the absorption spectra with a binding energy that was approximated to be 940 meV, which is substantially stronger than values found in other halide perovskites and, instead, more closely reflects values seen in alkali halide crystals. This large binding energy is indicative of a strongly localized character and results in a highly structured emission at room temperature as the exciton couples to vibrations in the lattice

A comparison of methods to adjust for continuous covariates in the analysis of randomised trials

BACKGROUND: Although covariate adjustment in the analysis of randomised trials can be beneficial, adjustment for continuous covariates is complicated by the fact that the association between covariate and outcome must be specified. Misspecification of this association can lead to reduced power, and potentially incorrect conclusions regarding treatment efficacy. METHODS: We compared several methods of adjustment to determine which is best when the association between covariate and outcome is unknown. We assessed (a) dichotomisation or categorisation; (b) assuming a linear association with outcome; (c) using fractional polynomials with one (FP1) or two (FP2) polynomial terms; and (d) using restricted cubic splines with 3 or 5 knots. We evaluated each method using simulation and through a re-analysis of trial datasets. RESULTS: Methods which kept covariates as continuous typically had higher power than methods which used categorisation. Dichotomisation, categorisation, and assuming a linear association all led to large reductions in power when the true association was non-linear. FP2 models and restricted cubic splines with 3 or 5 knots performed best overall. CONCLUSIONS: For the analysis of randomised trials we recommend (1) adjusting for continuous covariates even if their association with outcome is unknown; (2) keeping covariates as continuous; and (3) using fractional polynomials with two polynomial terms or restricted cubic splines with 3 to 5 knots when a linear association is in doubt

Nonthermal Emission from Star-Forming Galaxies

The detections of high-energy gamma-ray emission from the nearby starburst galaxies M82 & NGC253, and other local group galaxies, broaden our knowledge of star-driven nonthermal processes and phenomena in non-AGN star-forming galaxies. We review basic aspects of the related processes and their modeling in starburst galaxies. Since these processes involve both energetic electrons and protons accelerated by SN shocks, their respective radiative yields can be used to explore the SN-particle-radiation connection. Specifically, the relation between SN activity, energetic particles, and their radiative yields, is assessed through respective measures of the particle energy density in several star-forming galaxies. The deduced energy densities range from O(0.1) eV/cm^3 in very quiet environments to O(100) eV/cm^3 in regions with very high star-formation rates.Comment: 17 pages, 5 figures, to be published in Astrophysics and Space Science Proceeding

Activated Magnetospheres of Magnetars

Like the solar corona, the external magnetic field of magnetars is twisted by surface motions of the star. The twist energy is dissipated over time. We discuss the theory of this activity and its observational status. (1) Theory predicts that the magnetosphere tends to untwist in a peculiar way: a bundle of electric currents (the "j-bundle") is formed with a sharp boundary, which shrinks toward the magnetic dipole axis. Recent observations of shrinking hot spots on magnetars are consistent with this behavior. (2) Continual discharge fills the j-bundle with electron-positron plasma, maintaining a nonthermal corona around the neutron star. The corona outside a few stellar radii strongly interacts with the stellar radiation and forms a "radiatively locked" outflow with a high e+- multiplicity. The locked plasma annihilates near the apexes of the closed magnetic field lines. (3) New radiative-transfer simulations suggest a simple mechanism that shapes the observed X-ray spectrum from 0.1 keV to 1 MeV: part of the thermal X-rays emitted by the neutron star are reflected from the outer corona and then upscattered by the inner relativistic outflow in the j-bundle, producing a beam of hard X-rays.Comment: 23 pages, 7 figures; review chapter in the proceedings of ICREA Workshop on the High-Energy Emission from Pulsars and Their Systems, Sant Cugat, Spain, April 201

Seagrass can mitigate negative ocean acidification effects on calcifying algae

The ultimate effect that ocean acidification (OA) and warming will have on the physiology of calcifying algae is still largely uncertain. Responses depend on the complex interactions between seawater chemistry, global/local stressors and species-specific physiologies. There is a significant gap regarding the effect that metabolic interactions between coexisting species may have on local seawater chemistry and the concurrent effect of OA. Here, we manipulated CO2 and temperature to evaluate the physiological responses of two common photoautotrophs from shallow tropical marine coastal ecosystems in Brazil: the calcifying alga Halimeda cuneata, and the seagrass Halodule wrightii. We tested whether or not seagrass presence can influence the calcification rate of a widespread and abundant species of Halimeda under OA and warming. Our results demonstrate that under elevated CO2, the high photosynthetic rates of H. wrightii contribute to raise H. cuneata calcification more than two-fold and thus we suggest that H. cuneata populations coexisting with H. wrightii may have a higher resilience to OA conditions. This conclusion supports the more general hypothesis that, in coastal and shallow reef environments, the metabolic interactions between calcifying and non-calcifying organisms are instrumental in providing refuge against OA effects and increasing the resilience of the more OA-susceptible species.E.B. would like to thank the Coordenação de Aperfeiçoamento de Pessoas de Nível Superior (CAPES) for Masters funding. Funding for this project came from the Synergism grant (CNPq 407365/2013-3). We extend our thanks to the Brazil-based Projeto Coral Vivo and its sponsor PetroBras Ambiental for providing the Marine Mesocosm structure and experimental assistance.info:eu-repo/semantics/publishedVersio