Evaluation of Empiric Voriconazole Dosing and Therapeutic Drug Monitoring in Hospitalized Pediatric Patients.

SUMMARY: Invasive fungal infections are a significant cause of morbidity and mortality in children with immunodeficiencies. Current dosing recommendations for voriconazole often result in subtherapeutic exposure in pediatric patients. In this single-center retrospective study, we reviewed hospitalized pediatric patients receiving voriconazole with at least one inpatient serum trough concentration measured. Patient characteristics and voriconazole dosing courses with associated trough concentrations were summarized for all patients as well as grouped by age (0 to 1 y, 2 to 11 y, and 12 to 18 y). Of 106 included patients, the median age was 9 years (range, 29 d to 18 y). Five hundred ninety courses of voriconazole were administered with 365 associated troughs. Most troughs were subtherapeutic (49%) and 30% of patients never attained a therapeutic trough. The median oral daily dose associated with a therapeutic trough was higher in younger age groups: 21.6 mg/kg 0 to 1 year, 17.9 mg/kg 2 to 11, and 9.5 mg/kg 12 to 18 years (P<0.001). Patients younger than 2 years had the largest proportion of subtherapeutic troughs and variability in dosing. Attainment of therapeutic voriconazole concentrations was challenging across all pediatric age groups. Higher starting doses for patients younger than 2 years are likely needed.

Gender Differences in Student Comfort Voluntarily Asking and Answering Questions in Large-Enrollment College Science Courses.

Allowing students to ask and answer questions is a common practice employed by college science instructors. However, recent literature has identified that women participate in whole-class discussions less often than men. One hypothesized reason for this gender gap is that women may be less comfortable participating. However, no studies have examined students' comfort with asking and answering questions in large-enrollment science courses, identified what about these practices might make students uncomfortable, or explored whether there are gender differences with regard to student comfort. To answer these questions, we surveyed 417 undergraduates at an R1 institution about their experiences asking and answering questions in large-enrollment college science courses. Students answered questions about the extent to which they felt comfortable both asking and answering questions and selected possible factors that could make them uncomfortable participating. Using binary logistic regression, we tested whether student demographics predicted their opinions about these practices. Over half of students reported feeling uncomfortable both asking and answering questions in front of college science classes, and women were significantly less comfortable than men both asking and answering questions. Furthermore, we identified student confidence regarding their knowledge of the material and a concern that other students would judge them as some of the primary factors that could cause students to feel uncomfortable asking and answering questions in front of the whole class. This work highlights factors that instructors can target in hopes of maximizing student comfort participating in large-enrollment college science courses.

Call on me! Undergraduates' perceptions of voluntarily asking and answering questions in front of large-enrollment science classes.

Allowing students to voluntarily ask and answer questions in front of the whole class are common teaching practices used in college science courses. However, few studies have examined college science students' perceptions of these practices, the extent to which students choose to engage in these practices, and what discourages students from participating. In this study, we surveyed 417 undergraduates at a research-intensive institution about their experiences asking and answering questions in large-enrollment college science courses. Specifically, students answered questions about to what extent they perceive voluntarily asking and answering questions in large-enrollment science courses is helpful to them and why. They also answered questions about to what extent they engage in asking and answering questions in large-enrollment college science courses and what factors could discourage them from participating. Using binary logistic regression, we examined whether there were differences among students of different demographic groups regarding their opinions about asking and answering questions. We found that overwhelmingly students reported that other students voluntarily asking and answering instructor questions is helpful to them. Notably, compared to continuing generation students, first-generation students were more likely to perceive other students asking questions to be helpful. Despite perceiving asking and answering questions to be helpful, over half of students reported that they never ask or answer questions in large-enrollment college science courses during a semester, and women were more likely than men to report never asking questions. We identified fear of negative evaluation, or students' sense of dread associated with being unfavorably evaluated, as a primary factor influencing their decision to answer instructor questions. This work adds to a growing body of literature on student participation in large-enrollment college science courses and begins to uncover underlying factors influencing student participation.

Fecal Microbiota Transplantation for Treatment of Severe Clostridioides difficile Colitis in a Pediatric Patient With Non-Hodgkin Lymphoma.

BACKGROUND: Patients with malignant diseases are at high risk for refractory Clostridioides difficile infections (CDI). Fecal microbiota transplantation (FMT) restores the gastrointestinal microbiome and may be an effective treatment for patients who fail pharmacotherapy. However, FMT is not commonly used in the oncology population because of risk for donor-derived infection. OBSERVATIONS: The authors report successful use of FMT in a pediatric patient with refractory CDI actively receiving chemotherapy. The patient's symptoms improved 1 day following FMT. He did not experience infectious complications or other adverse effects. CONCLUSIONS: FMT may be a feasible option for treatment of refractory CDI in pediatric oncology patients.

Injuries in Adults 65 Years of Age and Older Prescribed Muscle Relaxants.

OBJECTIVE: The Beers criteria list skeletal muscle relaxants (SMR) as inappropriate for individuals 65 years of age and older because of anticholinergic effects, sedation, and risk of falls/fractures. Patients 65 years of age and older presenting to U.S. primary care clinics for injury, prescribed an SMR, are at risk for these events. SMR prescribing patterns in older adults with injury have not been well studied at the population level. Using nationally representative data, the prevalence of older adults prescribed an SMR presenting to U.S. primary care clinics with injury was examined. DESIGN: A cross-sectional study analyzing 2012 National Ambulatory Medical Care Survey (NAMCS) data using bivariate and multivariate techniques. NAMCS, a nationally representative database of the U.S. population, collects data from primary care office visits and uses a multi-stage sampling strategy. SETTING: Primary care offices throughout the United States. PATIENTS, PARTICIPANTS: Adults 65 years of age and older, presenting to rural primary care clinics with injury. MAIN OUTCOME MEASURE(S): Prescription for SMR. RESULTS: Multivariate analysis yielded that the study population presenting to rural clinics for injury had 28% greater odds, non-Caucasian adults had 11% greater odds, and those who had been seen at least twice in the past 12 months had 34% greater odds of being prescribed an SMR. Logistic regression analysis also yielded that females 65 to 74 years of age had greater odds of having a prescription for an SMR. CONCLUSION: The results of this study identified disparities among adults 65 years of age and older presenting to U.S. rural primary care clinics with injury and prescribed an SMR. Adults 65 years of age and older, Collaborative.