Parent and Clinician Views on Not Using Antibiotics for Mild Community-Acquired Pneumonia.

OBJECTIVES: Preschool-aged children with mild community-acquired pneumonia (CAP) routinely receive antibiotics even though most infections are viral. We sought to identify barriers to the implementation of a "no antibiotic" strategy for mild CAP in young children. METHODS: Qualitative study using semistructured interviews conducted in a large pediatric hospital in the United States from January 2021 to July 2021. Parents of young children diagnosed with mild CAP in the previous 3 years and clinicians practicing in outpatient settings (pediatric emergency department, community emergency department, general pediatrics offices) were included. RESULTS: Interviews were conducted with 38 respondents (18 parents, 20 clinicians). No parent heard of the no antibiotic strategy, and parents varied in their support for the approach. Degree of support related to their desire to avoid unnecessary medications, trust in clinicians, the emotional difficulty of caring for a sick child, desire for relief of suffering, willingness to accept the risk of unnecessary antibiotics, and judgment about the child's illness severity. Eleven (55%) clinicians were familiar with guidelines specifying a no antibiotic strategy. They identified challenges in not using antibiotics, including diagnostic uncertainty, consequences of undertreatment, parental expectations, follow-up concerns, and acceptance of the risks of unnecessary antibiotic treatment of many children if it means avoiding adverse outcomes for some children. CONCLUSIONS: Although both parents and clinicians expressed broad support for the judicious use of antibiotics, pneumonia presents stewardship challenges. Interventions will need to consider the emotional, social, and logistical aspects of managing pneumonia, in addition to developing techniques to improve diagnosis.

Screening for Youth Firearm Violence Exposure in Primary Care.

Introduction: The aim of this study was to assess a modified gun violence exposure tool at a pediatric clinic on the West Side of Chicago to identify youth at high risk of future gun violence. Methods: A modified version of the SaFETy gun violence exposure tool, studied in a community pediatric primary care setting, was implemented from June to August 2021. Patients and pediatric clinicians were surveyed after pilot. Results: Of 508 eligible patients, 341 youth (67.1%) completed the SaFETy tool. None had a SaFETy score ≥6, the threshold for immediate referral. Over a quarter (26.4%) of youth had scores of 1-5, and of those, 7.8% were referred at the clinician's discretion. Youth (n=84) participants randomly selected to complete an anonymous survey provided feedback about the SaFETY tool, reporting that the questions were easy to understand (92%). All 6 pediatric clinicians surveyed agreed that the tool helped to identify youth exposed to gun violence. Conclusions: Screening for gun violence exposure among youth is logistically feasible in the pediatric outpatient setting. A more sensitive validated tool to stratify low-/medium-risk patients in the primary care setting is needed.

Finding and addressing weaknesses in GP supervisor professional development.

BACKGROUND: The Royal Australian College of General Practitioners' Standards for general practice training require supervisor continuing professional development (PD) to meet the needs of the individual supervisors and develop the supervisory team. OBJECTIVE: The aim of this article is to explore current supervisor PD and consider how it might better meet the outcomes described in the standards. DISCUSSION: General practitioner supervisor PD delivered by regional training organisations (RTOs) continues to operate without a national curriculum. It is predominantly workshop based and is complemented in some RTOs by online modules. Workshop learning is important for supervisor identity formation and establishing and maintaining communities of practice. Current programs are not structured to deliver individualised supervisor PD or develop the in-practice supervision team. Supervisors may struggle to translate workshop learning into changes in their practice. An in-practice quality improvement intervention facilitated by a visiting medical educator has been developed to address weaknesses in current supervisor PD. This intervention is ready to be trialled and further evaluated.

A spatially resolved brain region- and cell type-specific isoform atlas of the postnatal mouse brain.

Splicing varies across brain regions, but the single-cell resolution of regional variation is unclear. We present a single-cell investigation of differential isoform expression (DIE) between brain regions using single-cell long-read sequencing in mouse hippocampus and prefrontal cortex in 45 cell types at postnatal day 7 ( www.isoformAtlas.com ). Isoform tests for DIE show better performance than exon tests. We detect hundreds of DIE events traceable to cell types, often corresponding to functionally distinct protein isoforms. Mostly, one cell type is responsible for brain-region specific DIE. However, for fewer genes, multiple cell types influence DIE. Thus, regional identity can, although rarely, override cell-type specificity. Cell types indigenous to one anatomic structure display distinctive DIE, e.g. the choroid plexus epithelium manifests distinct transcription-start-site usage. Spatial transcriptomics and long-read sequencing yield a spatially resolved splicing map. Our methods quantify isoform expression with cell-type and spatial resolution and it contributes to further our understanding of how the brain integrates molecular and cellular complexity.

Validation of simulated chestband data in frontal and lateral loading using a human body finite element model.

OBJECTIVE: Finite element (FE) computer models are an emerging tool to examine the thoracic response of the human body in the simulated environment. In this study, a recently developed human body model, the Global Human Body Models Consortium (GHBMC) mid-sized male, was used to examine chestband contour deformations in a frontal and lateral impact. The objective of this study was 2-fold. First, a methodology for extracting and analyzing virtual chestband data from a full-body FE model is presented. Then, this method is applied to virtual chestband data from 2 simulations to evaluate the model's performance against experimental data. METHODS: One frontal and one lateral impact case were simulated using the FE model, which was preprogrammed with upper, middle, and lower chestbands. Maximum compression was determined using established techniques. Furthermore, a quadrant-based analysis technique for the results was introduced that enabled regional comparisons between the model and the experimental data in the anterior, posterior, right, and left sections of the chestband. RESULTS: For the frontal case at 13.3 m/s, the model predicted a peak compression of 13.6 and 12.9 percent for the upper and middle chestbands. For the lateral case at 6.7 m/s, the model predicted peak compression of the upper, middle, and lower chestbands of 27.9, 26.0, and 20.4 percent. Regional analysis showed average differences at maximum deformation between the model and experiments ranging from 0.9 percent (posterior) to 6.3 percent (anterior) in the frontal case and 2.3 percent (posterior) to 10.8 percent (anterior) in the lateral case. The greatest difference between model and experimental findings was found in the anterior quadrant. CONCLUSIONS: Though this work was focused on techniques to extract and analyze chestband data from FE models, the comparative results provide further validation of the model used in this study. The results suggest the importance of evaluating comparisons between virtual and experimental chestband data on a regional basis. These data also provide the potential to correlate chestband deformations to the loading of underlying thoraco-abdominal structures. Supplemental materials are available for this article. Go to the publisher's online edition of Traffic Injury Prevention to view the supplemental file.

Investigation of the mass distribution of a detailed seated male finite element model.

Accurate mass distribution in computational human body models is essential for proper kinematic and kinetic simulations. The purpose of this study was to investigate the mass distribution of a 50th percentile male (M50) full body finite element model (FEM) in the seated position. The FEM was partitioned into 10 segments, using segment planes constructed from bony landmarks per the methods described in previous research studies. Body segment masses and centers of gravity (CGs) of the FEM were compared with values found from these studies, which unlike the present work assumed homogeneous body density. Segment masses compared well to literature while CGs showed an average deviation of 6.0% to 7.0% when normalized by regional characteristic lengths. The discrete mass distribution of the FEM appears to affect the mass and CGs of some segments, particularly those with low-density soft tissues. The locations of the segment CGs are provided in local coordinate systems, thus facilitating comparison with other full body FEMs and human surrogates. The model provides insights into the effects of inhomogeneous mass on the location of body segment CGs.

Comparison of organ location, morphology, and rib coverage of a midsized male in the supine and seated positions.

The location and morphology of abdominal organs due to postural changes have implications in the prediction of trauma via computational models. The purpose of this study is to use data from a multimodality image set to devise a method for examining changes in organ location, morphology, and rib coverage from the supine to seated postures. Medical images of a male volunteer (78.6 ± 0.77 kg, 175 cm) in three modalities (Computed Tomography, Magnetic Resonance Imaging (MRI), and Upright MRI) were used. Through image segmentation and registration, an analysis between organs in each posture was conducted. For the organs analyzed (liver, spleen, and kidneys), location was found to vary between postures. Increases in rib coverage from the supine to seated posture were observed for the liver, with a 9.6% increase in a lateral projection and a 4.6% increase in a frontal projection. Rib coverage area was found to increase 11.7% for the spleen. Morphological changes in the organs were also observed. The liver expanded 7.8% cranially and compressed 3.4% and 5.2% in the anterior-posterior and medial-lateral directions, respectively. Similar trends were observed in the spleen and kidneys. These findings indicate that the posture of the subject has implications in computational human body model development.

Illicit online marketing of lorcaserin before DEA scheduling.

OBJECTIVE: Antiobesity drugs have been marketed illicitly by "no prescription" online pharmacies after approval and scheduling by the drug enforcement agency. We assess whether antiobesity drug Belviq® (lorcaserin HCl) was available from illicit online vendors before DEA-scheduling when sales are unauthorized. DESIGN AND METHODS: Online searches of "buy Belviq no prescription" examining first five result pages marketing the drug. Searches were performed from 11/5/2012-12/8/2012, prior to DEA scheduing. RESULTS: Belviq® is actively marketed by "no prescription" online vendors despite official unavailability and prescription requirements. Approaches included direct-to-consumer advertising using descriptive website URLs; linking to illicit marketers; and directing customers to other weight-loss websites for additional marketing. Finally, large quantities were marketed by business-to-business vendors. CONCLUSION: Illicit online "no prescription" pharmacies are marketing unauthorized, suspect antiobesity drugs before DEA scheduling and permitted marketing. Regulators must legally intercede to ensure patient safety, and providers must educate patients about online-sourcing risks.

Abdominal Organ Location, Morphology, and Rib Coverage for the 5(th), 50(th), and 95(th) Percentile Males and Females in the Supine and Seated Posture using Multi-Modality Imaging.

The purpose of this study was to use data from a multi-modality image set of males and females representing the 5(th), 50(th), and 95(th) percentile (n=6) to examine abdominal organ location, morphology, and rib coverage variations between supine and seated postures. Medical images were acquired from volunteers in three image modalities including Computed Tomography (CT), Magnetic Resonance Imaging (MRI), and upright MRI (uMRI). A manual and semi-automated segmentation method was used to acquire data and a registration technique was employed to conduct a comparative analysis between abdominal organs (liver, spleen, and kidneys) in both postures. Location of abdominal organs, defined by center of gravity movement, varied between postures and was found to be significant (p=0.002 to p=0.04) in multiple directions for each organ. In addition, morphology changes, including compression and expansion, were seen in each organ as a result of postural changes. Rib coverage, defined as the projected area of the ribs onto the abdominal organs, was measured in frontal, lateral, and posterior projections, and also varied between postures. A significant change in rib coverage between postures was measured for the spleen and right kidney (p=0.03 and p=0.02). The results indicate that posture affects the location, morphology and rib coverage area of abdominal organs and these implications should be noted in computational modeling efforts focused on a seated posture.