Time-dependent infrared fluorescence ͑IRF͒ from the C-H fundamental and overtone bands was used to monitor the vibrational deactivation ͑by unexcited pyrazine͒ of pyrazine excited at 308 nm with a pulsed laser. The 1-color and 2-color IRF results were modeled with collisional master equation calculations in order to determine the temperature dependence of the energy transfer parameters. The experimental data cannot be modeled without invoking a biexponential collision step size distribution, which implies that ''super collisions'' are significant. The results show that the energy transfer parameters are essentially constant at temperatures greater than the Lennard-Jones well depth, but at lower temperatures, energy transfer is enhanced. It is likely that vibrationvibration energy transfer dominates in this system.
Washington State has some of the highest percentages of school immunization exemptions in the country. We compared school immunization records in a rural school district in Pierce County, Washington, to immunization records in the state immunization information system (IIS) and parent-held records. Correcting school immunization records resulted in an increase in the number of students classified as fully immunized from 1,189 to 1,564 (p < .0001). We conducted school-based immunization clinics that increased the number of fully immunized students to 1,624 (p = .013). Immunized students with certificates of exemption on file suggest exemptions of convenience. Strategies to improve school immunization services include assigning IIS access to school administrative staff and educating school staff and parents on the importance of immunization.
Background: Blood culture testing is an important diagnostic tool in identifying the presence of microbes in the bloodstream. Tests are frequently contaminated, leading to false-positive results. Blood culture contamination can result in unnecessary antibiotic treatment, extended hospital length of stay, and patient exposure to hospital-acquired conditions. Methods: St. Mary’s Regional Medical Center (SMRMC) in Russellville, Arkansas, struggled with blood-culture contamination rates, with an average of 6.8% from 2014 to 2018. Ongoing staff education yielded a reduction to an average of 5%. In an effort to reduce the contamination rates, our facility elected to try a novel specimen diversion device. Laboratory and emergency department (ED) staff were educated on the diversion device prior to the initiation of the trial period. Compliance with the diversion device averaged 70%–75% during the trial period. Monitoring of contaminations was added to our daily safety huddle to provide a quick turnaround time for false-positive education to specific clinical staff. Results: The results were significant, with a decrease in contamination rates from 4.93% to 1.66%—a 66% reduction. Improved blood culture testing has several advantages: best practice for patient care is first and foremost, along with other financial benefits for the facility. Several articles have estimated the cost of a contaminated culture to be $3,000–$10,000 per event; SMRMC has adopting an estimated cost of $4,000. The number of cultures at our hospital averages ~4,400 per year, and these results suggest a savings of >$500,000 per year (as contaminations on an annual basis fell from 217 to 73). With this intervention, 144 patients were spared from receiving unnecessary antibiotics as a result of a false-positive blood culture testing. Conclusions: We conducted a brief analysis to determine whether there was any obvious change in length of stay for patients with a false-positive blood culture compared to those with true negative results. In analyzing data for 3 different months, patients with contaminated cultures spent an average of 3.97 additional days in the facility. In conclusion, the implementation of this specimen diversion device significantly lowered our contamination rates, was integrated into practice, and has provided clinical and financial benefits.Funding: NoneDisclosures: None
BACKGROUND
Physician-rating websites (PRWs) are rising in popularity as the healthcare sector focuses more on patient-centered value-based care delivery. Recent studies have reported that the vast majority of orthopaedic surgeons across subspecialties already have at least one rating or review on at least one PRW. However, there are few studies identifying patient-facing factors related to the knowledge and use of PRWs and the level of influence PRWs may have on patient decision-making.
OBJECTIVE
The objectives of this study are: 1) to determine the prevalence of PRW use by patients seeking orthopaedic care, 2) to identify the influence PRWs have on patient decision-making, and 3) to identify factors associated with knowledge and use of PRWs.
METHODS
Survey administration was performed at three outpatient orthopaedic multi-specialty. Patients were asked about demographic characteristics including age, sex, occupation, and education, as well as their familiarity with PRWs, use of PRWs, and how PRWs have influenced their decision to see their surgeon.
RESULTS
A total of 350 patients completed the survey. The majority were women (59%) and Caucasian (77%), and the mean age of the population was 58 years old (range 15-91). 155 patients (44%) reported being somewhat (31%) or very (13%) familiar with PRWs, and 195 patients (56%) reported no familiarity with PRWs. Patients most familiar with PRWs were between 45-64 years old (p = 0.02), women (p < 0.01), had graduate/professional degrees (p < 0.01), and seen by adult reconstruction surgeons (p = 0.02). Seventy-two percent of patients utilizing PRWs reported that PRWs had an impact on their decision to see their chosen provider, with 93% noting ratings and reviews as the most valuable information.
CONCLUSIONS
Many patients in this study were not familiar with PRWs and did not utilize PRWs prior to their visit. However, most patients who did consult PRWs reported that the ratings and reviews did have an impact in their decision to choose their orthopaedic specialist. As PRW use increases, factors that influence patient decision-making are important to understand for surgeons and administrators.
That students should be able to pose questions, gather data, and represent that data in graphs seems reasonable enough—until you consider that these are the stated expectations for children just four to eight years old! The National Council of Teachers of Mathematics (NCTM) believes young students are capable of these skills and more. NCTM's Content Standard for data analysis and probability outlines what students in prekindergarten through grade 2 should know and be able to do (NCTM 2000).
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