IMPORTANCE Blood cultures are often obtained as part of the evaluation of infants with fever and these infants are typically observed until their cultures are determined to have no growth. However, the time to positivity of blood culture results in this population is not known.OBJECTIVE To determine the time to positivity of blood culture results in febrile infants admitted to a general inpatient unit. DESIGN, SETTING, AND PARTICIPANTS Multicenter, retrospective, cross-sectional evaluation of blood culture time to positivity. Data were collected by community and academic hospital systems associated with the Pediatric Research in Inpatient Settings Network. The study included febrile infants 90 days of age or younger with bacteremia and without surgical histories outside of an intensive care unit.EXPOSURES Blood culture growing pathogenic bacteria.MAIN OUTCOMES AND MEASURES Time to positivity and proportion of positive blood culture results that become positive more than 24 hours after placement in the analyzer.RESULTS A total of 392 pathogenic blood cultures were included from 17 hospital systems across the United States. The mean (SD) time to positivity was 15.41 (8.30) hours. By 24 hours, 91% (95% CI, 88-93) had turned positive. By 36 and 48 hours, 96% (95% CI, 95-98) and 99% (95% CI, 97-100) had become positive, respectively.CONCLUSIONS AND RELEVANCE Most pathogens in febrile, bacteremic infants 90 days of age or younger hospitalized on a general inpatient unit will be identified within 24 hours of collection. These data suggest that inpatient observation of febrile infants for more than 24 hours may be unnecessary in most infants.
Parenteral antibiotic treatment duration in young infants with bacteraemic UTI was variable and only minimally explained by measurable patient factors. Relapses were rare and were not associated with treatment duration. Shorter parenteral courses may be appropriate in some infants.
Although the Office of The National Coordinator for Health Information Technology’s (ONC) Information Blocking Provision in the Cures Act Final Rule is an important step forward in providing patients free and unfettered access to their electronic health information (EHI), in the contexts of multiuser electronic health record (EHR) access and proxy access, concerns on the potential for harm in adolescent care contexts exist. We describe how the provision could erode patients’ (both adolescent and older patients alike) trust and willingness to seek care. The rule’s preventing harm exception does not apply to situations where the patient is a minor and the health care provider wishes to restrict a parent’s or guardian’s access to the minor’s EHI to avoid violating the minor’s confidentiality and potentially harming patient-clinician trust. This may violate previously developed government principles in the design and implementation of EHRs for pediatric care. Creating legally acceptable workarounds by means such as duplicate “shadow charting” will be burdensome (and prohibitive) for health care providers. Under the privacy exception, patients have the opportunity to request information to not be shared; however, depending on institutional practices, providers and patients may have limited awareness of this exception. Notably, the privacy exception states that providers cannot “improperly encourage or induce a patient’s request to block information.” Fearing being found in violation of the information blocking provisions, providers may feel that they are unable to guide patients navigating the release of their EHI in the multiuser or proxy access setting. ONC should provide more detailed guidance on their website and targeted outreach to providers and their specialty organizations that care for adolescents and other individuals affected by the Cures Act, and researchers should carefully monitor charting habits in these multiuser or proxy access situations.
TCP over wireless networks is challenging due to random losses and DATA-ACK interference. Random linear coding schemes have been proposed to improve TCP robustness against extreme random losses, but a critical issue still remains of DATA-ACK interference. To address this problem, we use inter-flow coding between DATA and ACK at potential intersecting nodes to mitigate self-interference. In addition, a pipelined random linear coding scheme with adaptive redundancy is introduced to overcome high loss rates over unreliable links. The resulting coding scheme, ComboCoding, combines inter-flow and intra-flow coding to provide robust, fair TCP communication in multi-flow disruptive wireless networks. Simulation results show that TCP with ComboCoding delivers higher throughput than other coding options in high loss scenarios. Moreover, we study the behavior of multiple TCP flows intersecting and interfering with each other in the same ad hoc network. The results show that ComboCoding consistently provides better fairness among multiple co-existing TCP sessions when compared with TCP without coding. The main contributions of this paper are: the practical design of random linear coded packets and XOR coded packets on bi-directional streams (DATA and ACK), the adaptive redundancy control scheme, and the multiple coded TCP sessions fairness evaluation.
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