No abstract

BackgroundOveruse of antibiotics for upper respiratory tract infections (URIs) and acute bronchitis is a persistent and vexing problem. In the U.S., more than half of all patients with upper respiratory tract infections and acute bronchitis are treated with antibiotics annually, despite the fact that most cases are viral in etiology and are not responsive to antibiotics. Interventions aiming to reduce unnecessary antibiotic prescribing have had mixed results, and successes have been modest. The objective of this evaluation is to use mixed methods to understand why a multi-level intervention to reduce antibiotic prescribing for acute bronchitis among primary care providers resulted in measurable improvement in only one third of participating clinicians.MethodsClinician perspectives on print-based and electronic intervention strategies, and antibiotic prescribing more generally, were elicited through structured telephone surveys at high and low performing sites after the first year of intervention at the Geisinger Health System in Pennsylvania (n = 29).ResultsCompared with a survey on antibiotic use conducted 10 years earlier, clinicians demonstrated greater awareness of antibiotic resistance and how it is impacted by individual prescribing decisions—including their own. However, persistent perceived barriers to reducing prescribing included patient expectations, time pressure, and diagnostic uncertainty, and these factors were reported as differentially undermining specific intervention components’ effectiveness. An exam room poster depicting a diagnostic algorithm was the most popular strategy.ConclusionsFuture efforts to reduce antibiotic prescribing should address multi-level barriers identified by clinicians and tailor strategies to differences at individual clinician and group practice levels, focusing in particular on changing how patients and providers make decisions together about antibiotic use.

Introduction: Obesity is a risk factor for postmenopausal breast cancer and is independently associated with shorter disease-free and overall survival. Currently, in clinical settings, the combination of stage and grade of cancer at the initial presentation of the disease is the best prognostic indicator. Objective: To evaluate the association between body mass index (BMI) and risk of advanced stages and poorly differentiated grade of breast cancer. Design: A case-series study of women diagnosed with their first primary invasive breast cancer. Patients include a total of 831 women aged X40 years with a mean BMI of 29.6( ± 6.6) kg m À2 . Pathological, clinical and demographic data were retrieved from electronic medical records. Multinomial logistic regression analysis was preformed to estimate the risk of more advanced stages and poorly differentiated grade of cancer, adjusting for covariates. Results: Obese compared with normal weight women had an 80% increased risk of cancer with more advanced stages (III/IV) and poorly differentiated grade (odds ratio ¼ 1.80, 95% confidence interval 1.13-2.86, P ¼ 0.014). No significant increase in risk was observed for overweight women. Conclusion: Obesity at the time of diagnosis of breast cancer is associated with more advanced stages and poorly differentiated grade of cancers.

New insights into the complex relation between the thermal phase transformation and the excited state properties of chalcopyrite CuInS2 nanocrystals (CIS NCs) are presented. An in situ solution processing method via depositing molecular precursors is applied, offering advantages in terms of simplicity, low‐temperature processability, and control over crystallite size, and optical properties. At low annealing temperatures, strong carrier quantum confinement and small crystallite sizes are realized for CIS NC films. CIS crystal growth is found to set in at higher annealing temperatures inducing a complete transformation from quasi‐quantum‐dot (QD) via bulk‐like to bulk behavior. The transition of a near‐infrared localized surface plasmon resonance (LSPR) towards a bulk‐like plasmon resonance documents the crystal growth and further acts as a valuable probe to relate crystallite size with copper‐deficient stoichiometries. In addition, time‐resolved photophysical investigations help to shed light on the dynamics and mechanisms of exciton and charge carrier generation of CIS NC films as a function of annealing temperature. The in situ‐prepared CIS NC films are further passivated by a thin CdS layer, leading to the formation of long‐lived excitons and an effective CIS ground‐state depletion.

Despite constant improvement in surgical techniques and peri-operative management over the past decades, still about 90% of the Western patients with oesophageal cancer (EC) will die from their disease. Additionally, surgery causes significant mortality and morbidity of the patients. These problems raised the interest in nonoperative, organ-preserving treatment procedures. Apart from metastatic disease, it is not clear from the literature, however, if a nonoperative therapy offers the patients a comparable chance of cure with less toxicity. Therefore, surgery is recommended in localized oesophageal cancer, so far. However, as the number of promising data on combined chemoradiotherapy, particularly in locally advanced tumours, increases, efforts get imperative to investigate the role of nonoperative therapies within randomized clinical trials.