Additional Categories Research Articles

Perencanaan Persediaan Obat dengan Metode Analisis ABC-VEN di Instalasi Farmasi RS “Y” Kota Palopo

Background: ABC-VEN analysis is a effective method for evaluating drug needs because it can determine priority drug planning based on cost and therapy. However, not all Pharmacy Installation have implemented this method, one of that is The Pharmacy Installation of “Y” Hospital in Palopo City. Objective: To evaluate drug planning at Pharmacy Installation of “Y” Hospital using the ABC-VEN analysis so that, the investment value for drug procurement is suitable with the budget and meets drug needs in the hospital. Methods: The research is combining qualitative and quantitative approaches. The instruments used are the form of data collection sheets for drug use for the period September-November 2022 and interview guidelines. Results:Out of a total of 626 drug items used in September-November 2022, 11%, 81%, 9% of drug items were included in the priority, main, and additional categories which spent the budget respectively 17%, 81% and 2% of total budget. Conclusion: With the application of the ABC-VEN analysis method, the drug supply budget can be saved by reducing the number of drugs or substituting drugs by finding suppliers that offer lower prices, especially in the NA, NB, and NC categories.

Social protest action, stakeholder management, and risk: Managing the impact of service delivery protests in South Africa

AbstractStakeholder management is an important method for reducing business risk. Recent decades have seen the growth of a new type of stakeholder: social protest stakeholders, individuals engaging in protest action which is directed at other unrelated parties, often the government. However, the actions of social protest stakeholders may negatively affect companies located nearby. This stakeholder category has not received any formal attention in the literature, and this article addresses the knowledge gap by exploring the effects of community‐driven protest action in South Africa and the strategies that firms adopt to mitigate the negative consequences of such protests. A multiple case study analysis was used to describe this type of stakeholder group and the management of the consequences of social protest action. Eight manufacturing companies in the Gauteng province participated in the study, the companies varied in size and industry. Among the key findings are that companies need to be highly adaptable if they are to mitigate the impact of protest action. We make practical suggestions about how companies may manage these risks, including the recommendation that companies engage more directly with social protestors to manage risks. The study makes an important contribution to the literature by identifying an additional key category of stakeholder and proposing a risk management approach to avert or minimize loss and damage.

Fundamentals and perspectives of electrolyte additives for non-aqueous Na-ion batteries

Despite extensive research efforts to develop non-aqueous sodium-ion batteries (SIBs) as alternatives to lithium-based energy storage battery systems, their performance is still hindered by electrode-electrolyte side reactions. As a feasible strategy, the engineering of electrolyte additives has been regarded as one of the effective ways to address these critical problems. In this review, we provide a comprehensive overview of recent progress in electrolyte additives for non-aqueous SIBs. We classify the additives based on their effects on specific electrode materials and discuss the functions and mechanisms of each additive category. Finally, we propose future directions for electrolyte additive research, including studies on additives for improving cell performance under extreme conditions, optimizing electrolyte additive combinations, understanding the effect of additives on cathode-anode interactions, and understanding the characteristics of electrolyte additives.

Novel method for calculating the effective dose using size-specific dose estimates conversion factors in abdomen-pelvis computed tomography.

We propose a novel method for calculating the effective dose that closely reflects the individual attenuation, utilizing two conversion coefficients. A total of 180 adult patients who underwent abdomen-pelvis computed tomography were categorized into six groups based on sex and body type. The effective dose was calculated by multiplying the dose-length product with the effective dose conversion coefficient and the size-specific dose estimate conversion factor. The effective dose calculated using a simulation-based dose calculator (WAZA-ARI) was employed as the reference value. The following values, obtained through both methods, were compared within each category: distribution of the effective dose, median effective dose, and relative difference in median effective dose across additional body mass index (BMI) categories. For male patients, no significant disparity was observed in the median effective doses calculated using the two methods. The relative differences in median effective doses across additional BMI categories ranged from -5 to 6%. Conversely, among female patients, the median effective dose calculated using our method slightly undercut that calculated using WAZA-ARI, with relative differences ranging from -16 to -9%. Additionally, relative differences in median effective dose across additional BMI categories ranged from -18 to -7%. The median effective dose differed slightly depending on the calculation method because of the different reference phantoms applied in dose calculations. Our proposed method is sensitive to individual size and helps compute a size-specific effective dose.

Development of a generic approach for monitoring leachable compounds in hospital pharmacy-prepared prefilled plastic packaging by ultrahigh-performance liquid chromatography coupled to high-resolution mass spectrometry with postcolumn infusion

Prefilled plastic packaging is time- and cost-effective in hospital pharmacy because it prevents waste, preparation errors, dosage errors, microbial contamination and accidents. This packaging mostly includes prefilled syringes (PFS), intravenous (IV) bags and vials intended for long-term storage that can be used for immediate treatment. There is a rising availability in the market for prefilled drug products due to their practical approach. Leachable compounds could be evaluated in hospital pharmacy-prepared prefilled drug solutions. The Pharmacy Department at the Lausanne University Hospital has developed an innovative, highly sensitive, and generic method by postcolumn infusion based on ultrahigh-performance liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS) for the analysis of plastic additives in hospital pharmacies. The postcolumn infusion solution was developed with 2% ammonium hydroxide in methanol on a representative set of 30 candidate compounds with different physical-chemical properties, such as log P and molecular structure, to represent the most important categories of additives. The LODs obtained for all compounds ranged from 0.03 to 7.91 ng/mL with linearity up to 250 ng/mL. Through this screening method, plastic additives can be rapidly identified due to the combined use of retention time, exact mass (including isotopic pattern) and MS/MS spectra. In addition, the users can screen for vast categories of plastic additives, including plasticizers, epoxy monomers, antioxidants, UV stabilizers, and others. The screening is facilitated by assessments of a complex in-house-built database for extractable and leachable trace assessment (DELTA), containing 205 compounds for unambiguous identification. Relative response factors were established for all analytes to obtain a semiquantitation of compounds. Moreover, the database also contains valuable estimative toxicology information, which was obtained through calculating their permissible dose exposure threshold; thus, estimative toxicology assessment can be performed for identified compounds in prefilled drug products. This method and the database were applied to a hospital pharmacy-prepared prefilled vancomycin syringe for paediatric use. Ultrasound-assisted dispersive liquid-liquid microextraction (UA-DLLME) was used to prepare the samples for leachable analysis. As a result, 17 plastic additives were formally identified, and their concentrations were estimated. A toxicology assessment was performed by comparing their concentrations with their theoretical PDE thresholds. In conclusion, the prefilled drug solution released a negligible amount of known leachables that appeared to be safe for use in neonates and children.

A synthetic measure of energy security taking into account the influence of rare earth metals. The case of Poland

The article presents the results of research related to the energy security of the EU-27 countries, exemplified for Poland and EU-27 average. Indicators, which can be found in the literature, typically examine energy security using the 4A concept as a basis for research on energy security. The authors extended the set of factors determining energy security by adding an additional category related to renewable energy sources (RES). In the research presented, the authors analyzed not only the impact of the availability of energy raw materials on the level of energy security, but also impact of critical raw materials, such as rare earth elements. They are necessary to develop RES technology. A taxonomic method was used, which allowed determination of the synthetic energy security measure SEM. The authors wrote the SEM 1.0 program, which determines SEM value. The analysis showed that the level of the indicator, after taking into account the fifth category, decreased for Poland by 9%, and for the EU-27 by 12%. The authors also proposed remedial measures that would make it possible to increase the level of energy security of the member states.

Tunable biocomposite films fabricated using cellulose nanocrystals and additives for food packaging

Cellulose nanocrystals (CNCs) are considered a prospective packaging material to partially replace petroleum-based plastics attributed to their renewability, sustainability, biodegradability, and desirable attributes including transparency, oxygen, and oil barrier properties. However, neat CNC films are rigid and too brittle to handle or utilize for packaging applications. Hence different additives, including sorbitol, polyvinyl alcohol (PVA), chitin, and κ-carrageenan (CG) were selected to mix with CNCs for packaging film preparation. The influence of additive categories (plasticizer, nonionic polymer, weak cationic and anionic natural polysaccharide), and their concentrations on the performance of CNC suspensions as well as optical, barrier, mechanical, and thermal properties of CNC films were examined. The morphology and physical characterization including density, equilibrium moisture content, contact angle and water durability of the composite films were also determined. Sorbitol and PVA films had the best visible light transparency; mixing with chitin can effectively improve the water durability of CNC films, and CG changed the CNC film from hydrophilic to hydrophobic. Moreover, all CNC films exhibited sufficient oxygen barrier properties, high PVA content films attained the “very high” barrier grade. Thus, durable CNC films can be obtained by adding proper types and amounts of additives, which provides potential scenarios for practical application of CNC films in food packaging.

Choroid plexus tumors: A spectrum from benign to malignant

Choroid plexus tumors (CPT) are believed to originate from outgrowths of the choroid plexus. Despite their broad spectrum of symptoms, invasive nature, and prognosis, most CPTs typically exhibit similar presentations due to their relationship with the cerebral ventricles, as well as the mechanical obstruction and mass effect associated with their growth. In addition, these tumors mainly affect the pediatric population, further complicating the differentiation between benign and malignant subtypes. The World Health Organization classifies CPTs into three grades, namely, grades I, II, or III, based on their mitotic activity, which determine the benign or malignant nature of the tumors. CPTs classified by the World Health Organization (WHO) include choroid plexus papillomas (CPP), atypical CPPs (aCPP), and malignant choroid plexus carcinomas (CPC). Choroid plexus adenomas represent an additional category of benign CPTs not officially classified by the WHO. Despite the variations in histology, immunohistochemistry, imaging, treatment, and prognosis, CPTs cannot be reliably distinguished based solely on clinical presentation. Therefore, in this review, we aim to provide a comprehensive overview of each tumor subtype, along with the current management approach and emerging treatments.

Errors Made by Iraqi EFL Learners in the Use of Articles : An Error Analysis Study

The current study seeks to identify the article errors for both first and third year students in conversations. To achieve this the aim, interview and spot the differences tasks are used as a source for data collection. The study targeted 60 samples in the Department of English, College of Education for Humanities, University of Mosul, for the academic year 2021-2022. Participants are chosen randomly from the students. As for data analysis, errors are described according to Corder's (1973) classification viz omission, addition, misordering, and selection. The current study demonstrated that learners of English as a foreign language face some difficulties in using articles in conversations. Regarding the description of errors, first year students made 65% of the errors related to the omission category, while 31% of the errors were related to addition category. Errors related to selection category occupy only 4% of article errors. As far as third year students, it has been noticed that 60% of article errors related to omission category , it represents the highest percentage among other categories. Errors associated with addition category have the percentage of 38% , while 2% of these errors are represented by choosing inappropriate items. No errors have been noticed for two levels at the level of article ordering. Regarding sources of errors, both interlanguage and intralanguage were seen as sources of article errors.

Variety Predicts Discretionary Food and Beverage Intake of Australian Adults: A Cross-Sectional Analysis of an Online Food Intake Survey

BackgroundVariety has been used as a strategy for increasing intakes of healthy foods, but has not been well explored with respect to discretionary food/beverages. The diverse sensory properties of these foods suggests that variety could play an important role in total intake. ObjectiveThis study explored variety as a predictor of intake of discretionary food/beverages, and described the variety of these items consumed by Australian adults. DesignSecondary analyses of cross-sectional data from a validated, online survey that assesses participants’ dietary intake using frequency and portion-based questions. Discretionary food/beverages are grouped into 11 categories. Participants/settingParticipants included 235,203 Australian adults, aged 18 years or older, who provided data from May 2015 to November 2020. Outcome measuresVariety was the number of categories of discretionary food/beverages consumed. Servings were estimated from usual intake questions, and percent contribution summarized by category. Consumption prevalence was the proportion of the sample/subgroup consuming each category. Consumption was calculated as the mean of the sample and per capita in servings. Statistical analyses performedDescriptive statistics were used to present variety and percent contribution to total intake across the sample and subgroups, and multiple regression was used to examine whether or not variety predicted intake of discretionary food/beverages. ResultsParticipants consumed a median of 8 categories of discretionary food/beverages, with every additional category associated wit h an increase in intake of half a serving of discretionary food/beverages per day (B = 0.48; P < 0.001). Alcohol, cakes and cookies, takeaway, and confectionary collectively contributed around two-thirds of total daily intake of discretionary food/beverages, with alcohol contributing the largest proportion (28.3% of total daily intake). ConclusionsVariety is related to total intake of discretionary food/beverages. Intervention approaches targeting a reduction in variety, as an alternative to a focus on portion size or frequency of intake, would be a novel way of addressing overconsumption of discretionary food/beverages in future research.

Thromboembolic prophylaxis in spine surgery: an analysis of ChatGPT recommendations

BACKGROUND CONTEXTVenous thromboembolism is a negative outcome of elective spine surgery. However, the use of thromboembolic chemoprophylaxis in this patient population is controversial due to the possible increased risk of epidural hematoma. ChatGPT is an artificial intelligence model which may be able to generate recommendations for thromboembolic prophylaxis in spine surgery. PURPOSETo evaluate the accuracy of ChatGPT recommendations for thromboembolic prophylaxis in spine surgery. STUDY DESIGN/SETTINGComparative analysis. PATIENT SAMPLENone. OUTCOME MEASURESAccuracy, over-conclusiveness, supplemental, and incompleteness of ChatGPT responses compared to the North American Spine Society (NASS) clinical guidelines. METHODSChatGPT was prompted with questions from the 2009 NASS clinical guidelines for antithrombotic therapies and evaluated for concordance with the clinical guidelines. ChatGPT-3.5 responses were obtained on March 5, 2023, and ChatGPT-4.0 responses were obtained on April 7, 2023. A ChatGPT response was classified as accurate if it did not contradict the clinical guideline. Three additional categories were created to further evaluate the ChatGPT responses in comparison to the NASS guidelines: over-conclusiveness, supplementary, and incompleteness. ChatGPT was classified as over-conclusive if it made a recommendation where the NASS guideline did not provide one. ChatGPT was classified as supplementary if it included additional relevant information not specified by the NASS guideline. ChatGPT was classified as incomplete if it failed to provide relevant information included in the NASS guideline. RESULTSTwelve clinical guidelines were evaluated in total. Compared to the NASS clinical guidelines, ChatGPT-3.5 was accurate in 4 (33%) of its responses while ChatGPT-4.0 was accurate in 11 (92%) responses. ChatGPT-3.5 was over-conclusive in 6 (50%) of its responses while ChatGPT-4.0 was over-conclusive in 1 (8%) response. ChatGPT-3.5 provided supplemental information in 8 (67%) of its responses, and ChatGPT-4.0 provided supplemental information in 11 (92%) responses. Four (33%) responses from ChatGPT-3.5 were incomplete, and 4 (33%) responses from ChatGPT-4.0 were incomplete. CONCLUSIONSChatGPT was able to provide recommendations for thromboembolic prophylaxis with reasonable accuracy. ChatGPT-3.5 tended to cite nonexistent sources and was more likely to give specific recommendations while ChatGPT-4.0 was more conservative in its answers. As ChatGPT is continuously updated, further validation is needed before it can be used as a guideline for clinical practice.

Are we past the COVID-19 Pandemic? Insights from Singapore

ObjectiveThis study aims to examine the interplay between high policy stringency, vaccination rates and epidemiological outcomes to develop insights on COVID-19 policy transition in Singapore MethodsThe CPTI (Categorising Policy & Technology Interventions) framework was used to classify reported interventions from January 2021 to October 2022. To analyse the impact of vaccine measures, an additional category was created. The highest monthly proportion of de-escalated measures was used as a basis to define the periods that mark the policy transition in Singapore i.e. Phase 2 and 3. Proportions of significantly escalated measures were calculated and analysed against full and booster vaccination rates, alongside epidemiological indicators – monthly total number of infections and deaths, and monthly average active hospitalisation and ICU cases. ResultsImplementation of highly stringent policies were observed to have reduced in intensity as vaccination rates picked up from Phase 2 to 3. Containment measures were the most frequently and consistently adopted beside vaccine policies. Epidemiological indicators appeared to be generally lower in Phase 3 than Phase 2. Specifically, despite reduced intensity of stringent polices, hospitalisation and ICU cases were observed to remain relatively low when vaccination rates were correspondingly higher in Phase 3 compared to Phase 2. ConclusionThe descriptive analysis of COVID-19 policy shift in Singapore based on selected indicators preliminarily suggested its successful transition from the pandemic to endemic phase in its response strategies. A policy transition plan should consider the significance of vaccination rates in an exit strategy that protects the population against worse health outcomes.

Covid-19 triage in the emergency department 2.0: how analytics and AI transform a human-made algorithm for the prediction of clinical pathways

The Covid-19 pandemic has pushed many hospitals to their capacity limits. Therefore, a triage of patients has been discussed controversially primarily through an ethical perspective. The term triage contains many aspects such as urgency of treatment, severity of the disease and pre-existing conditions, access to critical care, or the classification of patients regarding subsequent clinical pathways starting from the emergency department. The determination of the pathways is important not only for patient care, but also for capacity planning in hospitals. We examine the performance of a human-made triage algorithm for clinical pathways which is considered a guideline for emergency departments in Germany based on a large multicenter dataset with over 4,000 European Covid-19 patients from the LEOSS registry. We find an accuracy of 28 percent and approximately 15 percent sensitivity for the ward class. The results serve as a benchmark for our extensions including an additional category of palliative care as a new label, analytics, AI, XAI, and interactive techniques. We find significant potential of analytics and AI in Covid-19 triage regarding accuracy, sensitivity, and other performance metrics whilst our interactive human-AI algorithm shows superior performance with approximately 73 percent accuracy and up to 76 percent sensitivity. The results are independent of the data preparation process regarding the imputation of missing values or grouping of comorbidities. In addition, we find that the consideration of an additional label palliative care does not improve the results.

A latent scale model to minimize subjectivity in the analysis of visual rating data for the National Turfgrass Evaluation Program.

Traditional evaluation procedure in National Turfgrass Evaluation Program (NTEP) relies on visually assessing replicated turf plots at multiple testing locations. This process yields ordinal data; however, statistical models that falsely assume these to be interval or ratio data have almost exclusively been applied in the subsequent analysis. This practice raises concerns about procedural subjectivity, preventing objective comparisons of cultivars across different test locations. It may also lead to serious errors, such as increased false alarms, failures to detect effects, and even inversions of differences among groups. We reviewed this problem, identified sources of subjectivity, and presented a model-based approach to minimize subjectivity, allowing objective comparisons of cultivars across different locations and better monitoring of the evaluation procedure. We demonstrate how to fit the described model in a Bayesian framework with Stan, using datasets on overall turf quality ratings from the 2017 NTEP Kentucky bluegrass trials at seven testing locations. Compared with the existing method, ours allows the estimation of additional parameters, i.e., category thresholds, rating severity, and within-field spatial variations, and provides better separation of cultivar means and more realistic standard deviations. To implement the proposed model, additional information on rater identification, trial layout, rating date is needed. Given the model assumptions, we recommend small trials to reduce rater fatigue. For large trials, ratings can be conducted for each replication on multiple occasions instead of all at once. To minimize subjectivity, multiple raters are required. We also proposed new ideas on temporal analysis, incorporating existing knowledge of turfgrass.

Stop-signal delay reflects response selection duration in stop-signal task.

The stop-signal task (SST) is widely used for studying the speed of the latent process of response inhibition. The SST patterns are typically explained by a horse-race model (HRM) with supposed Go and Stop processes. However, HRM does not agree with the sequential-stage model of response control. As a result, the exact relationship between the response selection, the response execution stages, and the Stop process remains unclear. We propose that response selection occurs within the stop-signal delay (SSD) period, and that the competition between the Go and Stop processes occurs within the response execution period. To confirm this, we conducted two experiments. In Experiment 1, participants carried out a modified SST task with an additional stimulus category - Cued-Go. In the Cued-Go trials, cues were followed by imperative Go signals. The Cue-Go period duration was dynamically adjusted by an adaptive algorithm based on the response times reflecting the individual response selection duration. In Experiment 2, Cued-Go stimuli were followed by Stop Signals in half of the trials and response inhibition efficiency was calculated. The results of Experiment 1 indicate that SSD reflects the duration of the response selection process. The results of Experiment 2 show that this process has an independent and small effect on the effectiveness of controlled inhibition of the target response. Based on our findings, we propose a two-stage model of response inhibition in SST, with the first stage including response selection process and the second stage response inhibition following the SS presentation.

Physicians differ in their perceptions of sensitive medical records: Survey and interview study.

Physician categorizations of electronic health record (EHR) data (e.g., depression) into sensitive data categories (e.g., Mental Health) and their perspectives on the adequacy of the categories to classify medical record data were assessed. One thousand data items from patient EHR were classified by 20 physicians (10 psychiatrists paired with ten non-psychiatrist physicians) into data categories via a survey. Cluster-adjusted chi square tests and mixed models were used for analysis. 10 items were selected per each physician pair (100 items in total) for discussion during 20 follow-up interviews. Interviews were thematically analyzed. Survey item categorization yielded 500 (50.0%) agreements, 175 (17.5%) disagreements, 325 (32.5%) partial agreements. Categorization disagreements were associated with physician specialty and implied patient history. Non-psychiatrists selected significantly (p = .016) more data categories than psychiatrists when classifying data items. The endorsement of Mental Health and Substance Use categories were significantly (p = .001) related for both provider types. During thematic analysis, Encounter Diagnosis (100%), Problems (95%), Health Concerns (90%), and Medications (85%) were discussed the most when deciding the sensitivity of medical information. Most (90.0%) interview participants suggested adding additional data categories. Study findings may guide the evolution of digital patient-controlled granular data sharing technology and processes.

UNVEILING COHERENCE: ANALYZING GRAMMATICAL DEVICES IN RECOUNT TEXT

The purpose of this study is to examine the grammatical cohesive devices used in the recount text writing of bilingual students. The cohesive device is crucial because it consists of grammatical and lexical devices that contribute to the writing’s strength and accuracy, as well as its contextual understanding. Twenty bilingual ninth-grade students of a junior high school participated in this study. The students’ recount text writings were used as the main data in this research. The qualitative descriptive method employed in this study to thoroughly assess and describe students’ writing and its’ cohesive device used. The result shows that the bilingual ninth-grade students were able to use grammatical cohesion in their recount text writing. The result revealed the reference is most dominated in 68.42% and the second device is in conjunction with 29.97%. Meanwhile, substitution showed the low rank with 1.61% and the last was ellipsis with 0%. Furthermore, in the reference device category, personal reference becomes the most highly used at 85%, meanwhile in the conjunction category, additive category becomes the most frequent one at 46% as well as nominal substitution at 50% in the substitution device. It was also found that the ninth-grade students of bilingual class can write well using numbers of grammatical cohesive devices even though there was still some monotonous repetition in their writing. he findings of this study have pedagogical implicature as the need to enhance students’ knowledge of grammatical cohesion device because understanding of cohesiveness is necessary for pertaining to the text’s cohesion and coherence particularly in writing ability.

Overall survival information and population correspondence for FDA cancer accelerated approval indications between 2006 and 2021.

e13653 Background: The US Food and Drug Administration (FDA) Accelerated Approval Program (AAP) was instituted to allow patients earlier access to medications that address large unmet need and are approved based on surrogate endpoints. Recently, approvals have been criticized for not providing overall survival data, and for confirmatory trials conducted in alternative populations. We investigated the availability of overall survival (OS) data for cancer accelerated approval (AA) indications and the correspondence between the population providing OS information and that of the original indication to assess the merit of these critiques. Methods: Approval letters and labels of cancer therapy products approved between January 1, 2006 and June 31, 2021 based on their verification status as of June 10, 2022 were identified from Drugs@FDA. Information was extracted irrespective of the final decision. Information about the exact indications and the trials that were used for AA and were cited for RA (confirmatory trial). OS data was searched for both AA and RA trials irrespective of approval dates, linked by NCT numbers identified in labels and letters. When OS was available only from the trial indicated for the RA, level of correspondence between the source of the OS data and the AA indication were described and then categorized in terms of the population characteristics, treatment lines, disease stage and changes in treatment regimen, to indicate level of correspondence. Results: OS data is available for 83% of closed AAs: 50 among the 57 converted and 12 among 18 withdrawn AAs. Further OS data was identified for seven AAs among the 55 ongoing reviews, creating a set of OS data for 69 out of the 130 total number of AAs identified. Exact or very good population overlap is evident in 50% of cases, defined as the availability of the trial reporting results for a population exact or very close to the original AA population; line change down was defined if the RA trial was conducted in an earlier line (without overlap with the original AA trial); and some additional categories were identified. Conclusions: Overall, OS information was available, and in half of the cases it was reported for a population very close to the original AA indication. Likely for ethical and practical reasons, RA trials are conducted in an indication that differs from the original AA indication and changes in the population was with the consent of the FDA. Policy discussions about AAP are incomplete without assessing its impact on survival and real-world considerations for conducting confirmatory trials. [Table: see text]

Scots and Italy as seen through Alba amicorum, 1540s–1720s Part 2

Part 2 of this article continues its investigation into the relationships between Scots and Italy, as seen through books of friendship, by considering additional socioprofessional categories beyond the academic and military worlds. Among the political activists considered is David Graham of Fintry, a Marian and member of the Catholic party, whose album is studied in great depth. It is a key document for our further knowledge of his activities as a courier and intelligencer for Scottish Catholic interests in Europe and adds to the scholarly understanding of his political involvement in the Counter-Reformation. More broadly speaking, friendship albums shed light on Scottish activists’ politico-religious networking processes and their connections with middle-ranking and regional intermediaries, at times in key locations or seats of power. As with the military officers studied in Part 1, it transpires from these contacts that there were lighter moments for artistic and cultural activities or edification. In correlation, the few ecclesiastical contributions studied in this paper cast light on a fluid matrix of information and networks and highlight their potential influences, both negative and positive. Indeed, there were risks involved in being in contact with dubious characters, whereas tapping into a rich circle of contacts with courtiers could present opportunities and patronage. For Scottish scientists, the genre of alba amicorum is particularly important, not so much to highlight their side activities as to lay the foundations for their subsequent careers and establish the potential links and backgrounds that underscore their subsequent scientific tasks, achievements, and modus operandi in their professional roles.

Evaluation of indication in a urinalysis driven reflex urine culture protocol at an academic medical center

Background: Asymptomatic bacteriuria (ASB) is a widespread problem in hospitalized patients in which only a small subset of patients benefit from treatment. Other patient populations with ASB are harmed by treatment. In 2014, our institution implemented a urinalysis (UA)-driven reflex culture protocol which evaluated patient symptoms, risk factors, and the UA to determine whether bacterial culture was performed (Fig. 1). The goal of this process was to ensure that urine cultures were only performed in those patients who had symptoms of UTI and an abnormal urinalysis while allowing for exceptions in populations where treatment of ASB may be appropriate (ie, pregnancy, aged &lt;3 years, impending urologic surgery, kidney transplant) or where the urinalysis may not be useful in determining whether infection is present (ie, neutropenia). An “other” indication with free-text documentation required was included to allow for unique situations. We evaluated the free-text option to determine whether additional indications were needed and whether data entered were medically appropriate. Methods: This retrospective review at a Midwestern, tertiary-care, academic medical center included inpatient UA with UTI evaluation order sets between July 1, 2020, and June 30, 2022. Descriptive statistics analyzed order-set utilization. Results: In total, 35,469 “urinalysis to reflex culture” order sets were submitted, of which 9,493 resulted in culture. Of these, 839 (8.8%) were ordered with an indication of “other.” “Other” was the most cited indication for special population override contributing to 40% (n = 839 of 2,085) of these indications, followed by kidney or pancreas transplant (29%) and neutropenia (13%). The write-in options fell into 1 of 11 themes (Fig. 2). The 3 most common reasons a urine culture was obtained using the free-text option were nonurologic surgical intervention (n = 223 of 839), immunosuppression not otherwise defined (n = 195 of 839), and symptom presence (n = 146 of 839). Based on current literature, 97% of other indications were inappropriate (n = 816 of 839). If the UTI protocol had been strictly followed, 696 of 839 (83%) cultures ordered with an indication of “other” would not have been obtained, due either to lack of symptoms or, if symptomatic, lack of pyuria. Conclusions: Most cultures obtained by selecting the “other” special population option on the algorithm were obtained in situations in which a urine culture was unnecessary. Removing the “other” indication from the algorithm may improve appropriateness of urine culturing with a possible decrease in CA-UTI and treatment of ASB. Although most write in rationales were inappropriate, adding an additional category for deceased donor-organ evaluation would be reasonable.Disclosures: None