Knowledge Of Best Practices Research Articles

Improving Schools' Readiness for Involvement in Suicide Prevention: An Evaluation of the Creating Suicide Safety in Schools (CSSS) Workshop.

Schools have an important role to play in combatting suicide, a significant public health problem that disproportionately affects adolescents and young adults. Schools can work to reduce youth suicidality by adopting policies that align with best practice recommendations pertaining to suicide prevention, intervention, and postvention. This study examined the impact of a one-day training, the Creating Suicide Safety in Schools (CSSS) workshop, on the readiness of school personnel to improve their schools’ suicide-related policies and procedures. Participants (N = 562) consisted predominantly of school-based mental health professionals working in communities of low or mixed socioeconomic status in New York State. Survey data were collected according to a one-group pre-test—post-test design with a 3-month follow-up. Workshop participants demonstrated improvements from pre-test to post-test in their attitudes about the importance of school-based suicide prevention, knowledge of best practices, perceptions of administrative support, and feelings of empowerment to work collaboratively to enhance their schools’ suicide safety. At follow-up, participants reported barriers to implementing changes, most commonly in the form of insufficient time and stigma surrounding the topic of suicide. The results of this study provide preliminary evidence for the effectiveness of the CSSS workshop as a promising method for improving schools’ suicide safety, yet additional research using randomized controlled trials needs to be conducted.

The (Mis) Education of Immigrant Children in Today’s America

In today’s America, not every child starts on a level playing field, and very few children move ahead based solely on hard work or talent. Generational poverty and a lack of cultural capital hold many students back, robbing them of the opportunity to move up professionally and socially. Children of immigrants are especially at-risk because, in addition to facing poverty, race, geographical location or economic disadvantages, they are also confronted with failure due to their limited or non-existent English proficiency. This study focuses on the degree to which teachers in a mid-sized urban school district take into consideration the individual needs of immigrant children in the process of their education. The study also examines the preparation teachers have had to equip them with knowledge of best practices in teaching immigrant children, and the relationship between teachers’ practices, beliefs, and their demographic and personal characteristics (age, gender, years of experience, level of education, etc.). Quantitative data was collected via a survey. Interviews with teachers and one central office administrator provided data for the qualitative section of the study. The findings revealed that teachers, in general, appeared to lack knowledge of specific policies for mainstreaming immigrant students into general education classrooms; their use of effective teaching practices for working with immigrant children were limited; and most of the teachers had not participated actively in professional development that focused on teaching immigrant children.

Bespoke STOMP training for learning disability teams—Does it work?

Accessible summary There is significant concern about medication being given to people with intellectual disability (ID) inappropriately particularly to manage their behaviours which needs to stop. This needs people who work and support people with ID with their distress to be aware of the national concerns and guidance. We checked whether NHS staff who work with people with ID , that is the ID service, are aware of the latest guidance and whether training them will help improve their knowledge. We found that there were differences in knowledge in some groups such as nurses and psychologists compared to others and training can make a positive change. This is important as training can possibly deliver better care to people with ID . AbstractBackgroundIntellectual disability (ID) is associated with polypharmacy particularly off‐label psychotropics for “challenging behaviour.” NHS England introduced the “stopping over medication of people with a learning disability (LD), autism or both” (STOMP) initiative. As ID services are a professionally diverse group, it is important to know whether teams have suitable knowledge to deliver STOMP. The impact of delivering bespoke STOMP training was evaluated.MethodsA 21‐item multiple‐choice questionnaire was distributed to three specialist ID teams in the south‐west of England. Current best practice and national guidance knowledge on psychotropic medication use in ID were assessed. One team received bespoke training covering the content of the questionnaire prior to completion.ResultsSurvey participation was 44% (21/48) by the trained team, 34% (15/44) and 70% (7/10) in the untrained teams. The trained team participants scored over 80% on 19/21 questions compared to 15/21 and 16/21 in the untrained teams. Subspeciality analysis of pooled data (n = 43) showed nursing scored more than 80% on 16/21 questions, psychology 15/21 and allied health professionals (AHPs) 19/21. Nursing and psychology both reported STOMP to be a priority. Majority responded “yes” to potentially being involved in STOMP.ConclusionsBetter STOMP knowledge and understanding of best practice and guidelines are associated with training. Nursing and psychology are essential to STOMP delivery but scored lower than AHPs. We recommend semi‐structured STOMP training developed locally with national underpinnings for all specialist ID teams, particularly focussed on front‐line staff directly involved in the management of challenging behaviour.

Scaling up innovative learning in mathematics: exploring the effect of different professional development approaches on teacher knowledge, beliefs, and instructional practice

Professional learning experiences (PLEs) provide teachers with opportunities to improve their understanding of mathematics content and teaching practices. However, PLEs are often conducted in person and in small groups—hence costly and localized. The purpose of the current study was to explore different ways for teachers to engage in PLEs and how these approaches might enable the field to scale up these efforts in a sustainable manner. We compared the impact of three PLE formats on the early algebra knowledge and teaching practices of elementary mathematics teachers: (1) a facilitated summer workshop, (2) a multimedia course completed on teachers’ own time, and (3) learning resources provided in the algebra curriculum unit that teachers used individually. Our findings suggest that all three formats can be mapped against a set of principles for quality professional learning. Analysis of pre- and post-treatment measures indicate that participating teachers’ knowledge of algebra content and best practices significantly increased, regardless of the PLE format with which they engaged. Interviews with a subset of the teachers from the three groups point to the key features of each of the formats that can be capitalized on by designers of PLEs.

Iatrogenic dys-appearance: first-person accounts of chronic neuromuscular disease reveal unintended harms of treatment

Background: Quantitative methods and a biomedical concept of the body dominate research in physiotherapy, and physiotherapists’ knowledge of best practices is usually valued higher than patients’ knowledge/values. Yet qualitative research on the lived experience of chronic neuromuscular disease can provide valuable insights for treatment priorities. The concepts of bodily ‘dys-appearance’ (Leder) and ‘eu-appearance’ (Zeiler) provide a foundation.Methods: Two first-person accounts of living with chronic neuromuscular disease were subjected to close thematic analysis.Results: Well-intentioned efforts on the part of healthcare providers to follow ‘best practices’ can result in unintended harm to patients’ wellbeing, particularly in the form of what we term iatrogenic dys-appearance.Conclusions: Guidelines are suggested for future research and practice in physiotherapy, including a critical ethics and holistic respect for patients’ knowledge about their bodies/lived experience. Literature about illness, especially life writing, provides a potentially useful tool for developing the empathetic imagination of healthcare professionals.

Intercomparison of Small Unmanned Aircraft System (sUAS) Measurements for Atmospheric Science during the LAPSE-RATE Campaign.

Small unmanned aircraft systems (sUAS) are rapidly transforming atmospheric research. With the advancement of the development and application of these systems, improving knowledge of best practices for accurate measurement is critical for achieving scientific goals. We present results from an intercomparison of atmospheric measurement data from the Lower Atmospheric Process Studies at Elevation—a Remotely piloted Aircraft Team Experiment (LAPSE-RATE) field campaign. We evaluate a total of 38 individual sUAS with 23 unique sensor and platform configurations using a meteorological tower for reference measurements. We assess precision, bias, and time response of sUAS measurements of temperature, humidity, pressure, wind speed, and wind direction. Most sUAS measurements show broad agreement with the reference, particularly temperature and wind speed, with mean value differences of 1.6 C and 0.22 m/s for all sUAS, respectively. sUAS platform and sensor configurations were found to contribute significantly to measurement accuracy. Sensor configurations, which included proper aspiration and radiation shielding of sensors, were found to provide the most accurate thermodynamic measurements (temperature and relative humidity), whereas sonic anemometers on multirotor platforms provided the most accurate wind measurements (horizontal speed and direction). We contribute both a characterization and assessment of sUAS for measuring atmospheric parameters, and identify important challenges and opportunities for improving scientific measurements with sUAS.

Society of Cardiovascular Anesthesiologists Clinical Practice Improvement Advisory for Management of Perioperative Bleeding and Hemostasis in Cardiac Surgery Patients

Bleeding after cardiac surgery is a common and serious complication leading to transfusion of multiple blood products and resulting in increased morbidity and mortality. Despite the publication of numerous guidelines and consensus statements for patient blood management in cardiac surgery, research has revealed that adherence to these guidelines is poor, and as a result, a significant variability in patient transfusion practices among practitioners still remains. In addition, although utilization of point of care coagulation monitors and the use of novel therapeutic strategies for perioperative hemostasis, such as the use of coagulation factor concentrates, has increased significantly over the last decade, they are still not widely available in every institution. Therefore, despite continuous efforts, blood transfusion in cardiac surgery has declined only modestly over the last decade, remaining at 50% or greater in high-risk patients. Given these limitations and in response to new regulatory and legislature requirements, the Society of Cardiovascular Anesthesiologists has formed the Blood Conservation in Cardiac Surgery Working Group in order to organize, summarize, and disseminate the available best-practice knowledge in patient blood management in cardiac surgery. The current publication includes the summary statements and algorithms designed by the working group, after collection and review of the existing guidelines, consensus statements, and recommendations for patient blood management practices in cardiac surgery patients. The overall goal is creating a dynamic resource of easily accessible educational material that will help to increase and improve compliance with the existing evidence-based best practices of patient blood management by cardiac surgery care teams.

Clinical Management of Intermittent Fasting in Patients with Diabetes Mellitus.

Intermittent fasting is increasing in popularity as a means of losing weight and controlling chronic illness. Patients with diabetes mellitus, both types 1 and 2, comprise about 10% of the population in the United States and would likely be attracted to follow one of the many methods of intermittent fasting. Studies on the safety and benefits of intermittent fasting with diabetes are very limited though, and health recommendations unfortunately today arise primarily from weight loss gurus and animal studies. Medical guidelines on how to manage therapeutic intermittent fasting in patients with diabetes are non-existent. The evidence to build such a clinical guideline for people with a diabetes diagnosis is almost non-existent, with just one randomized trial and several case reports. This article provides an overview of the available knowledge and a review of the very limited pertinent literature on the effects of intermittent fasting among people with diabetes. It also evaluates the known safety and efficacy issues surrounding treatments for diabetes in the fasting state. Based on those limited data and a knowledge of best practices, this paper proposes expert-based guidelines on how to manage a patient with either type 1 or 2 diabetes who is interested in intermittent fasting. The safety of each relevant pharmaceutical treatment during a fasting period is considered. When done under the supervision of the patient’s healthcare provider, and with appropriate personal glucose monitoring, intermittent fasting can be safely undertaken in patients with diabetes.

Congenital Cytomegalovirus and Hearing Loss: A Pilot Cross-Sectional Survey of Otologists' and Pediatric Otolaryngologists' Knowledge.

ObjectiveTo evaluate pediatric otolaryngologists, neurotologists, and otologists on awareness and knowledge of congenital cytomegalovirus (cCMV).Study DesignPilot cross-sectional online survey.SettingOtolaryngology practices.Subjects and MethodsAn electronic multiple-choice questionnaire was sent email listserv to physician members of the American Society of Pediatric Otolaryngology and American Otological Society. The survey assessed demographics, physician awareness, and practice patterns. Data were collected and analyzed.ResultsSeventy (14.5%) pediatric otolaryngologists and otologists responded. All responded that they are familiar with cCMV. Most were familiar with symptoms associated with cCMV with the exception of petechia/purpura. Less than 50% knew the incidence/natural history of cCMV-induced hearing loss. Only 63% knew that saliva or urine polymerase chain reaction/culture should be performed prior to 3 weeks of age. Less than half knew the indications for dry blood spot testing, and many incorrectly recommended serologic saliva or urine testing in a child >3 weeks old. Most respondents do not offer any diagnostic testing for cCMV or referral for antiviral therapy for those who may benefit from this treatment. Most either did not know the cCMV screening policy or did not have one at their institution.ConclusionDespite a relatively low overall response rate, this study suggests several knowledge gaps and underutilization of cCMV testing by physicians who frequently encounter pediatric hearing loss. The findings from this pilot study demonstrate the need for further educational directives focused on cCMV to improve knowledge and incorporation of cCMV best practices.

Catalog of energy patterns for mobile applications

Software engineers make use of design patterns for reasons that range from performance to code comprehensibility. Several design patterns capturing the body of knowledge of best practices have been proposed in the past, namely creational, structural and behavioral patterns. However, with the advent of mobile devices, it becomes a necessity a catalog of design patterns for energy efficiency. In this work, we inspect commits, issues and pull requests of 1027 Android and 756 iOS apps to identify common practices when improving energy efficiency. This analysis yielded a catalog, available online, with 22 design patterns related to improving the energy efficiency of mobile apps. We argue that this catalog might be of relevance to other domains such as Cyber-Physical Systems and Internet of Things. As a side contribution, an analysis of the differences between Android and iOS devices shows that the Android community is more energy-aware.

Professional or Patsy?

Professional or Patsy?

P55 The neurosurgical physician: a new role in the UK

ObjectivesWith reduction in numbers of junior doctors and strict deanery requirements for training opportunities, the provision of ward cover and continuity has consistently fallen. Various methods of addressing this have been implemented in the UK, including increased nurse practitioners and physician associates. We introduced a new position of GP with a specialist neuroscience interest in line with the North American model of hospitalist and review the impact on patients and trainees.DesignQualitative descriptive study.Subjects14 core and speciality trainees.MethodsRetrospective review of the impact of a permanent neurosurgical physician on ward care and provision of training with a qualitative study of trainee experience. Saturation was reached at 14 interviews.ResultsA neurosurgical physician role was instituted in 2013, enabling a formal training rota to fulfil deanery requirements for core training and provide continuity of care at senior medical level, reducing medical ward consults to zero, improved communication with relatives and reduced the need for ST ward rounds. Qualitative assessment revealed a senior medical presence aided trainees own knowledge, resulted in better rapport and communication with patients and improved patient care through knowledge of best medical practice guidelines.ConclusionsThe addition of the neurosurgical physician role has positively impacted on the quality of patient care and junior doctor training. Senior medical care is provided with continuity, in contrast to other models.

Putting Implementation Science into Practice: Lessons from the Creation of the National Maternal and Child Health Workforce Development Center.

Purpose This article describes how implementation science informed the design of a national training and technical assistance (TA) center, and how implementation best practices have been used to improve the quality of training and technical assistance services offered to states/jurisdictions. Description An existing tool, based on the Implementation Drivers Framework (in: Fixsen et al., Implementationresearch: a synthesis of the literature, University of South Florida, The National Implementation Research Network, Tampa, 2005), was adapted to assess efforts of the National MCH Workforce Development Center (the Center) against known implementation best practices. Staff identified specific examples of effective practice and gaps for inclusion in this article. Assessment Using implementation science to establish, assess and improve Center practice was both feasible and practical, requiring intentionality, dedicated time, and staff committed to deepening their understanding of implementation science. The Implementation Drivers framework proved useful for creating a shared approach to analysis and identification of opportunities for improvement of Center practice. Conclusion Policymakers and funding agencies should consider how training and technical assistance programs demonstrate knowledge and use of implementation science best practices among other evidence based practices in their work. Increasing attention to the use of implementation science can contribute to a higher quality of service among technical assistance centers, with the long term goal of improving outcomes for training and assistance recipients and the communities they serve. Establishing the link between customer satisfaction and quality of technical assistance, on the one hand, and long term outcomes, on the other, remains a challenge and an area of focus and learning for the Center.

RESTful API Automated Test Case Generation with EvoMaster

RESTful APIs are widespread in industry, especially in enterprise applications developed with a microservice architecture. A RESTful web service will provide data via an API over the network using HTTP, possibly interacting with databases and other web services. Testing a RESTful API poses challenges, because inputs/outputs are sequences of HTTP requests/responses to a remote server. Many approaches in the literature do black-box testing, because often the tested API is a remote service whose code is not available. In this article, we consider testing from the point of view of the developers, who have full access to the code that they are writing. Therefore, we propose a fully automated white-box testing approach, where test cases are automatically generated using an evolutionary algorithm. Tests are rewarded based on code coverage and fault-finding metrics. However, REST is not a protocol but rather a set of guidelines on how to design resources accessed over HTTP endpoints. For example, there are guidelines on how related resources should be structured with hierarchical URIs and how the different HTTP verbs should be used to represent well-defined actions on those resources. Test-case generation for RESTful APIs that only rely on white-box information of the source code might not be able to identify how to create prerequisite resources needed before being able to test some of the REST endpoints. Smart sampling techniques that exploit the knowledge of best practices in RESTful API design are needed to generate tests with predefined structures to speed up the search. We implemented our technique in a tool called E vo M aster , which is open source. Experiments on five open-source, yet non-trivial, RESTful services show that our novel technique automatically found 80 real bugs in those applications. However, obtained code coverage is lower than the one achieved by the manually written test suites already existing in those services. Research directions on how to further improve such an approach are therefore discussed, such as the handling of SQL databases.

Test Patterns for Cloud Applications

Software systems are becoming graphical user intensive. They involve web technologies organized in the cloud platform which supports translation of services to a wider community. Such cloud applications are more vulnerable to misuse. Consequently, system development needs to focus on system security features in a comprehensive manner. Therefore, techniques that are based on test-driven development will be a good choice to use for the quality maintenance of such systems. We need checklists and mechanisms that provide identification and knowledge of best practices to maintain consistency in performing testing activities. We propose a test patterns-based technique which supports identification of test cases on the bases of specification and domain analysis of system under test. We provide a set of test patterns that support Test Driven Development (TDD) as well. We link misuse cases and security requirement to testing and provide test patterns for testing cloud applications. We consider threats associated with cloud applications and make use of case studies to evaluate and present results.

Diagnostic of guinea fowl (Numida meleagris) farming in Ivory Coast

In order to promote farming of guinea fowl and to diversify the sources of income of Ivorian farmers, a survey was conducted in 2016 in 15 regions (197 farmers) out of a total of 31 regions in Ivory Coast. The aims were 1) to establish a better knowledge of guinea fowl farming; 2) to assess the level of technical knowledge of farmers; and 3) to establish a global typology of farmers based on their socio-economic profile, the goal of the farming (sale or consumption), and their level of technical knowledge. The sampling was realized according to a snowball type design (chain referral sampling method) a non-probabilistic method where farmers were selected not from a sampling frame but from the friendship network of existing farmers of the sample. Guinea fowl farming was undertaken by persons from all the social levels with no distinctions due to sex, religion, ethnic group, or level of education. For farmers with more than 48 guinea fowl and farmers who were Muslims, farming was a source of income. Owners of guinea fowl under 60 yr old, Christians and atheists kept a part of their production for their own consumption and marketed the remainder of the flock. Incubation was primarily accomplished by a laying hen, with an estimated hatching rate of 72%. In our survey, 68.5% of the farmers had a good practical knowledge of guinea fowl farming. The identified weaknesses of guinea fowl farming in the regions where the survey took place were the absence of knowledge of guinea fowl farming and the poverty of farmers who could not afford incubators nor provide a good nutrition to their animals. The future development of this farming will have to take into account all these weaknesses that are also limitations to this development.

Increasing Usage of ESL Instructional Practices in a Rural County Elementary School

The study setting is one elementary school located in a remote rural county school district in a mountain western state. Implementing a specific set of procedures, ESL Instructional Improvement Process, educators examined and increased use of research-based ESL instructional practices in the education of English learners (ELs). A key feature of the piloted process is educator self-assessment of instructional practices, resulting in the development of workshop sessions and action items, and completion of classroom observations. Researchers found that the process proved effective in increasing rural educators’ knowledge and application of ESL best practices. Self-assessment was highly effective in helping educators examine existing instructional practices, leading to relevant workshop sessions and classroom implementation of ESL action items. Numerous examples of the use of research-based ESL instructional practices as a result of this project are provided, along with suggestions for further research to improve the education of ELs in rural county schools.

Diagnostic ability and inappropriate antibiotic prescriptions: a quasi-experimental study of primary care providers in rural China.

China has one of the highest rates of antibiotic resistance. Existing studies document high rates of antibiotic prescription by primary care providers but there is little direct evidence on clinically inappropriate use of antibiotics or the drivers of antibiotic prescription. To assess clinically inappropriate antibiotic prescriptions among rural primary care providers, we employed unannounced standardized patients (SPs) who presented three fixed disease cases, none of which indicated antibiotics. We compared antibiotic prescriptions of the same providers in interactions with SPs and matching vignettes assessing knowledge of diagnosis and treatment to assess overprescription attributable to deficits in diagnostic knowledge, therapeutic knowledge and factors that lead providers to deviate from their knowledge of best practice. Overall, antibiotics were inappropriately prescribed in 221/526 (42%) SP cases. Compared with SP interactions, prescription rates were 29% lower in matching clinical vignettes (42% versus 30%, P < 0.0001). Compared with vignettes assessing diagnostic and therapeutic knowledge jointly, rates were 67% lower in vignettes with the diagnosis revealed (30% versus 10%, P < 0.0001). Antibiotic prescription in vignettes was inversely related to measures of diagnostic process quality (completion of checklists). Clinically inappropriate antibiotic prescription is common among primary care providers in rural China. While a large proportion of overprescription may be due to factors such as financial incentives tied to drug sales and perceived patient demand, our findings suggest that deficits in diagnostic knowledge are a major driver of unnecessary antibiotic prescriptions. Interventions to improve diagnostic capacity among providers in rural China are needed.

Ethical challenges in research on post-abortion care with adolescents: experiences of researchers in Zambia

ABSTRACT Post-abortion care (PAC) research is increasingly being conducted in low- and middle-income countries (LMICs) to help reduce the high burden of unsafe abortion. This study aims to help address the evidence gap about ethical challenges that researchers in LMICs face when carrying out PAC research with adolescents. Employing an explorative qualitative approach, the study identified several ethics challenges encountered by PAC researchers in Zambia, including those associated with seeking ethics and regulatory approvals at institutional and national levels. Persistent stigma around abortion and community perceptions that PAC studies encourage adolescents to seek abortion affected adolescents’ right to exercise their autonomy and to make decisions as well as exposed adolescents to social stigmatization risks. Challenges with recruitment was reported to result in abandoning of studies, thereby undermining development of PAC services that are more responsive to adolescent needs. Training needs identified included knowledge of best practices for conducting and disseminating PAC research. Strategies for addressing the ethical challenges included trust building and using less value-laden terminology when seeking permission and consent. It is essential to the future of PAC research in Zambia and globally that these important challenges be addressed through the development of comprehensive ethics guidance.

Drivers of inappropriate antibiotic prescriptions: a quasi-experimental study of antibiotic prescription by primary care providers in rural China

BackgroundChina has one of the highest rates of antibiotic resistance worldwide. Existing studies document high rates of antibiotic prescription by primary care providers, especially in rural areas, but there has been little research on clinically inappropriate use of antibiotics, and its drivers. In this study, we used direct measures of clinically inappropriate antibiotic prescriptions to document the degree of overprescription among primary care providers in rural China and to analyse the extent of overprescription attributable to deficits in provider diagnostic and therapeutic knowledge. The prescription rates in the USP interactions and the two vignettes enabled us to assess the amount of over-prescription attributable to deficits in diagnostic knowledge, therapeutic knowledge, and factors that lead providers to deviate from their knowledge of best practice and vignettes. MethodsTo assess clinically inappropriate antibiotic prescriptions among rural primary care providers, we used 63 unannounced standardised patients (USPs) who visited 442 providers in 207 township health centres and 132 village clinics in rural China. These facilities were randomly sampled from 21 counties in each prefecture in three provinces located in western, central and eastern China. The USPs presented three fixed disease cases, none of which indicated antibiotics. The providers also completed two types of matching vignettes. The first tested the providers' diagnostic and therapeutic knowledge (they were asked to diagnose a disease and suggest a treatment). The second tested their therapeutic knowledge (the correct diagnosis was revealed and the providers were asked to suggest a treatment). Approvals were obtained from the institutional review boards of Stanford University, USA (protocol number 25904) and Sichuan University, China (protocol number K2015025). Informed verbal consent was obtained from all providers participating in the study. To minimise the effect of prior knowledge on the study, both institutional review boards approved a procedure whereby providers consented to USP visits at any time within a 6-month period. Consent from the providers was obtained during a facility survey approximately 5 weeks before visits by USPs. All individuals who participated as USPs were trained to avoid any invasive tests or procedures. FindingsOverall, antibiotics were inappropriately prescribed in 221 out of 526 (42%) USP cases. In the matching clinical vignettes, 158 of 525 (30%) providers prescribed antibiotics, which was 29% (p<0·0001) lower than the prescription rates in the USP interactions. Compared to vignettes assessing diagnostic and therapeutic knowledge jointly, prescription rates were 67% lower in vignettes used to test therapeutic knowledge, in which the diagnosis was revealed (30% vs 10%, p<0·0001). In the case of both USP interactions and vignettes, providers who asked more clinically appropriate questions or carried out more relevant clinical examinations were less likely to prescribe antibiotics. InterpretationClinically inappropriate antibiotic prescriptions are common among primary care providers in rural China. Deficits in providers' diagnostic skills and diagnostic uncertainty are major drivers of clinically inappropriate antibiotic prescriptions. Insufficient knowledge of therapeutics plays a minor role. FundingThe authors are supported by the 111 Project (number B16031), the Laboratory of Modern Teaching Technology of the Ministry of Education, Shaanxi Normal University, the National Natural Science Foundation of China (numbers 71703083 and 71703084), the National Social Science Fund Youth Project (number 15CJL005), and the Knowledge for Change program at The World Bank (number 7172469).