Order Sentences Research Articles

2677. Evaluation of Expedited Partner Therapy Prescribing in an Urban Emergency Department

Abstract Background Expedited Partner Therapy (EPT) is a useful tool that facilitates prompt treatment of sex partners in patients diagnosed with sexually transmitted infections (STIs). This study describes EPT utilization and documentation practices in an urban Emergency Department (ED) after implementing electronic EPT orders into a medical record system. Methods This retrospective, cross-sectional study evaluated EPT prescribing and documentation practices in an urban ED from 1/1/22 – 9/30/22. The study included patients older than 18 years of age with suspected chlamydia, gonorrhea, and/or trichomoniasis who received either a physical EPT prescription or an EPT kit. Collected data included patient characteristics, diagnostic and treatment data, and documentation measures. Descriptive statistics were used to assess the number of STI cases and those who received EPT. Results Data was collected on 37 patients who received EPT during their ED visit. The majority were uninsured (43%), and each patient had an average of 1.27 sex partners. HIV and syphilis screening were performed only in 8 (22%) and 7 (19%) of patients seen for a suspected STI. The number of cases for chlamydia (n=228), gonorrhea (n=149), and trichomoniasis (n=282) were disproportional to the total number of EPT orders throughout the 9-month study period. The number of EPT prescriptions was highest after the implementation of electronic sentences (n=27). At discharge, 76% of patients received a medication kit to provide direct treatment access for sex partners of index patients. Electronic dot phrases were used by 81% of providers to meet state documentation requirements. The results of this study demonstrate a significant STI burden with low EPT utilization from providers. Conclusion There was an increase of EPT utilization after the implementation of electronic order sentences in the electronic medical record. Screenings for HIV and syphilis are an area for improvement among patients at risk for an STI who are seen in the ED. The integration of electronic EPT methods can help address the growing rates of STIs in the U.S. Disclosures All Authors: No reported disclosures

Similarity Discriminating Algorithm for Scientific Research Projects

An enormous challenge for project management is to identify similar research projects accurately and efficiently among numerous proposals. To address this challenge, this paper proposes an algorithm to calculate the similarity between research projects using an improved generating method for fused word order sentence vectors based on USIF (unsupervised random walk sentence embeddings). The experimental results show that the proposed algorithm is about 15.8% more accurate than the existing approaches. The authors also propose a pre-checking algorithm by introducing a complex research cooperation graph to enhance query efficiency. The results show the pre-checking method reduces the query time cost by 96% on average.

Implementation of indication-based antibiotic order sentences improves antibiotic use in emergency departments

IntroductionPrior data have suggested that suboptimal antibiotic prescribing in the emergency department (ED) is common for uncomplicated lower respiratory tract infections (LRTI), urinary tract infections (UTI), and acute bacterial skin and skin structure infections (ABSSSI). The objective of this study was to measure the effect of indication-based antibiotic order sentences (AOS) on optimal antibiotic prescribing in the ED. MethodsThis was an IRB-approved quasi-experiment of adults prescribed antibiotics in EDs for uncomplicated LRTI, UTI, or ABSSSI from January to June 2019 (pre-implementation) and September to December 2021 (post-implementation). AOS implementation occurred in July 2021. AOS are lean process, electronic discharge prescriptions retrievable by name or indication within the discharge order field. The primary outcome was optimal prescribing, defined as correct antibiotic selection, dose, and duration per local and national guidelines. Descriptive and bivariate statistics were performed; multivariable logistic regression was used to determine variables associated with optimal prescribing. ResultsA total of 294 patients were included: 147 pre-group and 147 post-group. Overall optimal prescribing improved from 12 (8%) to 34 (23%) (P < 0.001). Individual components of optimal prescribing were optimal selection at 90 (61%) vs 117 (80%) (P < 0.001), optimal dose at 99 (67%) vs 115 (78%) (P = 0.036), and optimal duration at 38 (26%) vs 50 (34%) (P = 0.13) for pre- and post-group, respectively. AOS was independently associated with optimal prescribing after multivariable logistic regression analysis (adjOR, 3.6; 95%CI,1.7–7.2). A post-hoc analysis showed low uptake of AOS by ED prescribers. ConclusionsAOS are an efficient and promising strategy to enhance antimicrobial stewardship in the ED.

Sentencing: New trajectories in law By E.A.O.Freer, Abingdon: Routledge. 2021. pp. 131. £44.99 (hbk); pp. 146. £16.99 (pbk). ISBN: 9780067862619; 9781032063027

Sentencing: New trajectories in law By E.A.O.Freer, Abingdon: Routledge. 2021. pp. 131. £44.99 (hbk); pp. 146. £16.99 (pbk). ISBN: 9780067862619; 9781032063027

Indication documentation and indication-based prescribing within electronic prescribing systems: a systematic review and narrative synthesis

BackgroundDespite recommendations, documentation of indication on prescriptions and inpatient medication orders is not routinely practised. There has been a recent systematic review of indication documentation for antimicrobials, but not for...

Effects of Conformity Bias Caused by Evacuation Order on Risk Evaluation

We have found that various cognitive biases would interfere with evacuation behavior during a disaster, and this have caused many casualties. In this study, we focused on the conformity bias, one of the cognitive biases, which is introduced by evacuation order sentences with information about other residences’ behavior, to facilitate evacuation behavior. In the experiment, we presented the evacuation order sentences, and pictures which depict the scene of disaster, or normal situation. Participants evaluated the degree of risk for the picture, and degree of necessity of evacuation from the scene. Our results demonstrated that the conformity bias would facilitate evacuation especially for the low-risk situation. In addition, we found that judgments of the need for evacuation can be predicted by the rating of the degree of danger, disaster experience, sense of crisis about disasters, and the other-personality-orientations of the participants.

910. Impact of Indication-based Antibiotic Order Sentences on Optimal Prescribing in the Emergency Department: A Quasi-experiment

Abstract Background A prior study demonstrated suboptimal antibiotic prescribing in the emergency department (ED) at 77.4% for uncomplicated lower respiratory tract infections (LRTI), urinary tract infections (UTI), and acute bacterial skin and skin structure infections (ABSSSI). This study measured the effect of indication-based antibiotic order sentences (AOS) on prescribing. Methods IRB-approved quasi-experiment of adults prescribed antibiotics in ED for uncomplicated LRTI, UTI, or ABSSSI from January - June 2019 (pre-group) or September - December 2021 (post-group). Exclusion: hospital admission, immunocompromised, active cancer, or prophylactic antibiotics. AOS are lean process, electronic discharge prescriptions retrievable by name or indication; AOS implementation occurred July 2021. Optimal prescribing was defined as the correct antibiotic selection, dose, and duration per local and national guidelines. Seven-day endpoints: antibiotic escalation, ED or hospital readmission, any outpatient contact, and reported adverse drug event (ADE). Descriptive and bivariate statistics performed. Variables considered for multivariable logistic regression had p&amp;lt; 0.2 or plausible association with optimal prescribing. Results 294 patients included: 147-pre and 147-post. Patient characteristics are in Table 1. Overall optimal prescribing improved from 12 (8.2%) to 34 (23.1%) (p&amp;lt; 0.001). Breakdown of optimal prescribing in pre- and post-groups: selection 90 (61.2%) vs 117 (79.6%) (p&amp;lt; 0.001), dose 99 (67.3%) vs 115 (78.2%) (p=0.036), duration 38 (25.9%) vs 50 (34%) (p=0.126). After adjustment, AOS were independently associated with optimal prescribing (Table 2). Secondary endpoints: antibiotic escalation 10 (6.8%) vs 7 (4.8%) (p=0.662), hospital or ED readmission 12 (8.2%) vs 10 (6.8%) (p=0.658), outpatient contact 31 (21.1%) vs 28 (19%) (p=0.662), and ADE 2 (1.4%) vs 4 (2.7%) (p=0.684). Post-hoc analysis showed suboptimal uptake of AOS by ED prescribers. Table 1:Baseline and Clinical CharacteristicsTable 2:Bivariable and Multivariable Regression Analysis of Factors Associated with Optimal Prescribing†Covaries with intervention group; Hosmer and Lemeshow p = 0.68; Method: backwards logistic regression; No variables removed Conclusion AOS is an efficient and promising antimicrobial stewardship strategy; provider re-education is needed to increase AOS uptake. Disclosures All Authors: No reported disclosures.

A Maximality Theorem for Continuous First Order Theories

In this paper we prove a Lindström like theorem for the logic consisting of arbitrary Boolean combinations of first order sentences. Specifically we show the logic obtained by taking arbitrary, possibly infinite, Boolean combinations of first order sentences in countable languages is the unique maximal abstract logic which is closed under finitary Boolean operations, has occurrence number ω1, has the downward Lüowenheim-Skolem property to ωand the upward Lüowenheim-Skolem property to uncountability, and contains all complete first order theories in countable languages as sentences of the abstract logic. We will also show a similar result holds in the continuous logic framework of [5], i.e. we prove a Lindström like theorem for the abstract continuous logic consisting of Boolean combinations of first order closed conditions. Specifically we show the abstract continuous logic consisting of arbitrary Boolean combinations of closed conditions is the unique maximal abstract continuous logic which is closed under approximate isomorphisms on countable structures, is closed under finitary Boolean operations, has occurrence number ω1, has the downward Lüowenheim-Skolem property toω, the upward Lüowenheim-Skolem property to uncountability and contains all first order theories in countable languages as sentences of the abstract logic.

Feferman–Vaught Decompositions for Prefix Classes of First Order Logic

The Feferman–Vaught theorem provides a way of evaluating a first order sentence \(\varphi \) on a disjoint union of structures by producing a decomposition of \(\varphi \) into sentences which can be evaluated on the individual structures and the results of these evaluations combined using a propositional formula. This decomposition can in general be non-elementarily larger than \(\varphi \). We introduce a “tree” generalization of the prenex normal form (PNF) for first order sentences, and show that for an input sentence in this form having a fixed number of quantifier alternations, a Feferman–Vaught decomposition can be obtained in time elementary in the size of the sentence. The sentences in the decomposition are also in tree PNF, and further have the same number of quantifier alternations and the same quantifier rank as the input sentence. We extend this result by considering binary operations other than disjoint union, in particular sum-like operations such as join, ordered sum and NLC-sum, that are definable using quantifier-free translation schemes.

Evaluation and Implementation of KIDs List Recommendations in a University Health System.

The study aims to identify the rate of inappropriate prescribing per the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) List versus total prescribing in patients at University of Missouri Health Care hospitals. This retrospective study evaluated orders for patients treated at University of Missouri Health Care inpatient units or emergency departments with a KIDs List medication between September 1, 2019, and September 1, 2020, or a reported adverse event to one of these medications between September 1, 2015, and September 1, 2020. Patients were excluded if the patient safety report was related to a medication error rather than an adverse event. Safety measures assessed included age and weight filtering, dose-range checking, clinical decision support, and override availability. There were 39 inappropriate orders and 4 possible adverse events identified. A total of 8 of 33 medications (24%) had age and weight filtering in place for at least 1 order sentence, 1 of 38 (2.6%) had dose-range checking, no medications had an active clinical decision support alert, and 33 of 38 (87%) had availability on automated dispensing cabinet override. Use of KIDs List medications is appropriately low, but low levels of safety measure implementation leave pediatric patients vulnerable.

Improving compliance with venous thromboembolism prophylaxis guidelines in obese inpatients.

Obesity is a well-recognised risk factor for venous thromboembolism, and increased dosing of pharmacological prophylaxis is recommended in obese inpatients. We performed a clinical decision support intervention by adjusting order sentences of prophylactic enoxaparin within our electronic medical records, which significantly improved appropriate dosing for thromboprophylaxis in obese inpatients at our institution.

Creating Meaningful Alerts and Reducing Alert Fatigue: Strategies Implemented by Informatics Pharmacists to Optimize Dose Range Checking Alerts in a Multihospital Health System.

Background: Among the many clinical decision support (CDS) mechanisms available in electronic health record (EHR) systems, dose range checking (DRC) is one of the most impactful safeguard tools integrated within most computerized provider order entry (CPOE) workflows. Unfortunately, improper configurations and lack of resources to maintain and monitor CDS systems can hinder and even disrupt daily clinical operations. Objective: This article seeks to highlight the impact that informatics pharmacists can make by implementing different strategies to decrease nuisance alerts and create clinically meaningful DRC alerts that guide clinicians in their practice. Methods: Following the activation of the DRC application for 3623 medication groupers (ie, generic drugs and all their dosage form variations), informatics pharmacists implemented strategies to monitor DRC alert output and decrease the number of inappropriate alerts. Such strategies included weekly monitoring of alerts, modification of order sentences (including dose, route, and age/weight filters), update to the rule triggering the alerts, and modifications of the preference settings. Results: From July to September 2018, an average of 70 DRC tables were reviewed by informatics pharmacists, reducing the number of overridden DRC alerts to 4796 in the first week of September-a 63% decrease in a 3-month period. Conclusions: By reducing the number of DRC nuisance alerts and improving the clinical content of DRC alerts, informatics pharmacists can contribute to lowering alert fatigue and improving providers' trust in CDS alerts.

EMSO(FO$^2$) 0-1 Law Fails for All Dense Random Graphs

In this paper, we disprove EMSO(FO$^2$) convergence law for the binomial random graph $G(n,p)$ for any constant probability $p$. More specifically, we prove that there exists an existential monadic second order sentence with 2 first order variables such that, for every $p\in(0,1)$, the probability that it is true on $G(n,p)$ does not converge.

Impact of order sentence implementation on outpatient antibiotic prescribing for urinary tract infection and skin and soft tissue infection

AbstractIntroductionDue to the high volume of outpatient antibiotic prescribing, the Joint Commission now requires antimicrobial stewardship program (ASP) expansion to ambulatory practice settings. Unfortunately, ASP resources in these settings are scarce. The purpose of this study was to determine whether the implementation of antibiotic order sentences alongside education would improve antibiotic prescribing for urinary tract infections (UTI) and skin and soft tissue infections (SSTI).ObjectivesThe primary objective was to compare the proportion of total guideline‐concordant antibiotic prescribing before (pre‐ASP) vs after (post‐ASP) implementing order sentences. Guideline concordance was defined as antibiotic selection, dosing, and duration in accordance with the health system's empiric guidelines. Secondary objectives included comparing patient‐centered outcomes, such as infection‐related revisits and Clostridiodes difficile infections between groups.MethodsThis retrospective, quasi‐experimental study evaluated adult patients treated for uncomplicated UTI or SSTI at an outpatient Family Medicine office between 1 February 2020 and 1 January 2021. The institution's stewardship team provided in‐person education and set prescribing order sentence “favorites” for providers. Patients were excluded who were diagnosed with a complicated UTI, treated only with topical antibiotics, were pregnant, or received care via telephone encounter.ResultsTwo hundred sixty patients were included in this study (pre‐ASP n = 139, post‐ASP n = 121). Total antibiotic appropriateness improved significantly from 24.5% to 39.7% after implementation of order sentences and education (P = .008). Significant improvement was seen for appropriate drug selection (52.5% vs 66.9%, P = .018) and duration (47.5% vs 68.6%, P = .001). There were no differences observed in patient‐centered outcomes between groups.ConclusionImplementing stewardship‐focused order sentences significantly improved outpatient antibiotic prescribing for UTI and SSTI. Tailoring antibiotic order sentences may be a useful tool for ASP expansion into the outpatient setting with limited resources to allocate to stewardship efforts.

An Effective Approach for Endocrine Dynamic Function Tests Workflow and Reporting Using Cerner Millennium®

Abstract Introduction/Objective Endocrine dynamic function testing (DFT), also known as hormone stimulation tests, are indispensable tools in the endocrine practice. Common pitfalls of ineffective testing and misdiagnosis are due to incorrect sample recordings, delay in sample collections and disorganized or confusing result presentation. Clinical and laboratory data deserves careful attention and discrepancies must be reviewed by a clinical biochemist before releasing results for proper patient diagnosis. The main objective of this Cerner DFT project is to design and implement Cerner Millennium applications for effective management and organized result reporting of hospital-wide DFT protocols. Methods/Case Report The DFT Cerner workflow is uniquely designed in-house and known as a pioneer build for Cerner Millenium. The design involves the use of Cerner Discern Analytics 2.0 and clinical modules to complete such a complex build. Five DFT panels are defined as care-sets with specific hormone discrete task assays (DTA). For each care-set, an ‘order sentence’ is created to produce the order priority rules. The DFT panels can only be requested as future orders in PowerChart and activated by the medical staff upon collection of the baseline sample. On Cerner PathNet, results are pre-verified by the medical technologists then auto-filtered in the clinical Review Queue (RQ) module for final verification and addition of comments by the biochemistry consultant. A word processing template is used to collate the results and present the summary of the DFT report where standardized canned comments are added using pre-defined codes. Results (if a Case Study enter NA) See Conclusion Section Conclusion The Cerner DFT project mproves the diagnosis and treatment of patients with hormone disorders. Before, there was a danger of misdiagnosis when samples are individually requested producing separate reports with no organized presentation. Report comments from the clinical biochemist consultant also served as good diagnostic guidance. This quality initiative has definitely improved the previous and long term issues of endocrine dynamic function tests.

Limiting probabilities of first order properties of random sparse graphs and hypergraphs

AbstractLet be the binomial random graph in the sparse regime, which as is well‐known undergoes a phase transition at . Lynch (, 1992) showed that for every first order sentence , the limiting probability that satisfies as exists, and moreover it is an analytic function of c. In this paper we consider the closure in the interval of the set of all limiting probabilities of first order sentences in . We show that there exists a critical value such that when , whereas misses at least one subinterval when . We extend these results to random sparse d‐uniform hypergraphs, where the probability of a d‐edge is .

التحلیل الترکیبی للجملة الإنشائیة الطلبیَّة فی الأحادیث الأربعین النوویة من منظور تداولی

مستخلص البحث باللغة العربية يهدف هذا البحث إلى بيان التحليل الترکيبي لجملة الإنشاء الطلبية من منظور تداولي، ومعرفة الأغراض البلاغية التي خرج إليها الحديث النبوي من خلال توظيف الجمل الإنشائية الطلبية المختلفة في صورتها الحقيقية والمجازية، أو على حد تعبير التداوليين : معرفة فيم تکمن مجموع الأفعال المنجزة بالقول مباشرة أو غير مباشرة في تحقيق قوى إنجازية حرفية أو مستلزمة مقاميا، ولدتها علاقة المتکلم الرسول – صلى الله عليه وسلم – بمخاطبه مقالا ومقاما، وتأکيد احتواء الحديث النبوي مقاصد ذات آليات تداولية، ومن ثم تکون التداولية مدخلا مناسبا من مداخل فهم الحديث النبوي، وأداة من أدوات قراءته. وقد اقتضت طبيعة البحث الاعتماد على المنهج الوصفي القائم على آليات الوصف والتحليل في تجسيد آليات التداولية؛ لأنه الأنسب لهذا النوع من البحوث القائمة على وصف الظواهر اللغوية، ورصد خصائص التداولية، وليس من منهج البحث الوقوف تطبيقيا على کل موضع للجملة الإنشائية الطلبية في الأحاديث؛ وإلا لجمع بين دفتيه مئات الصفحات، وإنما کانت السبيل المثلى في نظري أن يقوم في دراسة الجملة الإنشائية الطلبية على دراسة شاهد تطبيقي واحد لکل نوع من أنواع الطلب، وذلک بما يحقق وضوح الحکم والتحليل النحوي، وتبيان المعنى الدلالي الحرفي، والمعنى التداولي المقامي. Abstract This research aims to demonstrate the compositional analysis of the Constructivist Sentence from a deliberative perspective، and to know the rhetorical purposes to which the Prophetic hadith came out by employing the different structural sentences in their true and metaphorical form. Or indirectly in the realization of literal or imperative accomplishing powers، generated by the relationship of the Messenger speaker - may God bless him and grant him peace - to address him in an essay and a place، and the emphasis on the prophetic hadith contains intentions with deliberative mechanisms. Reading tools. The nature of the research necessitated relying on the “descriptive approach” based on the mechanisms of description and analysis in embodying the deliberative mechanisms، in which the mechanisms of description and analysis were used. Because it is best suited for this type of research based on describing linguistic phenomena and monitoring the deliberative characteristics، and it is not the research method to stand in practice on every place of the constructive sentence in the hadiths. Otherwise، he would collect hundreds of pages between his covers، but the best way in my opinion was for him to study the constructive order sentence on studying one applied witness for each type of request، in order to achieve clarity of judgment and grammatical analysis، and to clarify the literal semantic meaning، and the debating deliberative meaning.

Nonstandard methods for finite structures

AbstractWe discuss the possibility of applying the compactness theorem to the study of finite structures. Given a class of finite structures, it is important to determine whether it can be expressed by a particular category of sentences. We are interested in this type of problem, and use nonstandard method for showing the non‐expressibility of certain classes of finite graphs by an existential monadic second order sentence.

THE COHERENCE AND UNITY IN STUDENTS’ WRITING DESCRIPTIVE TEXT (Descriptive Study at Private Junior High School in East Jakarta)

&lt;p&gt;&lt;strong&gt;Abstract: &lt;/strong&gt;This study was conducted to analyze the coherence and unity of the paragraphs written by students in their descriptive text. The method of the study was descriptive analysis by using content analysis. The result of the research stated that: (1) the students’ writings are coherent. It could be seen in pronoun, anaphora, cataphora, repetition key noun, transition signal, and logical order are well organized. (2) the texts are not unified. They were able to state a clear topic discussion in the first sentence but couldn’t maintain the topic in all of the supporting sentences. They were lack of related supporting details in discussing the topic of the paragraph. The common errors made by the students are from the inconsistent topic, not logical order sentences, redundant sentences, and unrelated sentences. It can be concluded that the students were success to make coherent paragraphs, but they were failed to make unified paragraphs.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Keywords&lt;/strong&gt;: coherence; unity; students’ writing Descriptive text.&lt;/p&gt;

The acquisition of German declension in additive and concept-based approaches to instruction via computer-based cognitive tutors

AbstractThis study examines the different learning outcomes of two computer-based cognitive tutors using two approaches to instructing German declension: an additive, bottom-up approach, which focuses on a stepwise introduction of each case, and a concept-based, top-down approach, which focuses on developing students’ conceptual understanding of the functions related to each case form and the case marking system as a whole. The results indicate that both groups learned, but what and how they learned differed depending on the method of instruction. The additive group showed general gains in production and a slight increase in their ability to correctly interpret object-first sentences. The concept-based group showed larger gains, but in fewer areas. Specifically, the production of adjective endings increased, although there were no differences in determiner production or accuracy. The concept-based group also had a larger gain in their ability to interpret non-SVO word order sentences. This study shows how concept-based approaches to grammar can outperform additive ones, and that the development of these concepts can prepare students for future learning.