Suboptimal Patterns Research Articles

Incorporation of Eye Tracking and Gaze Feedback to Characterize and Improve Radiologist Search Patterns of Chest X-Rays: A Randomized Controlled Clinical Trial

Diagnostic errors in radiology often result from incomplete visual assessments attributed to insufficient training in search patterns. Radiologists lack consistent feedback, relying on ad-hoc strategies, leading to suboptimal patterns and potential false negatives. This study used eye tracking to analyze search patterns, quantify performance metrics, and evaluate the impact of an automated continuous improvement feedback-driven framework on detection accuracy. In a controlled trial with ten residents, the intervention group (received feedback) demonstrated a significant 38.9% absolute improvement in detecting suspicious pulmonary nodules compared to the control group (5.6%, p=0.006). While improvements were more rapid over sessions (p=0.0001), other metrics showed no significant changes. The findings highlight the potential of automated feedback systems to enhance radiologist accuracy and reduce errors, emphasizing the need for further research and broader implementation in radiology training.

Asthma-related lung function and physical activity patterns among children living in urban neighborhoods

Objective Black and Latino American children residing in urban environments are at increased risk for comorbid asthma and obesity. Physical activity (PA) is a modifiable behavior known to contribute to the asthma-obesity phenotype. While research has indicated links between optimal asthma status and high PA among children, little is documented about whether this group may display other asthma and PA patterns that warrant clinical attention and tailored interventions. Methods Children with persistent asthma (N = 97) ages 7–9 and their caregivers from urban neighborhoods completed daily measures of asthma status and moderate-to-vigorous physical activity (MVPA) and questionnaires about health and sociodemographic characteristics. Clinical asthma guidelines (e.g. FEV1 ≥ 80%) and sample means were used to categorize children into high or low lung function and MVPA patterns. Individual, family, and contextual differences across lung function and MVPA patterns were investigated. Results Twenty-nine percent of participants displayed optimal lung function and high MVPA. The remainder of the sample exhibited various less optimal patterns (e.g. poorer lung function and high MVPA). Caregivers of children displaying poorer lung function and high MVPA levels were more likely to report asthma related fears than caregivers of children with low MVPA levels regardless of lung function status. Conclusions Asthma and PA interventions can be tailored to better address each child’s unique clinical and behavioral patterns. An enhanced understanding of risk factors for suboptimal patterns of asthma status and PA may aid in multicomponent intervention efforts.

On-Field Biomechanical Assessment of High and Low Dive in Competitive 16-Year-Old Goalkeepers through Wearable Sensors and Principal Component Analysis.

Diving saves are the main duty of football goalkeepers. Few biomechanical investigations of dive techniques have been conducted, none in a sport-specific environment. The present study investigated the characteristics of goalkeepers’ dive in preferred (PS) and non-preferred (nPS) side through an innovative wearables-plus-principal-component analysis (PCA) approach. Nineteen competitive academy goalkeepers (16.5 ± 3.0 years) performed a series of high and low dives on their PS and nPS. Dives were performed in a regular football goal on the pitch. Full-body kinematics were collected through 17 wearable inertial sensors (MTw Awinda, Xsens). PCA was conducted to reduce data dimensionality (input matrix 310,878 datapoints). PCA scores were extracted for each kinematic variable and compared between PS and nPS if their explained variability was >5%. In high dive, participants exhibited greater hip internal rotation and less trunk lateral tilt (p < 0.047, ES > 0.39) in PS than nPS. In low dives, players exhibited greater ipsilateral hip abduction dominance and lower trunk rotation (p < 0.037, ES > 0.40) in PS than nPS. When diving on their nPS, goalkeepers adopted sub-optimal patterns with less trunk coordination and limited explosiveness. An ecological testing through wearables and PCA might help coaches to inspect relevant diving characteristics and improve training effectiveness.

Evaluation of Textbook Outcome as a Composite Quality Measure of Elective Laparoscopic Cholecystectomy

A textbook outcome (TO) is a composite quality measure that incorporates multiple perioperative events to reflect the most desirable outcome. The use of TO increases the event rate, captures more outcomes to reflect patient experience, and can be used as a benchmark for quality improvement. To introduce the concept of TO to elective laparoscopic cholecystectomy (LC), propose the TO criteria, and identify characteristics associated with TO failure. This retrospective cohort study was performed at 3 surgical units in a single health board in the United Kingdom. Participants included all patients undergoing elective LC between January 1, 2015, and January 1, 2020. Data were analyzed from January 1, 2015, to January 1, 2020. The TO criteria were defined based on review of existing TO metrics in the literature for other surgical procedures. A TO was defined as an unremarkable elective LC without conversion to open cholecystectomy, subtotal cholecystectomy, intraoperative complication, postoperative complications (Clavien-Dindo classification ≥2), postoperative imaging, postoperative intervention, prolonged length of stay (>2 days), readmission within 100 days, or mortality. The rate of TOs was reported. Reasons for TO failure were reported, and preoperative characteristics were compared between TO and TO failure groups using both univariate analysis and multivariable logistic regressions. A total of 2166 patients underwent elective LC (median age, 54 [range, 13-92] years; 1579 [72.9%] female). One thousand eight hundred fifty-one patients (85.5%) achieved a TO with an unremarkable perioperative course. Reasons for TO failure (315 patients [14.5%]) included conversion to open procedure (25 [7.9%]), subtotal cholecystectomy (59 [18.7%]), intraoperative complications (40 [12.7%]), postoperative complications (Clavien-Dindo classification ≥2; 92 [29.2%]), postoperative imaging (182 [57.8%]), postoperative intervention (57 [18.1%]), prolonged length of stay (>2 days; 142 [45.1%]), readmission (130 [41.3%]), and mortality (1 [0.3%]). Variables associated with TO failure included increasing American Society of Anesthesiologists score (odds ratio [OR], 2.55 [95 CI, 1.69-3.85]; P < .001), increasing number of prior biliary-related admissions (OR, 2.68 [95% CI, 1.36-5.27]; P = .004), acute cholecystitis (OR, 1.42 [95% CI, 1.08-1.85]; P = .01), preoperative endoscopic retrograde cholangiopancreatography (OR, 2.07 [95% CI, 1.46-2.92]; P < .001), and preoperative cholecystostomy (OR, 3.22 [95% CI, 1.54-6.76]; P = .002). These findings suggest that applying the concept of TO to elective LC provides a benchmark to identify suboptimal patterns of care and enables institutions to identify strategies for quality improvement.

Acculturation, Discrimination and 24-h Activity in Asian American Immigrant Women.

Asian American immigrant (AAI) women may have suboptimal 24-h activity patterns due to traditional gender role and caregiving responsibilities. However, little is known about their objectively-measured activity. We measured AAI women's 24-h activity patterns using accelerometry and examined cultural correlates of time in sedentary behavior (SB), light intensity physical activity (LIPA), moderate-to-vigorous physical activity (MVPA) and sleep. Seventy-five AAI women completed surveys on acculturation (years of U.S. residency and English proficiency), discrimination, and sleep quality, and 7days of wrist- and hip-accelerometer monitoring. Linear regression was conducted controlling for age, BMI, and education. We also compared activity patterns across Asian subgroups (East, Southeast, South Asians). On average, AAI women had 33min of MVPA, 6.1h of LIPA, 10h of SB, and 5.3h of sleep per day. South Asian women had the longest SB and the shortest sleep and MVPA hours. English proficiency was negatively related to MVPA (p = 0.03) and LIPA (p < 0.01). Years of U.S. residency was positively related to SB (p = 0.07). Discrimination was related to shorter (p = 0.03) and poorer quality sleep (p = 0.06). Culturally-tailored programs targeting SB and sleep and integrating coping strategies against discrimination could help optimize AAI women's 24-h activity patterns.

Impacts of software community patterns on process and product: An empirical study

Software engineering projects are now more than ever a community effort. In the recent past, researchers have shown that their success not only depends on source code quality, but also on other aspects like the balance of power distance, culture, and global engineering practices, and more. In such a scenario, understanding the characteristics of the community around a project and foresee possible problems may be the key to develop successful systems. In this paper, we focus on this research problem and propose an exploratory study on the relation between community patterns, i.e., recurrent mixes of organizational or social structure types, and aspects related to the quality of software products and processes by mining open-source software repositories hosted on GitHub . We first exploit association rule mining to discover frequent relations between community pattern and community smells, i.e., sub-optimal patterns across the organizational structure of a software development community that may be precursors of some form of social debt. Further on, we use statistical analyses to understand their impact on software maintainability and on the community engagement, in terms of contributions and issues. Our findings show that different organizational patterns are connected to different forms of socio-technical problems; further on, specific combinations are set in equally specific contextual conditions. Findings support two possible conclusions: (1) practitioners should put in place specific preventive actions aimed at avoiding the emergence of community smells and (2) such actions should be drawn according to the contextual conditions of the organization and the project. • A list of association rules between community patterns and community smells to see how they relate each other. • An empirical analysis on how community patterns affect the product quality. • An empirical analysis on how community patterns affect the development process. • A replication package containing all the materials to reproduce and extend our study.

Redundancy-selection trade-off in phenotype-structured populations

Realistic fitness landscapes generally display a redundancy-fitness trade-off: highly fit trait configurations are inevitably rare, while less fit trait configurations are expected to be more redundant. The resulting sub-optimal patterns in the fitness distribution are typically described by means of effective formulations, where redundancy provided by the presence of neutral contributions is modelled implicitly, e.g. with a bias of the mutation process. However, the extent to which effective formulations are compatible with explicitly redundant landscapes is yet to be understood, as well as the consequences of a potential miss-match. Here we investigate the effects of such trade-off on the evolution of phenotype-structured populations, characterised by continuous quantitative traits. We consider a typical replication-mutation dynamics, and we model redundancy by means of two dimensional landscapes displaying both selective and neutral traits. We show that asymmetries of the landscapes will generate neutral contributions to the marginalised fitness-level description, that cannot be described by effective formulations, nor disentangled by the full trait distribution. Rather, they appear as effective sources, whose magnitude depends on the geometry of the landscape. Our results highlight new important aspects on the nature of sub-optimality. We discuss practical implications for rapidly mutant populations such as pathogens and cancer cells, where the qualitative knowledge of their trait and fitness distributions can drive disease management and intervention policies.

Protocol of the Snuggle Bug/Acurrucadito Study: a longitudinal study investigating the influences of sleep-wake patterns and gut microbiome development in infancy on rapid weight gain, an early risk factor for obesity

BackgroundOverweight, obesity, and associated comorbidities are a pressing global issue among children of all ages, particularly among low-income populations. Rapid weight gain (RWG) in the first 6 months of infancy contributes to childhood obesity. Suboptimal sleep-wake patterns and gut microbiota (GM) have also been associated with childhood obesity, but little is known about their influences on early infant RWG. Sleep may alter the GM and infant metabolism, and ultimately impact obesity; however, data on the interaction between sleep-wake patterns and GM development on infant growth are scarce. In this study, we aim to investigate associations of infant sleep-wake patterns and GM development with RWG at 6 months and weight gain at 12 months. We also aim to evaluate whether temporal interactions exist between infant sleep-wake patterns and GM, and if these relations influence RWG.MethodsThe Snuggle Bug/ Acurrucadito study is an observational, longitudinal study investigating whether 24-h, actigraphy-assessed, sleep-wake patterns and GM development are associated with RWG among infants in their first year. Based on the Ecological Model of Growth, we propose a novel conceptual framework to incorporate sleep-wake patterns and the GM as metabolic contributors for RWG in the context of maternal-infant interactions, and familial and socio-physical environments. In total, 192 mother-infant pairs will be recruited, and sleep-wake patterns and GM development assessed at 3 and 8 weeks, and 3, 6, 9, and 12 months postpartum. Covariates including maternal and child characteristics, family and environmental factors, feeding practices and dietary intake of infants and mothers, and stool-derived metabolome and exfoliome data will be assessed. The study will apply machine learning techniques combined with logistic time-varying effect models to capture infant growth and aid in elucidating the dynamic associations between study variables and RWG.DiscussionRepeated, valid, and objective assessment at clinically and developmentally meaningful intervals will provide robust measures of longitudinal sleep, GM, and growth. Project findings will provide evidence for future interventions to prevent RWG in infancy and subsequent obesity. The work also may spur the development of evidence-based guidelines to address modifiable factors that influence sleep-wake and GM development and prevent childhood obesity.

A qualitative study of providers\u2019 perceptions of parental feeding practices of infants and toddlers to prevent childhood obesity

BackgroundWith a recent focus on establishing US Dietary Guidance for children ages 0 to 2 years old, the objective of this qualitative study was to determine misconceptions and barriers that prevent parents from implementing early childhood feeding and obesity prevention practices as reported by healthcare, community-based, and education providers.MethodsTrained researchers conducted one-on-one qualitative phone interviews, using a semi-structured script, with early childhood health and education providers working with families of young children. Interviews were audiotaped, transcribed verbatim, and analyzed using the classic analysis approach. Transcripts were coded by researchers and analyzed for themes.ResultsProviders (n = 21) reported commonly observed obesogenic practices including overfeeding tendencies, early initiation of solids or less optimal feeding practices, lack of autonomy and self-regulation by child, and suboptimal dietary patterns. Sources of parental misconceptions about feeding were often related to cultural, familial, and media influences, or lack of knowledge about optimal feeding practices for infants or toddlers.ConclusionsProviders indicated a need for engaging and consistent child feeding and obesity prevention education materials appropriate for diverse cultural and literacy levels of parents, with detailed information on transitioning to solid foods. Early education and community-based providers reported limited access to evidence-based educational materials more so than healthcare providers. It is an opportune time to develop reputable and evidence-based child feeding guidance that is readily available and accessible for parents of infants and toddlers to prevent early childhood obesity.

A pattern-oriented approach to safety climate: An empirical example

In this study we introduce and illustrate a novel way of describing employees’ perceptions of safety climate. Rather than treating core dimensions of safety climate as relatively independent, stand-alone variables, we examine natural combinations (i.e., patterns or configurations) of safety climate dimensions to better reflect the overall phenomenological experience of safety climate from the perspective of individual employees. We argue, and find, that a pattern-oriented approach to safety climate yields insights not available through traditional variable-centered analytic strategies. Using a mixture modeling technique, latent profile analysis, we cluster individuals (1259 Canadian employees drawn from a variety of safety-sensitive organizations within the oil and gas industry) who shared similar safety-related perceptions into distinct subgroups or patterns. Focusing on four factors of safety climate (management commitment, communication and use of procedures, tolerance to risk, and a general factor), four distinct safety-climate patterns were found: an optimal pattern and three sub-optimal patterns (negligent, disconnected, and lip service). Age was found to predict the likelihood of pattern membership. Outcomes, specifically perceived safety climate maturity and injury rate (based on claims data from the Canadian Workers’ Compensation Board), demonstrated differential relations with the four safety climate profiles. Implications for improved practice and future research are discussed.

960-P: The Usefulness of CGMS in Identifying and Treating Suboptimal Blood Glucose Patterns in In Vitro Fertilization Pregnancies with Normal OGTT and Increased Amniotic Fluid

IVF pregnancies have an increased incidence of polyhydramnios. Increased amniotic fluid has been considered an indicator to test the mother for Gestational Diabetes Mellitus. Furthermore, IVF pregnancies are associated with a higher prevalence of GDM. In this study, suboptimal BG patterns were detected by CGMS in 19 singleton IVF pregnancies with a 4 quadrant Amniotic Fluid Index (AFI) ≥20cm and a normal OGTT. Clinical characteristics include the following; age: 35±3.7 years, BMI: 25.2±3.8 kg/m2, OGTT: 0’=83.6±7.3, 60’=157.5±19.3, 120’=129±30 mg/dL, HbA1c: 5.3±0.2%, Hadlock (BPD-HC-AC-FL) percentile: 59.7±12.1%, AFI: 21.7±1.6 cm, U/S polyhydramnios confirmation: 21.1±4.7 week. A blind recording of BG patterns was accomplished using a CGMS for 7 days. Mean Sensor BG: 104.2±5 mg/dL, time&amp;gt;120 mg/dL: 221±61 min/24h, time&amp;lt;63 mg/dL: 93.2±81 min, Fasting BG: 90.7±6 mg/dL, 1h-Postprandial BG: 116.6±11 mg/dL, CV: 18.6±3. Mitigation of polyhydramnios was obtained through tight glycemic control using insulin therapy (mean dosage: 32±10.7 IU). Insulin treatment was adjusted to reach the BG target &amp;lt;95 fasting and &amp;lt;120 mg/dL 1-h postprandial. After a treatment duration of 8-weeks, the AFI in 16 of the cases was reduced to less than the 20cm threshold. The decrease noted in the other 3 cases did not reach a level below the 20cm threshold. Pregnancy outcome; Week of delivery: 37.4±1.5, birth weight: 2990±425 g, Small for Gestational age: 2 cases, Large for Gestational age: 1 case, Caesarean Section: 84.2%, there were no cases of congenital malformations. Increased amniotic fluid maybe an indicator of abnormal BG patterns in IVF pregnancies. CGMS is a useful technology to identify suboptimal BG levels which the OGTT may be unable to detect. Timely insulin treatment targeting tight glycemic control could assist in decreasing amniotic fluid. Aggressive and prompt GDM screening in IVF pregnancies is recommended. Disclosure P. Thomakos: None. C. Baretto: None. C. S. Zoupas: None.

Optimization analysis of partially coherent illumination for refractive index tomographic microscopy

Partially coherent optical diffraction tomography (PC-ODT) is a well-established label-free quantitative three-dimensional (3D) imaging technique based on the refractive index (RI) contrast by measuring the intensities at multiple axially displaced planes. The imaging performance of tomographic RI microscopy is determined by the inversion of phase optical transfer function (POTF) which depends on the illumination pattern of imaging system. Here, we propose the optimization analysis of illumination pattern in PC-ODT, and the custom-build quantitative criterion is demonstrated to maximize the performance of POTF related to the “goodness” evaluation of an illumination aperture. Source modulation with different segment scale and gray scale is implemented to acquire arbitrary distribution source, and the corresponding 3D POTF can be easy obtained through the numerical incoherent superposition of each segment components. Moreover, the metrics of 3D POTF for various illuminations over the condenser aperture are analyzed. We test the obtained optimal illumination by imaging both a simulated micro phase bead and a real control bead sample, suggesting superior performance over other suboptimal patterns in terms of both SNR and spatial resolution. Further, experimental result based on unstained MCF-7 cell clusters is presented support this finding as well, and the proposed method is expected to find versatile applications in biological and biomedical research.

Exploring Community Smells in Open-Source: An Automated Approach

Software engineering is now more than ever a community effort. Its success often weighs on balancing distance, culture, global engineering practices and more. In this scenario many unforeseen socio-technical events may result into additional project cost or “social” debt, e.g., sudden, collective employee turnover. With industrial research we discovered community smells , that is, sub-optimal patterns across the organisational and social structure in a software development community that are precursors of such nasty socio-technical events. To understand the impact of community smells at large, in this paper we first introduce CodeFace4Smells , an automated approach able to identify four community smell types that reflect socio-technical issues that have been shown to be detrimental both the software engineering and organisational research fields. Then, we perform a large-scale empirical study involving over 100 years worth of releases and communication structures data of 60 open-source communities: we evaluate (i) their diffuseness, i.e., how much are they distributed in open-source, (ii) how developers perceive them, to understand whether practitioners recognize their presence and their negative effects in practice, and (iii) how community smells relate to existing socio-technical factors, with the aim of assessing the inter-relations between them. The key findings of our study highlight that community smells are highly diffused in open-source and are perceived by developers as relevant problems for the evolution of software communities. Moreover, a number of state-of-the-art socio-technical indicators (e.g., socio-technical congruence) can be used to monitor how healthy a community is and possibly avoid the emergence of social debt.

Learning to detect community smells in open source software projects

Community smells are symptoms of organizational and social issues within the software development community that often lead to additional project costs. Recent studies identified a variety of community smells and defined them as sub-optimal patterns connected to organizational-social structures in the software development community. To early detect and discover existence of potential community smells in a software project, we introduce, in this paper, a novel machine learning-based detection approach, named csDetector, that learns from various existing bad community development practices to provide automated support in detecting such community smells. In particular, our approach learns from a set of organizational-social symptoms that characterize the existence of potential instances of community smells in a software project. We built a detection model using Decision Tree by adopting the C4.5 classifier to identify eight commonly occurring community smells in software projects. To evaluate the performance of our approach, we conduct an empirical study on a benchmark of 74 open source projects from Github. Our statistical results show a high performance of csDetector, achieving an average accuracy of 96% and AUC of 0.94. Moreover, our results indicate that the csDetector outperforms two recent state-of-the-art techniques in terms of detection accuracy. Finally, we investigate the most influential community-related metrics to identify each community smell type. We found that the number of commits and developers per time zone, the number of developers per community, and the social network betweenness and closeness centrality are the most influential community characteristics.

Strong Men, Strong Communities: Design of a Randomized Controlled Trial of a Diabetes Prevention Intervention for American Indian and Alaska Native Men.

Type 2 diabetes is a serious global epidemic that disproportionately affects disadvantaged populations. American Indians and Alaska Natives (AIs/ANs) have the highest rates of diabetes in the nation with a prevalence of 14.7% in 2018, more than twice that of non-Hispanic Whites. AI/AN men have the highest prevalence of diagnosed type 2 diabetes (14.5%) compared to non-Hispanic Black (11.4%), non-Hispanic Asian (10.0%), and non-Hispanic White (8.6%) men. Several landmark clinical trials have shown that lifestyle interventions can effectively prevent or delay the onset of diabetes among those at risk, including in AIs/ANs. Despite positive outcomes for AIs/ANs in these studies, very few were men. To date, there have been no concerted efforts to recruit and retain AI/AN men in interventions that promote weight loss and healthy lifestyles to prevent diabetes, and they remain underrepresented in these types of studies. This article describes the design and methods of the first randomized controlled trial of a diabetes prevention program with a study sample comprised entirely of AI/AN men. Research to date has demonstrated suboptimal patterns of recruitment and retention of AI/AN men, resulting in their virtual absence in health and intervention research. Effective methods to recruit and retain AI/AN men, and potential benefit gained from participation in diabetes prevention research, are unknown for this population who experience a high prevalence of type 2 diabetes. The study design presented in this article offers promising insights to help remedy these important shortcomings in the science of recruitment and retention of AI/AN men in research.

A Task-Analytic Framework Comparing Preoperative Electronic Health Record-Mediated Nursing Workflow in Different Settings.

Preoperative care is a critical, yet complex, time-sensitive process. Optimization of workflow is challenging for many reasons, including a lack of standard workflow analysis methods. We sought to comprehensively characterize electronic health record-mediated preoperative nursing workflow. We employed a structured methodological framework to investigate and explain variations in the workflow. Video recording software captured 10 preoperative cases at Arizona and Florida regional referral centers. We compared the distribution of work for electronic health record tasks and off-screen tasks through quantitative analysis. Suboptimal patterns and reasons for variation were explored through qualitative analysis. Although both settings used the same electronic health record system, electronic health record tasks and off-screen tasks time distribution and patterns were notably different across two sites. Arizona nurses spent a longer time completing preoperative assessment. Electronic health record tasks occupied a higher proportion of time in Arizona, while off-screen tasks occupied a higher proportion in Florida. The contextual analysis helped to identify the variation associated with the documentation workload, preparation of the patient, and regional differences. These findings should seed hypotheses for future optimization efforts and research supporting standardization and harmonization of workflow across settings, post-electronic health record conversion.

Nutritional anemia in Indonesia children and adolescents: Diagnostic reliability for appropriate management.

Nutritional anemia in Indonesian children and adolescents is generally regarded and treated as iron-deficient anemia, as it is in individuals in other age groups. Yet, it remains a public health threat without comprehensive management or a sustained solution. This review seeks to improve understanding of impediments to its resolution. Relevant studies reported in the past 5 years were identified in PubMed, Science Direct, Crossreff, Google Scholar, and Directory of Open Access Journals databases. In all, 12 studies in several Indonesian cities provided the basis for the review. Most were conducted in schools, indicating the potential of these institutions as targets for intervention but pointing to serious deficiencies in identification of the problem across the archipelago and in remote and rural areas. No study has evaluated coexistent anemia and malnutrition, which likely would have revealed the multi-factoriality of nutritional anemia. Data regarding nutrition education, food-based innovation, and supplementation, which may alleviate anemia in children and adolescents, are available, although study lengths and sample sizes have limited interpretation and comparison. Broadly, three intervention approaches to nutritional anemia have been undertaken, namely food-based interventions, nutrient supplementation, and nutrition education. Some progress has been made with these approaches, presumably through increases in iron intake. More information is needed regarding the underlying causality and pathogenesis, suboptimal food patterns, and comorbidities, any of which might limit the effectiveness of programs designed to resolve childhood and adolescent anemia in Indonesia.

Nutritional anemia in Indonesia children and adolescents: Diagnostic reliability for appropriate management.

Background Nutritional anemia in Indonesian children and adolescents is generally regarded and treated as iron-deficient anemia, as it is in individuals in other age groups. Objectives Yet, it remains a public health threat without comprehensive management or a sustained solution. Methods This review seeks to improve understanding of impediments to its resolution. Relevant studies reported in the past 5 years were identified in PubMed, Science Direct, Crossreff, Google Scholar, and Directory of Open Access Journals databases. Results In all, 12 studies in several Indonesian cities provided the basis for the review. Most were conducted in schools, indicating the potential of these institutions as targets for intervention but pointing to serious deficiencies in identification of the problem across the archipelago and in remote and rural areas. No study has evaluated coexistent anemia and malnutrition, which likely would have revealed the multi-factoriality of nutritional anemia. Data regarding nutrition education, food-based innovation, and supplementation, which may alleviate anemia in children and adolescents, are available, although study lengths and sample sizes have limited interpretation and comparison. Conclusions Broadly, three intervention approaches to nutritional anemia have been undertaken, namely food-based interventions, nutrient supplementation, and nutrition education. Some progress has been made with these approaches, presumably through increases in iron intake. More information is needed regarding the underlying causality and pathogenesis, suboptimal food patterns, and comorbidities, any of which might limit the effectiveness of programs designed to resolve childhood and adolescent anemia in Indonesia.

Can resources save rationality? "Anti-Bayesian" updating in cognition and perception.

Resource rationality may explain suboptimal patterns of reasoning; but what of "anti-Bayesian" effects where the mind updates in a direction opposite the one it should? We present two phenomena - belief polarization and the size-weight illusion - that are not obviously explained by performance- or resource-based constraints, nor by the authors' brief discussion of reference repulsion. Can resource rationality accommodate them?

Facility type and surgical specialty are associated with suboptimal surgical antimicrobial prophylaxis practice patterns: a multi-center, retrospective cohort study

BackgroundGuidelines recommend discontinuation of antimicrobial prophylaxis within 24 h after incision closure in uninfected patients. However, how facility and surgical specialty factors affect the implementation of these evidence-based surgical prophylaxis guidelines in outpatient surgery is unknown. Thus, we sought to measure how facility complexity, including ambulatory surgical center (ASC) status and availability of ancillary services, impact adherence to guidelines for timely discontinuation of antimicrobial prophylaxis after outpatient surgery. A secondary aim was to measure the association between surgical specialty and guideline compliance.MethodsA multi-center, national Veterans Health Administration retrospective cohort from 10/1/2015–9/30/2017 including any Veteran undergoing an outpatient surgical procedure in any of five specialties (general surgery, urology, ophthalmology, ENT, orthopedics) was created. The primary outcome was the association between facility complexity and proportion of surgeries not compliant with discontinuation of antimicrobials within 24 h of incision closure. Data were analyzed using logistic regression with adjustments for patient and procedural factors.ResultsAmong 153,097 outpatient surgeries, 7712 (5.0%) received antimicrobial prophylaxis lasting > 24 h after surgery; rates ranged from 0.4% (eye surgeries) to 13.7% (genitourinary surgeries). Cystoscopies and cystoureteroscopy with lithotripsy procedures had the highest rates (16 and 20%), while hernia repair, cataract surgeries, and laparoscopic cholecystectomies had the lowest (0.2–0.3%). In an adjusted logistic regression model, lower complexity ASC and hospital outpatient departments had higher odds of prolonged antimicrobial prophylaxis compared to complex hospitals (OR ASC, 1.3, 95% CI: 1.2–1.5). Patient factors associated with higher odds of noncompliance with antimicrobial discontinuation included younger age, female sex, and white race. Genitourinary and ear/nose/throat surgeries were associated with the highest odds of prolonged antimicrobial prophylaxis.ConclusionsFacility complexity appears to play a role in adherence to surgical infection prevention guidelines. Lower complexity facilities with limited infection prevention and antimicrobial stewardship resources may be important targets for quality improvement. Such interventions may be especially useful for genitourinary and ear/nose/throat surgical subspecialties. Increasing pharmacy, antimicrobial stewardship and/or infection prevention resources to promote more evidence-based care may support surgical providers in lower complexity ambulatory surgery centers and hospital outpatient departments in their efforts to improve this facet of patient safety.