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Diagnostic Stewardship Cutoffs for Urinalysis Results Prior to Performing a Urine Culture: Analysis of Data from a Healthcare System
Full text linkBackground Urinary Tract Infections (UTIs) are commonly overdiagnosed. Some labs conduct urinalysis (UA) as a preliminary screening before proceeding to urine culture to reduce processing unnecessary samples. However, the optimal UA cutoffs for this diagnostic stewardship intervention are not well defined.
UA squamous epithelial cells were not graphed b/c the value crossed the diagonal at multiple points. Methods We performed a retrospective, cross-sectional analysis of urine studies performed from 2/1/21-1/31/23 at the Los Angeles County Department of Health Services (4 medical centers & 20 clinics). We examined patient encounters in which a UA was ordered synchronously with a urine culture. We excluded patients who were pregnant, undergoing a urologic procedure, \u3c 3 months of age, or neutropenic. We examined the diagnostic accuracy, receiver operating characteristic (ROC) curves, and area under the curve (AUC) for pre-screening urinalysis parameters prior to urine culture performance. From the macroscopic test, we examined leukocytes and nitrite. From the microscopic exam, we examined bacteria, white blood cells (WBC), and squamous epithelial cells. We investigated each test’s correlation with a uropathogen isolated from culture. Results We examined 81,907 paired urinalysis and urine cultures (17,842 inpatient and 64,065 outpatient). Among the urine cultures, organisms isolated included 24,683 (30%) uropathogens, 4,373 (5%) organisms sometimes considered uropathogens, 3,000 (4%) organisms rarely considered a uropathogen, 30,511 (37%) multiple organisms, and 293 (0.7%) a non-uropathogen of clinical significance; 19,047 (23%) cultures were negative. When predicting a urine culture positive for a uropathogen, the UA parameter with the best diagnostic accuracy was WBCs (AUC: 0.758), followed by leukocytes, bacteria, nitrite, and squamous epithelial cells. (AUC: 0.723, 0.707, 0.652, and \u3c 0.500, respectively) (Figure). The sensitivity and specificity of WBC cutoffs are outlined in the Table. Conclusion In a large dataset of paired urinalysis and urine cultures, WBC on microscopic urinalysis showed highest diagnostic accuracy at predicting isolation of a uropathogen on urine culture. Stewardship programs should consider this parameter as the screening test for urine culture performance
Affect Regulation and Mortality Risk: The Role of Allostatic Load
No full textObjective:
Although growing evidence indicates that distinct affect regulation strategies (e.g., positive reappraisal, anger suppression) predict mortality risk, the biological processes involved remain understudied. We investigated the association of various affect regulation exposures with mortality risk while examining the role of allostatic load. Method:
In 2004-2006, 1,941 participants from the Midlife in the United States longitudinal study completed validated scales assessing use of nine general and emotion-specific regulatory strategies (e.g., denial, anger expression). A standard deviation-based algorithm was also used to characterize how flexibly participants regulate their affect (lower, moderate, or greater variability). Participants further provided data on relevant covariates and 24 allostatic load biomarkers (e.g., cortisol, glucose). Cox regressions modeled hazard ratios (HRs) and 95% confidence intervals (CI) examined associations of affect regulation variables and all-cause mortality risk until 2022. The confounding, mediating, and moderating role of allostatic load was examined in subsequent models. Results:
In fully-adjusted models, only greater vs. lower affect regulation variability (HR=1.54; 95%CI=1.11-2.14) significantly predicted a higher mortality risk. Associations were relatively unchanged with further inclusion of allostatic load in models and allostatic load did not mediate affect regulation-mortality relationships. Yet, when evaluating moderation effects, greater vs. lower and moderate variability as well as denial were marginally or significantly related to higher mortality risk among adults with lower allostatic load only. Conclusions:
Allostatic load may modify rather than confound or mediate the association between some dimensions of affect regulation and mortality risk. Future work should evaluate the potential roles of allostatic load among diverse samples
Addressing Equity Issues in Elementary Computer Science Education: Knowns, Unknowns, and Implications for Future Work
Full text linkIn 2016, a national coalition of stakeholders released the K-12 computer science (CS) framework. In the time since, there has been an increased push at the local, state, and national level to integrate CS knowledge and skills into K-12 education. Despite this push, significant equity issues exist within the field. While growing research has been done on CS equity issues at the high school level, we know these equity gaps often begin to emerge in elementary school where less is known. Therefore, we conducted a systematic literature review to better understand and explore the elementary CS equity research landscape from 2016 - 2022. We used the CAPE framework (Capacity, Access, Participation, Experience, Fletcher & Warner, 2021) to guide this work and explore what identity groups were (or were not) being supported through research, what levels of the CAPE framework were being addressed, and the specific type of equity-focused interventions that were occurring at the elementary level. We found that a greater research focus is needed in support of multilingual/English language learners and LGBTQIA2S+ students. Additionally, CAPE levels of Access and Participation are under-investigated as are holistic studies that examine all levels of the CAPE framework and CS ecosystem within a site. Of the work being done, capacity-level studies focused on providing professional development and co-designing CS resources, while experience-level studies varied across their implementations. Overall, a significant lack of research exists exploring CS equity issues at the elementary level
Ruchir Sharma: \u3cem\u3eWhat Went Wrong With Capitalism\u3c/em\u3e
Full text linkA review of Ruchir Sharma\u27s What Went Wrong With Capitalism
Comparing Arabic & Islamic and Classical Western Rhetorics
No full textThis poster compares the origins and tenets of Arabic and Islamic rhetorical tradition versus Classical Western, specifically Greek, rhetorical tradition. Evidence is drawn from Aristotle’s, On Rhetoric: A Theory of Civic Discourse, translated and commented on by George Alexander Kennedy, as well as the section “Arabic & Islamic Traditions 1.1” in, Global Rhetorical Traditions, by Hui Wu and Tarez Samra Graban. Both Arabic Islamic rhetorics and Greek rhetorics are lauded by historians as progenitors of art, language, and argumentation; they agree that the object of rhetoric is to tell the truth and that rhetoric has powerful applications for public use, but they differ dramatically in their inspirations. Born from Muhammad’s divine wisdom realized through a caliph, Arabic Islamic rhetoric is characterized by morality and eloquence. Born from human reason and distributed by secular scholars, Greek rhetoric is characterized by humanism and reasoning, and it played a vital role in forming the seminal democracy of Ancient Greece. While revolutionary, this “rule by the people” remained strikingly exclusionary. Democracy became the quintessential model taught and replicated in the Western world, indeed inspiring the formation of the United States. Analysis of religion, judiciary models, and the inheritance of power reveals the danger in privileging Classical Western traditions over Arabic and Islamic traditions, for this action further perpetuates enmity towards other ideas that are not circumscribed as part of the convention, the canon, or “the best.” Much more important than the differences between traditions are their similarities, proving understanding of diverse perspectives and cultures is an asset, not a weakness to governmental and judicial systems