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Introduction: Opioid prescribing patterns have come under increasing scrutiny with the recent rise in opioid prescriptions, opioid misuse and abuse, and opioid-related adverse events. To date, there have been limited studies on the effect of default tablet quantities as part of emergency department (ED) electronic order entry. Our goal was to evaluate opioid prescribing patterns before and after the removal of a default quantity of 20 tablets from ED electronic order entry.Methods: We performed a retrospective observational study at a single academic, urban ED with 58,000 annual visits. We identified all adult patients (18 years or older) seen in the ED and discharged home with prescriptions for tablet forms of hydrocodone and oxycodone (including mixed formulations with acetaminophen). We compared the quantity of tablets prescribed per opioid prescription 12 months before and 10 months after the electronic order-entry prescription default quantity of 20 tablets was removed and replaced with no default quantity. No specific messaging was given to providers, to avoid influencing prescribing patterns. We used two-sample Wilcoxon rank-sum test, two-sample test of proportions, and Pearson’s chi-squared tests where appropriate for statistical analysis. Results: A total of 4,104 adult patients received discharge prescriptions for opioids in the pre-intervention period (151.6 prescriptions per 1,000 discharged adult patients), and 2,464 post-intervention (106.69 prescriptions per 1,000 discharged adult patients). The median quantity of opioid tablets prescribed decreased from 20 (interquartile ration [IQR] 10-20) to 15 (IQR 10-20) (p

Introduction: For emergency department (ED) patients, delays in care are associated withdecreased satisfaction. Our department focused on implementing a front-end vertical patient flowmodel aimed to decrease delays in care, especially care initiation. The physical space for this newmodel was termed the Flexible Care Area (FCA). The purpose of this study was to quantify theimpact of this intervention on patient satisfaction.Methods: We conducted a retrospective study of patients discharged from our academic ED over aone-year period (7/1/2013-6/30/2014). Of the 34,083 patients discharged during that period, 14,075were sent a Press-Ganey survey and 2,358 (16.8%) returned the survey. We subsequently comparedthese survey responses with clinical information available through our electronic health record(EHR). Responses from the Press-Ganey surveys were dichotomized as being “Very Good” (VG, thehighest rating) or “Other” (for all other ratings). Data abstracted from the EHR included demographicinformation (age, gender) and operational information (e.g. – emergency severity index, length of stay,whether care was delivered entirely in the FCA, utilization of labs or radiology testing, or administrationof opioid pain medications). We used Fisher’s exact test to calculate statistical differences inproportions, while the Mantel-Haenszel method was used to report odds ratios.Results: Of the returned surveys, 62% rated overall care for the visit as VG. However, fewerpatients reported their care as VG if they were seen in FCA (53.4% versus 63.2%, p=0.027). Patientsseen in FCA were less likely to have advanced imaging performed (12% versus 23.8%, p=0.001) orlabs drawn (24.8% vs. 59.1%, p=0.001). Length of stay (FCA mean 159 ±103.5 minutes versus non-FCA 223 ±117 minutes) and acuity were lower for FCA patients than non-FCA patients (p=0.001).There was no statistically significant difference between patient-reported ratings of physicians ornurses when comparing patients seen in FCA vs. those not seen in FCA.Conclusion: Patients seen through the FCA reported a lower overall rating of care comparedto patients not seen in the FCA. This occurred despite a shorter overall length of stay for thesepatients, suggesting that other factors have a meaningful impact on patient satisfaction.

Background The rVSVΔG-ZEBOV-GP vaccine (ERVEBO®) is a single-dose, live-attenuated, recombinant vesicular stomatitis virus vaccine indicated for the prevention of Ebola virus disease (EVD) caused by Zaire ebolavirus in individuals 12 months of age and older. Methods The Partnership for Research on Ebola VACcination (PREVAC) is a multicenter, phase 2, randomized, double-blind, placebo-controlled trial of 3 vaccine strategies in healthy children (ages 1–17) and adults, with projected 5 years of follow-up (NCT02876328). Using validated assays (GP-ELISA and PRNT), we measured antibody responses after 1-dose rVSVΔG-ZEBOV-GP, 2-dose rVSVΔG-ZEBOV-GP (given on Day 0 and Day 56), or placebo. Furthermore, we quantified vaccine virus shedding in a subset of children's saliva using RT-PCR. Results In total, 819 children and 783 adults were randomized to receive rVSVΔG-ZEBOV-GP (1 or 2 doses) or placebo. A single dose of rVSVΔG-ZEBOV-GP increased antibody responses by Day 28 that were sustained through Month 12. A second dose of rVSVΔG-ZEBOV-GP given on Day 56 transiently boosted antibody concentrations. In vaccinated children, GP-ELISA titers were superior to placebo and non-inferior to vaccinated adults. Vaccine virus shedding was observed in 31.7% of children, peaking by Day 7, with no shedding observed after Day 28 post-dose 1 or any time post-dose 2. Conclusions A single dose of rVSVΔG-ZEBOV-GP induced robust antibody responses in children that was non-inferior to the responses induced in vaccinated adults. Vaccine virus shedding in children was time-limited and only observed after the first dose. Overall, these data support the use of rVSVΔG-ZEBOV-GP for the prevention of EVD in at-risk children. Clinical Trials Registration. The study is registered at ClinicalTrials.gov (NCT02876328), the Pan African Clinical Trials Registry (PACTR201712002760250), and the European Clinical Trials Register (EudraCT number: 2017-001798-18). [ABSTRACT FROM AUTHOR]

Purpose: The aim is to determine the characteristics of vision-specific quality of life restriction using the National lye Institute Visual Function Questionnaire (NEI VFQ-25) and Veterans Affairs Low Vision Visual [...]

Author(s): Jose A Cancelas [1, 2]; Andrew W Lee [2]; Rethinasamy Prabhakar [2]; Keith F Stringer [3]; Yi Zheng [2]; David A Williams (corresponding author) [2] The molecular events that [...]

We describe a novel modification of multimode-interference devices that has broad applicability. The modification involves introducing a slot (or slots), of a specific width and effective refractive index and at a specific position, that runs the longitudinal length of the multimode-interference region. Introducing N slots reduces the self-image length by a factor of N + 1. Varying the effective refractive index or width of the slot(s) creates a switch. The slot modification can be accomplished in a variety of ways, actually increases bandwidth, and has good error tolerances. OCIS codes: 130.0130, 130.0250, 130.1750, 130.3120, 250.0250, 250.3140, 250.5300.