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BACKGROUND:Palivizumab provides passive immunity for respiratory syncytial virus (RSV), but poor adherence compromises protection. A hospital initiative promoted administration of first palivizumab doses at an outpatient clinic immediately after discharge. The objectives of this study were to evaluate the impact of the initiative on location and timing of first palivizumab dose, patient adherence, reimbursement, acquisition cost and RSV-positive hospital readmissions.METHODS:This retrospective cohort study included pediatric patients who received palivizumab from 2012 to 2016. Three groups were compared: "before initiative," "transition" and "after initiative." Patients who did not qualify for palivizumab or who were eligible for palivizumab in previous RSV seasons were excluded. Multivariable logistic and linear regressions adjusted for patients' characteristics were used in outcome analysis.RESULTS:After adjusting for patients' characteristics, there was a 13.5-fold (95% confidence interval: 5.9-30.5, P < 0.0001) increase in odds that patients would receive outpatient administration of palivizumab and 2.7-fold (95% confidence interval: 1.3-5.7, P = 0.0103) increase in odds of receiving the second dose within 35 days after initiative implementation compared with before. Although there was no significant difference in reimbursement percentage after initiative implementation (32% ± 30% after initiative and 31% ± 22% before), calculated palivizumab acquisition costs were 20.8% lower. RSV readmissions were not significantly different.CONCLUSIONS:Implementation of an initiative with defined workflow, multidisciplinary collaboration, and early case management efforts to obtain insurance authorization increased outpatient administration of first palivizumab doses. Patient adherence improved as demonstrated by more timely receipt of the second palivizumab dose. There was no difference in reimbursement; however, acquisition cost decreased which is valuable considering low reimbursement rates. RSV-positive readmissions did not change significantly.

Anthropologists have long understood that a society's ideas about who or what is risky depend on how meaning and worth are attributed to objects, people, and processes in a given place and time. However, until recently, little consideration has been given to the ways race and other hierarchical relations of power and difference shape how risk is constructed and deployed in social life. This article explores how race and criminal status intersect to shape the perception and management of risk and vulnerability in the United States by chronicling the lived experience of one young African American man who was prevented from obtaining an emergency medical technician (EMT) license because of his felony convictions. His pursuit of the EMT license and a career in firefighting exposes how risk, as a purportedly value-neutral concept, builds on racialized ideas about threat and vulnerability and further entrenches racialized social exclusion. Whereas many have decried racism as an unfortunate by-product of actuarial practices, I argue that racism and antiblackness are among risk's core animating logics. Challenges to risk evaluations must therefore go beyond politics of deservedness, rehabilitation, and inclusion to confront the foundational premises of risk head-on. [ABSTRACT FROM AUTHOR]

Piperaquine (PQ) is part of a first-line treatment regimen for Plasmodium falciparum malaria recommended by the World Health Organization (WHO). We aimed to determine the major metabolic pathway(s) of PQ in vitro. A reliable, validated tandem mass spectrometry method was developed. Concentrations of PQ were measured after incubation with both human liver microsomes (HLMs) and expressed cytochrome P450 enzymes (P450s). In pooled HLMs, incubations with an initial PQ concentration of 0.3 µM resulted in a 34.8 ± 4.9% loss of substrate over 60 min, corresponding to a turnover rate of 0.009 min(-1) (r(2) = 0.9223). Miconazole, at nonspecific P450 inhibitory concentrations, resulted in almost complete inhibition of PQ metabolism. The greatest inhibition was demonstrated with selective CYP3A4 (100%) and CYP2C8 (66%) inhibitors. Using a mixture of recombinant P450 enzymes, turnover for PQ metabolism was estimated as 0.0099 min(-1); recombinant CYP3A4 had a higher metabolic rate (0.017 min(-1)) than recombinant CYP2C8 (p < .0001). Inhibition of CYP3A4-mediated PQ loss was greatest using the selective inhibitor ketoconazole (9.1 ± 3.5% loss with ketoconazole vs 60.7 ± 5.9% with no inhibitor, p < .0001). In summary, the extent of inhibition of in vitro metabolism with ketoconazole (83%) denotes that PQ appears to be primarily catalyzed by CYP3A4. Further studies to support these findings through the identification and characterization of PQ metabolites are planned.

This study investigated the presence of racial bias in mental health assessments among White trainees and clinicians using the shifting standards paradigm (Biernat, 2003) and the racial triangulation framework (Kim, 1999). A total of 181 White participants viewed one of three case vignettes, all of which were identical except for the race of a fictitious client named Karl. Participants completed a clinical impressions inventory (Gushue, 2004) and the internal causality subscale from the Causation Dimension Scale (Russell, 1982). Results indicated differences in examiner ratings based on Karl's race. Black Karl was rated as significantly less symptomatic, compared to White or East Asian Karl, consistent with the shifting standards paradigm (Biernat, 2003; Gushue, 2004). No difference was found in symptom severity ratings between White Karl and East Asian Karl. Symptoms were also more likely to be attributed to internal factors with Black Karl than with White or East Asian Karl. [ABSTRACT FROM AUTHOR]