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BackgroundSkin and soft tissue infections (SSTIs) are a key antimicrobial stewardship target because they are a common infection in hospitalized patients, and non-guideline-concordant antibiotic use is frequent. To inform antimicrobial stewardship interventions, we evaluated the proportion of veterans hospitalized with SSTIs who received guideline-concordant empiric antibiotics or an appropriate total duration of antibiotics.MethodsA retrospective medication use evaluation was performed in 34 Veterans Affairs Medical Centers between 2016 and 2017. Hospitalized patients who received antibiotics for uncomplicated SSTI were included. Exclusion criteria were complicated SSTI, severe immunosuppression, and antibiotics for any non-SSTI indication. Data were collected by manual chart review. The primary outcome was the proportion of patients receiving both guideline-concordant empiric antibiotics and appropriate treatment duration, defined as 5-10 days of antibiotics. Data were analyzed and reported using descriptive statistics.ResultsOf the 3890 patients manually evaluated for inclusion, 1828 patients met inclusion criteria. There were 1299 nonpurulent (71%) and 529 purulent SSTIs (29%). Overall, 250 patients (14%) received guideline-concordant empiric therapy and an appropriate duration. The most common reason for non-guideline-concordance was receipt of antibiotics targeting methicillin-resistant Staphylococcus aureus (MRSA) in 906 patients (70%) with a nonpurulent SSTI. Additionally, 819 patients (45%) received broad-spectrum Gram-negative coverage, and 860 patients (48%) received an antibiotic duration >10 days.ConclusionsWe identified 3 common opportunities to improve antibiotic use for patients hospitalized with uncomplicated SSTIs: use of anti-MRSA antibiotics in patients with nonpurulent SSTIs, use of broad-spectrum Gram-negative antibiotics, and prolonged durations of therapy.

Regional collaboration has been suggested as a more effective way to promote economic development than competitive approaches. In Ontario, despite attempts by the provincial government to encourage regional collaboration, research finds that municipalities are still engaging in inter-territorial competition. In this article, we conducted interviews with thirty-seven practitioners to determine if economic development practices in Ontario have shifted towards more collaborative approaches during the COVID-19 pandemic. The article finds that regional collaboration, as an economic development practice, has intensified in the province during the recent pandemic. Practitioners noted three reasons for engaging in regional collaboration: pool resources, reduce duplication, and complete regionally task-oriented goals. Sommaire On a laisse entendre que la collaboration regionale est un moyen plus efficace de promouvoir le developpement economique que les approches concurrentielles. En Ontario, malgre les tentatives du gouvernement provincial d'encourager la collaboration regionale, des etudes demontrent que les municipalites se livrent toujours a une concurrence interterritoriale. Dans cet article, nous avons mene des entrevues avec trente-sept praticiens afin de determiner si les pratiques de developpement economique en Ontario ont glisse vers des approches plus collaboratives pendant la pandemie de COVID-19. En tant que pratique de developpement economique, nous constatons que la collaboration regionale s'est intensifiee dans cette province au cours de la recente pandemie. Les praticiens ont releve trois raisons pour s'engager dans une collaboration regionale : la mise en commun des ressources, la diminution du double emploi et l'atteinte des objectifs regionaux axes sur des taches precises., INTRODUCTION The Ontario provincial government has attempted to foster regional collaboration between municipalities over the past several decades. However, despite local practitioners' acknowledgement of the benefits of collaborative approaches to [...]

Since the early 2000s, plant closures have been a significant concern in Ontario, Canada. Scholars and policymakers alike aim to investigate the causes of plant closures and determine how to mitigate their impacts. Despite the large body of literature on plant closures, local economic development practitioners' perspectives and experiences have been neglected. To fill this gap, this paper interviewed twenty-two practitioners from various cities in Ontario to understand how practitioners perceive and respond to plant closures. The findings provide a comprehensive overview of the various dynamics of plant closures. Also, based on the findings, seven policy recommendations are presented. [ABSTRACT FROM AUTHOR]

Regions are embedded in complex webs of interactions that influence, among other things, their economic resilience. However, a general lack of attention is given to the spatial dependence underlying regions' economic resilience. This paper advocates investigating such spatial interactions and, in doing so, provides a road map to guide researchers through the specification search. The road map is theoretically underpinned by the argument that regions' resilience is influenced by local spillovers. The several articles in the resilience literature that incorporate spatial dependence are evaluated, and their shortcomings discussed. The paper provides an empirical illustration of the road map. [ABSTRACT FROM AUTHOR]

To contain the 2019 coronavirus, many localities were placed on lockdown and were required to follow social distancing guidelines implemented by upper-level governments. A consequence of these containment measures was that local practitioners had to conduct economic development remotely, an activity traditionally centered around face-to-face interactions. Thus, this raises the question, how important is face-to-face contact for local economic development? To answer this question, in-depth interviews were conducted with thirty-seven senior management economic development practitioners in the Province of Ontario, Canada from 2019 to 2020. The analysis found that face-to-face contact is highly important for practitioners' economic development efforts because it, among other things, facilitates the creation and transmission of tacit knowledge between practitioners as well as with businesses, community organizations, and other stakeholders. [ABSTRACT FROM AUTHOR]

Background Most skin and soft tissue infections (SSTIs) are managed in the outpatient setting, but data are lacking on treatment patterns outside the emergency department (ED). Available data suggest that there is poor adherence to SSTI treatment guidelines. Methods We conducted a retrospective cohort study of Veterans diagnosed with SSTIs in the ED or outpatient clinics from 1 January 2005 through 30 June 2018. The incidence of SSTIs over time was modeled using Poisson regression using robust standard errors. Antibiotic selection and incision and drainage (I&D) were described and compared between ambulatory settings. Anti–methicillin-resistant Staphylococcus aureus (MRSA) antibiotic use was compared to SSTI treatment guidelines. Results There were 1 740 992 incident SSTIs in 1 156 725 patients during the study period. The incidence of SSTIs significantly decreased from 4.58 per 1000 patient-years in 2005 to 3.27 per 1000 patient-years in 2018 (P <.001). There were lower rates of β-lactam prescribing (32.5% vs 51.7%) in the ED compared to primary care (PC), and higher rates of anti-MRSA therapy (51.4% vs 35.1%) in the ED compared to PC. The I&D rate in the ED was 8.1% compared to 2.6% in PC. Antibiotic regimens without MRSA activity were prescribed in 24.9% of purulent SSTIs. Anti-MRSA antibiotics were prescribed in 40.1% of nonpurulent SSTIs. Conclusions We found a decrease in the incidence of SSTIs in the outpatient setting over time. Treatment of SSTIs varied depending on the presenting ambulatory location. There is poor adherence to guidelines in regard to use of anti-MRSA therapies. Further study is needed to understand the impact of guideline nonadherence on patient outcomes. [ABSTRACT FROM AUTHOR]

The purpose of the study was to explore the efficacy of weighted blanket applications and sleep quality in children with autism spectrum disorder and behavioral manifestations of sensory processing deficits. Two 4-year-old participants diagnosed with autism spectrum disorder who also experienced sleep disturbances took part in a single-subject design study. Objective sleep measures and caregiver surveys were tracked for a baseline period of eight days, followed by a 14-day weighted blanket intervention and a seven-day withdrawal phase. Caregiver reports and objective data were evaluated using visual analysis and the percentage of non-overlapping data methods. The results suggest minimal changes in sleep patterns as a result of the weighted blanket intervention. The findings based on using a weighted blanket intervention were enhanced morning mood after night use and a significantly decreased time to fall asleep for participants, though they were not strong enough to recommend for clinical use. Future directions include single-subject and cohort-designed studies exploring the efficacy of weighted blankets with increasing sleep quality among children with autism. [ABSTRACT FROM AUTHOR]