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Outpatient Antibiotic Overprescribing Rampant

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Clinicians prescribed antibiotics without an infection-related diagnosis nearly half of the time and one in five prescriptions were provided without an in-person visit, according to research being presented at IDWeek 2018. The study, which is the first to look at overall outpatient antibiotic prescribing, analyzed more than half a million prescriptions from 514 outpatient clinics.

Previous research has found antibiotics often are prescribed for certain symptoms (such as a sore throat or cough) when they shouldn’t be.

Most of these types of illnesses are caused by viruses and therefore don’t benefit from antibiotics, which only treat bacterial infections.

“We looked at all outpatient antibiotic prescribing and results suggest misuse of these drugs is a huge problem, no matter the symptom,” said Jeffrey A. Linder, MD, MPH, lead author of the study and chief of the Division of General Internal Medicine and Geriatrics at Northwestern University Feinberg School of Medicine, Chicago.

“We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics, or don’t provide a reason at all. When you consider about 80 percent of antibiotics are prescribed on an outpatient basis, that’s a concern.”

The research, which was funded by the Agency for Healthcare Research and Quality (AHRQ), analyzed 509,534 outpatient antibiotic prescriptions given to 279,169 patients from November 2015 through October 2017 by 2,413 clinicians at 514 clinics. The prescribers included physicians, attending physicians, nurse practitioners, and physician assistants in specialties including primary care internal medicine, obstetrics/gynecology, family medicine, dermatology, cardiology, and gastroenterology. Researchers determined 46 percent of antibiotics were prescribed without an infection-related diagnosis: 29 percent noted something other than an infection diagnosis (such as high blood pressure or annual visit) and 17 percent were written without a diagnosis indicated. Researchers hypothesize that some of that is related to sloppy diagnosis coding, but much of it reflects antibiotic prescribing for vague or inappropriate reasons, such infections that are caused by viruses, said Dr. Linder.

Of the 20 percent of antibiotics that were prescribed outside of an in-person visit, most were by phone (10 percent). Others were via an electronic health record system that allows prescription writing but there is no opportunity to gather information about symptoms or testing (4 percent), refill (4 percent) and online portal (1 percent). There are some cases where that may be appropriate, such as for women who suffer from recurrent urinary tract infections or teens taking antibiotics for acne. Researchers will analyze which of those prescriptions were appropriate in the next phase of research.

“Despite 40 years of randomized controlled trials showing antibiotics don’t help for most coughs and sinus infections, many people are convinced they will not get better without an antibiotic and specifically call the doctor requesting one,” said Dr. Linder.

“At busy clinics, sadly the most efficient thing to do is just call in an antibiotic prescription. We need to dig into the data more, but we believe there is a lot of antibiotic prescribing for colds, the flu and non-specific symptoms such as just not feeling well, none of which are helped by antibiotics.”

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Do You Know The Carbon Footprint Of Your Food Choices?

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Shoppers greatly underestimate the difference their food choices can make to climate change, but they’ll favour items with a lower carbon footprint if they’re given clear information on the label, according to new research from the University of Technology Sydney and Duke University.

Between 19% and 29% of global greenhouse gas emissions come from food production, with beef and lamb the biggest contributors, so shifting diets towards greater fruit and vegetable intake is a promising strategy for reducing climate change.

Lead author Dr Adrian Camilleri wanted to know how well consumers understood the carbon consequences of their food choices, as previous research had shown people significantly underestimate the carbon emissions from electrical appliances.

“With an appliance such as a heater you can feel the energy used and see an electricity bill at the end of the month, so the impact is quite salient, whereas the impact of food production is largely invisible,” says Dr Camilleri.

The study, published in the journal Nature Climate Change, asked more than 1000 people to estimate the energy embedded in 19 foods and 18 appliances, and the amount of greenhouse gas emissions associated with those appliances and foods.

The researchers found participants significantly underestimated energy consumption and greenhouse gas emissions for both electrical appliances and foods – but food was more severely underestimated.

“If you ask people to guess the difference between items such as beef and vegetable soup on the environment they assume there is not much difference, but beef soup creates more than 10 times the amount of greenhouse gases than vegetable soup,” says Dr Camilleri.

“This is a bit of a blind spot because if someone wants to reduce their greenhouse gas emissions, they might think to turn off the heater, drive less or fly less. Very few people think to eat less beef.”

The researchers also looked at whether they could improve people’s perception of the environmental impact of their food choices through the use of labelling, in the same way that a five-star rating system for electrical appliances conveys energy use.

They presented 120 participants with a choice of soups to buy. When the soups had a carbon footprint label, participants bought fewer beef soups and more vegetable soups than when there was no label provided.

The research suggests that the introduction of carbon footprint labels on food items could be a simple intervention to increase understanding of energy use and greenhouse gas emissions from food production, and so reduce environmental impacts.

Greenhouse gases emerging from beef and lamb production include those created in the production of fertiliser for feed, methane emitted from the animals, livestock transportation and the loss of trees to clear land for pasture.

A vegan diet based on fruits, vegetables and grains has the least impact on the environment, with pork, chicken and fish creating a moderate impact, and beef and lamb the greatest impact.

“The choices we make at the dinner table can have a significant impact on global challenges such as climate change, and our research shows consumers are keen to make that choice,” says Dr Camilleri.g

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How A Personality Trait Puts You At Risk For Cybercrime

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Impulse online shopping, downloading music and compulsive email use are all signs of a certain personality trait that make you a target for malware attacks. New research from Michigan State University examines the behaviors – both obvious and subtle – that lead someone to fall victim to cybercrime involving Trojans, viruses and malware.

“People who show signs of low self-control are the ones we found more susceptible to malware attacks,” said Tomas Holt, professor of criminal justice and lead author of the research.

“An individual’s characteristics are critical in studying how cybercrime perseveres, particularly the person’s impulsiveness and the activities that they engage in while online that have the greatest impact on their risk.”

Low self-control, Holt explained, comes in many forms. This type of person shows signs of short-sightedness, negligence, physical versus verbal behavior and an inability to delay gratification.

“Self-control is an idea that’s been looked at heavily in criminology in terms of its connection to committing crimes,” Holt said.

“But we find a correlation between low self-control and victimization; people with this trait put themselves in situations where they are near others who are motivated to break the law.”

The research, published in Social Science Computer Review, assessed the self-control of nearly 6,000 survey participants, as well as their computers’ behavior that could indicate malware and infection. To measure victimization, Holt and his team asked participants a series of questions about how they might react in certain situations. For computer behavior, they asked about their computer having slower processing, crashing, unexpected pop-ups and the homepage changing on their web browser.

“The internet has omnipresent risks,” Holt said.

“In an online space, there is constant opportunity for people with low self-control to get what they want, whether that is pirated movies or deals on consumer goods.”

As Holt explained, hackers and cybercriminals know that people with low self-control are the ones who will be scouring the internet for what they want – or think they want – which is how they know what sites, files or methods to attack.

Understanding the psychological side of self-control and the types of people whose computers become infected with malware – and who likely spread it to others – is critical in fighting cybercrime, Holt said. What people do online matters, and the behavioral factors at play are entirely related to risks.

Computer scientists, Holt said, approach malware prevention and education from a technical standpoint; they look for new software solutions to block infections or messaging about the infections themselves. This is important, but it is also essential to address the psychological side of messaging to those with low self-control and impulsive behaviors.

“There are human aspects of cybercrime that we don’t touch because we focus on the technical side to fix it,” he said.

“But if we can understand the human side, we might find solutions that are more effective for policy and intervention.”

Looking ahead, Holt hopes to help break the silos between computer and social sciences to think holistically about fighting cybercrime.

“If we can identify risk factors, we can work in tandem with technical fields to develop strategies that then reduce the risk factors for infection,” Holt said.

“It’s a pernicious issue we’re facing, so if we can attack from both fronts, we can pinpoint the risk factors and technical strategies to find solutions that improve protection for everyone.”

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Unrelated Events Are Linked in Memory When They Happen Close Together

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When two events occur within a brief window of time they become linked in memory, such that calling forth memory of one helps retrieve memory for the other event, according to research published in Psychological Science, a journal of the Association for Psychological Science. This happens even when temporal proximity is the only feature that the two events share.

“Our research shows that people are constantly recording information about the order in which events happen, even if those events are unrelated. They can then use the order to help search memory,” explains psychological scientist M. Karl Healey of Michigan State University.

Memory scientists have long been interested in determining whether temporal proximity acts as a tether of sorts that connects memories for different events. In most studies, researchers have tried to examine the phenomenon by asking people to memorize lists of words in the lab, but it is unclear how well this lab-based approach translates to memory for real-world events.

“In the fall of 2016, I was obsessing over US election coverage and it occurred to me that many other people probably were, too. This provided the opportunity for a more naturalistic test—we could ask people to remember news stories rather than word lists,” Healey explains.

In one online study, Healey and coauthor Mitchell G.Uitvlugt collected and analyzed data following Election Day in 2016. The study participants had 7 minutes to recall as many election-related news stories as they could – for each story, they also drafted a short newspaper-style headline.

Healey and Uitvlugt identified actual news stories that corresponded with the headlines generated by the participants, noting the date that the stories appeared. For their analyses, the researchers did not include stories that were not associated with specific election-related events. This process yielded 7,759 headlines from 855 participants.

The researchers then calculated a lag score that measured the transition, in days, from one headline in a participant’s story sequence to the next.

The results showed that participants tended to recall stories in time-based clusters: Short transitions between stories (0 to 10 days) were much more common than would be expected according to chance. Furthermore, long transitions of more than 50 days were less frequent than one would expect by chance. The analyses showed that what participants remembered wasn’t due to news events naturally clustering close together in time but rather the clustering of stories together in memory.

This pattern held even after the researchers accounted for similarity between events. And a second online study, in which a separate group of 561 participants recalled news stories from the previous 4 months, showed similar results.

“I was surprised at how well these real-world data agreed with lab data,” says Healey.

“Although remembering world events you’ve read about over the course of months seems different than memorizing a list of random words presented over the course of minutes, at a fundamental level it seems both are governed by the same principles.”

Uitvlugt and Healey point out that the participants could not have prepared for the memory task, which rules out the possibility that participants used specific strategies when the events occurred to aid subsequent recall. Instead, the findings suggest that our memories are tagged with time-correlated information as we encode them, and that this information can be used when we search memory later on.

“This research tells us something about memory in general. It suggests we all have a tendency to bind events together in memory when they occur near together in time,” Healey says.

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