Pneumocystis jirovecii pneumonia (PJP) is an opportunistic infection associated with high dose steroid use in non-HIV patients. Many patients on high dose steroids (>20 mg prednisone equivalents for 28 days or longer), developed PJP within a month of steroid use. This study aims to develop an electronic alert for providers to consider PJP prophylaxis for patients discharged on high-dose steroids. Cases were obtained from the University of Utah Enterprise Data Warehouse between October 2014 and September 2017. A retrospective, manual chart review evaluated adults 18 years of age or older, with an inpatient PJP diagnosis made via direct fluorescent antibody or PCR. Patients with PJP due to HIV were excluded. Steroid dose and duration one month prior to diagnosis of PJP were evaluated. After retrospective analysis, via a multidisciplinary team, a best practice advisory (BPA) alert was created to flag providers to consider PJP prophylaxis at discharge, with consideration of creatinine levels and allergy profile to guide drug choices. The alert was trailed in a silent mode from January to April 2018 without provider notification so it could be modified to prevent inappropriate firing. The alert was approved for live use by the Clinical Decision Support Committee and is now active in the University of Utah Epic system as of April 10, 2018. In retrospective analysis, of 94 non-HIV patients diagnosed with PJP, 31/94 (33%) cases were in the setting of high dose steroids. 7/31 (23%) cases were exclusively with high dose steroids, while 24/31 (77%) cases were in combination with chemotherapy or other immune modulating agents. Data from the silent BPA from February to April 2018 demonstrated 23 cases triggered the alert, all of which were determined to be appropriate by chart review. Since live use, the BPA has fired 15 times, of which 14 cases met criteria for prophylaxis and 4/14 (29%) resulted in prophylaxis on discharge. Chart review identified high dose steroids as a target for a quality improvement intervention, which led to development of a BPA. Data indicates room for improvement on discharge with prophylaxis. Goals include reducing morbidity, mortality and cost associated with PJP, as well as educating providers regarding the need for prophylaxis. All authors: No reported disclosures.
Little is known about women's use of vibrators within sexual partnerships. Data were collected from a population-based, cross-sectional survey of 2056 women aged 18–60 years in the United States. Partnered vibrator use was common among heterosexual-, lesbian-, and bisexual-identified women. Most vibrator users indicated comfort using them with a partner and vibrator use was related to positive sexual function as measured by the Female Sexual Function Index (FSFI). In addition, partner knowledge and perceived liking of vibrator use was a significant predictor of sexual satisfaction for heterosexual women (p < .01). Clinical and research implications are discussed.
Research suggests the relationship between pleasure and condom use during penile–vaginal intercourse (PVI) is associated with relationship status. This online study examined pleasure ratings and condom use at last PVI, stratifying by partner type, among a national sample of Canadian university students. Participants were 715 undergraduates (60.7% women, 39.3% men) who reported on their most recent sexual experience. Condom use decreased with level of relationship commitment, whereas ratings of pleasure increased. Overall, participants were more likely to rate their most recent PVI as Very pleasurable when condoms were not used compared to when condoms were used. However, when stratified by partner type, these differences largely disappeared. For women, with one exception, there were no differences in pleasure between PVI with and without condoms across most partner-type categories. Women in committed dating relationships were more likely to report their last PVI as very pleasurable if condoms were not used than women in these same relationships who had used condoms. Across relationship categories, men who did and did not use condoms did not differ in terms of their pleasure ratings. The results of this study suggest relationship context should be taken into account when assessing condom use experiences.
Marine species assessments rely heavily on baseline surveys conducted after the 1960s, long after many anthropogenic pressures began, which could lead to misinformed management decisions and poor conservation outcomes. In this study, we collaborated with Florida Fish and Wildlife to conduct stock assessments for mollusks of the west Florida shelf that incorporate shell death assemblages. One of our first assessments was of the Florida Fighting Conch, Strombus alatus, an abundant gastropod that is also under consideration as a replacement fishery for the threatened Queen Conch. Live and dead shells were collected from >300 dredge tows between 2008-2018 covering the entire west Florida shelf. Shells were age-partitioned by 14C- and AAR-calibrated taphonomic criteria. Counts were converted to densities per m2. Inverse distance weighting interpolation of S. alatus death assemblages reveals multiple population centers along the coast and a rapid decrease in density with depth from 25-120 m. In contrast, live conchs were absent in our dredge samples from shelf depths deeper than 40 m. These differences are confirmed by single-visit occupancy methods that account for variation in detectability across the samples. Live-dead differences in spatial distribution are probably influenced by time averaging in death assemblages, which increases detectability of conchs in deeper habitats, where they may be too rare to be sampled alive. However, extirpation of offshore populations was also indicated by independent natural history collection occurrence records, which show numerous live-collected conchs from 1940-1980 but none afterwards, despite an increase in sampling effort. These results suggest that live-dead comparisons can reveal biodiversity loss at the scale of large marine ecosystems.
Background The aim of this study was to test the hypothesis that receptive partners in penile-vaginal intercourse (PVI) who exercise independent decision making over condom use during menses do so to avert sexually transmissible infection (STI) transmission or acquisition.Data were collected through a partnership with Clue, the industry-leading female health app. A brief web-based questionnaire was developed, translated into 10 languages, and made accessible via a URL link sent to Clue users and posted on social media. Inclusion criteria were: age ≥14 years, not being currently pregnant and engaging in PVI and condom use during menses in the past 3 months. The analytical subsample comprised 12889 respondents residing in 146 countries.Twenty per cent indicated independent decision making about condom use during menses. Independent decision making was associated with lower odds of reporting that condoms were used for contraception (adjusted odds ratio (aOR) 0.65; 99% confidence interval (CI) 0.57-0.73) and higher odds that they were used for the prevention of STIs (aOR 1.44; 99% CI 1.28-1.61). A third significant finding pertained to always using condoms during menses; this was less likely among those indicating independent (female only) decision making (aOR 0.69; 99% CI 0.62-0.78). Non-significant associations with another two outcomes were found: protecting the partner against menstrual blood and protecting themselves against semen.Findings from people in 146 countries strongly support the hypothesis that those exercising independent decision making over condom use during menses do so to avert STI transmission or acquisition. That only one-fifth of this global sample reported this type of independent decision making suggests that empowerment-oriented (structural-level) interventions may be advantageous for individuals who are the receptive partner in PVI that occurs during menses.
Male (n = 289) and female (n = 268) college students were administered the Leifer-Roberts Response Hierarchy (Reinisch Revision) to evaluate the utility of this measure in reflecting sex differences in self-described potential for aggressive response. The Response Hierarchy provides a retrospective estimate of where physical and verbal aggression reside in an individual's hierarchy of possible behavioral responses to hypothetical conflict situations in adolescence. A score is obtained for: (a) physical aggression, (b) verbal aggression, (c) nonaggressive coping, and (d) withdrawal. When asked to respond as they would have or did at age 13 years, verbal aggression was the most frequent response with no significant sex difference in mean scores. Men selected physical aggression significantly more often than women (p less than .001). Using the binomial effect size display (BESD) to illustrate the magnitude of the sex difference, 69% of the men would be classified as physically aggressive (above the median), whereas only 31% of the women would be so classified. It was concluded that the Response Hierarchy consistently demonstrates sex differences among college students in retrospectively reported preference for choosing physical aggression versus other coping strategies as a response to hypothetical interpersonal conflict situations of adolescence.
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