act

DC Deals - Double Decker Bus Tours - Attractions

Double Decker Tours offers the best experience. Our Double Decker buses have the most visible sights like US Capitol, White House, Museums and Memorials




act

DC Deals - Mount Vernon: George Washington's Estate & Gardens - Attractions

Discover the real George Washington through his restored home and gardens, over 1,000 artifacts, and an immersive Revolutionary War "snow" experience




act

DC Deals - Old Town Trolley Tours of Washington DC - Attractions

Voted "Washington's Best Tour" by Washingtonian Magazine. See the best of Washington aboard on our 2 hour tour with live narration




act

DC Deals - On Location Tours - Attractions

Take a bus tour to the sites of movies and TV shows. Your guide will entertain you as you visit over 30 locations used in West Wing, The Exorcist and more




act

DC Deals - Segs in the City - Attractions

Get up close to the DC sites on a Segway! Segs in the City offers daily guided 1 hour and 2 hour Segway tours and rentals. Join the fun!




act

DC Deals - The Historical Society of Washington, D.C. - Attractions

The Best Museum Experience of All Things Washington, D.C. Experience the stories behind the people and events of the Nation's Capital.




act

Contact Tracing With Salesforce

Contact tracing is a big job, like trying to drain an ocean with a teaspoon. It involves finding people who have been exposed to the coronavirus and testing them to determine if they are infected or are carriers. Public health officials then can take necessary steps to prevent the virus' spread. It's a perfect fit for CRM, and Salesforce's core technology is coming to the forefront.




act

No active cases of COVID-19 in P.E.I., province easing restrictions further

All of P.E.I.'s 27 confirmed cases of COVID-19 are now considered recovered, said Chief Public Health Officer Dr. Heather Morrison.



  • News/Canada/PEI

act

Flint Registry Enrolls Residents Impacted By Water Crisis

The Flint Registry is holding in-person enrollment across the city of Flint all week. Officials are trying to track the health of residents made ill by the Flint Water Crisis.




act

John C Williams: A time for bold action

Remarks (delivered via videoconference) by Mr John C Williams, President and Chief Executive Officer of the Federal Reserve Bank of New York, at the Economic Club of New York, New York City, 16 April 2020.




act

NBA plan to reopen practice facilities pushed back to May 8 at the earliest

The NBA has pushed back plans that would allow teams to reopen their practice facilities for at least one week, and cautioned that the new target is far from set in stone.



  • Sports/Basketball/NBA

act

Mavs owner Mark Cuban sees too much risk in reopening practice facilities

The NBA gave its approval for teams to reopen their practice facilities on a limited basis on Friday, but only three teams have confirmed they will. And Dallas Mavericks owner Mark Cuban is in no hurry for his team to join the list.



  • Sports/Basketball/NBA

act

Raftaar: Our biggest contribution will be to acknowledge the fact that the COVID warriors are doing a brilliant job

"I have tied up with several NGO’s like Parivartan the change who donate food to over 500 people every day as well with welfare organisations like 4dogsakeindia where we feed over 200 street dogs."



  • IMC News Feed

act

Cyber Actors Take Advantage of COVID-19 Pandemic to Exploit Increased Use of Virtual Environments




act

Supporters propose changes to N.B. motor vehicle act to honour Brady Francis

Friends and family of Brady Francis, a 22-year-old man who died in 2018 after a hit-and-run collision, are proposing changes to make reporting vehicle collisions with wildlife mandatory in New Brunswick.




act

Canadian Duvernay-Tardif reworks contract to give NFL's Chiefs cap space

Laurent Duvernay-Tardif and the Kansas City Chiefs have agreed to a restructured deal for the Canadian offensive lineman.



  • Sports/Football/NFL

act

Regina braces for impact of likely Grey Cup cancellation

Hope for a 2020 Grey Cup in Regina is slowly dwindling as the CFL hints at a season cancellation. 



  • News/Canada/Saskatchewan

act

The pandemic’s impact on Toronto’s islands

Toronto’s islands are closed to the public to prevent the spread of COVID-19 and there’s no word on when tourists can return. Ali Chiasson looks at the impact the pandemic will have on the islands.



  • News/Canada/Toronto

act

'Thanks for ripping me off': B.C. government, ICBC hit with $900M proposed class action lawsuit

A proposed class action lawsuit has been filed in B.C. Supreme Court which, if successful, could mean every ICBC-insured motorist and crash victim will be in line for a share of almost $1 billion. 



  • News/Canada/British Columbia

act

How some B.C. municipalities are handling the financial impacts of COVID-19

Municipalities across the province are re-evaluating their financial situations as COVID-19 continues to keep municipal facilities closed and has put other revenue streams on hold. 



  • News/Canada/British Columbia

act

MLSE in contact with Ontario about Toronto serving as NHL hub city, Doug Ford says

Ontario Premier Doug Ford says the Toronto Maple Leafs' parent company has been in contact with the province about the possibility of Canada's biggest city serving as a so-called "hockey pod" for teams should the NHL resume its season.



  • Sports/Hockey/NHL

act

CME Group Achieves Record International Average Daily Volume of 7.2 Million Contracts in Q1 2020, Up 57 Percent from Q1 2019




act

SOLIDWORKS Electrical Formula SAE Tutorial: Assigning, Creating and Modifying Manufacturer Part

In the prior video, we learned how to insert and create a line diagram symbol. In this video we will learn how to assign a manufacturer part to a line diagram symbol, create our own manufacturer parts and edit an

Author information

Ajay Vaidya

I am the SOLIDWORKS Education Brand Advocacy Digital Marketing Intern in Waltham, MA. I go to Marywood University, Scranton, PA. Currently, I am studying Management Information Systems. During my free time, I love to play the keyboard, guitar, and ukulele. I can speak 8 languages!

The post SOLIDWORKS Electrical Formula SAE Tutorial: Assigning, Creating and Modifying Manufacturer Part appeared first on SOLIDWORKS Education Blog.




act

Measuring Systemic Risk: A Quantile Factor Analysis

Central Bank of Chile Working Papers by Andrés Sagner




act

The impact of information laws on consumer credit access: evidence from Chile

Central Bank of Chile Working Papers by Carlos Madeira




act

International and domestic interactions of macroprudential and monetary policies: the case of Chile

Central Bank of Chile Working Papers by Tomás Gómez, Alejandro Jara and David Moreno




act

NHS contact tracing team reportedly mulls switch to Apple-Google API



In what could herald a course reversal for the UK's National Health Service, health officials in that country have reportedly asked a team of developers to "investigate" switching its contact tracing app to a cross-platform API provided by Apple and Google.




act

Apple grants $10 million to COVID-19 test collection kit manufacturer



Early Thursday morning, Apple announced it is awarding $10 million from its Advanced Manufacturing Fund plus manufacturing machinery design assistance to COVID-19 test kit collection equipment manufacturer COPAN Diagnostics.




act

European countries form coalition over contact tracing app concerns



Several European countries, including Switzerland and Germany, are demanding all user data generated by coronavirus contact tracing apps be stored on-device, rather than aggregated on a centralized server.




act

Building shelter, building impact

An OM couple serving in Bar, Montenegro share how a short-term team building a shelter has had positive and lasting impact on a community they serve through a club for kids.




act

Cincinnati auxiliary bishop resigns after failing to act on allegations

Washington, D.C. Newsroom, May 7, 2020 / 07:55 am (CNA).- Pope Francis has accepted the resignation of Bishop Joseph Binzer, Cincinnati's auxiliary bishop, who was accused in August of failing to act on allegations made against a priest. 

A statement from the Holy See press office May 7 said the pope had accepted the 65-year-old bishop’s resignation but gave no reason for the decision. 

In a statement released by the Archdiocese of Cincinnati, Archbishop Dennis Schnurr said the pope accepted Binzer’s resignation after conversations between the bishop and the Holy See. 

The archdiocese also included a brief statement from Binzer in which he said he was “deeply sorry for my role in addressing the concerns raised about Father Drew, which has had a negative impact on the trust and faith of the people of the Archdiocese of Cincinnati.”  

“In April, having studied this matter since last summer, the Holy See informed me that it agreed with this assessment. As a result, and after much prayer and reflection, I offered my resignation from the Office of Auxiliary Bishop of the Archdiocese of Cincinnati,” said Binzer. ”I believe this to be in the best interest of the archdiocese.”

Archbishop Schnurr said that although retired, Binzer will continue to serve in the archdiocese with the title of “Auxiliary Bishop Emeritus.” 

“What exactly that ministry will look like will be determined after discussions between Bishop Binzer, the Priest Personnel Board, and me,” Schnurr said. “In this difficult and unfortunate time, please keep Bishop Binzer and all the people of the archdiocese in your prayers.”

Archbishop Schnurr removed Binzer from his position as head of priest personnel in August, after CNA presented officials with its investigation into claims that Binzer failed to pass on reports that a priest had engaged in inappropriate behavior with teenage boys.

In August last year, Schnurr told CNA that “We obviously made serious mistakes in our handling of this matter, for which we are very sorry.”

While Schnurr’s public comments did not address Binzer’s role directly, senior sources in the archdiocese told CNA in August that Schnurr had “gone nuclear” when he discovered the situation.

“The archbishop was as mad as I have ever seen him. When he was told that Bishop Binzer had withheld information, well, he used words I have never heard him use before,” one senior source told CNA, saying Schnurr called Binzer’s actions a “firestorm” for the archdiocese.

In September, 2019, an archdiocesan spokesperson told CNA that Schnurr had sent a "full report to Rome on the whole case and he is waiting for the Vatican’s response,” and he expected "a full investigation” to be conducted by the Vatican.

Binzer later resigned as a member of the U.S. bishops’ conference committee for the protection of children and young people, on which he represented Region VI.

CNA reported in August last year that Binzer was told in 2013 about allegations concerning a recently suspended priest, Fr. Geoff Drew, and failed to disclose them to Cincinnati Archbishop Dennis Schnurr and other archdiocesan officials.

While the archdiocesan victims’ assistance coordinator, who reported to Binzer, was aware of the allegation, the information was not made known to the diocesan priest personnel board or Archbishop Schnurr. 

In 2015, similar allegations were again made against Drew. The matter was forwarded to Butler County officials, who determined that the activity was not criminal. Again, Binzer reported neither the complaints nor the investigation to the archbishop or informed the priest personnel board.

Sources in the archdiocesan chancery told CNA in August that Binzer met with Drew twice, was assured by him that he would reform his conduct, and considered this sufficient.

In early 2018, Drew applied for a transfer to St. Ignatius of Loyola Parish in Green Township, which is attached to the largest Catholic school in the archdiocese.

As head of priest personnel, Binzer was in charge of the process that considers requests and proposals for reassignment, in conjunction with the priest personnel board.

Neither the board nor the archbishop were made aware of the multiple complaints against Drew, and the transfer was approved.

The allegations were also reportedly not recorded by Binzer in the priest’s personnel file that would have been available to the archdiocesan personnel board as part of the process.

A month after Drew’s arrival at St. Ignatius, a parishioner at Drew’s former parish resubmitted the 2015 complaints about the priest, but this time it was also brought to the attention of Archbishop Schnurr.

Also in 2018, Binzer received an additional complaint of similarly inappropriate contact by Drew, dating to his time as a high school music teacher, before his ordination as a priest. 

Following a diocesan investigation, Drew was ordered to attend counselling with a psychologist.

On July 23, Drew was removed from ministry, when it emerged that he had sent a series of inappropriate text messages to a 17-year-old. 

Chancery sources told CNA in August that it was only after the recent incident at St. Ignatius that archdiocesan officials discovered that the otherwise undisclosed complaints about Drew had been made to Binzer, and that the auxiliary bishop had failed to report them to other diocesan officials, or raise them during the decision to approve his transfer in 2018.




act

The Impact of Image Quality on SOLIDWORKS Performance and File Size

SOLIDWORKS Image Quality settings have the biggest impact on file size and system performance. We always assumed that it would have an impact on overall performance also. The effect varies widely across different files, so we decided to do SOLIDWORKS

Author information

E G S Computers India Private Limited, since 1993, has been in the forefront of delivering solutions
to customers in the areas of Product Design and Development with SOLIDWORKS 3D CAD,Remaining Life Calculations,
Validation using Finite Element Analysis, Customization of Engineering activities and Training in advanced engineering functions
relating to design and development.

EGS India - Authorized Reseller for SOLIDWORKS Solutions in India - Chennai, Coimbatore, Trichy, Madurai - Tamil Nadu, Pondicherry.
For any queries on SOLIDWORKS Solutions contact @ 9445424704 | mktg@egs.co.in
| Website - www.egsindia.com

The post The Impact of Image Quality on SOLIDWORKS Performance and File Size appeared first on SOLIDWORKS Tech Blog.




act

Activation error message, standalone license

This is the first blog post regarding the SOLIDWORKS activation error message. I will briefly try to go through the four most common activation error messages when using a standalone license. I will in a later blog post cover the

Author information

User success at PLM group

I started working with CAD systems in 2003, and have since 2012 worked solely with SOLIDWORKS. I am a certified Technical support specialist as well as a SOLIDWORKS Certified Professional and is currently in the process to become a SOLIDWORKS Certified Expert. Since 2016 I have helped PLM Group customers to work smarter, not harder.
The inspiration for most of my posts comes from the support cases i work on.
When writing blogpost I try to focus on the everyday use of SOLIDWORKS.

The post Activation error message, standalone license appeared first on SOLIDWORKS Tech Blog.




act

Activation Error message – SNL

Working with SOLIDWORKS on an SNL server, you can sometimes experience an Activation error message. Often these messages are not the same as the activation error messages you recieve when performing standalone activation What is SNL? SNL is short for

Author information

User success at PLM group

I started working with CAD systems in 2003, and have since 2012 worked solely with SOLIDWORKS. I am a certified Technical support specialist as well as a SOLIDWORKS Certified Professional and is currently in the process to become a SOLIDWORKS Certified Expert. Since 2016 I have helped PLM Group customers to work smarter, not harder.
The inspiration for most of my posts comes from the support cases i work on.
When writing blogpost I try to focus on the everyday use of SOLIDWORKS.

The post Activation Error message – SNL appeared first on SOLIDWORKS Tech Blog.




act

Chinese Communist Party 'is the most serious virus of all,' human rights activist says

Washington D.C., Apr 24, 2020 / 02:00 pm (CNA).- The Chinese Communist Party (CCP) covered up the spread of the new coronavirus within the country, suppressing the real rate of infection and violating the rights of its citizens as it did so, a Chinese human rights activist told a forum at The Catholic University of America on Friday.

“It is time to recognize the threat the Chinese Communist Party poses to all humanity. The CCP represses and manipulates information to strengthen its hold on power, regardless of the toll on human lives,” human rights lawyer Chen Guangcheng said April 24 during an online forum on the CCP and the new coronavirus.

The forum was hosted by Faith & Law in partnership with the Institute for Human Ecology at the Catholic University of America. Guanchen is Distinguished Visiting Fellow at Catholic University’s Institute for Policy Research and Catholic Studies.

Guangcheng is a blind human rights lawyer from China, who received sanctuary in the U.S. in 2012 after he was targeted by the CCP for his advocacy work. Guangcheng has sharply criticized the party for its human rights abuses, including from its one-child family planning policy.

He was sent to prison and subject to house arrest, during which he claims he and his family were repeatedly beaten and denied medical treatment.

On Friday, the lawyer warned audience members against suggestions that other countries should emulate China’s authoritarian response to the new coronavirus (COVID-19).

There are currently more than 2.7 million confirmed cases of COVID-19 in the world.

The city of Wuhan is recognized as the epicenter of the global pandemic, and the government on Jan. 23 instituted a strict lockdown in the city of 11 million people. Guangchang cited reports of Chinese families being barricaded inside their own homes, and the group Human Rights Watch compiled stories of residents reportedly dying from lack of access to care during the lockdown.

“Whole families have been found dead in their apartments because they could not get out,” he said, noting that despite the CCP’s claim that it has the virus under control, lockdowns are currently in force in the city of Harbin.

“This is despite the authorities ordering everyone back to work and telling the outside world that they have the virus under control,” Guangcheng said. “The resurgence is directly related to the CCP hiding the truth, and cracking down on people who tried to share information on the virus.”

He also claimed that the CCP has been using the crisis caused by the pandemic to crack down on dissent, detaining human rights activists at separate “so-called quarantine sites.”

The wife of one human rights lawyer—who had just been released from prison told The Guardian that she feared the government was putting her husband under house arrest near where he was imprisoned, 400 kilometers away from her, under the guise of a quarantine.

According to World Health Organization (WHO) statistics, China’s number of COVID-19 cases rose considerably through January and February to 79,389 on Feb. 29 with 2,838 deaths, before its daily increase in case numbers slowed to a trickle in March including just one new reported case on March 22 in the country of more than 1.4 billion people.

Just 3,352 deaths were reported on April 16 before the reported number jumped to 4,642 the next day.

“There is nothing about the CCP’s numbers that are believable,” Guangcheng said. “What people are calculating is that roughly 700,000 may have died in China—in terms of people who have been infected, no one knows the numbers.”

For instance, he said, during the Wuhan lockdown citizen journalists claimed that the situation was far worse than the CCP was reporting; they recorded people collapsing in the streets and hearses and vans carrying body bags at all hours of the day.

“In summary, the CCP is the biggest and most serious virus of all, with over 193,000 people dead worldwide from the coronavirus,” the lawyer said. “There should be no question of the regime’s threat.”



  • Asia - Pacific

act

Product Modification Summary: Amendments to the Price Increments of the 3-Year U.S. Treasury Note Futures Contract

Amendments to the Price Increments of the 3-Year U.S. Treasury Note Futures Contract

Click here for the full text of the advisory

20-188




act

Zimbabwe: Time for International Action




act

Leaders of Africa must act now to save Zimbabwe




act

A Poor Excuse for Inaction




act

Hiking to impact mothers and children worldwide

On 12 May, 130 people in Atlanta, Georgia, participate in a hike at to benefit trafficked and exploited women across our world.




act

A practical tribute to Dave and Joy Thomas

The OM Ships’ Thomas Guesthouse in South Carolina, USA, was dedicated to Dave and Joy Thomas, faithful members of OM Ships for 40 years.




act

Scottish pro-life student group investigated, but no action taken

CNA Staff, May 5, 2020 / 02:01 pm (CNA).- After complaints that a pro-life event held by the Aberdeen Life Ethics Society violated a 'safe space policy', an investigation has resulted in no action being taken against the pro-life group.

Ales held an event March 12 called “Does Abortion Violate Human Rights?”, about which some students at Aberdeen University complained. Among the complaints were that it included “highly graphic material,” the Gaudie, Aberdeen University's student paper, reported April 30.

Ales told the Gaudie that “In response to these unfounded complaints, we provided [the Aberdeen University Students' Association] with various examples of our efforts to warn attendees about sensitive content. We maintain that these efforts fulfilled our obligation to caution anyone who might be uncomfortable with an honest discussion of abortion (i.e., the intentional killing of antenatal humans by vacuum aspiration, poisoning, and/or dismemberment).”

“Thankfully, AUSA was satisfied with our defence against these vexatious complaints and will take no action against us. We look forward to organising future public events about the ethical importance of human life in the womb, and we pledge to continue to offer clear and explicit content warnings about the grisly reality of abortion,” the pro-life group continued.

Ausa told complainants that “the issues have been raised with ALES and they have provided assurances to AUSA that clearer and more explicit content warnings, and cautions will be issued, prior to showing similar videos in the future,” and that “on this basis we have concluded that no further action will be taken by AUSA against ALES and this matter is now concluded.”

One of those who complained about the event, Martin Le Brech, called Ausa's decision “very disappointing,” adding: I hope AUSA will thoroughly scrutinise ALES' activities and listen to the wider University community that is utterly embarrassed such misinformation and graphic contents are regularly spread on campus. We need to make sure our University is a safe space for everybody, free of bigotry and insidious violence.”

And Leah Robb, president of the Pro-Choice Society, said that if Ales “continue with similar events/demonstrations I am considering launching another complaint to AUSA.”

Ales was granted affiliation by the Aberdeen student association in May 2019, following a protracted disagreement.

In October 2018 Ausa had prevented the affiliation of Ales, citing its own pro-choice policy which it adopted in 2017. The policy says, in part, that “Ausa should oppose the unreasonable display of pro-life material within campus and at Ausa events.”

The move limited Ale's access to funds and venues at the university.

After failing to have the policy changed, Ales filed a lawsuit in April 2019 against Ausa and the university, “alleging unlawful discrimination against the society and the violation of rights protected by UK law.”

In its lawsuit, Ales charged that Ausa's no platform policy violates the Equality Act 2010 and the Human Rights Act 1998 by restricting “the freedoms of association and belief for certain students on the basis of an ideological litmus test.”

According to the Gaudie, Ales received “a financial pay-out” from Ausa over the matter.

After receiving affiliation, Ales stated: “We look forward to actively engaging with the student body and working to foster a civil yet honest conversation about the vitally important ethical issues surrounding human life. While there are some intolerant students who wanted our society to fail … we truly believe that there are many more students on this campus who are willing to take a fair-minded approach to this debate. These are the students we’ve heard from all along the way – they may not agree with our position, but they adamantly believe that we should be free to espouse our beliefs on campus.”

Pro-life groups at other Scottish universities have faced similar problems.

In 2018 the University of Strathclyde (in Glasgow) lifted a ban on pro-life groups following legal pressure. Strathclyde Sudents for Life argued that the student associaton's no platforming policy violated the Equality Act 2010 “by directly discriminating against a group of students based on their beliefs.”

Glasgow Students for Life were barred from affiliation by the Glasgow University's Students' Representative Council in November 2018.

In March 2018 a joint committee on human rights of the UK parliament noted troubling barriers to free speech at the nation's universities, writing: “Whilst the original intention behind safe space policies may have been to ensure that minority or vulnerable groups can feel secure, in practice the concept of safe spaces has proved problematic, often marginalising the views of minority groups.”




act

Back in action!

Tampico, Mexico :: After a five-week maintenance period, Logos Hope resumes her schedule in a new port, to an enthusiastic reception.




act

Impact in Mexico

Progreso, Mexico :: Reflections on the impact among churches and on people stirred up for mission, after Logos Hope's four months in Mexico.




act

Factors Associated With Seizure Onset in Children With Autism Spectrum Disorder

BACKGROUND AND OBJECTIVES:

Children with autism spectrum disorder (ASD) have a higher prevalence of epilepsy compared with general populations. In this pilot study, we prospectively identified baseline risk factors for the development of seizures in individuals with ASD and also identified characteristics sensitive to seizure onset up to 6 years after enrollment in the Autism Speaks Autism Treatment Network.

METHODS:

Children with ASD and no history of seizures at baseline who either experienced onset of seizures after enrollment in the Autism Treatment Network or remained seizure free were included in the analysis.

RESULTS:

Among 472 qualifying children, 22 (4.7%) experienced onset of seizures after enrollment. Individuals who developed seizures after enrollment exhibited lower scores at baseline on all domains of the Vineland Adaptive Behavior Scales, greater hyperactivity on the Aberrant Behavior Checklist (25.4 ± 11.8 vs 19.2 ± 11.1; P = .018), and lower physical quality of life scores on the Pediatric Quality of Life Inventory (60.1 ± 24.2 vs 76.0 ± 18.2; P < .001). Comparing change in scores from entry to call-back, adjusting for age, sex, length of follow-up, and baseline Vineland II composite score, individuals who developed seizures experienced declines in daily living skills (–8.38; 95% confidence interval –14.50 to –2.50; P = .005). Adjusting for baseline age, sex, and length of follow-up, baseline Vineland II composite score was predictive of seizure development (risk ratio = 0.95 per unit Vineland II composite score, 95% confidence interval 0.92 to 0.99; P = .007).

CONCLUSIONS:

Individuals with ASD at risk for seizures exhibited changes in adaptive functioning and behavior.




act

The Autism Treatment Network: Bringing Best Practices to All Children With Autism

The Autism Treatment Network and Autism Intervention Research Network on Physical Health were established in 2008 with goals of improving understanding of the medical aspects of autism spectrum disorders. Over the past decade, the combined network has conducted >2 dozen clinical studies, established clinical pathways for best practice, developed tool kits for professionals and families to support better care, and disseminated these works through numerous presentations at scientific meetings and publications in medical journals. As the joint network enters its second decade continuing this work, it is undergoing a transformation to increase these activities and accelerate their incorporation into clinical care at the primary care and specialty care levels. In this article, we describe the past accomplishments and present activities. We also outline planned undertakings such as the establishment of the Autism Learning Health Network, the increasing role of family members as co-producers of the work of the network, the growth of clinical trials activities with funding from foundations and industry, and expansion of work with primary care practices and autism specialty centers. We also discuss the challenges of supporting network activities and potential solutions to sustain the network.




act

Perspectives on Informed Consent Practices for Minimal-Risk Research Involving Foster Youth




act

Improving Antibiotic Prescribing for Pediatric Urinary Tract Infections in Outpatient Settings

OBJECTIVES:

To determine if a multicomponent intervention was associated with increased use of first-line antibiotics (cephalexin or sulfamethoxazole and trimethoprim) among children with uncomplicated urinary tract infections (UTIs) in outpatient settings.

METHODS:

The study was conducted at Kaiser Permanente Colorado, a large health care organization with ~127 000 members <18 years of age. After conducting a gap analysis, an intervention was developed to target key drivers of antibiotic prescribing for pediatric UTIs. Intervention activities included development of new local clinical guidelines, a live case-based educational session, pre- and postsession e-mailed knowledge assessments, and a new UTI-specific order set within the electronic health record. Most activities were implemented on April 26, 2017. The study design was an interrupted time series comparing antibiotic prescribing for UTIs before versus after the implementation date. Infants <60 days old and children with complex urologic or neurologic conditions were excluded.

RESULTS:

During January 2014 to September 2018, 2142 incident outpatient UTIs were identified (1636 preintervention and 506 postintervention). Pyelonephritis was diagnosed for 7.6% of cases. Adjusted for clustering of UTIs within clinicians, the proportion of UTIs treated with first-line antibiotics increased from 43.4% preintervention to 62.4% postintervention (P < .0001). The use of cephalexin (first-line, narrow spectrum) increased from 28.9% preintervention to 53.0% postintervention (P < .0001). The use of cefixime (second-line, broad spectrum) decreased from 17.3% preintervention to 2.6% postintervention (P < .0001). Changes in prescribing practices persisted through the end of the study period.

CONCLUSIONS:

A multicomponent intervention with educational and process-improvement elements was associated with a sustained change in antibiotic prescribing for uncomplicated pediatric UTIs.




act

Impacting Ireland

Participants from all over the world joined together in Ireland for two weeks of training and outreach in partnership with local churches.




act

Participants have a plan but rely on God to act

OM Ireland's biggest outreach of the year teaches participants to commit their ways to Him and trust Him to act.