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Rotch Library - PN1997.2.J86 2017

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Barker Library - TD345.S97 2019

Peachpit Publishes Rise of the DEO

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Just as we need to understand our content before we can recategorize it, we need to understand the system before we try to rebuild it.

Enter the structural audit: a review of the site focused solely on its menus, links, flows, and hierarchies. I know you thought we were done with audits back in Chapter 2, but hear me out! Structural audits have an important and singular purpose: to help us build a new sitemap.

This isn’t about recreating the intended sitemap—no, this is about experiencing the site the way users experience it. This audit is meant to track and record the structure of the site as it really works.

Setting up the template

First, we’re gonna need another spreadsheet. (Look, it is not my fault that spreadsheets are the perfect system for recording audit data. I don’t make the rules.)

Because this involves building a spreadsheet from scratch, I keep a “template” at the top of my audit files—rows that I can copy and paste into each new audit (Fig 4.1). It’s a color-coded outline key that helps me track my page hierarchy and my place in the auditing process. When auditing thousands of pages, it’s easy to get dizzyingly lost, particularly when coming back into the sheet after a break; the key helps me stay oriented, no matter how deep the rabbit hole.

Color-coding

Color is the easiest, quickest way to convey page depth at a glance. The repetition of black text, white cells, and gray lines can have a numbing effect—too many rows of sameness, and your eyes glaze over. My coloring may result in a spreadsheet that looks like a twee box of macarons, but at least I know, instantly, where I am.

The exact colors don’t really matter, but I find that the familiar mental model of a rainbow helps with recognition—the cooler the row color, the deeper into the site I know I must be.

The nested rainbow of pages is great when you’re auditing neatly nested pages—but most websites color outside the lines (pun extremely intended) with their structure. I leave my orderly rainbow behind to capture duplicate pages, circular links, external navigation, and other inconsistencies like:

• On-page navigation. A bright text color denotes pages that are accessible via links within page content—not through the navigation. These pages are critical to site structure but are easily overlooked. Not every page needs to be displayed in the navigation menus, of course—news articles are a perfect example—but sometimes this indicates publishing errors.
• External links. These are navigation links that go to pages outside the domain. They might be social media pages, or even sites held by the same company—but if the domain isn’t the one I’m auditing, I don’t need to follow it. I do need to note its existence in my spreadsheet, so I color the text as the red flag that it is. (As a general rule, I steer clients away from placing external links in navigation, in order to maintain a consistent experience. If there’s a need to send users offsite, I’ll suggest using a contextual, on-page link.)
• Files. This mostly refers to PDFs, but can include Word files, slide decks, or anything else that requires downloading. As with external links, I want to capture anything that might disrupt the in-site browsing experience. (My audits usually filter out PDFs, but for organizations that overuse them, I’ll audit them separately to show how much “website” content is locked inside.)
• Unknown hierarchy. Every once in a while, there’s a page that doesn’t seem to belong anywhere—maybe it’s missing from the menu, while its URL suggests it belongs in one section and its navigation scheme suggests another. These pages need to be discussed with their owners to determine whether the content needs to be considered in the new site.
• Crosslinks. These are navigation links for pages that canonically live in a different section of the site—in other words, they’re duplicates. This often happens in footer navigation, which may repeat the main navigation or surface links to deeper-but-important pages (like a Contact page or a privacy policy). I don’t want to record the same information about the page twice, but I do need to know where the crosslink is, so I can track different paths to the content. I color these cells gray so they don’t draw my attention.

Note that coloring every row (and indenting, as you’ll see in a moment) can be a tedious process—unless you rely on Excel’s formatting brush. That tool applies all the right styles in just two quick clicks.

Outlines and page IDs

Color-coding is half of my template; the other half is the outline, which is how I keep track of the structure itself. (No big deal, just the entire point of the spreadsheet.)

Every page in the site gets assigned an ID. You are assigning this number; it doesn’t correspond to anything but your own perception of the navigation. This number does three things for you:

1. It associates pages with their place in the site hierarchy. Decimals indicate levels, so the page ID can be decoded as the page’s place in the system.
2. It gives each page a unique identifier, so you can easily refer to a particular page—saying “2.4.1” is much clearer than “you know that one page in the fourth product category?”
3. You can keep using the ID in other contexts, like your sitemap. Then, later, when your team decides to wireframe pages 1.1.1 and 7.0, you’ll all be working from the same understanding.

Let me be completely honest: things might get goofy sometimes with the decimal outline. There will come a day when you’ll find yourself casually typing out “1.2.1.2.1.1.1,” and at that moment, a fellow auditor somewhere in the universe will ring a tiny gong for you.

In addition to the IDs, I indent each level, which reinforces both the numbers and the colors. Each level down—each digit in the ID, each change in color—gets one indentation.

I identify top-level pages with a single number: 1.0, 2.0, 3.0, etc. The next page level in the first section would be 1.1, 1.2, 1.3, and so on. I mark the homepage as 0.0, which is mildly controversial—the homepage is technically a level above—but, look: I’ve got a lot of numbers to write, and I don’t need those numbers to tell me they’re under the homepage, so this is my system. Feel free to use the numbering system that work best for you.

Criteria and columns

So we’ve got some secret codes for tracking hierarchy and depth, but what about other structural criteria? What are our spreadsheet columns (Fig 4.2)? In addition to a column for Page ID, here’s what I cover:

• URL. I don’t consistently fill out this column, because I already collected this data back in my automated audit. I include it every twenty entries or so (and on crosslinks or pages with unknown hierarchy) as another way of tracking progress, and as a direct link into the site itself.
• Menu label/link. I include this column only if I notice a lot of mismatches between links, labels, and page names. Perfect agreement isn’t required; but frequent, significant differences between the language that leads to a page and the language on the page itself may indicate inconsistencies in editorial approach or backend structures.
• Name/headline. Think of this as “what does the page owner call it?” It may be the H1, or an H2; it may match the link that brought you here, or the page title in the browser, or it may not.
• Page title. This is for the name of the page in the metadata. Again, I don’t use this in every audit—particularly if the site uses the same long, branded metadata title for every single page—but frequent mismatches can be useful to track.
• Section. While the template can indicate your level, it can’t tell you which area of the site you’re in—unless you write it down. (This may differ from the section data you applied to your automated audit, taken from the URL structure; here, you’re noting the section where the page appears.)
• Notes. Finally, I keep a column to note specific challenges, and to track patterns I’m seeing across multiple pages—things like “Different template, missing subnav” or “Only visible from previous page.” My only caution here is that if you’re planning to share this audit with another person, make sure your notes are—ahem—professional. Unless you enjoy anxiously combing through hundreds of entries to revise comments like “Wow haha nope” (not that I would know anything about that).

Depending on your project needs, there may be other columns, too. If, in addition to using this spreadsheet for your new sitemap, you want to use it in migration planning or template mapping, you may want columns for new URLs, or template types. 

You can get your own copy of my template as a downloadable Excel file. Feel free to tweak it to suit your style and needs; I know I always do. As long as your spreadsheet helps you understand the hierarchy and structure of your website, you’re good to go.

Gathering data

Setting up the template is one thing—actually filling it out is, admittedly, another. So how do we go from a shiny, new, naive spreadsheet to a complete, jaded, seen-some-stuff spreadsheet? I always liked Erin Kissane’s description of the process, from The Elements of Content Strategy:

Big inventories involve a lot of black coffee, a few late nights, and a playlist of questionable but cheering music prominently featuring the soundtrack of object-collecting video game Katamari Damacy. It takes quite a while to exhaustively inventory a large site, but it’s the only way to really understand what you have to work with.

We’re not talking about the same kind of exhaustive inventory she was describing (though I am recommending Katamari music). But even our less intensive approach is going to require your butt in a seat, your eyes on a screen, and a certain amount of patience and focus. You’re about to walk, with your fingers, through most of a website.

Start on the homepage. (We know that not all users start there, but we’ve got to have some kind of order to this process or we’ll never get through it.) Explore the main navigation before moving on to secondary navigation structures. Move left to right, top to bottom (assuming that is your language direction) over each page, looking for the links. You want to record every page you can reasonably access on the site, noting navigational and structural considerations as you go.

My advice as you work:

• Use two monitors. I struggle immensely without two screens in this process, which involves constantly switching between spreadsheet and browser in rapid, tennis-match-like succession. If you don’t have access to multiple monitors, find whatever way is easiest for you to quickly flip between applications.
• Record what you see. I generally note all visible menu links at the same level, then exhaust one section at a time. Sometimes this means I have to adjust what I initially observed, or backtrack to pages I missed earlier. You might prefer to record all data across a level before going deeper, and that would work, too. Just be consistent to minimize missed links.
• Be alert to inconsistencies. On-page links, external links, and crosslinks can tell you a lot about the structure of the site, but they’re easy to overlook. Missed on-page links mean missed content; missed crosslinks mean duplicate work. (Note: the further you get into the site, the more you’ll start seeing crosslinks, given all the pages you’ve already recorded.)
• Stick to what’s structurally relevant. A single file that’s not part of a larger pattern of file use is not going to change your understanding of the structure. Neither is recording every single blog post, quarterly newsletter, or news story in the archive. For content that’s dynamic, repeatable, and plentiful, I use an x in the page ID to denote more of the same. For example, a news archive with a page ID of 2.8 might show just one entry beneath it as 2.8.x; I don’t need to record every page up to 2.8.791 to understand that there are 791 articles on the site (assuming I noted that fact in an earlier content review).
• Save. Save frequently. I cannot even begin to speak of the unfathomable heartbreak that is Microsoft Excel burning an unsaved audit to the ground.  

Knowing which links to follow, which to record, and how best to untangle structural confusion—that improves with time and experience. Performing structural audits will not only teach you about your current site, but will help you develop fluency in systems thinking—a boon when it comes time to document the new site.

Dewey Library - HC240.25.S7 M37 2018

EIA Studies

StudioX

BEE Certified Energy Auditors

Interview with Fangjun Zhou, PhD, MS and Rafael Harpaz, MD, MPH, authors of Impact of Varicella Vaccination on Health Care Utilization, published in the August 17 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Varicella can be severe and at times life threatening, however, since the introduction of varicella vaccine in 1995, varicella hospitalizations have declined significantly, as have outpatient visits. 2. Herd immunity is protecting unvaccinated persons from varicella. Since varicella can be more severe in adults, it is particularly important that patients be screened for evidence of immunity to varicella and anyone susceptible be vaccinated, so that children and adolescents do not remain susceptible at adulthood. The federal government's Advisory Committee on Immunization Practices, or ACIP, provides new recommendations regarding screening patients for evidence of immunity to varicella and vaccinating those at risk of the disease. 3. The diagnosis of varicella has become challenging as rates have declined and since the disease is highly modified among those vaccinated. Laboratory testing will play an increasing role in diagnosis of varicella. 4. Providers should report varicella to the local health department so that public health authorities can act to control outbreaks and can monitor for development of problems in the vaccination program. Thanks to everyone who took part in Author in the Room on September 21. During the call, Dr. Rafael Harpaz mentioned that the CDC has some photo images of more attenuated forms of varicella. You can find these images at www.cdc.gov.

Interview with Charles N. Ford, MD, author of Evaluation and Management of Laryngopharyngeal Reflux, published in the September 28 issue of JAMA, the Journal of the American Medical Association. Summary points: 1. Differentiating between gastroesophageal reflux and laryngopharyngeal reflux. 2. Making and confirming laryngopharyngeal reflux diagnosis. 3. Resolution of laryngopharyngeal reflux findings may require aggressive and prolonged treatment.

Interview with David R. Flum, MD, MPH, author of Use of Early Mortality Among Medicare Beneficiaries Undergoing Bariatric Surgical Procedures, published in the October 19 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Patients 65 years or older have a much higher risk of early death than younger patients after bariatric (obesity) surgery. 2. Already a high risk population, Medicare medically disabled patients have a higher risk of early death after bariatric (obesity) surgery is performed than previously reported. 3. Older patients of more experienced bariatric surgeons had a much lower risk of death than those older patients whose surgeons had less experience performing the surgery.

Interview with Sandra Dial, MD, MSc, author of Use of Gastric Acid Suppressive Agents and the Risk of Community Acquired Clostridium difficile Associated Disease, published in the December 21 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Acid suppressive therapy use was associated with an increased risk of CDAD, with PPIs appearing to be associated with a higher risk than h2blockers. These agents, particularly PPIs, are being prescribed with increasing frequency to patients, including situations where the benefits may be small. 2. Although the rate is lower than in the hospital, CDAD is occurring in the community and is being diagnosed more frequently. 3. Prior antibiotic exposure appears to be less frequent in patients diagnosed in the community as compared to patients diagnosed in hospital.

Interview with Olga Jonasson, MD, author of Watchful Waiting vs Repair of Inguinal Hernia in Minimally Symptomatic Men, published in the January 18 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Men, and men only, who have few if any symptoms from their inguinal hemia, can safely delay having it fixed. 2. When symptoms develop, especially if the symptoms worsen suddenly, they should visit a surgeon and request a repair. 3. If the hernia suddenly becomes incarcerated, painful, and signs of a bowel obstruction develop (vomiting, abdominal cramps), an operation should be done immediately. In 2006, even this emergency operation is safe and mortality rates are low.

Interview with Anna Taddio, PhD, author of Intravenous Morphine and Topical Tetracaine for Treatment of Pain in Preterm Neonates Undergoing Central Line Placement, published in the February 15 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Infants feel pain during central line placement and this pain can be reduced with analgesics. 2. IV Morphine used alone or in combination with Tetracaine Gel is more effective than Tetracaine alone or no treatment. 3. IV Morphine and Tetracaine Gel are associated with expected side effects; IV Morphine causes mild respiratory depression and Tetracaine causes reddening discoloration of the skin.

Interview with Thomas Nolan, PhD, and Donald M. Berwick, MD, MPP, author of All-or-None Measurement Raises the Bar on Performance, published in the March 8 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. All or none measurement more closely reflects the interests and likely desires of patients than other approaches to measurement such as composite or item-by-item. 2. All or none measurement forces a system perspective. 3. All or none measurement offers a more sensitive scale for assessing improvements.

Interview with William Taylor, MD, author of A 71-Year-Old Woman Contemplating a Screening Colonoscopy, published in the March 8 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Embedded in experts’ recommendations for colorectal cancer screening are nearly impossible demands on primary care clinicians to discuss the pros and cons of various modalities for screening with each patient and to assess risk even to the detail of learning the pathology of the biopsy of relatives’ colonoscopies (e.g., adenomatous vs. hyperplastic polyps). 2. The complex set of components involved in the decision to screen (or not) for colon cancer includes input from both the doctor (e.g., data about what might happen and how likely the possibilities are) and the patient (e.g., how the patient weighs the relative desirability of the various possible outcomes that result from the possible decisions). 3. The decision to undertake a preventive maneuver involves weighing the risks, cost, and inconvenience of an intervention now for a potential benefit in the future.

Interview with Christopher M. Callahan, MD, author of Effectiveness of Collaborative Care for Older Adults With Alzheimer Disease in Primary Care: A Randomized Controlled Trial, published in the May 10 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Primary care practices have standard protocols to offer a patient with Alzheimer Disease and their caregivers. 2. The quality of care of many geriatric syndromes, including Alzheimer Disease, can be improved by implementing a collaborative care model. 3. Similarly to many geriatric syndromes, medication may be useful, but it is not enough. Medications are one part of a package of care.

Interview with Victor G. Vogel, MD, MHS, author of Effects of Tamoxifen vs Raloxifene on the Risk of Developing Invasive Breast Cancer and Other Disease Outcomes , published in the June 21 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Raloxifene is as effective in reducing the risk of invasive breast cancer in postmenopausal women who are at increased risk of the disease. 2. The safety profile of raloxifene is more favorable than tamoxifen with fewer hysterectomies, uterine malignancies, serious thrombotic events, and cataracts. 3. Both physicians and patients are familiar with raloxifene and its use for preventing and treating osteoporosis, and there is a long experience with its use in healthy women.

Interview with David Gonzales, PhD, and Stephen Rennard, MD, authors of Helping Patients Stop Smoking: Varenicline vs Bupropion, published in the July 5 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. There is a new and novel pharmaceutical approach to treating nicotine addiction that helps smokers quit by specifically targeting nicotine receptors. 2. Efficacy for varenicline was three to four times that of placebo and twice that of bupropion at the end of 12 weeks of treatment, but abstinence rates in all groups declined after drug treatment ended. 3. The launch of a new smoking cessation medication will likely drive patient demand for smoking cessation services. Medical practices should be prepared to respond to this demand by having a clear, systematic approach to smoking cessation.

Interview with Harriet L. MacMillan, MD, MSc, FRCP(C), author of Approaches to Screening for Intimate Partner Violence in Health Care Settings: A Randomized Trial, published in the August 8 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Even though we have long assumed that clinicians should ask patients directly about intimate partner violence, this study shows that self-complete methods for soliciting such information are preferred by women, and may be more efficient. 2. The prevalence rate for intimate partner violence differs by setting and population and varies significantly from approximately 4% to approximately 18%. 3. While this study provides evidence on the best methods to solicit information on intimate partner violence, it doesn't tell us if collecting this information improves outcomes for women exposed to such violence. A randomized controlled trial evaluating the effectiveness of screening women for intimate partner violence in health care settings is currently underway.

Interview with David Mark Spiro, MD, MPH, author of Wait-and-See Prescription for the Treatment of Acute Otitis, published in the September 13 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. Wait-and-See Prescription (WASP) is a viable approach to managing children with acute otitis media. Compared with the standard prescription group, the WASP group filled the antimicrobial prescription much less frequently and had equivalent clinical outcomes. 2. Within the WASP group, fever and ear pain were associated with filling the prescription demonstrating that parents are able to make appropriate care decisions when given clear guidance. 3. In the management of acute otitis media, important points for clinicians are first to make right diagnosis and then to provide sufficient analgesia. Adequate pain control allows parents to better manage their sick child and use antimicrobials judiciously while also reducing the risk of medical adverse effects and antibiotic resistance.

Interview with Dariush Mozaffarian, MD, DrPH, author of Fish Intake, Contaminants, and Human Health, published in the October 18 issue of JAMA, the Journal of the American Medical Association. Summary Points: 1. For the general population, the health benefits of fish intake far outweigh the risks. 2. Women of childbearing age, nursing mothers and young children should eat up to two servings of fish per week as the benefits of fish intake still outweigh the risks. 3. Given the magnitude of the benefits, physicians should regularly give dietary advice to patients for cardiovascular disease prevention.

Interview with Louise Walter, MD, author of PSA Screening Among Elderly Men With Limited Life Expectancies. Summary Points: 1. Most cancer screening guidelines do not recommend screening elderly persons in poor health who have limited life expectancies because the harms of screening (which occur immediately) outweigh the potential benefits (which occur many years in the future). 2. PSA screening rates among elderly men with limited life expectancies should be much lower than current practice to avoid harming these men with unnecessary tests and procedures. 3. Guidelines should be more explicit about how life expectancy is defined and provide tools to help clinicians identify men with poor prognoses who are most likely to be harmed by PSA screening, considering both age and the presence of severe disease.

Interview with Dennis Black, PhD, author of The Effects of Continuing or Stopping Alendronate after Five Years of Treatment: Results from the Fracture Intervention Trial Long-term Extension. Summary Points: 1. The long-term use of alendronate for up to 10 years is safe. 2. Those who discontinued treatment at 5 years lost bone mass compared with those who continued but the bone loss was only moderate. Rates of fracture were similar among those who continued vs those who discontinued except for clinical vertebral fractures which, although relatively uncommon, were higher in those who discontinued treatment. 3. Results suggest that after 5 years of alendronate, many women may discontinue therapy for up to 5 years. However, those at high risk of clinical vertebral fracture may benefit by continuing.

Interview with David Ganz, MD, MPH, author of The Rational Clinical Exam: Will My Patient Fall? Summary Points: 1. Screening for falls is as simple as asking the patient if she's fallen in the past year. For patients who have not fallen, ask about gait or balance problems (e.g. "Do you have a walking or balance problem?"). 2. Most older patients who have a history of falls in the past year, or a gait/balance problem, have at least a 50% chance of falling in the coming year. You may want to do a more thorough evaluation on these patients. 3. To make screening easy for new patients, add into your pre-visit questionnaire questions that ask about a history of falls and/or gait/balance problems. Or, have your office staff ask these questions routinely when patients are being checked in.

Interview with Paul M. Ridker, MD, MPH, author of Development and Validation of Improved Algorithms for the Assessment of Global Cardiovascular Risk in Women: The Reynolds Risk Score. Summary Points: 1. Half of all heart attacks and strokes occur among those with normal cholesterol levels and 15-20% occur among those with no major risk factors at all. 2. The major breakthroughs in understanding cardiovascular disease over the past decade include insights about inflammation and genetics. Each of these can easily be ascertained with either a simple blood test (hsCRP for inflammation) or a simple question about parental history of myocardial infarction. 3. By incorporating these 2 new measures into how we think about risk, a new risk tool was derived known as the "Reynolds Risk Score." 4. This is a win-win for everyone as it allows us to better target therapies, avoid toxicity, and improve overall prevention strategies for heart disease.

Interview with Peter B. Bach, MD, author of Computed Tomography Screening and Lung Cancer Outcomes. Summary Points: 1. Screening and other prevention approaches involve subjecting very large numbers of people to an intervention, with the expectation that a few will benefit, but most will not (as they would have never developed the condition anyway). 2. In general, screening for diseases such as cancer will uncover some reservoir of abnormalities that appear to be precursors to clinical disease but are not yet causing disease. 3. We really have no evidence to support screening for lung cancer right now with any technology. 4. We really should be advocating for our patients to help them understand why they shouldn't have this test until we know that it is more likely to hurt them or help them.

Interview with Steven R. Steinhubl, MD, author of Aspirin Dose for the Prevention of Cardiovascular Disease. Summary Points: 1. While aspirin is generally a safe drug and extremely effective, with more than 50 million US adults taking it every day for cardiovascular disease prevention, even a very small incidence of adverse effects can have major implications. Consistent with this, one study found that the most common medication leading to an adverse event requiring hospitalization was aspirin for cardiovascular disease prevention. 2. In terms of preventing heart attacks, strokes, or cardiovascular deaths, no clinical trial has identified an aspirin dose more efficacious than 75 to 81 mg daily. 3. Although there is no dose of aspirin that doesn't increase the risk of GI toxicity or bleeding, greater doses of aspirin are consistently associated with a greater risk. For example, in the United States alone, if everyone took 325 mg of aspirin daily instead of 81 mg, based on observational data, this could translate into nearly 1 million additional major bleeding complications a year.

Interview with Jan L. Brandes, MD, author of Sumatriptan-Naproxen for Acute Treatment of Migraine. Summary Points: 1. Evidence from two replicate randomized, double-blind, placebo-controlled trials showed sumatriptan-naproxen as a fixed dose combination was superior in treating an attack of migraine when compared with sumatriptan alone, naproxen alone, or placebo. 2. Most importantly, given that migraine attacks in adults are 4 to 72 hours in duration, the fixed-dose combination of sumatriptan-naproxen was significantly more effective than sumatriptan monotherapy or naproxen monotherapy in providing a 24-hour sustained pain-free response. 3. Patients using the fixed-dose combination therapy were less likely to use rescue medication or to have headache recurrence, and did not experience any increase in adverse effects using the combination.

Interview with Bernard Cole, PhD, and Robert S. Sandler, MD, authors of Folic Acid for Prevention of Colorectal Adenomas. Summary Points: 1. Folic acid supplementation is not useful for preventing colorectal adenomas. 2. Folic acid supplementation may be harmful through increasing colorectal adenomas. 3. Practitioners and patients should wait for strong evidence before initiating therapies given the potential for waste and unintended adverse consequences.

Interview with Roy C. Ziegelstein, MD, author of Acute Emotional Stress and Cardiac Arrhythmias. Summary Points: 1. Episodes of emotional stress, especially when sudden, severe, and unexpected, may have significant adverse effects on the heart. 2. Acute emotional stress can increase sympathetic stimulation of the heart and can alter brain activity in a way that makes the heart more susceptible to rhythm disturbances. 3. Since episodes of emotional stress are almost inevitable in life, part of a healthy lifestyle is learning how to deal effectively with stress.

Interview with Douglas R. Lowy, MD, author of Effect of Human Papillomavirus 16/18 L1 Viruslike Particle Vaccine Among Young Women With Preexisting Infection. Summary Points: 1. The HPV vaccine has been shown to work very well in preventing new (incident) infection and disease caused by the HPV types targeted in the vaccine. 2. The JAMA study shows that HPV vaccination does not hasten clearance of existing (prevalent) infection with the HPV types targeted by the vaccine (HPV16 and 18). 3. It is most cost-effective to administer the vaccine before patients are exposed to HPV, because the vaccine is effective in preventing new infection but does not appear to be effective in treating established infection.

Interview with Romsai T. Boonyasai, MD, MPH, author of Effectiveness of Teaching Quality Improvement to Clinicians. Summary Points: 1. Quality Improvement (QI) curricula are often effective in improving learners plus or minus QI-related participation, attitudes, and knowledge. 2. QI curricula are less often associated with clinical improvements. 3. Clinical improvements occur more often when learners engage in multiple small cycles of change, and when they have individualized coaching in QI, access to their performance data, and access to pre-developed QI tools.

Interview with R. Monina Klevens, DDS, MPH, author of Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States. Summary Points: 1. The magnitude of MRSA infection is significant, demonstrating that it is a major healthcare and public health issue. 2. The majority of invasive MRSA infections are healthcare associated; hospitals and other healthcare facilities should make MRSA prevention a priority. 3. MRSA skin infections are common in the community and rarely become life threatening or invasive.

Interview with Dena M. Bravata, MD, MS, author of Using Pedometers to Increase Physical Activity and Improve Users' Health. Summary Points: 1. Pedometer users increase their physical activity. They walked 2000 steps per day more than people who do not use a pedometer. 2000 steps is equivalent to about 1 mile per day or about 100 calories per day. 2. Having a daily step goal is important for increasing physical activity with a pedometer. Pedometer users with any goal plus or minus either 10,000 steps per day or an individualized step goal plus or minus increase their physical activity whereas those pedometer users without a goal do not. 3. Pedometer users lose weight and lower their blood pressure. 4. Pedometer interventions that take place in the workplace are less likely to result in improvements in physical activity than interventions that took place in non-workplace settings. This is because the people who chose to participate in workplace interventions already had relatively high baseline physical activity which suggests that workplace interventions should target sedentary employees.

Interview with Ian G. Williamson, MD, author of Antibiotics and Topical Nasal Steroid for Treatment of Acute Maxillary Sinusitis. Summary Points: 1. Antibiotics are not so effective in the routine treatment of cases of acute sinusitis even when of probable bacterial origin, and should therefore be used more judiciously and with greater caution. 2. Expectations should not necessarily be for antibiotics but balanced risk assessments and symptom advice are still important. 3. Findings of lack of efficacy for antibiotics should drive a research agenda which aims to identify subgroups that might benefit from their use and/or other types of treatment.

Interview with Mark J. Pletcher, MD, MPH, author of Trends in Opioid Prescribing by Race/Ethnicity for Patients Seeking Care in US Emergency Departments. Summary Points: 1. Doctors appear to prescribe opioids less often to blacks and Hispanics/Latinos than they do to whites in the emergency department. 2. These differences do not appear to be explained by differences in type or severity of pain. To address these disparities, we would recommend: 1. Educating patients to make sure non-white patients expect good pain control and know how/when to ask for it. 2. Educating physicians and nurses about the existing disparities and the need to eliminate them, specifically addressing fears of prescription opioid abuse and other reasons physicians may withhold opioids. 3. Creating systems that minimize barriers to prescribing and monitor resolution of pain. 4. Monitoring quality of care by measuring resolution of pain and collecting and analyzing data by race/ethnicity.