Explore the vast range of titles available.

Background. Reported allergy to beta-lactam antibiotics is common and often leads to unnecessary avoidance in patients who could tolerate these antibiotics. We prospectively evaluated the impact of these reported allergies on clinical outcomes. Methods. We conducted a trainee-led prospective cohort study to determine the burden and clinical impact of reported beta-lactam allergy on patients seen by infectious diseases consultation services at 3 academic hospitals. The primary outcome was a composite measure of readmission for the same infection, acute kidney injury, Clostridium difficile infection, or drug-related adverse reactions requiring discontinuation. Predictors of interest were history of beta-lactam allergy and receipt of preferred beta-lactam therapy. Results. Among 507 patients, 95 (19%) reported beta-lactam allergy; preferred therapy was a beta-lactam in 72 (76%). When betalactam therapy was preferred, 25 (35%) did not receive preferred therapy due to their report of allergy even though 13 (52%) reported non-severe prior reactions. After adjustment for confounders, patients who did not receive preferred beta-lactam therapy were at greater risk of adverse events (adjusted odds ratio [aOR], 3.1; 95% confidence interval [CI], 1.28–7.89) compared with those without reported allergy. In contrast, patients who received preferred beta-lactam therapy had a similar risk of adverse events compared with patients not reporting allergy (aOR, 1.33; 95% CI, .62–2.87). Conclusions. Avoidance of preferred beta-lactam therapy in patients who report allergy is associated with an increased risk of adverse events. Development of inpatient programs aimed at accurately identifying beta-lactam allergies to safely promote beta-lactam administration among these patients is warranted.

We apply the empirical framework of the displaced worker literature to the study of outcomes for displacing employers. Long-term patterns of employment, average wages, and closure probabilities before and after mass layoffs vary by the reason for layoffs, the industry of employers, employer age, and the period in which the layoff took place. Employers with mass layoffs during the Great Recession and the recovery that has followed have milder patterns of employment levels and closure probabilities than employers with layoffs in previous periods. These differences are not fully explained by changes in the observable characteristics of employers and layoffs.

Bendamustine has been retrospectively shown to be an effective and safe lymphodepletion regimen prior to the anti-CD19 chimeric antigen receptor T cell (CART) products tisagenlecleucel and axicabtagene ciloleucel, as well as the anti-BCMA CART products idecabtagene vicleucel and ciltacabtagene autoleucel. However, bendamustine as lymphodepletion prior to lisocabtagene maraleucel (liso-cel), a 4-1BB co-stimulated, fixed CD4:CD8 ratio anti-CD19 CART product, has not been described yet. Thus, we studied a cohort of sequentially-treated patients with large B-cell lymphomas who received bendamustine lymphodepletion before liso-cel at the University of Pennsylvania between 5/2021 and 12/2023 ( n  = 31). Patients were evaluated for toxicities and responses. Of note, 7 patients (22.6%) would have dnot met the inclusion criteria for the registrational liso-cel clinical trials, mostly due to older age. Overall and complete response rates were 76.9% and 73.1%, respectively. At a median follow-up of 6.3 months, the 6-month progression-free and overall survival were 59.9% and 91.1%, respectively. Rates of cytokine-release syndrome (CRS) and neurotoxicity (ICANS) of any grade were 9.7% and 9.7%, respectively, with no grade ≥ 3 events. No infections were reported during the first 30 days following liso-cel infusion. Neutropenia ≥ grade 3 was observed in 29.0% of patients; thrombocytopenia ≥ grade 3 occurred in 9.7%. In conclusion, bendamustine lymphodepletion before liso-cel appears to be a strategy that can drive tumor responses while ensuring a mild toxicity profile.

Background: Cephalosporins can induce severe or life-threatening IgE-mediated reactions in some individuals. In this study, we wish to describe a group of non-penicillin-allergic patients who were evaluated for immediate allergic reactions to cephalosporins. Methods: The patients were assessed by skin tests with the culprit cephalosporin as well as with other cephalosporins and penicillins. If indicated, oral challenge testing was performed. Results: Six patients were assessed. A total of 42 skin tests and 20 oral challenges were performed. In 4 patients, skin tests included the causative drug; in 2 patients, the diagnosis of a cephalosporin allergy was made by skin test; in 4 patients, the diagnosis of a cephalosporin hypersensitivity was made by oral challenge. In 96.9% of the oral challenges, which were done using medications with no structural side chain similarities to the culprit drug, no adverse reaction occurred. Conclusion: A positive skin test to cephalosporin implies the presence of drug-specific IgE antibodies. Cephalosporins without side chain similarities are suggested to patients with cephalosporin reactions and no β-lactam reactivity.

This exploratory, qualitative study examined the perspectives of 22 lesbian and gay parents (15 female and seven male) who were residents of Florida while the state’s gay adoption ban was in effect and who had adopted or were in the process of adopting a child. Participants were interviewed about their experiences before and after the lifting of the gay adoption ban, which occurred in 2010. Participants described numerous negative consequences of the ban, including the inability to adopt foster children and the legal invisibility of one partner’s parental status (e.g., among lesbian couples who had become parents via donor insemination). Parents described various positive changes that occurred in their families once the ban was lifted, such as a profound sense of relief for parents and their children, as well as legal recognition of both partners as parents. Our findings highlight the negative consequences of discriminatory legislation on lesbian/gay-parent families, as well as some subsequent positive effects once such legislation is removed.

Does sending children to college affect the contemporaneous labor supply of older workers? Drawing on biennial waves of the Health and Retirement Survey from 1992-2006, the author tracks the labor supply of parents before and after they send their children to college and shows that parents delay retirement while they are financing their children's college education. Controlling for the total number of children who ever attend college and the total number of those whose college expenses are paid for by older parents, she finds that mothers and fathers are more likely to be working (by 10.5 percentage points for fathers and by 6.9 percentage points for mothers), less likely to be collecting Social Security benefits, and less likely to report that they are retired if they are currently paying for a child's college education. Of those working, there is little evidence that paying for a child's education has any impact on work intensity.

In this paper we outline an approach to learner preparation that provides a framework to effectively structure a collaborative and cooperative student research assignment using a wiki site as a writing platform. While students are familiar with posting pictures and videos online, they may not be aware of how to effectively integrate text and visual information to present their research in the online wiki format. Likewise, collaborative writing for an audience requires an understanding of authorship, how to productively collaborate on composing, revising, and editing, and how to interact synchronously and asynchronously through online means to provide feedback. The framework we provide outlines how to scaffold wiki-based assignments to ensure an optimal language and culture learning experience. We developed this framework based on our reflections on the implementation of scaffolding procedures and a comprehensive review of the relevant research literature. The individual components of a wiki research project for intermediate language learners, selected grading rubrics, and a survey tool to assess student perception are provided.

We document new stylized facts on the occupational mix of businesses in the United States and how their internal organization evolves over their life cycles. Our main empirical finding is that younger businesses have fewer hierarchical layers and lower span of control than comparable older businesses do. Our results suggest that businesses become simultaneously more hierarchical and increase their managerial span of control over their life cycles. We show that this pattern is not entirely driven by selection or differences in size and is pervasive across cohorts and sectors.

Background. β-lactam allergy skin testing (BLAST) is recommended by antimicrobial stewardship program (ASP) guidelines, yet few studies have systematically evaluated its impact when delivered at point of care. Methods. We conducted a pragmatic multicenter prospective evaluation of the use of point-of-care BLAST by ASPs. In staggered 3-month intervals, ASP teams at 3 hospitals received training by allergists to offer BLAST for eligible patients with infectious diseases receiving nonpreferred therapy due to severity of their reported allergy. The primary outcome was the proportion of patients receiving the preferred β-lactam therapy. Results. Of 827 patients with reported β-lactam allergy over 15 months, β-lactam therapy was preferred among 632 (76%). During baseline periods, 50% (124/246) received preferred β-lactam therapy based on history, compared with 60% (232/386) during the intervention periods (P = .02), which improved further to 81% (313/386) upon provision of BLAST (P < .001) without any increase in incidence of adverse drug reactions (4% vs 3%; P = .4). After adjusting for patient variables and the correlation between hospitals, the intervention period was associated with a 4.5-fold greater odds of receiving preferred β-lactam therapy (95% confidence interval, 2.4-8.2; P < .0001). Conclusions. The use of BLAST at the point of care across 3 hospital ASPs resulted in greater use of preferred β-lactam therapy without increasing the risk of adverse drug reactions. Longer-term studies are needed to better assess the safety and clinical impact of this ASP intervention.

This book examines relations which hold between morphosyntactic form and communicative function in discourse by examining form-function correlations of noninterrogative questions in ordinary English conversation. So-called nontypical declarative and nonclausal questions are identified functionally. The role morphosyntax plays in the production and interpretation of these forms as doing questioning is then considered. Speakers are shown to use specific patterns of morphosyntactic marking to enable recipients to interpret noninterrogatives as functional questions. Explanations for morphosyntactic patterns found in the data are stated in terms of discourse use.