Editor’s note: On Tuesday, we’ll showcase the best and most iconic drivers from Nos. 91-09 in the final week of our Driver by Number project. The selection of the No. 99 will be unveiled Monday at 6 p.m. ET exclusively on “NASCAR Race Hub” on FS1.Who wore it best? As it applies to NASCAR, that age-old question might refer to fire suits, driving gloves or helmets.This summer, NASCAR.com is taking a different tack — with car numbers. Our Driver by Number project will ask: Which driver either had the most success or was most emblematic with the closest association to every car number ever run in NASCAR’s top division.MORE: All Driver by Number contentWe’ll be counting up all summer long with weekly Tuesday morning reveals and features, from Nos. 1 to 99 and all the aughts (No. 0, 00, 01 … ) taken 10 at a time. Check in every Tuesday to see who made our Driver by Number list, determined by statistical analysis and research from our archives. Then feel free to chime in with your picks and join the time-worn debate of who wore each car number the best.Sample some of the content from Driver by Number and be sure to return to NASCAR.com every Tuesday for more:— Photos: Best drivers, Nos. 1-50— Debate: Best 4? Harvick or White?— Debate: Best 2? Wallace or Keselowski?— Debate: No. 17, Kenseth or Pearson?— Insight: Hemric on No. 3 and No. 8— Debate: The best in the No. 11?— Insight: No. 21, Pearson and the Wood Brothers— Insight: Gordon’s impact with No. 24— Debate: No. 28’s links to Allison, Lorenzen— Insight: Hailing Harvick at No. 29— Photos: ‘Handsome’ Harry Gant through the years— Photos: Iconic No. 43 paint schemes— Photos: Janet Guthrie’s historic career— Photos: Key wins in the No. 88
A new study of European emergency departments has found that antibiotic prescribing for children who show up with a fever varies widely across the continent, and many of those children are discharged with a broad-spectrum antibiotic. The findings appeared yesterday in The Lancet Infectious Diseases.The cross-sectional, observational analysis of more than 5,100 children admitted to 28 emergency departments in 11 countries across Europe over a 16-month period found that about a third of the children who presented with a fever but no other illnesses received an antibiotic on discharge, with the prescribing frequency ranging from 19% in Switzerland to 64% in Turkey.More than 60% of those prescriptions, which were written mainly for respiratory tract infections, were for second-line antibiotics.While the study did not evaluate whether the antibiotics were appropriately prescribed, the authors say the findings indicate a significant amount of overprescribing is occurring, particularly in children with respiratory infections, and that the drivers of this inappropriate prescribing need to be identified and addressed at the hospital and national level.Respiratory infections drive prescribingThe study of hospitals participating in the Research in European Pediatric Emergency Medicine (REPEM) network looked at emergency department visits by children aged 1 month to 16 years who presented with a fever on one random sampling day per month from November 2014 to February 2016.The researchers then determined the proportion of those children without comorbidities who received antibiotics on discharge by country, type of infection, and type of antibiotic. They then performed a detailed analysis of that population to assess the factors that influenced variability in prescribing.Of the 5,177 children who were included in the analysis, 617 (12%) had comorbidities. Of the 4,560 children without comorbidities, 1,454 (32%) received an antibiotic, and 893 (61%) of those prescriptions were for second-line antibiotics, which included doxycycline, broad-spectrum penicillins, and second- and third-generation cephalosporins. The countries with the highest prescribing rates (Turkey, the United Kingdom, Hungary, Italy, and Romania), were also the most frequent prescribers of second-line antibiotics.When the researchers looked at the type of infections for which antibiotics were prescribed in children without comorbidities, they found that respiratory tract infections (upper and lower) accounted for 83% (1,208 of 1,454) of all prescriptions. The variation in prescribing frequency across hospitals was even greater for these infections, ranging from 15% (Switzerland) to 67% (Turkey) for upper respiratory tract infections and 24% (Switzerland) to 87% (Turkey) for lower respiratory tract infections.Analysis of patient characteristics found that older age (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.08 to 2.13), longer duration of fever (OR, 1.45; 95% CI, 1.01 to 2.07), blood concentrations of C-reactive protein (OR, 2.31; 95% CI, 1.67 to 3.19), and chest x-ray results (OR,10.62; 95% CI, 5.65 to 19.94 for focal abnormalities; OR, 3.49; 95% CI, 1.59 to 7.64 for diffuse abnormalities) were all associated with the increased likelihood of receiving an antibiotic prescription.After the researchers adjusted their analysis to account for patient characteristics, diagnostic assessment, and hospital characteristics (hospital type and national healthcare system), they found the rate of antibiotic prescribing for respiratory infections was still highly variable across hospitals and countries, which suggests others factors are involved.”Even though specific determinants of antibiotic prescription could be identified in the whole population of patients, differences in patient mix, diagnostic assessment, or hospital characteristics could not explain all variability in antibiotic prescription,” lead study author Josephine van de Maat, MD, and her co-authors write.Diagnostic uncertaintyWhat could explain the variability? As van de Maat and her colleagues explain, even though most respiratory infections are viral in nature and don’t require antibiotics, bacterial causes can’t be ruled out. But since there is no gold standard for diagnosing bacterial respiratory tract infections, diagnostic uncertainty could influence the decision to prescribe an antibiotic.And as Elise Launay, MD, and Christele Gras Le Guen, MD, PhD, of Centre Hospitalier Universitaire de Nantes in France, explain in an accompanying commentary, that diagnostic uncertainty could play a bigger role in hospitals in Turkey, where estimated mortality for bacterial pneumonia in children under 5 is significantly higher than it is in western European countries.”When in doubt, clinicians generally might prescribe antibiotics, thinking that the treatment would be less harmful than missing a severe bacterial infection,” they write. “Pneumonia is a good example of a doubtful situation that could explain why children with lower respiratory tract infections showed the most variation in antibiotic prescription frequency.”But, they note, that wouldn’t explain why the prescribing rates for lower respiratory tract infections in hospitals were also high in countries like the United Kingdom and Italy, where mortality rates for pediatric bacterial pneumonia are lower.Whatever the reasons, van de Maat and her colleagues suggest that identifying the source of the problem is critical for stewardship efforts across the continent.”To ensure successful antibiotic stewardship initiatives in Europe aimed at reducing unnecessary prescription of antibiotics, variability of prescription across hospitals should be considered, drivers of suboptimal antibiotic prescription at the local level need to be identified, and European guidelines need to be devised,” they write.See also:Feb 28 Lancet Infect Dis studyFeb 28 Lancet Infect Dis commentary
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CSKA was close to a historic disgrace in Europe to compete with the spots affixed against Moore and Zimbru. CSKA played another weak match during the season and escaped the magic of shame against the debutant in the European tournaments – Sirens, Malta. Another issue is that there are almost no Maltese in this team. That last year it was a team from the island that eliminated Croatian Hajduk. We can’t get the Croats to football soon, and they are getting worse. But the pitcher of the “Army” cracked in the first round of the championship – against a rookie in the elite, and miraculously did not fall to pieces against Botev from Plovdiv, Botev from Vratsa and especially Sirens from Malta.Coach Stamen Belchev said at the press conference before the Europa League match that he will not stop explaining to his players how the opponent should not be underestimated until he leaves the field. Either he didn’t, or they didn’t understand. There was underestimation. And the on-duty apologies after the meeting. It is time to stop apologizing and act with a firmer hand. Belchev is a coach liked by most fans. This man is clear about football. Watch only 2-3 workouts and you will agree. His problem, however, is also clear. And he has had it since his first stay at CSKA. Namely – not a good motivator. No matter how much we talk about being in such a club, you don’t need motivation, that’s not true. Every football player needs a coach against himself, to burn him, to make the best of him, to inspire him with sports malice, to demand, to shout when needed, to knock on the table. Stamen is a kind man. I didn’t hear him shout during yesterday’s match. Then he apologized to the people.Belchev or another of the sports and technical management, from the bosses in the club, should pull the players by the ears as soon as possible and take them to the “Army” museum. Explain to them again and again which club they are in. And how they have no right to play in this insulting way at the stadium where Kolev, Penev, Yakimov, Zhekov, Stoichkov and dozens of other luminaries played in sports. Against teams many times bigger than … the one with the naked mermaid for a logo. CSKA continued in the next round of the Europa League, but the fans do not know if they will be happy. The expectations are that the next rival of the team will be of the rank of Milan, Tottenham and Granada, the “reds” will not be put in the draw. Even if they are, whoever falls, with such an attitude the pitcher will already break. The question will be how many pieces.CSKA said they would tolerate constructive criticism. It is also good for them to learn lessons. There is no room for apologies anymore. There are matches of the truth in the championship as well – against Slavia, although in bad shape, against Cherno More, Ludogorets and Loko (Plovdiv). With the game from these first four matches, nothing good awaits CSKA.Let them understand it – Belchev, the bosses, especially those on the field. This is CSKA and you have no right to walk the team even for a minute. Especially in Europe, where the team over the years has reached heights unattainable for many others. If they do not understand it, there remains the last person who will easily explain to them – Grisha Ganchev. They will hardly like it …Drama of the “Army”! CSKA struggled against a debutant from Malta, but continues to advance in the Europa LeagueThe Reds beat Sirens 2-1