OBJECTIVE: We sought to determine factors associated with the absence of pyuria in symptomatic children whose urine culture was positive for a known uropathogen. METHODS:We obtained data on children evaluated at the Children's Hospital of Pittsburgh emergency department between 2007 and 2013 with symptoms of urinary tract infection (UTI) who had paired urinalysis and urine cultures. We excluded children with an unknown or bag urine collection method, major genitourinary anomalies, immunocompromising conditions, or with multiple organisms on culture. We chose a single, randomly-selected urine specimen per child and limited the analysis to those with positive cultures.RESULTS: There were 46 158 visits during the study period; 1181 children diagnosed with UTI met all inclusion criteria and had a microscopic urinalysis for pyuria. Pyuria (≥5 white blood cells per high-powered field or ≥10 white blood cells per cubic millimeter) was present in 1031 (87%) children and absent in 150 (13%). Children with Enterococcus species, Klebsiella species, and Pseudomonas aeruginosa were significantly less likely to exhibit pyuria than children with Escherichia coli (odds ratio of 0.14, 0.34, and 0.19, respectively). Children with these organisms were also less likely to have a positive leukocyte esterase on dipstick urinalysis. Results were similar when we restricted the analysis to children whose urine samples were collected by bladder catheterization. CONCLUSIONS:We found that certain uropathogens are less likely to be associated with pyuria in symptomatic children. Identification of biomarkers more accurate than pyuria or leukocyte esterase may help reduce over-and undertreatment of UTIs.

Objectives: To evaluate the benefits of TimeSlips, a group creative storytelling intervention used in residential care settings, on quality of life (QOL), interactions with caregivers, and Mini-Mental State Examination (MMSE) scores for persons with varying degrees of dementia severity. Design: A mixed-methods approach was used weekly over a 6-month period to measure QOL and resident-caregiver relationships. Setting: A dementia care unit in Pennsylvania. Participants: Twenty-two residents with mildto-severe dementia. Measurements: Dementia severity and QOL were assessed using the MMSE and Greater Cincinnati Chapter Well-Being Observational Tool. Resident-caregiver interactions were analyzed using a modified version of the Quality of Interactions Schedule. Semistructured interviews were conducted upon the study's conclusion. Results: Quantitatively, participants initially classified with mild-moderate dementia were significantly more likely to experience positive benefits compared to those initially classified with severe dementia. There were no significant changes in dementia severity over time. There was also no change in QOL or resident-caregiver relationships for those with mild-moderate dementia over time, although there was a decrease in certain measures of QOL and resident-caregiver relationships for those with severe dementia. Qualitative analysis identified consistent benefits for residents with both mild-moderate and severe dementia over time. Conclusions: Mixedmethods analyses helped identify benefits of TimeSlips for persons at all levels of dementia severity, but particularly for those with milder dementia. Such an observation helps demonstrate how arts-based programs like TimeSlips can uniquely benefit people with advanced memory impairments and thereby support QOL.

Internet technology makes information from both peer-reviewed sources and crowdsourced content, such as Wikipedia, instantly accessible. Health sciences education must adapt by providing learners with the skills needed to effectively and appropriately access and use information.In this article, we introduce a conceptual framework for teaching and learning using crowdsourced content. Using this framework, we show how educators can help learners develop the skills they need for critically assessing information quality, acquiring knowledge, and making clinical decisions.

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