Trends and patterns in antibiotic prescribing among out-of-hours primary care providers in England, 2010–14

Objectives: Antimicrobial resistance is a global threat, increasing morbidity and mortality. In England, publicly funded clinical commissioning groups (CCGs) commission out-of-hours (OOH) primary care services outside daytime hours. OOH consultations represent 1% of in-hours general practice (GP) consultations. Antibiotic prescriptions increased 32% in non-GP community services between 2010 and 2013. We describe OOH antibiotic prescribing patterns and trends between 2010 and 2014. Methods: We: estimated the proportion of CCGs with OOH data available; described and compared antibiotic prescribing by volume of prescribed items, seasonality and trends in GP and OOH, using linear regression; and compared the proportion of broad-spectrum to total antibiotic prescriptions in OOHs with their respective CCGs in terms of seasonality and trends, using binomial regression. Results: Data were available for 143 of 211 (68%) CCGs. OOH antibiotic prescription volume represented 4.5%-5.4% of GP prescription volume and was stable over time ( P  =   0.37). The proportion of broad-spectrum antibiotic prescriptions increased in OOH when it increased in the CCG they operated in (regression coefficient 0.98; 95% CI 0.96-0.99). Compared with GP, the proportion of broad-spectrum antibiotic prescriptions in OOH was higher but decreased both in GP and OOH (-0.57%, 95% CI - 0.54% to - 0.6% and -0.76%, 95% CI - 0.59% to - 0.93% per year, respectively). Conclusions: OOH proportionally prescribed more antibiotics than GPs although we could not comment on prescribing appropriateness. OOH prescribing volume was stable over time, and followed GP seasonal patterns. OOH antibiotic prescribing reflected the CCGs they operated in but with relatively more broad-spectrum antibiotics than in-hours GP. Understanding factors influencing prescribing in OOH will enable the development of tailored interventions promoting optimal prescribing in this setting

Trajectories of distress and recovery, secondary stressors, and social cure processes in people who used the Resilience Hub after the Manchester Arena bombing

Background Terrorist incidents lead to a range of mental health outcomes for people affected, sometimes extending months and years after the event. Secondary stressors can exacerbate them, and social support can provide mitigation and aid recovery. There is a need to better understand the distress and mitigations among survivors of the Manchester Arena attack in 2017. Aims We explored three questions. First, what experiences of distress did participants report? Second, how might secondary stressors have influenced participants’ psychosocial recoveries? Third, what part has social support played in the relationships between distress and participants’ recovery trajectories? Method We conducted a cross-sectional online survey of a convenience sample of survivors of the Manchester bombing (N=84) in January 2021, 3 years 8 months post-incident, and a longitudinal study of the same participants’ scores on mental health measures over 3 years from September 2017. Results Survivors’ mental wellbeing scores in early 2021 were significantly lower than general population norms. Longitudinal follow-up provided evidence of enduring distress. Secondary stressors, specifically disruptions to close relationships, were associated with greater post-event distress and slower recovery. We found an indirect relationship between identifying with, and receiving support from others present at the Arena event and mental wellbeing more than 3 years later. Conclusions The Arena attack has had an enduring impact on mental health, even in survivors who had a mild response to the event. The quality of close relationships is pivotal to long-term outcome. Constructive support from families, and friends, and people with shared experiences are key to social cure processes that facilitate coping and recovery

Trajectories of distress and recovery, secondary stressors, and social cure processes in people who used the Resilience Hub after the Manchester Arena bombing

BackgroundTerrorist incidents lead to a range of mental health outcomes for people affected, sometimes extending months and years after the event. Secondary stressors can exacerbate them, and social support can provide mitigation and aid recovery. There is a need to better understand the distress and mitigations among survivors of the Manchester Arena attack in 2017.AimsWe explored three questions. First, what experiences of distress did participants report? Second, how might secondary stressors have influenced participants’ psychosocial recoveries? Third, what part has social support played in the relationships between distress and participants’ recovery trajectories? MethodWe conducted a cross-sectional online survey of a convenience sample of survivors of the Manchester bombing (N=84) in January 2021, 3 years 8 months post-incident, and a longitudinal study of the same participants’ scores on mental health measures over 3 years from September 2017.ResultsSurvivors’ mental wellbeing scores in early 2021 were significantly lower than general population norms. Longitudinal follow-up provided evidence of enduring distress. Secondary stressors, specifically disruptions to close relationships, were associated with greater post-event distress and slower recovery. We found an indirect relationship between identifying with, and receiving support from others present at the Arena event and mental wellbeing more than 3 years later.ConclusionsThe Arena attack has had an enduring impact on mental health, even in survivors who had a mild response to the event. The quality of close relationships is pivotal to long-term outcome. Constructive support from families, and friends, and people with shared experiences are key to social cure processes that facilitate coping and recovery.</p

Media 1: Fibre-coupled multiphoton microscope with adaptive motion compensation

Originally published in Biomedical Optics Express on 01 May 2015 (boe-6-5-1876

Media 2: Fibre-coupled multiphoton microscope with adaptive motion compensation

Originally published in Biomedical Optics Express on 01 May 2015 (boe-6-5-1876

Supplementary Video 1 from Optical Projection Tomography Implemented for Accessibility and Low-cost (OPTImAL)

Volumetric image of labelled vasculature in an in vivo fli:GFP zebrafish embryo reconstructed from 400 projection images recorded at 4x magnification. Rotating rendered view

Supplementary Video 2 from Optical Projection Tomography Implemented for Accessibility and Low-cost (OPTImAL)

Fixed mouse pancreas tissue, cleared using the FLASH protocol and imaged using Optical Projection Tomography, showing labelling for CK19 (blue channel), pancreatic amylase (green channel) and c-peptide (red channel). Recorded using the CellCam Kikker CMOS camera. Rotating rendered view

FISH_PROJ800_FLUO_part10

<p>Fluorescence data set with 800 projections, part 10 of 16.</p

FISH_PROJ800_TRANS_part3

<p>Transmission data set with 800 projections, part 3 of 16.</p

Supplementary Information and Figures from Optical Projection Tomography Implemented for Accessibility and Low-cost (OPTImAL)

Document containing supplementary information with links to online resources and additional figures to support the main paper.figures