How did a Quality Premium financial incentive influence antibiotic prescribing in primary care? Views of Clinical Commissioning Group and general practice professionals

Background: The Quality Premium (QP) was introduced for Clinical Commissioning Groups (CCGs) in England to optimize antibiotic prescribing, but it remains unclear how it was implemented. Objectives: To understand responses to the QP and how it was perceived to influence antibiotic prescribing. Methods: Semi-structured telephone interviews were conducted with 22 CCG and 19 general practice professionals. Interviews were analysed thematically. Results: The findings were organized into four categories. (i) Communication: this was perceived as unstructured and infrequent, and CCG professionals were unsure whether they received QP funding. (ii) Implementation: this was influenced by available local resources and competing priorities, with multifaceted and tailored strategies seen as most helpful for engaging general practices. Many antimicrobial stewardship (AMS) strategies were implemented independently from the QP, motivated by quality improvement. (iii) Mechanisms: the QP raised the priority of AMS nationally and locally, and provided prescribing targets to aim for and benchmark against, but money was not seen as reinvested into AMS. (iv) Impact and sustainability: the QP was perceived as successful, but targets were considered challenging for a minority of CCGs and practices due to contextual factors (e.g. deprivation, understaffing). CCG professionals were concerned with potential discontinuation of the QP and prescribing rates levelling off. Conclusions: CCG and practice professionals expressed positive views of the QP and associated prescribing targets and feedback. The QP helped influence change mainly by raising the priority of AMS and defining change targets rather than providing additional funding. To maximize impact, behavioural mechanisms of financial incentives should be considered pre-implementation

Information Organization and Access in Digital Humanities: TaDiRAH Revised, Formalized and FAIR

Classifying and categorizing the activities that comprise the digital humanities (DH) has been a longstanding area of interest for many practitioners in this field, fueled by ongoing attempts to define the field both within the academic and public sphere. Several European initiatives are currently shaping advanced research infrastructures that would benefit from an implementation of a suiting taxonomy. Therefore, new humanities and information science collaborations have been formed to provide a service that meets their needs. This working paper presents the transformation of the Taxonomy of Digital Research Activities in the Humanities (TaDiRAH) in order to make it machine-readable and become a formalized taxonomy. This includes the methodology and realization containing a complete revision of the original version, decisions in modelling, the implementation as well as organization of ongoing and future tasks. TaDiRAH addresses a wide range of humanities disciplines and integrates application areas from philologies as well as epigraphy, and musicology to name just a few. For this reason, the decision in favor of SKOS was made purely pragmatically in terms of technology, concept and domains. New language versions can now be easily integrated and low-threshold term extensions can be carried out via Wikidata. The new TaDiRAH not only represents a knowledge organization system ( KOS ) which has recently been released as version 2.0. According to the FAIR principles this new version improves the Findability, Accessibility, Interoperability, and Reuse of research data and digital assets in the digital humanities

Enzymatic Activities of Isolated Cytochrome bc1-like Complexes Containing Fused Cytochrome b Subunits with Asymmetrically Inactivated Segments of Electron Transfer Chains

Homodimeric structure of cytochrome bc_1, a common component of biological energy conversion systems, builds in four catalytic quinone oxidation/reduction sites and four chains of cofactors (branches) that, connected by a centrally located bridge, form a symmetric H-shaped electron transfer system. The mechanism of operation of this complex system is under constant debate. Here, we report on isolation and enzymatic examination of cytochrome bc1-like complexes containing fused cytochrome b subunits in which asymmetrically introduced mutations inactivated individual branches in various combinations. The structural asymmetry of those forms was confirmed spectroscopically. All the asymmetric forms corresponding to cytochrome bc_1 with partial or full inactivation of one monomer retain high enzymatic activity but at the same time show a decrease in the maximum turnover rate by a factor close to 2. This strongly supports the model assuming independent operation of monomers. The cross-inactivated form corresponding to cytochrome bc_1 with disabled complementary parts of each monomer retains the enzymatic activity at the level that, for the first time on isolated from membranes and purified to homogeneity preparations, demonstrates that intermonomer electron transfer through the bridge effectively sustains the enzymatic turnover. The results fully support the concept that electrons freely distribute between the four catalytic sites of a dimer and that any path connecting the catalytic sites on the opposite sides of the membrane is enzymatically competent. The possibility to examine enzymatic properties of isolated forms of asymmetric complexes constructed using the cytochrome b fusion system extends the array of tools available for investigating the engineering of dimeric cytochrome bc1 from the mechanistic and physiological perspectives

Optimising antimicrobial stewardship interventions in English primary care: a behavioural analysis of qualitative and intervention studies

Objective: While various interventions have helped reduce antibiotic prescribing, further gains can be made. This study aimed to identify ways to optimise antimicrobial stewardship (AMS) interventions by assessing the extent to which important influences on antibiotic prescribing are addressed (or not) by behavioural content of AMS interventions. Settings: English primary care. Interventions: AMS interventions targeting healthcare professionals’ antibiotic prescribing for respiratory tract infections. Methods: We conducted two rapid reviews. The first included qualitative studies with healthcare professionals on self-reported influences on antibiotic prescribing. The influences were inductively coded and categorised using the Theoretical Domains Framework (TDF). Prespecified criteria were used to identify key TDF domains. The second review included studies of AMS interventions. Data on effectiveness were extracted. Components of effective interventions were extracted and coded using the TDF, Behaviour Change Wheel and Behaviour Change Techniques (BCTs) taxonomy. Using prespecified matrices, we assessed the extent to which BCTs and intervention functions addressed the key TDF domains of influences on prescribing. Results: We identified 13 qualitative studies, 41 types of influences on antibiotic prescribing and 6 key TDF domains of influences: ‘beliefs about consequences’, ‘social influences’, ‘skills’, ‘environmental context and resources’, ‘intentions’ and ‘emotions’. We identified 17 research-tested AMS interventions; nine of them effective and four nationally implemented. Interventions addressed all six key TDF domains of influences. Four of these six key TDF domains were addressed by 50%–67% BCTs that were theoretically congruent with these domains, whereas TDF domain 'skills' was addressed by 24% of congruent BCTs and 'emotions' by none. Conclusions: Further improvement of antibiotic prescribing could be facilitated by: (1) national implementation of effective research-tested AMS interventions (eg, electronic decision support tools, training in interactive use of leaflets, point-of-care testing); (2) targeting important, less-addressed TDF domains (eg, 'skills', 'emotions'); (3) using relevant, under-used BCTs to target key TDF domains (eg, ‘forming/reversing habits’, ‘reducing negative emotions’, ‘social support’). These could be incorporated into existing, or developed as new, AMS interventions

Optimising interventions for catheter-associated urinary tract infections (Cauti) in primary, secondary and care home settings

Catheter-associated urinary tract infections (CAUTI) are common yet preventable. Healthcare professional behaviours, such as reducing unnecessary catheter use, are key for preventing CAUTI. Previous research has focused on identifying gaps in the national response to CAUTI in multiple settings in England. This study aimed to identify how national interventions could be optimised. We conducted a multi-method study comprising: a rapid review of research on interventions to reduce CAUTI; a behavioural analysis of effective research interventions compared to national interventions; and a stakeholder focus group and survey to identify the most promising options for optimising interventions. We identified 37 effective research interventions, mostly conducted in United States secondary care. A behavioural analysis of these interventions identified 39 intervention components as possible ways to optimise national interventions. Seven intervention components were prioritised by stakeholders. These included: checklists for discharge/admission to wards; information for patients and relatives about the pros/cons of catheters; setting and profession specific guidelines; standardised nationwide computer-based documentation; promotion of alternatives to catheter use; CAUTI champions; and bladder scanners. By combining research evidence, behavioural analysis and stakeholder feedback, we identified how national interventions to reduce CAUTI could be improved. The seven prioritised components should be considered for future implementation

Ethylene-Vinyl Acetate Potential Problems for Photovoltaic Packaging: Preprint

Photovoltaic (PV) devices are typically encapsulated using ethylene-vinyl acetate (EVA) to provide mechanical support, optical coupling, electrical isolation, and protection against environmental exposure. Under exposure to atmospheric water and/or ultraviolet radiation, EVA will decompose to produce acetic acid, lowering the pH and increasing the surface corrosion rates of embedded devices. Even though acetic acid is produced at a very slow rate, it may not take much to catalyze reactions that lead to rapid module deterioration. Another consideration is that the glass transition of EVA, as measured using dynamic mechanical analysis, begins at temperatures of about ?15 C. Temperatures lower than this can be reached for extended periods of time in some climates. Because of increased moduli below the glass transition temperature, a module may be more vulnerable to damage if a mechanical load is applied by snow or wind at low temperatures. Modules using EVA should not be rated for use at such low temperatures without additional low-temperature mechanical testing beyond the scope of UL 1703

Potential Problems with Ethylene-Vinyl Acetate for Photovoltaic Packaging (Poster)

Photovoltaic (PV) devices are typically encapsulated using ethylene-vinyl acetate (EVA) to provide mechanical support electrical isolation, optical coupling, and protection against environmental exposure. Under exposure to atmospheric water and/or ultraviolet radiation, EVA will decompose to produce acetic acid, lowering the pH and increasing the surface corrosion rates of embedded devices. Even though acetic acid is produced at a very slow rate it may not take much to catalyze reactions that lead to rapid module deterioration. Another consideration is that the glass transition of EVA, as measured using dynamic mechanical analysis, begins at temperatures of about -15 C. Temperatures lower than this can be reached for extended periods of time in some climates. Due to increased moduli below the glass transition temperature, a module may be more vulnerable to damage if a mechanical load is applied by snow or wind at low temperatures. Modules using EVA should not be rated for use at such low temperatures without additional low-temperature mechanical testing beyond the scope of UL 1703

Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework

Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants' experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting 'Mechanisms of Action in Group-based Interventions' (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research