Determinants of antibiotic prescribing for upper respiratory tract infections in an emergency department with good primary care access: a qualitative analysis

Upper respiratory tract infections (URTIs) account for substantial attendances at emergency departments (EDs). There is a need to elucidate determinants of antibiotic prescribing in time-strapped EDs – popular choices for primary care despite highly accessible primary care clinics. Semi-structured in-depth interviews were conducted with purposively sampled physicians (n = 9) in an adult ED in Singapore. All interviews were analysed using thematic analysis and further interpreted using the Social Ecological Model to explain prescribing determinants. Themes included: (1) reliance on clinical knowledge and judgement, (2) patient-related factors, (3) patient–physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness. The physicians relied strongly on their clinical knowledge and judgement in managing URTI cases and seldom interfered with their peers’ clinical decisions. Despite departmental norms of not prescribing antibiotics for URTIs, physicians would prescribe antibiotics when faced with uncertainty in patients’ diagnoses, treating immunocompromised or older patients with comorbidities, and for patients demanding antibiotics, especially under time constraints. Participants had a preference for antibiotic prescribing guidelines based on local epidemiology, but viewed hospital policies on prescribing as a hindrance to clinical judgement. Participants highlighted the need for more public education and awareness on the appropriate use of antibiotics and management of URTIs. Organisational practice norms strongly influenced antibiotic prescribing decisions by physicians, who can be swayed by time pressures and patient demands. Clinical decision support tools, hospital guidelines and patient education targeting at individual, interpersonal and community levels could reduce unnecessary antibiotic use

Identification of Slow States at the SiO2/SiC Interface through Sub-Bandgap Illumination

We show that it is possible to obtain information relating to deep level interface traps, or so called ‘slow states’, by using the photo-CV characterisation method. Sub-bandgap illumination has been chosen in order to avoid band-to-band excitation for the creation of minority carriers. This enables information to be extracted from trapping states at the SiO2/SiC interface that are energetically deep within the band gap. Empirical observations of deep level trapping states with life times in the order of tens of hours are reported and the interface trap density as a function of energy has been extracted using the Terman method. Characterisation of these interface states will aid the development of new fabrication processes, with the aim of reducing the interface trap density to the same level as that of the SiO2/Si interface and facilitating the production of higher quality SiC based devices

Special fast diffusion with slow asymptotics. Entropy method and flow on a Riemannian manifold

We consider the asymptotic behaviour of positive solutions $u(t,x)$ of the fast diffusion equation $u_t=\Delta (u^{m}/m)={\rm div} (u^{m-1}\nabla u)$ posed for x\in\RR^d, $t>0$, with a precise value for the exponent $m=(d-4)/(d-2)$. The space dimension is $d\ge 3$ so that $m<1$, and even $m=-1$ for $d=3$. This case had been left open in the general study \cite{BBDGV} since it requires quite different functional analytic methods, due in particular to the absence of a spectral gap for the operator generating the linearized evolution. The linearization of this flow is interpreted here as the heat flow of the Laplace-Beltrami operator of a suitable Riemannian Manifold (\RR^d,{\bf g}), with a metric ${\bf g}$ which is conformal to the standard \RR^d metric. Studying the pointwise heat kernel behaviour allows to prove {suitable Gagliardo-Nirenberg} inequalities associated to the generator. Such inequalities in turn allow to study the nonlinear evolution as well, and to determine its asymptotics, which is identical to the one satisfied by the linearization. In terms of the rescaled representation, which is a nonlinear Fokker--Planck equation, the convergence rate turns out to be polynomial in time. This result is in contrast with the known exponential decay of such representation for all other values of $m$.Comment: 37 page

Rules, Standards, and the Internal Point of View

Large scale structure and cosmolog

Complex patterns of spontaneous initiations and terminations of reentrant circulation in a loop of cardiac tissue

A two-component model is developed that consists of a discrete loop of cardiac cells that circulates action potentials together with a cardiac pacing mechanism. Physiological properties of cells such as restitutions of refractoriness and of conduction velocity are given via experimentally measured functions. The dynamics of circulating pulses and their interactions with the pacer are regulated by two threshold relations. Patterns of spontaneous initiations and terminations of reentry (SITR) generated by this system are studied through numerical simulations and analytical observations. These patterns can be regular or irregular; causes of irregularities are identified as the threshold bistability of reentrant circulation (T-bistability) and in some cases, also phase-resetting interactions with the pacer.Comment: 27 pages, 10 figures, 61 references; A version of this paper (same results) is to appear in the Journal of Theoretical Biology; arXiv V2 adds helpful commments to facilitate reading and corrects minor errors in presentatio

Evaluation of a subunit H5 vaccine and an inactivated H5N2 avian influenza marker vaccine in ducks challenged with Vietnamese H5N1 highly pathogenic avian influenza virus

The protective efficacy of a subunit avian influenza virus H5 vaccine based on recombinant baculovirus expressed H5 haemagglutinin antigen and an inactivated H5N2 avian influenza vaccine combined with a marker antigen (tetanus toxoid) was compared with commercially available inactivated H5N2 avian influenza vaccine in young ducks. Antibody responses, morbidity, mortality, and virus shedding were evaluated after challenge with a Vietnamese clade 1 H5N1 HPAI virus [A/VN/1203/04 (H5N1)] that was known to cause a high mortality rate in ducks. All three vaccines, administered with water-in-oil adjuvant, provided significant protection and dramatically reduced the duration and titer of virus shedding in the vaccinated challenged ducks compared with unvaccinated controls. The H5 subunit vaccine was shown to provide equivalent protection to the other two vaccines despite the H5 antibody responses in subunit vaccinated ducks being significantly lower prior to challenge. Ducks vaccinated with the H5N2 marker vaccine consistently produced antitetanus toxoid antibody. The two novel vaccines have attributes that would enhance H5N1 avian influenza surveillance and control by vaccination in small scale and village poultry systems

Metabolic Syndrome and Cardiac Preventive Care: Nurses

Metabolic syndrome (MetSyn), a clustering of specific risk factors for cardiovascular disease and diabetes, is considered a growing worldwide epidemic

Knowledge Sharing Idiosyncrasies of University Students in Ghana

Part 6: Decision Making and Knowledge ManagementInternational audienceThis study explored the factors affecting knowledge sharing behaviour of students in a higher institution of learning. Using a model derived from the Social Cognitive Theory and the Theory of Reason Action, six hypotheses were tested from a cross-sectional data collected from 371 undergraduate students on a 4-year degree programme in the University of Ghana. Five out of the six hypotheses were supported. The results showed that the knowledge sharing behaviour (KSB) of the students was significantly related to five of the human and environmental factors (F=639.9, df=5, 290, p<0.05) with a co-efficient of variation of R2=0.917 (91.7%). The knowledge sharing behavior of the students was, however, not significantly dependent on their personal characteristics. The study makes a case for increased attention in understanding the human and environmental factors of knowledge sharing since knowledge sharing is largely a people activity shaped by culture