Community-based prescribing for impetigo in remote Australia: An opportunity for antimicrobial stewardship

Background: To support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/ trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing. What we did: Finding a paucity of relevant research, we first investigated contextual factors influencing local prescribing. We also designed a systematic survey of experts with experience relevant to our setting using a structured response survey (12 questions) to better understand specific AMS risks. Using these findings, recommendations were formulated for the AMS Committee. What we learned: Prescribing recommendations in a regional Skin Infections Protocol had previously been altered in December 2014. From 15 experts, we received 9 comprehensive responses (60%) about AMS risks in community prescribing. If feasible, pre-scribing audits also would have been valuable. Ten recommendations regarding specific antibiotic recommendations were submitted to the AMS Committee. Strengthening AMS in remote settings: As AMS Committees in Australia usually focus on hospital-based prescribing, novel methods such as external expert opinion could inform delib-erations about community-based prescribing. Our approach meant that this AMS Committee was able to intervene in the 2017 organizational review of the regional Skin Infections Protocol used by prescribers likely unaware of AMS risks. This experience demonstrates the value of incorporating AMS principles in community-based prescribing in context of a remote setting

Athermal colorless C-band optical transmitter system for passive optical networks

This paper reports an uncooled transmitter system using a digital super-mode (DS) distributed Bragg reflector (DBR) tunable laser, which is able to act as an athermal, wavelength agnostic transmitter suitable for wavelength division multiplexed (WDM) passive optical network (PON) applications. An open-loop laser current control algorithm is designed to compensate autonomously for wavelength drift, thus allowing constant operating wavelength to be achieved regardless of ambient temperature. An improved wavelength accuracy of ±3 GHz is achieved when using low bandwidth feedback from the central office using information from a centralized shared wavelength locker. The entire laser start-up, channel selection and subsequent wavelength control is autonomous and has been implemented on micro-controllers and field programmable gate arrays. We demonstrate a three channel WDM-PON system comprising an uncooled packaged DS-DBR laser in the presence of two neighboring interfering channels. Error free transmission over 40 km single mode fiber of 10 Gb/s externally modulated NRZ data, is achieved for each of 48 C-band channels on the 100 GHz ITU grid. Successful athermal operation is demonstrated by sweeping the ambient temperature of the laser from 15 to 70 °C with a maximum wavelength deviation for any channel of no more than 0.1 nm.This work has been supported by the Technology Strategy Board, UK and by the German ministry for education and research, through the EU ERA-NET+ projects PIANO+ IMPACT (BMBF grant: 13N11434) and TUCAN (BMBF grant: 13N11573). We also acknowledge the support of the UK Engineering and Physical Sciences Research Council via the INTERNET project.This is the final version of the article. It first appeared from IEEE via http://dx.doi.org/10.1109/JLT.2014.235405

Religion as practices of attachment and materiality: the making of Buddhism in contemporary London

This article aims to explore Buddhism’s often-overlooked presence on London’s urban landscape, showing how its quietness and subtlety of approach has allowed the faith to grow largely beneath the radar. It argues that Buddhism makes claims to urban space in much the same way as it produces its faith, being as much about the practices performed and the spaces where they are enacted as it is about faith or beliefs. The research across a number of Buddhist sites in London reveals that number of people declaring themselves as Buddhists has indeed risen in recent years, following the rise of other non-traditional religions in the UK; however, this research suggests that Buddhism differs from these in several ways. Drawing on Baumann’s (2002) distinction between traditionalist and modernist approaches to Buddhism, our research reveals a growth in each of these. Nevertheless, Buddhism remains largely invisible in the urban and suburban landscape of London, adapting buildings that are already in place, with little material impact on the built environment, and has thus been less subject to contestation than other religious movements and traditions. This research contributes to a growing literature which foregrounds the importance of religion in making contemporary urban and social worlds

What makes you not a Buddhist? : a preliminary mapping of values

This study sets out to establish which Buddhist values contrasted with or were shared by adolescents from a non-Buddhist population. A survey of attitude toward a variety of Buddhist values was fielded in a sample of 352 non-Buddhist schoolchildren aged between 13 and 15 in London. Buddhist values where attitudes were least positive concerned the worth of being a monk/nun or meditating, offering candles & incense on the Buddhist shrine, friendship on Sangha Day, avoiding drinking alcohol, seeing the world as empty or impermanent and Nirvana as the ultimate peace. Buddhist values most closely shared by non-Buddhists concerned the Law of Karma, calming the mind, respecting those deserving of respect, subjectivity of happiness, welfare work, looking after parents in old age and compassion to cuddly animals. Further significant differences of attitude toward Buddhism were found in partial correlations with the independent variables of sex, age and religious affiliation. Correlation patterns paralleled those previously described in theistic religions. Findings are applied to spiritual, moral, social and cultural development and for the teaching of religious to pupils of no faith adherence. The study recommends that quantitative psychometrics employed to conceptualize Buddhist values by discriminant validity in this study could be extended usefully to other aspects of the study of Buddhism, particularly in quest of validity in the conceptualization of Buddhist identity within specifically Buddhist populations

Acute liver transplantation in a 41-year-old male patient presenting symptoms of adult-onset Still's disease

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The Williams Scale of Attitude toward Paganism: development and application among British Pagans

This article builds on the tradition of attitudinal measures of religiosity established by Leslie Francis and colleagues with the Francis Scale of Attitude toward Christianity (and reflected in the Sahin-Francis Scale of Attitude toward Islam, the Katz-Francis Scale of Attitude toward Judaism, and the Santosh-Francis Scale of Attitude toward Hinduism) by introducing a new measure to assess the attitudinal disposition of Pagans. A battery of items was completed by 75 members of a Pagan Summer Camp. These items were reduced to produce a 21-item scale that measured aspects of Paganism concerned with: the God/Goddess, worshipping, prayer, and coven. The scale recorded an alpha coefficient of 0.93. Construct validity of the Williams Scale of Attitude toward Paganism was demonstrated by the clear association with measures of participation in private rituals

A systematic review of interventions to improve knowledge and self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis

This systematic review aimed to determine the effectiveness of interventions for improving knowledge and/or self-management skills concerning contraception, pregnancy and breastfeeding in people with rheumatoid arthritis (RA). We searched four databases (MEDLINE, CINAHL, Cochrane Trials, PsycINFO) using a comprehensive search strategy. Studies were eligible if they were prospective, published in English from 2004 to 2015, included participants with RA and tested an intervention designed to improve knowledge and/or self-management skills relating to family planning, pregnancy or breastfeeding. As no studies met the latter criterion, the search strategy was expanded to include all prospective studies evaluating RA educational and/or self-management interventions. Data on study characteristics, participant characteristics and programme content were extracted to summarise the evidence base for interventions to support people with RA during their reproductive years. Expanded literature searches identified 2290 papers, of which 68 were eligible. Of these, nine papers (13 %) specifically excluded pregnant women/breastfeeding mothers or recruited only older people.Only one study (1 %) explicitly evaluated pregnancy-focused education via a motherhood decision aid, while eight studies (12 %) incorporated relevant (albeit minor) components within broader RA educational or self-management interventions. Of these, three studies provided methotrexate education in relation to conception/pregnancy/breastfeeding; three incorporated discussions on RA and relationships, impact of RA on the family or sexual advice; one provided information regarding contraception and fertility; and one issued a warning regarding use of biologic therapy in pregnancy/breastfeeding. In conclusion, information regarding family planning, pregnancy or breastfeeding represents a negligible part of published RA educational interventions, with scope to develop targeted resources