Developing and evaluating interventions to reduce inappropriate prescribing by general practitioners of antibiotics for upper respiratory tract infections: a randomised controlled trial to compare paper-based and web-based modelling experiments

Background: Much implementation research is focused on full-scale trials with little evidence of preceding modelling work. The Medical Research Council Framework for developing and evaluating complex interventions has argued for more and better theoretical and exploratory work prior to a trial as a means of improving intervention development. Intervention modelling experiments (IMEs) are a way of exploring and refining an intervention before moving to a full-scale trial. They do this by delivering key elements of the intervention in a simulation that approximates clinical practice by, for example, presenting general practitioners (GPs) with a clinical scenario about making a treatment decision. Methods: The current proposal will run a full, web-based IME involving 250 GPs that will advance the methodology of IMEs by directly comparing results with an earlier paper-based IME. Moreover, the web-based IME will evaluate an intervention that can be put into a full-scale trial that aims to reduce antibiotic prescribing for upper respiratory tract infections in primary care. The study will also include a trial of email versus postal invitations to participate. Discussion: More effective behaviour change interventions are needed and this study will develop one such intervention and a system to model and test future interventions. This system will be applicable to any situation in the National Health Service where behaviour needs to be modified, including interventions aimed directly at the public. Trial registration: ClinicalTrials (NCT): NCT0120673

Development of Conceptual Motivation Framework to Enhance Construction Labour Productivity in the UK

Motivation is essential because labour performance depends on motivation. The study presents vital motivation factors influencing labour productivity and the relationship between social compliance, motivation, and productivity for decision-making. The construction industry in the U.K. is to become the largest construction market by 2030. However, construction productivity in the U.K. is low relative to other industries, resulting in a skilled labour shortage and low productivity growth. Hence, the opportunities for research to improve productivity in constructing for the future through motivation by social compliance. The study conducts a critical literature review of 32 significant motivation and productivity articles from construction and other industries in an online database to identify 31 factors. The findings indicate that motivation mediates social compliance and productivity. The study developed a conceptual motivation framework that indicates a positive relationship with motivation, social compliance, and productivity. The next stage is empirically testing the framework on sites

Developing the content of two behavioural interventions : using theory-based interventions to promote GP management of upper respiratory tract infection without prescribing antibiotics #1

Background: Evidence shows that antibiotics have limited effectiveness in the management of upper respiratory tract infection (URTI) yet GPs continue to prescribe antibiotics. Implementation research does not currently provide a strong evidence base to guide the choice of interventions to promote the uptake of such evidence-based practice by health professionals. While systematic reviews demonstrate that interventions to change clinical practice can be effective, heterogeneity between studies hinders generalisation to routine practice. Psychological models of behaviour change that have been used successfully to predict variation in behaviour in the general population can also predict the clinical behaviour of healthcare professionals. The purpose of this study was to design two theoretically-based interventions to promote the management of upper respiratory tract infection (URTI) without prescribing antibiotics. Method: Interventions were developed using a systematic, empirically informed approach in which we: selected theoretical frameworks; identified modifiable behavioural antecedents that predicted GPs intended and actual management of URTI; mapped these target antecedents on to evidence-based behaviour change techniques; and operationalised intervention components in a format suitable for delivery by postal questionnaire. Results: We identified two psychological constructs that predicted GP management of URTI: "Self-efficacy," representing belief in one's capabilities, and "Anticipated consequences," representing beliefs about the consequences of one's actions. Behavioural techniques known to be effective in changing these beliefs were used in the design of two paper-based, interactive interventions. Intervention 1 targeted self-efficacy and required GPs to consider progressively more difficult situations in a "graded task" and to develop an "action plan" of what to do when next presented with one of these situations. Intervention 2 targeted anticipated consequences and required GPs to respond to a "persuasive communication" containing a series of pictures representing the consequences of managing URTI with and without antibiotics. Conclusion: It is feasible to systematically develop theoretically-based interventions to change professional practice. Two interventions were designed that differentially target generalisable constructs predictive of GP management of URTI. Our detailed and scientific rationale for the choice and design of our interventions will provide a basis for understanding any effects identified in their evaluation. Trial registration: Clinicaltrials.gov NCT00376142This study is funded by the European Commission Research Directorate as part of a multi-partner program: Research Based Education and Quality Improvement (ReBEQI): A Framework and tools to develop effective quality improvement programs in European healthcare. (Proposal No: QLRT-2001-00657)

Development of Conceptual Motivational Framework to Improve Construction Labour Productivity in the U.K.

The theoretical study presents vital motivational factors influencing labour productivity and understanding the relationship between motivation, social compliance, and labour productivity for decision-making. Labour motivation is essential because the quality of labour performance depends upon motivation. Labour who put forth more effort makes a big difference in company productivity. The construction industry in the U.K. is to become Europe’s largest construction market by 2030. However, the trend of construction industry productivity in the U.K. has been low relative to other industries resulting in a skilled labour shortage, project delays, high construction costs, and low productivity growth as foreign migrants execute most projects. The U.K. serves as a security for the concerns of Middle Eastern and other war-torn countries, including the effects of the Ukraine war. It is the largest market for U.S.A. service exports, thus accepting more migrants. Therefore, demands for housing projects are ever-increasing, leading to a rise in construction projects that present opportunities for research to improve productivity through motivation by enhancing social compliance. The findings indicate that motivation mediates social compliance and labour productivity and that the essential way to motivate labour is by upholding social compliance. The present study conducts a comprehensive literature review to identify motivational factors influencing labour productivity. The findings developed a conceptual motivational framework that indicates a positive relationship between motivation, social compliance, and labour productivity. The next level is to test the framework on construction sites empirically through pragmatism philosophy with quantitative and qualitative approaches

Using psychological theory to understand the clinical management of type 2 diabetes in Primary Care : a comparison across two European countries

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The development of a theory-based intervention to promote appropriate disclosure of a diagnosis of dementia

Background: The development and description of interventions to change professional practice are often limited by the lack of an explicit theoretical and empirical basis. We set out to develop an intervention to promote appropriate disclosure of a diagnosis of dementia based on theoretical and empirical work. Methods: We identified three key disclosure behaviours: finding out what the patient already knows or suspects about their diagnosis; using the actual words 'dementia' or 'Alzheimer's disease' when talking to the patient; and exploring what the diagnosis means to the patient. We conducted a questionnaire survey of older peoples' mental health teams (MHTs) based upon theoretical constructs from the Theory of Planned Behaviour (TPB) and Social Cognitive Theory (SCT) and used the findings to identify factors that predicted mental health professionals' intentions to perform each behaviour. We selected behaviour change techniques likely to alter these factors. Results: The change techniques selected were: persuasive communication to target subjective norm; behavioural modelling and graded tasks to target self-efficacy; persuasive communication to target attitude towards the use of explicit terminology when talking to the patient; and behavioural modelling by MHTs to target perceived behavioural control for finding out what the patient already knows or suspects and exploring what the diagnosis means to the patient. We operationalised these behaviour change techniques using an interactive 'pen and paper' intervention designed to increase intentions to perform the three target behaviours. Conclusion : It is feasible to develop an intervention to change professional behaviour based upon theoretical models, empirical data and evidence based behaviour change techniques. The next step is to evaluate the effect of such an intervention on behavioural intention. We argue that this approach to development and reporting of interventions will contribute to the science of implementation by providing replicable interventions that illuminate the principles and processes underlying change.This project is funded by UK Medical Research Council, Grant reference number G0300999. Jeremy Grimshaw holds a Canada Research Chair in Health Knowledge Transfer and Uptake. Jill Francis is funded by the Chief Scientist Office of the Scottish Government Health Directorate. The views expressed in this study are those of the authors

Laboratory electrical studies on the thermo-chemo-mechanics of faults and fault slip.

In nature, electrical signals have been recorded contemporaneously with volcanic and seismic activity, and have been proposed as precursors to earthquakes and volcanic eruptions. In the hydrocarbon industry, streaming potentials are used to investigate steam fronts, thus aiding enhanced oil recovery. There is therefore considerable current interest in electrical signals emanating from the Earth's crust and the mechanisms which give rise to them. Two of the theories that have been proposed to explain electrical signal generation are: The piezoelectric effect, caused by stress changes on piezoelectric minerals, such as quartz, which is found in many crustal rocks. The electrokinetic phenomenon, produced at a solid-liquid interface, where an electrokinetic current such as the streaming potential can be induced through a pressure, chemical or temperature gradient, resulting in electrical charge transport within the moving fluid. In order to investigate the possible mechanisms responsible for the generation of electrical signals in the Earth's crust, carefully controlled laboratory rock deformation and rock physics experiments have been performed under simulated shallow crustal conditions, where both electrical potential signals and acoustic emissions were measured. The deformation strain rate, confining pressure, pore fluid pressure, pore fluid chemistry and temperature were all varied systematically during conventional triaxial rock deformation tests on a range of rock types. Confining pressures were varied from 20 MPa to 100 MPa, pore fluid pressures from 5 MPa to 40 MPa, strain rates from 1.5 x 10"4 s"1 to 1.5 x 10"7 s"1 and temperatures from room temperature (25 C) up to 125 C. Over thirty five experiments were completed at room temperature on rock samples Clashach, Bentheim and Darley Dale sandstones and Portland limestone. More than ten experiments were done at elevated temperature on both dry and saturated samples of Clashach sandstone using a range of pore fluid chemistries. Significant developments in experimental apparatus were necessary for these latter experiments, including the design and construction of an electrical internal heater for the triaxial deformation cell. I identify that, for the temperature range between 25 and 125 C, that the primary sources of electrical potential signal generation are (i) piezoelectric in dry quartz-rich sandstone and (ii) electrokinetic in saturated samples of both sandstones and limestone. Factors that are found to influence the electrical potential signals during deformation include effective pressure, temperature, strain rate, pore fluid type and fluid flow. As failure is approached, both pre-seismic and co-seismic signals are observed with the magnitude of the signals varying with rock type. These observations can be explained by differences in the rock composition and variation in hydraulic and electrical pathways available for electric current flow during rock deformation. Variation in electrical potential difference can be seen during both the compactive and dilatant stages of deformation. At slower strain rates, local rock variation can be seen through changes in electrical potential signals which appear to be obscured at higher strain rates. The change in electrical and streaming potential signals during deformation reflect both the accumulating and accelerating damage identified by acoustic emission prior to fracture and the localisation of damage at dynamic fracture. After failure the potential decreases to a background value where it remains during constant frictional sliding at essentially constant stress. The presence of a crack or fault was identified to affect the electrical and streaming potential signals depending on their relative position with respect to the fault suggesting that electrical potential could be used as a method for fault location. An increase in temperature was found not to affect the mechanical properties within the range of experimental conditions explored. The effect of increased temperature on the electrical potential signals depends on the conditions applied to the rock such as thermal equilibrium times, deformation and ionic species within the pore fluid. If the rock is allowed to reach thermal equilibrium, the electrokinetic reactions between the solid-liquid interface are increased with an average electrical potential increase of 38 mV per 25 C. However, the new surfaces formed during rapid deformation cannot reach equilibrium, so that temperature has no effect on the electrical potential signals during compaction, dilatancy & failure. With this, the results as a whole suggest that in shallow crustal rocks, the change in electrical potential signal with temperature is below the background electrical noise level

Improving the delivery of care for patients with diabetes through understanding optimised team work and organisation in primary care

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Space Weather Effects on Mid-Latitude HF Propagation Paths: Observations and a Data-Driven D-Region Model

A two-pronged study is under way to improve understanding of the D region response to space weather and its effects on HF propagation. One part, the HF Investigation of D region Ionospheric Variation Experiment (HIDIVE), is designed to obtain simultaneous, quantitative propagation and absorption data from an HF signal monitoring network along with solar X-ray flux from the NOAA GOES satellites. Observations have been made continuously since late December 2002 and include the severe disturbances of October–November 2003. GOES satellite X-ray observations and geophysical indices are assimilated into the Data-Driven D Region (DDDR) electron density model developed as the second part of this project. ACE satellite proton observations, the HIDIVE HF observations, and possibly other real-time space weather data will be assimilated into DDDR in the future. Together with the Ionospheric Forecast Model developed by the Space Environment Corporation, DDDR will provide improved specification of HF propagation and absorption characteristics when supplemented by near-real-time propagation observations from HIDIVE

Academic Functioning and Mental Health in Adolescence

The current study examines patterns of academic functioning and mental health in 184 middle school children and the relation of such patterns to their prior and subsequent functioning. Data were collected from children during their second, third, fourth, eighth, and ninth grade school years. Cluster analyses were used to delineate patterns of academic functioning and mental health during eighth grade. The authors examined the relation of these patterns to academic functioning and mental health 1 year later the transition to high school, and then examined the long-term developmental roots of the eighth grade patterns using data collected during elementary school years. Results indicated variegated patterns of academic and emotional functioning at eighth grade and stability in these patterns across the high school transition. Some long-term continuity was found among children showing uniformly positive or negative functioning at eighth grade. Studying child functioning across multiple domains and time periods is discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68127/2/10.1177_0743558499142002.pd