Let\u27s talk about antibiotics: A randomised trial of two interventions to reduce antibiotic misuse

BACKGROUND: Children with acute respiratory tract infections (ARTIs) receive ≈11.4 million unnecessary antibiotic prescriptions annually. A noted contributor is inadequate parent-clinician communication, however, efforts to reduce overprescribing have only indirectly targeted communication or been impractical. OBJECTIVES: Compare two feasible (higher vs lower intensity) interventions for enhancing parent-clinician communication on the rate of inappropriate antibiotic prescribing. DESIGN: Multisite, parallel group, cluster randomised comparative effectiveness trial. Data collected between March 2017 and March 2019. SETTING: Academic and private practice outpatient clinics. PARTICIPANTS: Clinicians (n=41, 85% of eligible approached) and 1599 parent-child dyads (ages 1-5 years with ARTI symptoms, 71% of eligible approached). INTERVENTIONS: All clinicians received 20 min ARTI diagnosis and treatment education. Higher intensity clinicians received an additional 50 min communication skills training. All parents viewed a 90 second antibiotic education video. MAIN OUTCOMES AND MEASURES: Inappropriate antibiotic treatment was assessed via blinded medical record review by study clinicians and a priori defined as prescriptions for the wrong diagnosis or use of the wrong agent. Secondary outcomes were revisits, adverse drug reactions (both assessed 2 weeks after the visit) and parent ratings of provider communication, shared decision-making and visit satisfaction (assessed at end of the visit on Likert-type scales). RESULTS: Most clinicians completed the study (n=38, 93%), were doctors (n=25, 66%), female (n=30, 78%) and averaged 8 years in practice. All parent-child dyad provided data for the main outcome (n=855 (54%) male, n=1043 (53%) CONCLUSIONS AND RELEVANCE: Rate of inappropriate prescribing was low in both arms. Clinician education coupled with parent education may be sufficient to yield low inappropriate antibiotic prescribing rates. The absence of a significant difference between groups indicates that communication principles previously thought to drive inappropriate prescribing may need to be re-examined or may not have as much of an impact in practices where prescribing has improved in recent years. TRIAL REGISTRATION NUMBER: NCT03037112

Conducting a Large Public Health Data Collection Project in Uganda: Methods, Tools, and Lessons Learned

We report on the implementation experience of carrying out data collection and other activities for a public health evaluation study on whether U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) investment improved utilization of health services and health system strengthening in Uganda. The retrospective study period focused on the PEPFAR scale-up, from mid-2005 through mid-2011, a period of expansion of PEPFAR programing and health services. We visited 315 health care facilities in Uganda in 2011 and 2012 to collect routine health management information system data forms, as well as to conduct interviews with health system leaders. An earlier phase of this research project collected data from all 112 health district headquarters, reported elsewhere. This article describes the lessons learned from collecting data from health care facilities, project management, useful technologies, and mistakes. We used several new technologies to facilitate data collection, including portable document scanners, smartphones, and web-based data collection, along with older but reliable technologies such as car batteries for power, folding tables to create space, and letters of introduction from appropriate authorities to create entrée. Research in limited-resource settings requires an approach that values the skills and talents of local people, institutions and government agencies, and a tolerance for the unexpected. The development of personal relationships was key to the success of the project. We observed that capacity building activities were repaid many fold, especially in data management and technology

Depicting the tree of life in museums: guiding principles from psychological research

The Tree of Life is revolutionizing our understanding of life on Earth, and, accordingly, evolutionary trees are increasingly important parts of exhibits on biodiversity and evolution. The authors argue that in using these trees to effectively communicate evolutionary principles, museums need to take into account research results from cognitive, developmental, and educational psychology while maintaining a focus on visitor engagement and enjoyment. Six guiding principles for depicting evolutionary trees in museum exhibits distilled from this research literature were used to evaluate five current or recent museum trees. One of the trees was then redesigned in light of the research while preserving the exhibit’s original learning goals. By attending both to traditional factors that influence museum exhibit design and to psychological research on how people understand diagrams in general and Tree of Life graphics in particular, museums can play a key role in fostering 21st century scientific literacy

The noise-lovers: cultures of speech and sound in second-century Rome

This chapter provides an examination of an ideal of the ‘deliberate speaker’, who aims to reflect time, thought, and study in his speech. In the Roman Empire, words became a vital tool for creating and defending in-groups, and orators and authors in both Latin and Greek alleged, by contrast, that their enemies produced babbling noise rather than articulate speech. In this chapter, the ideal of the deliberate speaker is explored through the works of two very different contemporaries: the African-born Roman orator Fronto and the Syrian Christian apologist Tatian. Despite moving in very different circles, Fronto and Tatian both express their identity and authority through an expertise in words, in strikingly similar ways. The chapter ends with a call for scholars of the Roman Empire to create categories of analysis that move across different cultural and linguistic groups. If we do not, we risk merely replicating the parochialism and insularity of our sources.Accepted manuscrip

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

New Zealanders discuss the economic and social issues of state-funded income support in retirement : a thesis presented in partial fulfilment of the requirements for the degree of Master of Arts in Psychology at Massey University, Palmerston North, New Zealand

The New Zealand government provides a universal pension to citizens over the age of sixty-five years. The basis for this is widely understood as a ‘social contract’ between generations in which tax-payers fund income support for the older generation of the day. As demographics shift markedly towards an older population, concerns about the future cost of pensions are apparent in New Zealand politics, media and everyday conversations. Data for this project was collected from two newspaper articles that discussed the future cost of pensions, and from 233 online public responses to these articles. Rhetorical analyses of both the articles and the public responses were undertaken. The results consisted of three main findings. Firstly, accounts that emphasised intergenerational inequity generated antagonism and widened divisions between generational groups. Secondly, New Zealanders prominently constructed the state-funded pension as a return for a lifetime of economic contributions. Lastly the discussions of New Zealanders reflected a shift in understandings about the responsibility for the funding of income in retirement, with expectations that individuals should prepare financially for their own retirement apparent. These understandings around income support for older people appear incongruent with the current universal pension, and raise questions about its status. The focus on intergenerational issues may overlook other kinds of inequity in retirement. The invocation of economic contributions as the basis for pension deservingness has implications for those without a steady history of paid work

INFORMATION NEEDS OF ORGANIC FARMERS

Information is a key input into all conventional and organic farming systems. Organic production systems are low-input and intensive, requiring a thorough and detailed knowledge of the farming system and of organic production methods. This paper compares the processes involved in information flow into organic and conventional farming systems and argues that the adoption-diffusion model of technology transfer is even less appropriate for organic producers than conventional. Models of a participatory or interdependent nature are likely to be more useful. It is argued that the viability of the industry is likely to depend on the development of methods of information flow which are appropriate for both producers and their systems

The commercial paper market since the mid-seventies

Negotiable instruments ; Commercial paper issues

ACTION RESEARCH AS A MECHANISM FOR CLIENT-DRIVEN DEVELOPMENT

The New Zealand dairy industry is viewed, and views itself, as having a progressive approach to scientific research and the acquisition and adoption of technology. It is also generally accepted that, in order to remain competitive in international markets, technological improvement is a continual necessity. In each component of the industry/system - producer (farms), processor (co-operatives, manufacturing), researchers, extensionists/consultants and marketers (NZ Dairy Board, statutory authority) - practitioners deal regularly with issues requiring solution. However each has a different W (world view) and successful outcomes for one are not necessarily so for the others. For producer practitioners the management issue may be one of seeking solutions to problematic situations by adapting known technology to their own production circumstances. The dairy industry model for this process is the research-consultant/extensionist-producer system. The industry view is that this process has been effective in “transferring” only some of the technologies which are viewed as important for the survival and development of the industry. The paper builds on a project in which a group of dairy-farming women worked with two researchers on a particular technical problem. Using action research (AR) as a framework the group devised a problem-solving process that was structured around three elements; consultancy advice, research findings and self-directed learning in a structurally coupled action researching system. The paper describes the model that was developed, where AR provided a framework for client-centred research and consulting. The authors suggest that this model may contribute to the growth of the dairy system in a way that builds on the respective strengths of consultants, researchers and producers

The commercial paper market

Commercial paper issues ; Commercial paper issues - Ratings