Australian consumer perspectives, attitudes and behaviours on antibiotic use and antibiotic resistance: A qualitative study with implications for public health policy and practice

© 2017 The Author(s). Background: Consumers receive over 27 million antibiotic prescriptions annually in Australian primary healthcare. Hence, consumers are a key group to engage in the fight against antibiotic resistance. There is a paucity of research pertaining to consumers in the Australian healthcare environment. This study aimed to investigate the perspectives, attitudes and behaviours of Australian consumers on antibiotic use and antibiotic resistance, to inform national programs for reducing inappropriate antibiotic consumption. Method: Semi-structured interviews with 32 consumers recruited via convenience and snowball sampling from a university population in South East Queensland. Interview transcripts were deductively and inductively coded. Main themes were identified using iterative thematic analysis. Results: Three themes emerged from the analysis, to elucidate factors affecting antibiotic use: (a) prescription type; (b) consumer attitudes, behaviours, skills and knowledge; and (c) consumer engagement with antibiotic resistance. Consumers held mixed views regarding the use of delayed antibiotic prescriptions, and were often not made aware of the use of repeat antibiotic prescriptions. Consumers with regular general practitioners were more likely to have shared expectations regarding minimising the use of antibiotics. Even so, advice or information mediated by general practitioners was influential with all consumers; and helped to prevent inappropriate antibiotic use behaviours. Consumers were not aware of the free Return of Unwanted Medicines service offered by pharmacies and disposed of leftover antibiotics through household waste. To engage with mitigating antibiotic resistance, consumers required specific information. Previous public health campaigns raising awareness of antibiotics were largely not seen by this sample of consumers. Conclusions: Australian consumers have specific information needs regarding prescribed antibiotics to enable appropriate antibiotic use behaviours. Consumers also have expectations for high quality general practice consults conducted in a manner that increases consumer confidence in the treatment decision, regardless of whether an antibiotic is prescribed. To reduce inappropriate consumption of antibiotics and to more fully engage Australian consumers in mitigating antibiotic resistance, changes in health policy and practice are required

Calcium effects on vascular endpoints

Abstract Calcium is one of the most abundant minerals in the body and its metabolism is one of the basic biologic processes in humans. Although historically linked primarily to bone structural development and maintenance, calcium is now recognized as a key component of many physiologic pathways necessary for optimum health including cardiovascular, neurological, endocrine, renal, and gastrointestinal systems. A recent meta-analysis published in August 2011 showed a potential increase in cardiovascular events related to calcium supplementation. The possible mechanism of action of this correlation has not been well elucidated. This topic has generated intense interest due to the widespread use of calcium supplements, particularly among the middle aged and elderly who are at the most risk from cardiac events. Prior studies did not control for potential confounding factors such as the use of statins, aspirin or other medications. These controversial results warrant additional well-designed studies to investigate the relationship between calcium supplementation and cardiovascular outcomes. The purpose of this review is to highlight the current literature in regards to calcium supplementation and cardiovascular health; and to identify areas of future research.Peer Reviewe

Protozoal Coinfection in Horses with Equine Protozoal Myeloencephalitis in the Eastern United States

Background: Infection by 2 or more protozoa is linked with increased severity of disease in marine mammals with protozoan encephalitis. Hypothesis/Objectives: To assess whether horses with equine protozoal myeloencephalitis (EPM) caused by Sarcocystis neurona also have evidence of infection with Neospora hughesi or Toxoplasma gondii. We hypothesized that horses with EPM would be more likely than horses with cervical vertebral stenotic myelopathy (CVSM) to be positive for antibodies to multiple protozoan parasites. Animals: One hundred one horses with neurologic disease: 49 with EPM and 52 with CVSM. Methods: Case review. Archived serum and cerebrospinal fluid (CSF) from 101 horses were examined. Inclusion criteria included neurologic disease, antemortem or postmortem diagnosis of EPM or CVSM, and availability of serological results or archived samples for testing. Additional testing for antibodies was performed on serum for T. gondii, as well as serum and CSF for N. hughesi. Results: Horses with EPM were more likely than horses with CVSM to have positive immunologic results for S. neurona on serum (95.9% versus 76.9%, P = .0058), CSF (98.0% versus 44.2%, P \u3c .00001), and serum : CSF titer ratio (91.8% versus 0%, P \u3c .00001). Positive results for Neospora and Toxoplasma were uncommon, with total seroprevalence rates of 12.9% and 14.9%, respectively. The proportions of EPM cases testing positive for Neospora and Toxoplasma (16% and 12%) were not different from the proportions of CVSM cases testing positive (10% and 17%, P = .31 and .47, respectively). Conclusion: Results do not indicate an important role for protozoal coinfection in EPM in the eastern United States

Calibration and quality assurance for rounded leaf‐end MLC systems

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/134970/1/mp3517.pd

Compact x-ray source based on burst-mode inverse Compton scattering at 100 kHz

A design for a compact x-ray light source (CXLS) with flux and brilliance orders of magnitude beyond existing laboratory scale sources is presented. The source is based on inverse Compton scattering of a high brightness electron bunch on a picosecond laser pulse. The accelerator is a novel high-efficiency standing-wave linac and RF photoinjector powered by a single ultrastable RF transmitter at x-band RF frequency. The high efficiency permits operation at repetition rates up to 1 kHz, which is further boosted to 100 kHz by operating with trains of 100 bunches of 100 pC charge, each separated by 5 ns. The entire accelerator is approximately 1 meter long and produces hard x-rays tunable over a wide range of photon energies. The colliding laser is a Yb:YAG solid-state amplifier producing 1030 nm, 100 mJ pulses at the same 1 kHz repetition rate as the accelerator. The laser pulse is frequency-doubled and stored for many passes in a ringdown cavity to match the linac pulse structure. At a photon energy of 12.4 keV, the predicted x-ray flux is $5 \times 10^{11}$ photons/second in a 5% bandwidth and the brilliance is $2 \times 10^{12}\mathrm{photons/(sec\ mm^2\ mrad^2\ 0.1\%)}$ in pulses with RMS pulse length of 490 fs. The nominal electron beam parameters are 18 MeV kinetic energy, 10 microamp average current, 0.5 microsecond macropulse length, resulting in average electron beam power of 180 W. Optimization of the x-ray output is presented along with design of the accelerator, laser, and x-ray optic components that are specific to the particular characteristics of the Compton scattered x-ray pulses.Comment: 25 pages, 24 figures, 54 reference

The high costs of getting ethical and site-specific approvals for multi-centre research.

BACKGROUND: Multi-centre studies generally cost more than single-centre studies because of larger sample sizes and the need for multiple ethical approvals. Multi-centre studies include clinical trials, clinical quality registries, observational studies and implementation studies. We examined the costs of two large Australian multi-centre studies in obtaining ethical and site-specific approvals. METHODS: We collected data on staff time spent on approvals and expressed the overall cost as a percent of the total budget. RESULTS: The total costs of gaining approval were 38 % of the budget for a study of 50 centres (mean cost AUD $6960 per site) and 2$2300 per site). Seventy-five and 90 % of time was spent on repeated tasks, respectively, and many time-consuming tasks, such as reformatting documents, did nothing to improve the study design or participant safety. CONCLUSIONS: Improvements have been made to the ethical approval application system, but more gains could be made without increasing risks of harm to research participants. We propose that ethical review bodies and individual sites publish statistics on how long they take to process approvals which could then be nationally benchmarked

The Sloan Lens ACS Survey. IX. Colors, Lensing and Stellar Masses of Early-type Galaxies

We present the current photometric dataset for the Sloan Lens ACS (SLACS) Survey, including HST photometry from ACS, WFPC2, and NICMOS. These data have enabled the confirmation of an additional 15 grade `A' (certain) lens systems, bringing the number of SLACS grade `A' lenses to 85; including 13 grade `B' (likely) systems, SLACS has identified nearly 100 lenses and lens candidates. Approximately 80% of the grade `A' systems have elliptical morphologies while ~10% show spiral structure; the remaining lenses have lenticular morphologies. Spectroscopic redshifts for the lens and source are available for every system, making SLACS the largest homogeneous dataset of galaxy-scale lenses to date. We have developed a novel Bayesian stellar population analysis code to determine robust stellar masses with accurate error estimates. We apply this code to deep, high-resolution HST imaging and determine stellar masses with typical statistical errors of 0.1 dex; we find that these stellar masses are unbiased compared to estimates obtained using SDSS photometry, provided that informative priors are used. The stellar masses range from 10^10.5 to 10^11.8 M$_\odot$ and the typical stellar mass fraction within the Einstein radius is 0.4, assuming a Chabrier IMF. The ensemble properties of the SLACS lens galaxies, e.g. stellar masses and projected ellipticities, appear to be indistinguishable from other SDSS galaxies with similar stellar velocity dispersions. This further supports that SLACS lenses are representative of the overall population of massive early-type galaxies with M* >~ 10^11 M$_\odot$, and are therefore an ideal dataset to investigate the kpc-scale distribution of luminous and dark matter in galaxies out to z ~ 0.5.Comment: 20 pages, 18 figures, 5 tables, published in Ap

Cost-Effectiveness of a national initiative to improve hand hygiene compliance using the outcome of healthcare associated staphylococcus aureus bacteraemia

© 2016 Graves et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Background The objective is to estimate the incremental cost-effectiveness of the Australian National Hand Hygiene Inititiave implemented between 2009 and 2012 using healthcare associated Staphylococcus aureus bacteraemia as the outcome. Baseline comparators are the eight existing state and territory hand hygiene programmes. The setting is the Australian public healthcare system and 1,294,656 admissions from the 50 largest Australian hospitals are included. Methods The design is a cost-effectiveness modelling study using a before and after quasi-experimental design. The primary outcome is cost per life year saved from reduced cases of healthcare associated Staphylococcus aureus bacteraemia, with cost estimated by the annual on-going maintenance costs less the costs saved from fewer infections. Data were harvested from existing sources or were collected prospectively and the time horizon for the model was 12 months, 2011-2012. Findings No useable pre-implementation Staphylococcus aureus bacteraemia data were made available from the 11 study hospitals in Victoria or the single hospital in Northern Territory leaving 38 hospitals among six states and territories available for cost-effectiveness analyses. Total annual costs increased by $2,851,475 for a return of 96 years of life giving an incremental cost-effectiveness ratio (ICER) of$29,700 per life year gained. Probabilistic sensitivity analysis revealed a 100% chance the initiative was cost effective in the AustralianCapital Territory and Queensland, with ICERs of $1,030 and$8,988 respectively. There was an 81% chance it was cost effective in New South Wales with an ICER of $33,353, a 26$64,729 and a 1% chance for Tasmania and Western Australia. The 12 hospitals in Victoria and the Northern Territory incur annual on-going maintenance costs of $1.51M; no information was available to describe cost savings or health benefits. Conclusions The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of$42,000 per life year gained. The return on investment varied among the states and territories of Australia