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

The interpretive approach to religious education : challenging Thompson's interpretation

In a recent book chapter, Matthew Thompson makes some criticisms of my work, including the interpretive approach to religious education and the research and activity of Warwick Religions and Education Research Unit. Against the background of a discussion of religious education in the public sphere, my response challenges Thompson’s account, commenting on his own position in relation to dialogical approaches to religious education. The article rehearses my long held view that the ideal form of religious education in fully state funded schools of a liberal democracy should be ‘secular’ but not ‘secularist’; there should be no implication of an axiomatic secular humanist interpretation of religions

Religion and religious education : comparing and contrasting pupils’ and teachers’ views in an English school

This publication builds on and develops the English findings of the qualitative study of European teenagers’ perspectives on religion and religious education (Knauth et al. 2008), part of ‘Religion in Education: A contribution to dialogue or a factor of conflict in transforming societies of European countries?’ (REDCo) project. It uses data gathered from 27 pupils, aged 15-16, from a school in a multicultural Northern town in England and compares those findings with data gathered from ten teachers in the humanities faculty of the same school, collected during research for the Warwick REDCo Community of Practice. Comparisons are drawn between the teachers’ and their pupils’ attitudes and values using the same structure as the European study: personal views and experiences of religion, the social dimension of religion, and religious education in school. The discussion offers an analysis of the similarities and differences in worldviews and beliefs which emerged. These include religious commitment/observance differences between the mainly Muslim-heritage pupils and their mainly non-practising Christian-heritage teachers. The research should inform the ways in which the statutory duties to promote community cohesion and equalities can be implemented in schools. It should also facilitate intercultural and interreligious understanding between teachers and the pupils from different ethnic and religious backgrounds

A double-blind, placebo-controlled, phase II, randomized study of lovastatin therapy in the treatment of mildly active rheumatoid arthritis

© 2019 The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. 3-hydroxy-3-methylglutaryl coenzyme-A (HMG Co-A) reductase inhibitors (statins) are standard treatment for hyperlipidaemia. In addition to lipid-lowering abilities, statins exhibit multiple anti-inflammatory effects. The objectives of this study were to determine whether treatment of patients with RA with lovastatin decreased CRP or reduced disease activity. Methods: We conducted a randomized double-blind placebo-controlled 12 week trial of lovastatin vs placebo in 64 RA patients with mild clinical disease activity but an elevated CRP. The primary efficacy end point was the reduction in mean log CRP. Secondary end points included disease activity, RF and anti-CCP antibody titres. Mechanistic end points included levels of serum cytokines. Safety was assessed; hepatic and muscle toxicities were of particular interest. Results: Baseline features were similar between groups. No significant difference in mean log CRP reduction between the two groups was observed, and disease activity did not change from baseline in either treatment group. Mechanistic analyses did not reveal significant changes in any biomarkers. A post hoc analysis of subjects not using biologic therapy demonstrated a significantly greater proportion achieving ≥20% reduction in CRP from baseline in the lovastatin group compared with placebo (P-value = 0.007). No difference was observed in subjects receiving biologics. Lovastatin was well tolerated with no serious safety concerns. Conclusion: This study showed no anti-inflammatory or clinical effects on RA disease activity after 12 weeks of treatment with lovastatin. Lovastatin had a modest effect on CRP in subjects not using biologics, suggesting statins may be anti-inflammatory in selected patients. Trial registration: ClinicalTrials.gov, http://clinicaltrials.gov, NCT00302952

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

Stereospecific Lasofoxifene Derivatives Reveal the Interplay between Estrogen Receptor Alpha Stability and Antagonistic Activity in <i>ESR1</i> Mutant Breast Cancer Cells

Chemical manipulation of estrogen receptor alpha ligand binding domain structural mobility tunes receptor lifetime and influences breast cancer therapeutic activities. Selective estrogen receptor modulators (SERMs) extend ERα cellular lifetime/accumulation. They are antagonists in the breast but agonists in the uterine epithelium and/or in bone. Selective estrogen receptor degraders/downregulators (SERDs) reduce ERα cellular lifetime/accumulation and are pure antagonists. Activating somatic ESR1 mutations Y537S and D538G enable resistance to first-line endocrine therapies. SERDs have shown significant activities in ESR1 mutant setting while few SERMs have been studied. To understand whether chemical manipulation of ERα cellular lifetime and accumulation influences antagonistic activity, we studied a series of methylpyrollidine lasofoxifene derivatives that maintained the drug’s antagonistic activities while uniquely tuning ERα cellular accumulation. These molecules were examined alongside a panel of antiestrogens in live cell assays of ERα cellular accumulation, lifetime, SUMOylation, and transcriptional antagonism. High-resolution x-ray crystal structures of WT and Y537S ERα ligand binding domain in complex with the methylated lasofoxifene derivatives or representative SERMs and SERDs show that molecules that favor a highly buried helix 12 antagonist conformation achieve the greatest transcriptional suppression activities in breast cancer cells harboring WT/Y537S ESR1. Together these results show that chemical reduction of ERα cellular lifetime is not necessarily the most crucial parameter for transcriptional antagonism in ESR1 mutated breast cancer cells. Importantly, our studies show how small chemical differences within a scaffold series can provide compounds with similar antagonistic activities, but with greatly different effects of the cellular lifetime of the ERα, which is crucial for achieving desired SERM or SERD profiles. SIGNIFICANCE This study shows that antiestrogens that enforce a wild-type-like estrogen receptor alpha antagonist conformation demonstrate improved therapeutic activities in hormone-resistant breast cancer cells harboring activating Y537S ESR1 mutant

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