Written information for patients (or parents of child patients) to reduce the use of antibiotics for acute upper respiratory tract infections in primary care

BackgroundAcute upper respiratory tract infections (URTIs) are frequently managed in primary care settings. Although many are viral, and there is an increasing problem with antibiotic resistance, antibiotics continue to be prescribed for URTIs. Written patient information may be a simple way to reduce antibiotic use for acute URTIs. ObjectivesTo assess if written information for patients (or parents of child patients) reduces the use of antibiotics for acute URTIs in primary care. Search methodsWe searched CENTRAL, MEDLINE, Embase, CINAHL, LILACS, Web of Science, clinical trials.gov, and the World Health Organization (WHO) trials registry up to July 2016 without language or publication restrictions. Selection criteriaWe included randomised controlled trials (RCTs) involving patients (or parents of child patients) with acute URTIs, that compared written patient information delivered immediately before or during prescribing, with no information. RCTs needed to have measured our primary outcome (antibiotic use) to be included. Data collection and analysisTwo review authors screened studies, extracted data, and assessed study quality. We could not meta-analyse included studies due to significant methodological and statistical heterogeneity; we summarised the data narratively. Main resultsTwo RCTs met our inclusion criteria, involving a total of 827 participants. Both studies only recruited children with acute URTIs (adults were not involved in either study): 558 children from 61 general practices in England and Wales; and 269 primary care doctors who provided data on 33,792 patient-doctor consultations in Kentucky, USA. The UK study had a high risk of bias due to lack of blinding and the US cluster-randomised study had a high risk of bias because the methods to allocate participants to treatment groups was not clear, and there was evidence of baseline imbalance. In both studies, clinicians provided written information to parents of child patients during primary care consultations: one trained general practitioners (GPs) to discuss an eight-page booklet with parents; the other conducted a factorial trial with two comparison groups (written information compared to usual care and written information plus prescribing feedback to clinicians compared to prescribing feedback alone). Doctors in the written information arms received 25 copies of two-page government-sponsored pamphlets to distribute to parents. Compared to usual care, we found moderate quality evidence (one study) that written information significantly reduced the number of antibiotics used by patients (RR 0.53, 95% CI 0.35 to 0.80; absolute risk reduction (ARR) 20% (22% versus 42%)) and had no significant effect on reconsultation rates (RR 0.79, 95% CI 0.47 to 1.32), or parent satisfaction with consultation (RR 0.95, 95% CI 0.87 to 1.03). Low quality evidence (two studies) demonstrated that written information also reduced antibiotics prescribed by clinicians (RR 0.47, 95% CI 0.28 to 0.78; ARR 21% (20% versus 41%); and RR 0.84, 95% CI 0.81 to 0.86; 9% ARR (45% versus 54%)). Neither study measured resolution of symptoms, patient knowledge about antibiotics for acute URTIs, or complications for this comparison. Compared to prescribing feedback, we found low quality evidence that written information plus prescribing feedback significantly increased the number of antibiotics prescribed by clinicians (RR 1.13, 95% CI 1.09 to 1.17; absolute risk increase 6% (50% versus 44%)). Neither study measured reconsultation rate, resolution of symptoms, patient knowledge about antibiotics for acute URTIs, patient satisfaction with consultation or complications for this comparison. Authors' conclusionsCompared to usual care, moderate quality evidence from one study showed that trained GPs providing written information to parents of children with acute URTIs in primary care can reduce the number of antibiotics used by patients without any negative impact on reconsultation rates or parental satisfaction with consultation. Low quality evidence from two studies shows that, compared to usual care, GPs prescribe fewer antibiotics for acute URTIs but prescribe more antibiotics when written information is provided alongside prescribing feedback (compared to prescribing feedback alone). There was no evidence addressing resolution of patients' symptoms, patient knowledge about antibiotics for acute URTIs, or frequency of complications. To fill evidence gaps, future studies should consider testing written information on antibiotic use for adults with acute URTIs in high- and low-income settings provided without clinician training and presented in different formats (such as electronic). Future study designs should endeavour to ensure blinded outcome assessors. Study aims should include measurement of the effect of written information on the number of antibiotics used by patients and prescribed by clinicians, patient satisfaction, reconsultation, patients' knowledge about antibiotics, resolution of symptoms, and complications.</p

Family support and ease of access link socio-economic status and sports club membership in adolescent girls : a mediation study

Background Much research has been conducted into the determinants of physical activity (PA) participation among adolescent girls. However, the more specific question of what are the determinants of particular forms of PA participation, such as the link between participation through a sports club, has not been investigated. Accordingly, the aim of this study was to investigate the relationships between participation in a sports club and socio-economic status (SES), access to facilities, and family and peer support, for female adolescents.Methods A survey of 732 female adolescent school students (521 metropolitan, 211 non-metropolitan; 489 Year 7, 243 Year 11) was conducted. The survey included demographic information (living arrangements, ethnicity indicators, and indicators of SES such as parental education and employment status and locality); access to facilities; and family and peer support (travel, encouragement, watching, praise, joint participation). For each characteristic, sports club participants and non-participants were compared using chi-square tests. Multiple mediation analyses were used to investigate the role of access, family and peer support in the link between SES and sport participation.Results There were significant associations (p&lt;0.05) between sports club participation and: all demographic characteristics; all measures of family and peer support; and access to sport-related facilities. Highest levels of participation were associated with monolingual Australian-born families, with two parents, at least one of whom was well-educated, with both parents employed, and high levels of parental assistance, engagement and support. Participation in club sport among both younger and older adolescent girls was significantly positively associated with the SES of both their neighbourhoods and their households, particularly in metropolitan areas. These associations were most strongly mediated by family support and by access to facilities.Conclusions To facilitate and promote greater participation in club sport among adolescent girls from low SES neighbourhoods and households, strategies should target modifiable determinants such as facility access and parental support. This will involve improving access to sports facilities and promoting, encouraging and assisting parents to provide support for their daughters&rsquo; participation in sport clubs.<br /

Identification of potential signature whistles from free-ranging common dolphins (Delphinus delphis) in South Africa

Conveying identity is important for social animals to maintain individually based relationships. Communication of identity information relies on both signal encoding and perception. Several delphinid species use individually distinctive signature whistles to transmit identity information, best described for the common bottlenose dolphin (Tursiops truncatus). In this study, we investigate signature whistle use in wild common dolphins (Delphinus delphis). Acoustic recordings were analysed from 11 encounters from three locations in South Africa (Hout Bay, False Bay, and Plettenberg Bay) during 2009, 2016 and 2017. The frequency contours of whistles were visually categorised, with 29 signature whistle types (SWTs) identified through contour categorisation and a bout analysis approach developed specifically to identify signature whistles in bottlenose dolphins (SIGID). Categorisation verification was conducted using an unsupervised neural network (ARTwarp) at both a 91% and 96% vigilance parameter. For this, individual SWTs were analysed type by type and then in a ‘global’ analysis whereby all 497 whistle contours were categorised simultaneously. Overall the analysis demonstrated high stereotypy in the structure and temporal production of whistles, consistent with signature whistle use. We suggest that individual identity information may be encoded in these whistle contours. However, the large group sizes and high degree of vocal activity characteristic of this dolphin species generate a cluttered acoustic environment with high potential for masking from conspecific vocalisations. Therefore, further investigation into the mechanisms of identity perception in such acoustically cluttered environments is required to demonstrate the function of these stereotyped whistle types in common dolphins.This research (2014–2018) was supported by Sea Search Research and Conservation NPO and Grant 93689 to Simon Elwen from the South African National Research Foundation. For the data collected in Plettenberg Bay in 2009, funding was provided by the Russel Trust.http://link.springer.com/journal/100712020-06-08hj2019Mammal Research InstituteZoology and Entomolog

Effect of a Low–Resource-Intensive Lifestyle Modification Program Incorporating Gymnasium-Based and Home-Based Resistance Training on Type 2 Diabetes Risk in Australian Adults

OBJECTIVE—The purpose of this study was to assess the effectiveness of a low–resource-intensive lifestyle modification program incorporating resistance training and to compare a gymnasium-based with a home-based resistance training program on diabetes diagnosis status and risk

T-Duality and Penrose limits of spatially homogeneous and inhomogeneous cosmologies

Penrose limits of inhomogeneous cosmologies admitting two abelian Killing vectors and their abelian T-duals are found in general. The wave profiles of the resulting plane waves are given for particular solutions. Abelian and non-abelian T-duality are used as solution generating techniques. Furthermore, it is found that unlike in the case of abelian T-duality, non-abelian T-duality and taking the Penrose limit are not commutative procedures.Comment: 16 pages, 4 figures. Discussion on non-abelian T-duality expande

1956: Abilene Christian College Bible Lectures - Full Text

Golden Anniversary Edition featuring the theme THEY SHALL ALL BE TAUGHT OF GOD Price: $3.50 FIRM FOUNDATION PUBLISHING HOUSE Box 77 Austin, Texa

Search for CP Violation in the Decay Z -> b (b bar) g

About three million hadronic decays of the Z collected by ALEPH in the years 1991-1994 are used to search for anomalous CP violation beyond the Standard Model in the decay Z -> b \bar{b} g. The study is performed by analyzing angular correlations between the two quarks and the gluon in three-jet events and by measuring the differential two-jet rate. No signal of CP violation is found. For the combinations of anomalous CP violating couplings, ${\hat{h}}_b = {\hat{h}}_{Ab}g_{Vb}-{\hat{h}}_{Vb}g_{Ab}$ and $h^{\ast}_b = \sqrt{\hat{h}_{Vb}^{2}+\hat{h}_{Ab}^{2}}$, limits of \hat{h}_b < 0.59$and$h^{\ast}_{b} < 3.02$ are given at 95\% CL.Comment: 8 pages, 1 postscript figure, uses here.sty, epsfig.st

Non-Perturbative Dynamics in Supersymmetric Gauge Theories

I give an introductory review of recent, fascinating developments in supersymmetric gauge theories. I explain pedagogically the miraculous properties of supersymmetric gauge dynamics allowing one to obtain exact solutions in many instances. Various dynamical regimes emerging in supersymmetric Quantum Chromodynamics and its generalizations are discussed. I emphasize those features that have a chance of survival in QCD and those which are drastically different in supersymmetric and non-supersymmetric gauge theories. Unlike most of the recent reviews focusing almost entirely on the progress in extended supersymmetries (the Seiberg-Witten solution of N=2 models), these lectures are mainly devoted to N=1 theories. The primary task is extracting lessons for non-supersymmetric theories.Comment: 121 pages, LATEX, epsfig, 4 figures. Several typos corrected and references added. Extended version of lectures given at International School of Physics "Enrico Fermi", Varenna, Italy, July 3-6, 1995; Institute of Nuclear Science, UNAM, Mexico, April 11-17, 1996, and Summer School in High-Energy Physics and Cosmology, 10 - 26 July, 1996, ICTP, Triest, Ital