Clinician-targeted interventions to reduce antibiotic prescribing for acute respiratory infections in primary care:An overview of systematic reviews

This is the protocol for a review and there is no abstract. The objectives are as follows: To systematically review the literature and appraise the existing evidence from systematic reviews regarding the effects of interventions, aimed at changing clinician behaviour, to reduce antibiotic prescribing for ARIs in primary care

Continuous versus bolus intermittent loop diuretic infusion in acutely decompensated heart failure: a prospective randomized trial.

Intravenous loop diuretics are a cornerstone of therapy in acutely decompensated heart failure (ADHF). We sought to determine if there are any differences in clinical outcomes between intravenous bolus and continuous infusion of loop diuretics.Methods: Subjects with ADHF within 12 hours of hospital admission were randomly assigned to continuous infusion or twice daily bolus therapy with furosemide. There were three co-primary endpoints assessed from admission to discharge: the mean paired changes in serum creatinine, estimated glomerular filtration rate (eGFR), and reduction in B-type natriuretic peptide (BNP). Secondary endpoints included the rate of acute kidney injury (AKI), change in body weight and six months follow-up evaluation after discharge.Results: A total of 43 received a continuous infusion and 39 were assigned to bolus treatment. At discharge, the mean change in serum creatinine was higher (+0.8 ± 0.4 versus -0.8 ± 0.3 mg/dl P <0.01), and eGFR was lower (-9 ± 7 versus +5 ± 6 ml/min/1.73 m2P <0.05) in the continuous arm. There was no significant difference in the degree of weight loss (-4.1 ± 1.9 versus -3.5 ± 2.4 kg P = 0.23). The continuous infusion arm had a greater reduction in BNP over the hospital course, (-576 ± 655 versus -181 ± 527 pg/ml P = 0.02). The rates of AKI were comparable (22% and 15% P = 0.3) between the two groups. There was more frequent use of hypertonic saline solutions for hyponatremia (33% versus 18% P <0.01), intravenous dopamine infusions (35% versus 23% P = 0.02), and the hospital length of stay was longer in the continuous infusion group (14. 3 ± 5 versus 11.5 ± 4 days, P <0.03). At 6 months there were higher rates of re-admission or death in the continuous infusion group, 58% versus 23%, (P = 0.001) and this mode of treatment independently associated with this outcome after adjusting for baseline and intermediate variables (adjusted hazard ratio = 2.57, 95% confidence interval, 1.01 to 6.58 P = 0.04).Conclusions: In the setting of ADHF, continuous infusion of loop diuretics resulted in greater reductions in BNP from admission to discharge. However, this appeared to occur at the consequence of worsened renal filtration function, use of additional treatment, and higher rates of rehospitalization or death at six months

Kidney and Pancreas Transplantation in the United States, 1998–2007: Access for Patients with Diabetes and End-Stage Renal Disease

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73092/1/j.1600-6143.2009.02566.x.pd

Developing autonomous learning in first year university students using perspectives from positive psychology

Autonomous learning is a commonly occurring learning outcome from university study, and it is argued that students require confidence in their own abilities to achieve this. Using approaches from positive psychology, this study aimed to develop confidence in first‐year university students to facilitate autonomous learning. Psychological character strengths were assessed in 214 students on day one at university. Two weeks later their top three strengths were given to them in study skills modules as part of a psycho‐educational intervention designed to increase their self‐efficacy and self‐esteem. The impact of the intervention was assessed against a control group of 40 students who had not received the intervention. The results suggested that students were more confident after the intervention, and that levels of autonomous learning increased significantly compared to the controls. Character strengths were found to be associated with self‐efficacy, self‐esteem and autonomous learning in ways that were theoretically meaningful

Defining forgiveness: Christian clergy and general population perspectives.

The lack of any consensual definition of forgiveness is a serious weakness in the research literature (McCullough, Pargament &amp; Thoresen, 2000). As forgiveness is at the core of Christianity, this study returns to the Christian source of the concept to explore the meaning of forgiveness for practicing Christian clergy. Comparisons are made with a general population sample and social science definitions of forgiveness to ensure that a shared meaning of forgiveness is articulated. Anglican and Roman Catholic clergy (N = 209) and a general population sample (N = 159) completed a postal questionnaire about forgiveness. There is agreement on the existence of individual differences in forgiveness. Clergy and the general population perceive reconciliation as necessary for forgiveness while there is no consensus within psychology. The clergy suggests that forgiveness is limitless and that repentance is unnecessary while the general population suggests that there are limits and that repentance is necessary. Psychological definitions do not conceptualize repentance as necessary for forgiveness and the question of limits has not been addressed although within therapy the implicit assumption is that forgiveness is limitless.</p

Generators for the hyperelliptic Torelli group and the kernel of the Burau representation at t = -1

We prove that the hyperelliptic Torelli group is generated by Dehn twists about separating curves that are preserved by the hyperelliptic involution. This verifies a conjecture of Hain. The hyperelliptic Torelli group can be identified with the kernel of the Burau representation evaluated at t = −1 and also the fundamental group of the branch locus of the period mapping, and so we obtain analogous generating sets for those. One application is that each component in Torelli space of the locus of hyperelliptic curves becomes simply connected when curves of compact type are added

Properties of 3-manifolds for relativists

In canonical quantum gravity certain topological properties of 3-manifolds are of interest. This article gives an account of those properties which have so far received sufficient attention, especially those concerning the diffeomorphism groups of 3-manifolds. We give a summary of these properties and list some old and new results concerning them. The appendix contains a discussion of the group of large diffeomorphisms of the $l$-handle 3-manifold.Comment: 20 pages. Plain-TeX, no figures, 1 Table (A4 format