Reducing inappropriate antibiotics prescribing: The role of online commentary on physical examination findings

Objective: This study investigates the relationship of ‘online commentary’(contemporaneous physician comments about physical examination [PE] findings) with (i) parent questioning of the treatment recommendation and (ii) inappropriate antibiotic prescribing. Methods: A nested cross-sectional study of 522 encounters motivated by upper respiratory symptoms in 27 California pediatric practices (38 pediatricians). Physicians completed a post-visit survey regarding physical examination findings, diagnosis, treatment, and whether they perceived the parent as expecting an antibiotic. Taped encounters were coded for ‘problem’ online commentary (PE findings discussed as significant or clearly abnormal) and ‘no problem’ online commentary (PE findings discussed reassuringly as normal or insignificant). Results: Online commentary during the PE occurred in 73% of visits with viral diagnoses (n = 261). Compared to similar cases with ‘no problem’ online commentary, ‘problem’ comments were associated with a 13% greater probability of parents uestioning a non-antibiotic treatment plan (95% CI 0-26%, p = .05,) and a 27% (95% CI: 2-52%, p < .05) greater probability of an inappropriate antibiotic prescription. Conclusion: With viral illnesses, problematic online comments are associated with more pediatrician-parent conflict over non-antibiotic treatment recommendations. This may increase inappropriate antibiotic prescribing. Practice implications: In viral cases, physicians should consider avoiding the use of problematic online commentary

The influence of habitat quality on the foraging strategies of the entomopathogenic nematodes Steinernema carpocapsae and Heterorhabditis megidis

Entomopathogenic nematodes (EPN) are soil-transmitted parasites and their foraging strategies are believed to range from ‘ambush’ to ‘cruise’ foragers. However, research on their behaviour has not considered the natural habitat of these nematodes. We hypothesized that EPN behaviour would be influenced by soil habitat quality and tested this hypothesis using 2 EPN species Steinernema carpocapsae (an ‘ambusher’) and Heterorhabditis megidis (a ‘cruiser’) in 2 contrasting habitats, sand and peat. As predicted from previous studies, in sand most S. carpocapsae remained at the point of application and showed no taxis towards hosts, but in peat S. carpocapsae dispersed much more and showed a highly significant taxis towards hosts. H. megidis dispersed well in both media, but only showed taxis towards hosts in sand. In outdoor mesocosms in which both species were applied, S. carpocapsae outcompeted H. megidis in terms of host finding in peat, whereas the opposite was true in sand. Our data suggest that these 2 EPN may be habitat specialists and highlight the difficulties of studying soil-transmitted parasites in non-soil media

Scaffold searching: automated identification of similar ring systems for the design of combinatorial libraries

Rigid ring systems can be used to position receptor-binding functional groups in 3D space and they thus play an increasingly important role in the design of combinatorial libraries. This paper discusses the use of shape-similarity methods to identify ring systems that are structurally similar to, and aligned with, a user-defined target ring system. These systems can be used as alternative scaffolds for the construction of a combinatorial library

Displays and claims of understanding in conversation by people with aphasia

Background: There is scope for additional research into the specific linguistic and sequential structures used in speech and language therapist (SLT)-led therapeutic conversations with people with aphasia (PWA). Whilst there is some evidence that SLTs use different conversational strategies than the partners of PWA, research to date has focussed mainly on measuring the effects of conversation-based therapies—not on analysing therapeutic conversations taking place between SLTs and PWA. Aims: This paper presents an analysis of the use of oh-prefacing by some PWA during therapeutic supported conversations with SLTs. Methods & Procedures: Normally occurring therapeutic conversations between SLTs and PWA after stroke were qualitatively analysed using Conversation Analysis. Interactions with five PWA were video-recorded, involving three different specialist stroke SLTs. Outcomes & Results: The analysis revealed a difference in the way some PWA use turns that display understanding (e.g., oh right) versus those that continue the conversation, merely claiming understanding (e.g., right). This use of oh-prefacing is similar to that described in the literature on typical conversations. In our data, SLTs are shown to treat oh-prefaced turns differently from non-oh-prefaced turns, by pursuing the topic in the latter, and progressing on to a new topic in the former. Conclusions: At least some PWA use oh-prefacing in the same way as non-language-impaired adults to display understanding of information versus merely claiming to understand. The SLTs in our data are shown to treat non-oh-prefaced turns as mere claims of understanding by providing the PWA with additional information, using supported conversation techniques, and pursuing additional same-topic talk, whereas oh-prefaced turns are treated as displays of understanding by being confirmed, and leading to changes of topic. This study is a first step in providing SLTs with a clearer understanding of the ways in which they are assessing the understanding of PWA, which may in turn help them better support non-therapy staff

Walking the talent tightrope : becoming a 'top cop' in the Metropolitan Police Service (MPS)

Chief police officers represent a small cadre of individuals who have risen to occupy some of the most important and, arguably, testing roles within modern British public life, wielding a powerful influence over crime, security and safety in the UK. However, although there is now a significant body of research on policing, very little of it has focused on examining those who occupy the top ranks of the police service and the processes by which they are identified, selected, assessed and appointed. The purpose of this study is to consider what constitutes a ‘top cop’ within the modern Metropolitan Police Service (MPS) and to review the key steps in the chief officer selection and appointment process. Based upon an extensive literature review and confidential interviews with a sample of chief officers in the MPS, the research examines the backgrounds, experience and leadership qualities of the MPS chief officer team. It also explores their views on the challenges of modern policing, on key policing debates, such as direct entry, and the ‘system’ and processes that got them to where they are. Building on the works of Reiner (1991), Wall (1998) and Caless (2011), it is intended that this research study will shed some new light on this elite, but relatively undocumented group, which will be of interest to academics and practitioners alike, and also encourage others to undertake further research in this field. The study concludes by highlighting some key aspects of the chief officer selection and appointment process that are worth revisiting and refining in the face of the growing leadership challenges that policing faces at the top of the service. Specifically, the thesis sets out five recommendations for wider consideration by the police Human Resources (HR) community. These include: - The need to establish a national talent management approach to support the appointment and ongoing development of chief officers; - Commissioning research to define the leadership skills and experience that are required at chief officer level; - Introducing more robust evaluation and external validation into the chief officer selection and appointment process; - Reviewing and repositioning Direct Entry within the police service; - Reviewing the chief officer structure within the MP

Culture or communicative conflict? : The analysis of equivocation in broadcast Japanese political interviews

The focus of this article is on equivocation in Japanese televised interviews, broadcast over a 14-month period in 2012-2013 (before and after the general election of December 16, 2012). An analysis was conducted of responses to questions by three different groups (national politicians, local politicians, and nonpoliticians). Results showed a striking level of equivocation by both national and local politicians, who together equivocated significantly more than nonpoliticians. Furthermore, national level Diet members equivocated significantly more than local politicians, and both coalition groupings when in power were significantly more likely to equivocate than when in opposition. The results were interpreted in terms of the situational theory of communicative conflict and also in terms of cultural norms characteristic of Japanese politics and society. The failure to consider the role of such norms, it is proposed, represents an important omission in the original theory of equivocation