Behaviour change interventions to influence antimicrobial prescribing: a cross-sectional analysis of reports from UK state-of-the-art scientific conferences

Background To improve the quality of antimicrobial stewardship (AMS) interventions the application of behavioural sciences supported by multidisciplinary collaboration has been recommended. We analysed major UK scientific research conferences to investigate AMS behaviour change intervention reporting. Methods Leading UK 2015 scientific conference abstracts for 30 clinical specialties were identified and interrogated. All AMS and/or antimicrobial resistance(AMR) abstracts were identified using validated search criteria. Abstracts were independently reviewed by four researchers with reported behavioural interventions classified using a behaviour change taxonomy. Results Conferences ran for 110 days with >57,000 delegates. 311/12,313(2.5%) AMS-AMR abstracts (oral and poster) were identified. 118/311(40%) were presented at the UK’s infectious diseases/microbiology conference. 56/311(18%) AMS-AMR abstracts described behaviour change interventions. These were identified across 12/30(40%) conferences. The commonest abstract reporting behaviour change interventions were quality improvement projects [44/56 (79%)]. In total 71 unique behaviour change functions were identified. Policy categories; “guidelines” (16/71) and “service provision” (11/71) were the most frequently reported. Intervention functions; “education” (6/71), “persuasion” (7/71), and “enablement” (9/71) were also common. Only infection and primary care conferences reported studies that contained multiple behaviour change interventions. The remaining 10 specialties tended to report a narrow range of interventions focusing on “guidelines” and “enablement”. Conclusion Despite the benefits of behaviour change interventions on antimicrobial prescribing, very few AMS-AMR studies reported implementing them in 2015. AMS interventions must focus on promoting behaviour change towards antimicrobial prescribing. Greater focus must be placed on non-infection specialties to engage with the issue of behaviour change towards antimicrobial use

Behavioral ontogeny in larvae and early juveniles of the giant trevally (Caranx ignobilis) (Pisces: Carangidae)

Behavior of young (8−18 mm SL) giant trevally (Caranx ignobilis), a large coral-reef−associated predator, was observed in the laboratory and the ocean. Size was a better predictor of swimming speed and endurance than was age. Critical speed increased with size from 12 to 40 cm/s at 2.7 cm/s for each mm increase in size. Mean scaled critical speed was 19 body lengths/s and was not size related. Swimming speed in the ocean was 4 to 20 cm/s (about half of critical speed) and varied among areas, but within each area, it increased at 2 cm/s for each mm increase in size. Swimming endurance in the laboratory increased from 5 to 40 km at 5 km for each mm increase in size. Vertical distribution changed ontogenetically: larvae swam shallower, but more variably, and then deeper with growth. Two-thirds of individuals swam directionally with no ontogenetic increase in orientation precision. Larvae swam offshore off open coasts, but not in a bay. In situ observations of C. ignobilis feeding, interacting with pelagic animals, and reacting to reefs are reported. Manus

Management of varices and variceal hemorrhage in cirrhosis

Variceal hemorrhage is a lethal complication of cirrhosis, particularly in patients in whom clinical decompensation (i.e., ascites, encephalopathy, a previous episode of hemorrhage, or jaundice) has already developed. Practice guidelines for the management of varices and variceal hemorrhage1 in cirrhosis are mostly based on evidence in the literature that has been summarized and prioritized at consensus conferences..

Balancing Market Share Growth and Customer Profitability: Budget Allocation for Customer Acquisition and Retention

This study adds to the knowledge of budget allocation for customer acquisition and retention spending in an inertia segment.  The results indicate that when retention spending surpassed the optimal budget allocation, increased spending did not grow the expected value of customer equity.  Since the inertia segment is comprised of loyal customers, an examination of brand equity and its role in customer loyalty and its influence on customer equity are discussed

Hypercalcaemia and in vitro osteolysis associated with xenografts of squamous carcinomas of the tongue.

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Upregulation of glycolysis and oxidative phosphorylation in benzo[β]pyrene and arsenic-induced rat lung epithelial transformed cells

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The Messy Teaching Conversation: Toward a Model of Collegial Reflection, Exchange, and Scholarship on Classroom Problems

Whether we teach in junior or senior colleges, we often represent our teaching in the best possible light, leaving little room for acknowledgment or discussion of uncertainty or errors. It seems that the only way to discuss a set back is as part of a larger narrative, one where a failure is simply a precursor to success, a way of highlighting a challenge overcome.This wall of silence about our messes prevents us from honestly discussing our day-to-day work in the classroom. This article models just such a messy teaching conversation

Rheology of Dense Bubble Suspensions

The rheological behavior of rapidly sheared bubble suspensions is examined through numerical simulations and kinetic theory. The limiting case of spherical bubbles at large Reynolds number Re and small Weber number We is examined in detail. Here, Re = p y a^2 / u and We = p y^2 a^3 / s, a being the bubble radius, g the imposed shear, s the interfacial tension, and m and r , respectively, the viscosity and density of the liquid. The bubbles are assumed to undergo elastic bounces when they come into contact; coalescence can be prevented in practice by addition of salt or surface-active impurities. The numerical simulations account for the interactions among bubbles which are assumed to be dominated by the potential flow of the liquid caused by the motion of the bubbles and the shear-induced collision of the bubbles. A kinetic theory based on Grad’s moment method is used to predict the distribution function for the bubble velocities and the stress in the suspension. The hydrodynamic interactions are incorporated in this theory only through their influence on the virtual mass and viscous dissipation in the suspension. It is shown that this theory provides reasonable predictions for the bubble-phase pressure and viscosity determined from simulations including the detailed potential flow interactions. A striking result of this study is that the variance of the bubble velocity can become large compared with (y a)^2 in the limit of large Reynolds number. This implies that the disperse-phase pressure and viscosity associated with the fluctuating motion of the bubbles is quite significant. To determine whether this prediction is reasonable even in the presence of nonlinear drag forces induced by bubble deformation, we perform simulations in which the bubbles are subject to an empirical drag law and show that the bubble velocity variance can be as large as 15 y^2 a^2