General Practitioner Antimicrobial Stewardship Programme Study (GAPS): protocol for a cluster randomised controlled trial

Background There is a strong link between antibiotic consumption and the rate of antibiotic resistance. In Australia, the vast majority of antibiotics are prescribed by general practitioners, and the most common indication is for acute respiratory infections. The aim of this study is to assess if implementing a package of integrated, multifaceted interventions reduces antibiotic prescribing for acute respiratory infections in general practice. Methods/design This is a cluster randomised trial comparing two parallel groups of general practitioners in 28 urban general practices in Queensland, Australia: 14 intervention and 14 control practices. The protocol was peer-reviewed by content experts who were nominated by the funding organization. This study evaluates an integrated, multifaceted evidence-based package of interventions implemented over a six month period. The included interventions, which have previously been demonstrated to be effective at reducing antibiotic prescribing for acute respiratory infections, are: delayed prescribing; patient decision aids; communication training; commitment to a practice prescribing policy for antibiotics; patient information leaflet; and near patient testing with C-reactive protein. In addition, two sub-studies are nested in the main study: (1) point prevalence estimation carriage of bacterial upper respiratory pathogens in practice staff and asymptomatic patients; (2) feasibility of direct measures of antibiotic resistance by nose/throat swabbing. The main outcome data are from Australia’s national health insurance scheme, Medicare, which will be accessed after the completion of the intervention phase. They include the number of antibiotic prescriptions and the number of patient visits per general practitioner for periods before and during the intervention. The incidence of antibiotic prescriptions will be modelled using the numbers of patients as the denominator and seasonal and other factors as explanatory variables. Results will compare the change in prescription rates before and during the intervention in the two groups of practices. Semi-structured interviews will be conducted with the general practitioners and practice staff (practice nurse and/or practice manager) from the intervention practices on conclusion of the intervention phase to assess the feasibility and uptake of the interventions. An economic evaluation will be conducted to estimate the costs of implementing the package, and its cost-effectiveness in terms of cost per unit reduction in prescribing. Discussion The results on the effectiveness, cost-effectiveness, acceptability and feasibility of this package of interventions will inform the policy for any national implementation.

'Hero to healing' drink driving program for Indigenous communities in Far North Queensland

Issue addressed: Alcohol-related road crashes are a leading cause of the injury burden experienced by Indigenous Australians. Existing drink driving programs are primarily designed for the mainstream population. The ‘Hero to Healing’ program was specifically developed with Indigenous communities and is underpinned by the Community Reinforcement Approach (CRA). This paper reports on the formative evaluation of the program from delivery in two Far North Queensland communities. Methods: Focus groups and semistructured interviews were conducted with drink driver participants (n = 17) and other Elders and community members (n = 8) after each program. Qualitative content analysis was used to categorise the transcripts. Results: The CRA appealed to participants because of its flexible nature and encouragement of rearranging lifestyle factors, without specific focus on alcohol use. Participants readily identified with the social and peer-related risk and protective factors discussed. Cofacilitation of the program with Elders was identified as a key aspect of the program. More in-depth discussion about cannabis and driving, anger management skills and relationship issues are recommended. Conclusions: Participants’ recognition of content reinforced earlier project results, particularly the use of kinship pressure to motivate younger family members to drink drive. Study findings suggest that the principles of the CRA are useful; however, some amendments to the CRA components and program content were necessary. So what?: Treating drink driving in regional and remote Indigenous Australian communities as a community and social issue, rather than an individual phenomenon, is likely to lead to a reduction in the number of road-related injuries Indigenous people experience.

Comprehending adverbs of doubt and certainty in health communication: A multidimensional scaling approach

This research explored the feasibility of using multidimensional scaling (MDS) analysis in novel combination with other techniques to study comprehension of epistemic adverbs expressing doubt and certainty (e.g., evidently, obviously, probably) as they relate to health communication in clinical settings. In Study 1, Australian English speakers performed a dissimilarity-rating task with sentence pairs containing the target stimuli, presented as "doctors' opinions". Ratings were analyzed using a combination of cultural consensus analysis (factor analysis across participants), weighted-data classical-MDS, and cluster analysis. Analyses revealed strong within-community consistency for a 3-dimensional semantic space solution that took into account individual differences, strong statistical acceptability of the MDS results in terms of stress and explained variance, and semantic configurations that were interpretable in terms of linguistic analyses of the target adverbs. The results confirmed the feasibility of using MDS in this context. Study 2 replicated the results with Canadian English speakers on the same task. Semantic analyses and stress decomposition analysis were performed on the Australian and Canadian data sets, revealing similarities and differences between the two groups. Overall, the results support using MDS to study comprehension of words critical for health communication, including in future studies, for example, second language speaking patients and/or practitioners. More broadly, the results indicate that the techniques described should be promising for comprehension studies in many communicative domains, in both clinical settings and beyond, and including those targeting other aspects of language and focusing on comparisons across different speech communities.

Beyond Words : The European Court of Justice and Legal Certainty in Multilingual EU Law

This study addresses the issue of multilingualism in EU law. More specifically, it explores the implications of multilingualism for conceptualising legal certainty, a central principle of law both in domestic and EU legal systems. The main question addressed is how multilingualism and legal certainty may be reconciled in the EU legal system. The study begins with a discussion on the role of translation in drafting EU legislation and its implications for interpreting EU law at the European Court of Justice (ECJ). Uncertainty regarding the meaning of multilingual EU law and the interrelationship between multilingualism and ECJ methods of interpretation are explored. This analysis leads to questioning the importance of linguistic-semantic methods of interpretation, especially the role of comparing language versions for clarifying meaning and the ordinary meaning thesis, and to placing emphasis on other, especially the teleological, purpose-oriented method of interpretation. As regards the principle of legal certainty, the starting-point is a two-dimensional concept consisting of both formal and substantive elements; of predictability and acceptability. Formal legal certainty implies that laws and adjudication, in particular, must be predictable. Substantive legal certainty is related to rational acceptability of judicial decision-making placing emphasis on its acceptability to the legal community in question. Contrary to predictability that one might intuitively relate to linguistic-semantic methods of interpretation, the study suggests a new conception of legal certainty where purpose, telos, and other dynamic methods of interpretation are of particular significance for meaning construction in multilingual EU law. Accordingly, the importance of purposive, teleological interpretation as the standard doctrine of interpretation in a multilingual legal system is highlighted. The focus on rational, substantive acceptability results in emphasising discourse among legal actors among the EU legal community and stressing the need to give reasons in favour of proposed meaning in accordance with dynamic methods of interpretation including considerations related to purposes, aims, objectives and consequences. In this context, the role of ideal discourse situations and communicative action taking the form of interaction among the EU legal community in an ongoing dialogue especially in the preliminary ruling procedure is brought into focus. In order for this dialogue to function, it requires that the ECJ gives persuasive, convincing and acceptable reasons in justifying its decisions. This necessitates transparency, sincerity, and dialogue with the relevant audience.

Every method counts

In this study we explore the concurrent, combined use of three research methods, statistical corpus analysis and two psycholinguistic experiments (a forced-choice and an acceptability rating task), using verbal synonymy in Finnish as a case in point. In addition to supporting conclusions from earlier studies concerning the relationships between corpus-based and ex- perimental data (e. g., Featherston 2005), we show that each method adds to our understanding of the studied phenomenon, in a way which could not be achieved through any single method by itself. Most importantly, whereas relative rareness in a corpus is associated with dispreference in selection, such infrequency does not categorically always entail substantially lower acceptability. Furthermore, we show that forced-choice and acceptability rating tasks pertain to distinct linguistic processes, with category-wise in- commensurable scales of measurement, and should therefore be merged with caution, if at all.

Luotettavaa tietoa ja merkityksellisiä valintoja – Kuluttajien ympäristövastuullista järkeilyä ilmastonmuutoksesta ja ohjausjärjestelmien hyväksyttävyydestä

Tutkielmassa tarkastellaan kuluttajien näkemyksiä ilmastonmuutoksesta ja ilmastovaikutusten seuranta- ja palautejärjestelmän hyväksyttävyydestä kulutuksen ohjauskeinona. 15 kuluttajaa kokeili kuukauden ajan kulutuksen ilmastovaikutusten seuranta- ja palautejärjestelmän demonstraatioversiota ja he osallistuivat kokeilun pohjalta aihepiiriä käsitelleeseen verkkokeskusteluun. Analysoin verkkokeskustelun aineistoa arkisen järkeilyn näkökulmasta tutkien kuluttajien ilmastonmuutokseen ja ympäristövastuullisuuteen liittyvää arkitietoa sekä palvelun hyväksyttävyyteen liittyviä heuristiikkoja. Ilmastonmuutoksen todettiin yleisesti olevan vielä melko abstrakti ja monitulkintainen ilmiö, minkä vuoksi kuluttajilla on vaikeuksia ymmärtää omien valintojensa konkreettista merkitystä ilmastonmuutoksen kannalta. Vaikka tietoa kulutuksen ilmastovaikutuksista on saatavilla paljon, niin erityisesti yritysten tuottama tieto koettiin ristiriitaiseksi ja osin epäluotettavaksi. Kuluttajat myös kritisoivat ilmastonmuutoskeskustelun tarjoamaa kapeaa näkemystä kulutuksen ympäristövaikutuksista. Hiilidioksidipäästöihin keskittymisen sijaan ympäristövaikutuksia tulisi kuluttajien mielestä tarkastella kokonaisuutena, josta ilmastovaikutukset muodostavat vain yhden osan. Tutkimukseen osallistuneiden kuluttajien kulutustottumuksiin ilmastonmuutos vaikutti eriasteisesti. Toisille ilmastonmuutoksesta oli muodostunut keskeinen omaa kulutusta ohjaava normi, kun taas toiset kertoivat pohtivansa ilmastovaikutuksia pääasiassa suurimpien hankintojen kohdalla. Ympäristövastuullisuudessa merkitykselliseksi koettiin tasapainon löytäminen ja henkilökohtainen tunne siitä, että kokee toimivansa oikein. Ilmasto- tai ympäristökysymyksiä punnitaan valinnoissa joustavasti yhdessä muiden tekijöiden kanssa. Vaikka kuluttajilla toisaalta olisi tietoa ja halua ottaa ilmasto- ja ympäristövaikutukset huomioon valinnoissaan, toimintaympäristö rajaa keskeisesti kuluttajien mahdollisuuksia toimia ympäristövastuullisesti. Tutkimus toi esille neljä kuluttajien käyttämää heuristiikkaa heidän pohtiessaan ilmastovaikutusten seuranta- ja palautejärjestelmän hyväksyttävyyden ehtoja ja toimivuutta ohjauskeinona. Ensinnäkin palvelun tulee olla käytettävyydeltään nopea ja vaivaton sekä tarjota tietoa havainnollisessa ja helposti ymmärrettävässä muodossa. Toiseksi palvelun tarjoaman tiedon tulee olla ehdottoman luotettavaa ja kuluttajien valintojen kannalta merkityksellistä siten, että palvelu ottaa huomioon erilaiset kuluttajat ja tiedontarpeet. Kolmanneksi palvelu tulee toteuttaa kokonaisvaltaisesti ja läpinäkyvästi useampien kaupparyhmittymien ja julkisten toimijoiden yhteistyönä. Neljänneksi toteutuksessa tulee huomioda palvelun kannustavuus ja kytkeytyminen muihin ohjauskeinoihin.

Advances in storage batteries

Over the years, new power requirements for telecommunication, space, automotive and traction applications have arisen which need to be met. Although lead-acid and nickel-cadmium storage batteries continue to be the work horses with limited advances, associated environmental hazards and recycling are still the issues to be resolved. As a result, lead-acid and nickel-cadmium storage batteries have declined in importance whilst nickel-metal hydride and lithium secondary batteries with superior performances have shown greater acceptability in newer applications. These developments are reflected in this article.

Mathematical Analysis of Sensor Fusion for Intrusion Detection Systems

Fusion of multiple intrusion detection systems results in a more reliable and accurate detection for a wider class of intrusions. The paper presented here introduces the mathematical basis for sensor fusion and provides enough support for the acceptability of sensor fusion in performance enhancement of intrusion detection systems. The sensor fusion system is characterized and modeled with no knowledge of the intrusion detection systems and the intrusion detection data. The theoretical analysis is supported with an experimental illustration with three of the available intrusion detection systems using the DARPA 1999 evaluation data set.

A Durable RuO2-Carbon-Supported Pt Catalyst for PEFCs: A Cause and Effect Study

As Polymer Electrolyte Fuel Cells (PEFCs) are nearing the acceptable performance level for automotive and stationary applications, the focus on the research is shifting more and more toward enhancing their durability that still remains a major concern in their commercial acceptability. Hydrous ruthenium oxide (RuO2) is a promising material for pseudocapacitors due to its high stability, high specific-capacitance and rapid faradaic-reaction. Incorporation of carbon-supported RuO2 (RuO2/C) to platinum (Pt) is found to ameliorate both stability and catalytic activity of fuel cell cathodes that exhibit higher performance and durability in relation to Pt/C cathodes as evidenced by cell polarization, impedance and cyclic voltammetry data. The degradation in performance of Pt-RuO2/C cathodes is found to be only similar to 8% after 10000 accelerated stress test (AST) cycles as against similar to 60% for Pt/C cathodes after 7000 AST cycles under similar conditions. These data are in conformity with the Electrochemical Surface Area and impedance results. Interestingly, Pt-RuO2/C cathodes can withstand more than 10000 AST cycles with only a nominal loss in their performance. Studies on catalytic electrodes with X-ray diffraction, transmission electron microscopy and cross-sectional field-emission scanning electron microscopy reflect that incorporation of RuO2 to Pt helps mitigating aggregation of Pt particles and improves its stability during long-term operation of PEFCs. (C) 2012 The Electrochemical Society. DOI: 10.1149/2.jes113440] All rights reserved.

Detailed investigation of a gamma-cyclodextrin inclusion complex with L-thyroxine for improved pharmaceutical formulations

Thyroxine is a naturally occurring human hormone produced by the thyroid gland. Clinical applications of thyroxine to treat several chronic disorders are limited by poor water solubility and instability under physiological conditions. An inclusion complex of levo-thyroxine (l-thyroxine), the active form of the hormone with gamma cyclodextrin (gamma-CD) has been obtained and studied with the aim of improving oral delivery rather than the injection formulation of the sodium salt. In addition to greater patient acceptability, inclusion complexes often improve aqueous solubility and bioavailability, stability, and reduce toxicity of drugs, thus providing enhanced pharmaceutical formulations. Physicochemical characterization of the inclusion complex was carried out using Fourier transform infrared spectroscopy, X-ray diffractometry, differential scanning calorimetry, scanning electron microscopy and proton nuclear magnetic resonance spectroscopy. Intermolecular dipolar interactions for the inclusion complex were also studied using 2 dimensional ROESY experiments. Formation of the inclusion complex between the protons H3 and H5 of cyclodextrin with aromatic protons of thyroxine was confirmed by their dipolar interaction. Molecular modelling was used to understand the basis for the complex formation and predict the formation of other complexes. Interestingly, we found that l-thyroxine forms an inclusion complex only with the larger gamma-CD and not with other available alpha and beta forms.

Analysis of five glucometers available in India

In this study, we report on the accuracy, precision and clinical acceptability of the five blood glucose meters available in India. Glucose levels of 100 blood samples were measured with each meter, at IISc health centre laboratory under same conditions and the results were compared with laboratory reference standard. In order to calculate the coefficient of variation (CV), each sample was tested three times. None of the glucometer showed 100 % compliance on CV measure. In terms of accuracy, none of the glucometer satisfied the most stringent ADA-1994 standard. In general all the glucometers showed improved accuracy with respect to the most relaxed ISO 1597:2003 standard. The Clarke error grid analysis was performed to assess the clinical acceptability of the glucometers. All five glucometers had more than 90 % of test results in Zone A and B. Bland-Altman analysis indicates that all glucometers show a positive bias, indicating that the measured values tend to be higher than the laboratory reference standard.

Comportamiento prooxidante y antioxidante de hierbas aromáticas en queso

Los quesos de cabra, con mejores cualidades funcionales provienen de leche de cabras en pastoreo, esto obedece al mayor contenido de ácidos grasos ω-3 y ω-6 en una relación óptima para la salud, sumado a un menor contenido de grasa y colesterol. Saborizar quesos con especias, otorga beneficios sensoriales y saludables al producto. Las especias son usadas para realzar el flavor de los alimentos además presentan beneficios antioxidantes. Sin embargo, se reportaron evidencias del doble papel de los flavonoides como antioxidantes o prooxidantes en función de la concentración de uso. El objetivo del trabajo es evaluar el efecto de distintas concentraciones de especias aromáticas con capacidad antioxidante, frente a las reacciones de deterioro que ocurren en el almacenamiento de quesos de cabra. Se estudió la actividad antirradicalaria (AAR) de 18 especias. Para evaluar la actividad antioxidante (AA0) se usó la técnica de desaparición de un radical libre estable el 2,2-difenil-1-picril hidrazilo (DPPH) y se calculó la AAR porcentual. Definido el queso base estándar (control), se ensayaron tres variedades con especies, elegidas de entre las de mayor AAR (orégano, romero y tomillo) y se adicionaron con las concentraciones 0,4 – 1 % p/p. Estos, fueron madurados 30 días y almacenados 7 meses a 4 °C. Se analizaron cada 4 semanas. Se realizaron pruebas sensoriales de aceptabilidad con 60 consumidores de queso (condición), usando planillas, con escala hedónica. Se trabajó sobre los lípidos extraídos de los quesos. El rancidez y deterioro fueron evaluados con análisis de acidez; índice peróxido y sustancias reactivas al ácido TBA. Los resultados se compararon con el comportamiento sensorial del producto en el tiempo de almacenamiento. En los quesos adicionados al 1 %, la acidez se incrementó con el almacenamiento. El máximo valor corresponde al queso con orégano (3,72 % de ac. láctico a los 126 días). En el control, la acidez inicial fue inferior y alcanzó 1,05 g de ác. láctico % a los 166 días. El IP más alto corresponde a los quesos con orégano al 1% , resultado que se contrapone a la actividad antirradicalaria de esta especia. Al 0,4 %, tanto el IP como el número de TBA son menores en quesos adicionados, respecto del control. En los quesos de cabra analizados las especias agregadas al 1% ejercieron acción prooxidante, mientras que al ser agregadas al 0,4% la acción es antioxidante, lo que indica la importancia de la selección de concentraciones adecuadas.

Breed effect on quality veal production in mountain areas: Emphasis on meat

This study was designed to compare the quality of veal produced from ‘Tudanca x Charolais’ cross (n=6) and Limousin (n=6) breeds when allowed to feed freely on mountain pastures and suckle naturally from birth to 7 months of age. After 80 days of age calves also had access to concentrate (maximum of 3 Kg/day), while mothers did not. At slaughter, Limousin calves were heavier (P<0.01) and provided better carcass yield (P<0.05) and conformation (P<0.001) than Tudanca calves. Tudanca beef provided higher fat content (P<0.05) was less tough (P<0.05), and was scored as more tender and juicy (P<0.1) with higher acceptability than Limousin beef (P<0.1). In general, Tudanca had a better fatty acid profile than Limousin beef, especially in terms of the content of polyunsaturated (P<0.05), long-chain polyunsaturated fatty acids (P<0.05) and their n-6/n-3 ratios (P<0.1), as well as vaccenic acid (P<0.1) and the overall trans-18:1 isomer profile.

Aquiculture and Marketing of the Florida Bay Scallop in Crystal River, Florida

The overall goal of this study was to develop a new fishery resource product through open-water aquaculture for the west coast of Florida that would compete as a non-traditional product through market development. Specific objectives were as follows: I. To grow a minimum of 50, 000 juvenile scallops to a minimum market size of40 mm in a cage and float system in the off-shore waters of Crystal River, Florida. 2. To determine the growth rate, survival, and time to market size for the individuals in this system and area to other similar projects like Virginia. 3. To introduce local fishermen and the aquaculture students at Crystal River High School to the hatchery, nursery, and grow-out techniques. 4. To determine the economic and financial characteristics of bay scallop culture in Florida and assess the sensitivity of projected costs and earnings to changes in key technical, managerial, and market related parameters. 5. To determine the market acceptability and necessary marketing strategy for whole bay scallop product in Florida. (PDF has 99 pages)

Aquaculture and marketing of the Florida Bay Scallop in Crystal River, Florida

The overall goal of this study was to develop a new fishery resource product through open-water aquaculture for the west coast of Florida that would compete as a non-traditional product through market development. Specific objectives were as follows: I. To grow a minimum of 50, 000 juvenile scallops to a minimum market size of40 mm in a cage and float system in the off-shore waters of Crystal River, Florida. 2. To determine the growth rate, survival, and time to market size for the individuals in this system and area to other similar projects like Virginia. 3. To introduce local fishermen and the aquaculture students at Crystal River High School to the hatchery, nursery, and grow-out techniques. 4. To determine the economic and financial characteristics of bay scallop culture in Florida and assess the sensitivity of projected costs and earnings to changes in key technical, managerial, and market related parameters. 5. To determine the market acceptability and necessary marketing strategy for whole bay scallop product in Florida. (PDF has 99 pages.)