Overtreatment of asymptomatic bacteriuria: a qualitative study

BACKGROUND Overtreatment of asymptomatic bacteriuria (ASB) is widespread and may result in antibiotic side-effects, excess costs to the healthcare system, and may potentially trigger antimicrobial resistance. According to international management guidelines, ASB is not an indication for antibiotic treatment (with few exceptions). AIM To determine reasons for using antibiotics to treat ASB in the absence of a treatment indication. METHODS A qualitative study was conducted at a tertiary care hospital in Switzerland during 2011. We interviewed 21 internal medicine residents and attending physicians selected by purposive sampling, using a semi-structured questionnaire. Responses were analysed in an inductive thematic content approach using dedicated software (MAXQDA(®)). FINDINGS In the 21 interviews, the following thematic rationales for antibiotic overtreatment of ASB were reported (in order of reporting frequency): (i) treating laboratory findings without taking the clinical picture into account (N = 17); (ii) psychological factors such as anxiety, overcautiousness, or anticipated positive impact on patient outcomes (N = 13); (iii) external pressors such as institutional culture, peer pressure, patient expectation, and excessive workload that interferes with proper decision-making (N = 9); (iv) difficulty with interpreting clinical signs and symptoms (N = 8). CONCLUSION In this qualitative study we identified both physician-centred factors (e.g. overcautiousness) and external pressors (e.g. excessive workload) as motivators for prescribing unnecessary antibiotics. Also, we interpreted the frequently cited practice of treating asymptomatic patients based on laboratory findings alone as lack of awareness of evidence-based best practices.

Beef production and the environment: Is it really 'hard to be green when you are in the red'?

The statement. 'it is hard to be green when you are in the red' is commonly used by pnmary producers to explain the necessity of placing a greater emphasis on financial survival rather than longer term environmental sustainability. The subject of environmental sustainabilty on pastoral properties was explored during face-to:face interviews with cattle graziers in the Filzroy Basin area of Central Queensland. Findings from the study suggest that while economic factors are important, they are not the only determinant in whether a landholder prioritises environmental sustainability, Rather. social factors such as knowledge claims. beliefs, attitudes. values, peer pressure and social sanctioning, constructed and enacted within the productivist paradigm of primary production. play a crucial role in how landholders manage their natural assets. This suggests that the edict that 'It is hard to be green when you are in the red' is inaccurate and does not explain why conservation-focused pastoral management is not yet occurring on a large scale

The impact of family forms on interpersonal influence between single parent and full families

The relationship between individual thoughts and the social environment has been widely studied in sociology (Weber, 1968), psychology (Lewin, 1951) and social psychology. The influence of reference groups on individual behaviour is often manifested in the decisions made by consumers while members of these reference groups are often the individual’s friends and acquaintances. Their decisions, their values and norms serve as an example for the individual. In this study the influences of reference groups are examined within the context of the family form in Hungary. The paper focuses on the nature of peer influence in single parent households and full families, to analyse the normative and informational dimensions of peer pressure and communication patterns within the family.

Black middle school students' perceptions of success and their influence on academic performance

The purpose of the study was to investigate the perceptions of success held by Black middle school students in a Miami-Dade County (FL) public school and how these perceptions influence academic performance. The study sought to determine if differences exist among African-American, Haitian-American, and Haitian immigrant subgroups of the Black student population. ^ The study combined qualitative and quantitative methodology in data collection and analysis. The qualitative data consisted of three focus group interviews. Using a semi-structured protocol, questions focused on the student's perceptions of the characteristics of successful people, definitions of success, behaviors associated with achieving success, and peer, family and school support. The quantitative data comprised the responses of 352 Black middle school students to the Inventory of Student Motivation (ISM) developed to measure mastery, performance and social goal orientations. Response similarities and differences were examined using a series of two-way ANOVAs on the success scales by gender and culture. A three-way repeated measures ANOVA was conducted on mastery, performance and social general goal scales by culture and gender. ^ The results of the ISM revealed no statistically significant differences among African-American, Haitian-American, and Haitian students in their mastery, performance or social goal orientations. All three cultural groups scored significantly high on the mastery goal scale. There was a significant effect for gender on the mastery general scale with the females being more concerned with mastery than the males. Qualitative focus group interview results included varying definitions of success. African-American and Haitian-American students defined success in materialistic terms. Haitian students defined success in scholastic achievement terms. All students indicated hard work, persistence and goal setting through completion as important to achieving success. Negative influences included peer pressure, teacher and societal expectations, and classroom environment. Parental reaction to low academic performance varied by culture. ^

Toward an understanding of how individuals overcome challenges to development: A phenomenological study of an inner -city student's attitude toward academic orientation and life

The purpose of this qualitative case study was to gain an understanding of the phenomenon of academic orientation by seeking the insights into an inner-city Haitian-American middle school student's attitudes and world view toward education and life. A phenomenological approach was used in order to explore the way in which Cindy, a minority student, gives meaning to her lived-experiences in terms of her desire to meet academic expectations and her ability to overcome social adversity and/or other risk factors.^ The study attempted to answer the following two research questions: (1) What provides the focus for Cindy's (the subject's) approach to her school work and/or life? (2) What are the processes that give meaning and direction to academic orientation and life for Cindy? In-depth interviewing was the primary method of data collection. In addition, journal and sketchbook entries and school district records were used and classroom observations made.^ The nature of the study to understand lived-experience facilitated the use of the case study method and a phenomenological method of description. Data analysis was conducted by means of an adapted form of the constant comparative approach. Patterns in the data which emerged were coded and categorized according to underlying generative themes. Phenomenological reflection and analysis were used to grasp the experiential structures of Cindy's experience. The following textural themes were identified and confirmed to be essential themes to Cindy's experience: personal challenge to do her best, personal challenge to want to learn, having a sense of determination, being able to think for self, having a disposition to like self, achieving self-respect through performance, seeing a need to help others, being intrinsically motivated, being an independent learner, attending more to academic pressure and less to peer pressure, having motivational catalysts in her life, learning and support opportunities, and having a self-culture. Using Mahrer's humanistic theory of experiencing, Cindy's development was interpreted in terms of her progression through a sequence of developmental plateaus: externalized self, internalized self, and integrating and actualizing self.^ The findings of this study were that Cindy's desire to meet academic expectations is guided by a meaning construction internal frame of reference. High expectations of self in conjunction with other protective factors found in Cindy's home and school environments were also found to be linked to her educational resilience and success. Cindy's lived-experiences were also found to be related to Mahrer's theory of human development. In addition, it was concluded that "minority" students do not all fit into social categories and labels. ^

Factors Impacting Grandparent and Grand Child Communication Across Sex- Related Topics in Kenya

Background: Although many studies have investigated sexual communication between parents and children in Kenya, none have focused singularly on grandparent and grandchild communication when grandparents are primary caregivers. Further, few studies have asked about specific topics related to sex, instead asking generally about “sex related topics” or focusing on HIV/AIDS. This research aims to investigate communication on ten specific sex- related topics between grandparents who are primary caregivers and their grandchildren. The primary research aim was to identify facilitators and barriers to grandparent-grandchild communication associated with frequency of communication. A secondary exploratory question was whether frequency of communication and youth satisfaction with communication were associated with youth’s desire for more communication in the future. Methods: The study was conducted in urban and peri-urban central Kenya. A convenience sample of 193 grandparents and 166 twelve to fifteen year old grandchildren were identified by community health workers. A cross sectional survey assessed nine potential barriers or facilitators to communication (e.g., frequency of communication, perceived grandparent knowledge, grandparent sense of responsibility to communication on a given topic) on ten specified sex- related topics (e.g., peer pressure on sex topics, romantic relationships, condoms). Bivariate and multivariable analyses identified significant associations between communication variables and the outcomes of interest. Results: Bivariate regression showed that higher grandchild age, grandchild gender, higher perceived grandparent knowledge, higher perceived grandparent comfort, higher grandparent-reported sense of responsibility, higher grandparent-reported belief that child should be aware of a given topic before initiating in sex, and higher youth’s own comfort during communication, were significantly associated with higher levels of communication frequency. In the multivariable model, higher grandchild age, gender, higher comfort during communication, and higher perceived grandparent knowledge remained significantly associated with higher levels communication frequency. For the secondary research question, higher communication frequency and higher levels of youth satisfaction were both significantly associated with higher levels of youth desire for more communication in bivariate regression, and higher levels of youth’s satisfaction with communication remained significantly associated with higher levels of youth’s desire for more in the adjusted analysis. Conclusions: This study found that several potential barriers and facilitators of communication are associated with both frequency of and youth’s desire for more communication. The association between grandchild age, gender and perceived grandparent knowledge and frequency of communication is similar to findings from other studies that have examined sex-related communication between parent primary caregivers and children. This finding has important implications for understanding grandparent and grandchild communication, and communication on specific topics in a population from Kenya. The positive association between youth satisfaction of and desire for more communication has important education policy and intervention implications, suggesting that if youth are satisfied with the communication with their caregivers, they may want to learn more.

Children of Matter: Luxury Value Perceptions of Millennials in Higher Education in Europe

In recent years, the luxury market has entered a period of very modest growth, which has been dubbed the ‘new normal’, where varying tourist flows, currency fluctuations, and shifted consumer tastes dictate the terms. The modern luxury consumer is a fickle mistress. Especially millennials – people born in the 1980s and 1990s – are the embodiment of this new form of demanding luxury consumer with particular tastes and values. Modern consumers, and specifically millennials, want experiences and free time, and are interested in a brand’s societal position and environmental impact. The purpose of this thesis is to investigate what the luxury value perceptions of millennials in higher education are in Europe, seeing as many of the most prominent luxury goods companies in the world originate from Europe. Perceived luxury value is herein examined from the individual’s perspective. As values and value perceptions are complex constructs, using qualitative research methods is justifiable. The data for thesis has been gathered by means of a group interview. The interview participants all study hospitality management in a private college, and each represent a different nationality. Cultural theories and research on luxury and luxury values provide the scientific foundation for this thesis, and a multidimensional luxury value model is used as a theoretical tool in sorting and analyzing the data. The results show that millennials in Europe value much more than simply modern and hard luxury. Functional, financial, individual, and social aspects are all present in perceived luxury value, but some more in a negative sense than others. Conspicuous, status-seeking consumption is mostly frowned upon, as is the consumption of luxury goods for the sake of satisfying social requisites and peer pressure. Most of the positive value perceptions are attributed to the functional dimension, as luxury products are seen to come with a promise of high quality and reliability, which justifies any price premiums. Ecological and ethical aspects of luxury are already a contemporary trend, but perceived even more as an important characteristic of luxury in the future. Most importantly, having time is fundamental. Depending on who is asked, luxury can mean anything, just as much as it can mean nothing.

Malnutrition and pressure ulcer risk in adults in Australian health care facilities

Aims To determine the effect of nutritional status on the presence and severity of pressure ulcers in statewide? public healthcare facilities, in Queensland, Australia. Research Methods A multicentre, cross sectional audit of nutritional status of a convenience sample of subjects was carried out as part of a large audit of pressure ulcers in a sample of state based public healthcare facilities in 2002 and 2003. Dietitians in 20 hospitals and six residential aged care facilities conducted single day nutritional status audits of 2208 acute and 839 aged care subjects using the Subjective Global Assessment. The effect of nutritional status on the presence, highest stage and number of pressure ulcers was determined by logistic regression in a model controlling for age, gender, medical specialty and facility location. The potential clustering effect of facility was accounted for in the model using an analysis of correlated data approach. Results Subjects with malnutrition had an adjusted odds risk of 2.6 (95% CI 1.8-3.5, p<0.001) of having a pressure ulcer in acute facilities and 2.0 (95% CI 1.5-2.7, p<0.001) for residential aged care facilities. There was also increased odds risk of having a pressure ulcer, having a higher stage pressure ulcer and a higher number of pressure ulcers with increased severity of malnutrition. Conclusion Malnutrition was associated with at least twice the odds risk of having a pressure ulcer of in public healthcare facilities in Queensland. Action must be taken to identify, prevent and treat malnutrition, especially in patients at risk of pressure ulcer.

The costs arising from pressure ulcers attributable to malnutrition

Aim To estimate the economic consequences of pressure ulcers attributable to malnutrition. Method Statistical models were developed to predict the number of cases of pressure ulcer, associated bed days lost and the dollar value of these losses in public hospitals in 2002/2003 in Queensland, Australia. The following input parameters were specified and appropriate probability distributions fitted • Number of at risk discharges per annum • Incidence rate for pressure ulcer • Attributable fraction of malnutrition in the development of pressure ulcer • Independent effect of pressure ulcer on length of hospital stay • Opportunity cost of hospital bed day One thousand random re-samples were made and the results expressed as (output) probabilistic distributions. Results The model predicts a mean 16060 (SD 5 671) bed days lost and corresponding mean economic cost of AU$12 968 668 (SD AU$4 924 148) (EUROS 6 925 268 SD 2 629 495; US$ 7 288 391 SD 2 767 371) of pressure ulcer attributable to malnutrition in 2002/2003 in public hospitals in Queensland, Australia. Conclusion The cost of pressure ulcer attributable to malnutrition in bed days and dollar terms are substantial. The model only considers costs of increased length of stay associated with pressure ulcer and not other factors associated with care.

The effect of hydrogel and silicone hydrogel contact lenses on the measurement of intraocular pressure with rebound tonometry

Purpose: To assess the accuracy of intraocular pressure(IOP) measurements using rebound tonometry over disposable hydrogel (etafilcon A) and silicone hydrogel (senofilcon A) contact lenses (CLs) of different powers. Methods: The experimental group comprised 36 subjects (19 male, 17 female). IOP measurements were undertaken on the subject’s right eyes in random order using a rebound tonometer (ICare). The CLs had powers of +2.00D, −2.00D and−6.00D. Six measurements were taken over each contact lens and also before and after the CLs had been worn. Results: A good correlation was found between IOP measurements with and without CLs (all r≥0.80; p < 0.05). Bland Altman plots did not show any significant trend in the difference in IOP readings with and without CLs as a function of IOP value. A two-way ANOVA revealed a significant effect of material and power (p < 0.01) but no interaction. All the comparisons between the measurements without CLs and with hydrogel CLs were significant (p < 0.01). The comparisons with silicone hydrogel CLs were not significant. Conclusions: Rebound tonometry can be reliably performed over silicone hydrogel CLs. With hydrogel CLs, the measurements were lower than those without CLs. However, despite the fact that these differences were statistically significant, their clinical significance was minimal.

Inter-cycle variability of in-cylinder pressure parameters in an ethanol fumigated common rail diesel engine

The effects of ethanol fumigation on the inter-cycle variability of key in-cylinder pressure parameters in a modern common rail diesel engine have been investigated. Specifically, maximum rate of pressure rise, peak pressure, peak pressure timing and ignition delay were investigated. A new methodology for investigating the start of combustion was also proposed and demonstrated—which is particularly useful with noisy in-cylinder pressure data as it can have a significant effect on the calculation of an accurate net rate of heat release indicator diagram. Inter-cycle variability has been traditionally investigated using the coefficient of variation. However, deeper insight into engine operation is given by presenting the results as kernel density estimates; hence, allowing investigation of otherwise unnoticed phenomena, including: multi-modal and skewed behaviour. This study has found that operation of a common rail diesel engine with high ethanol substitutions (>20% at full load, >30% at three quarter load) results in a significant reduction in ignition delay. Further, this study also concluded that if the engine is operated with absolute air to fuel ratios (mole basis) less than 80, the inter-cycle variability is substantially increased compared to normal operation.

Effect of temperature and moisture on high pressure lipid/oil extraction from microalgae

Commercially viable carbon–neutral biodiesel production from microalgae has potential for replacing depleting petroleum diesel. The process of biodiesel production from microalgae involves harvesting, drying and extraction of lipids which are energy- and cost-intensive processes. The development of effective large-scale lipid extraction processes which overcome the complexity of microalgae cell structure is considered one of the most vital requirements for commercial production. Thus the aim of this work was to investigate suitable extraction methods with optimised conditions to progress opportunities for sustainable microalgal biodiesel production. In this study, the green microalgal species consortium, Tarong polyculture was used to investigate lipid extraction with hexane (solvent) under high pressure and variable temperature and biomass moisture conditions using an Accelerated Solvent Extraction (ASE) method. The performance of high pressure solvent extraction was examined over a range of different process and sample conditions (dry biomass to water ratios (DBWRs): 100%, 75%, 50% and 25% and temperatures from 70 to 120 ºC, process time 5–15 min). Maximum total lipid yields were achieved at 50% and 75% sample dryness at temperatures of 90–120 ºC. We show that individual fatty acids (Palmitic acid C16:0; Stearic acid C18:0; Oleic acid C18:1; Linolenic acid C18:3) extraction optima are influenced by temperature and sample dryness, consequently affecting microalgal biodiesel quality parameters. Higher heating values and kinematic viscosity were compliant with biodiesel quality standards under all extraction conditions used. Our results indicate that biodiesel quality can be positively manipulated by selecting process extraction conditions that favour extraction of saturated and mono-unsaturated fatty acids over optimal extraction conditions for polyunsaturated fatty acids, yielding positive effects on cetane number and iodine values. Exceeding biodiesel standards for these two parameters opens blending opportunities with biodiesels that fall outside the minimal cetane and maximal iodine values.

Contraction/expansion flows: The pressure drop and related issues

Binding, David; Phillips, P.M.; Philips, T.N., (2006) 'Contraction/expansion flows: The pressure drop and related issues', Journal of Non-Newtonian Fluid Mechanics 137 pp.31-38 RAE2008

Pressure-induced amorphization and an amorphous-amorphous transition in densified porous silicon

Deb, S. K., Wilding, M. C., Somayazulu, M., McMillan, P. F. (2001). Pressure-induced amorphization and an amorphous-amorphous transition in densified porous silicon. Nature, 414, 528-530. RAE2008

The rheology of collapsing zeolites amorphized by temperature and pressure

Greaves, G.; Meneau, F.; ap Gwynn, I.A.; Wade, S., (2003). The rheology of collapsing zeolites amorphized by temperature and pressure. Nature Materials 2, 622-629. RAE2008