Predictors of an antibiotic prescription by GPs for respiratory tract infections: a pilot

Background. Antibiotics are over-prescribed for respiratory tract infections in Australia. Objectives. The aim of this study was to describe the clinical predictors of GPs' prescribing of antibiotics. Methods. We used Clinical Judgment Analysis to study the responses of GPs to hypothetical paper-based vignettes of a 20-year-old with a respiratory tract infection. The nature of four symptoms and signs (colour of nasal mucous discharge; soreness of the throat; presence of fever; and whether any cough was productive of sputum) was varied and their effect on prescribing measured using logistic regression. Results. Twenty GPs participated. The nature of each symptom and sign significantly predicted prescribing of an antibiotic. Cough productive of yellow sputum; presence of sore throat; fever; and coloured nasal mucus increased the probability of an antibiotic being prescribed. Conclusions. GPs are influenced by clinical signs and symptoms to use antibiotics for respiratory infections for which there is poor evidence of efficacy from the literature.

Predictors of emotional well-being following a 'false positive' breast cancer screening result

Using a short-term longitudinal design, and consistent with a stress and coping perspective, this study examined the main and stress-buffering effects of social support and coping on emotional well-being following a 'false positive' breast cancer screening result. Immediately prior to obtaining results of follow-up assessment, 178 women completed measures of emotional well-being, stress appraisal, coping strategies and social support. Six weeks later, 85 women found to be cancer free completed a measure of well-being. Hierarchical regression analyses were used to examine the effects of social support and coping on well-being after controlling for initial well-being and stress appraisal. Consistent with predictions, avoidant coping was associated with higher levels of emotional well-being and social support was found to have a stress buffering effect on well-being. Active-cognitive coping strategies had a stress-buffering effect on well-being. Findings suggest that social support and coping do influence emotional well-being following recall for follow-up assessment of a 'false positive' breast cancer screening result.

Predictors of care-giver stress in families of preschool-aged children with developmental disabilities

Background This study examined the predictors, mediators and moderators of parent stress in families of preschool-aged children with developmental disability. Method One hundred and five mothers of preschool-aged children with developmental disability completed assessment measures addressing the key variables. Results Analyses demonstrated that the difficulty parents experienced in completing specific caregiving tasks, behaviour problems during these caregiving tasks, and level of child disability, respectively, were significant predictors of level of parent stress. In addition, parents’ cognitive appraisal of care-giving responsibilities had a mediating effect on the relationship between the child’s level of disability and parent stress. Mothers’ level of social support had a moderating effect on the relationship between key independent variables and level of parent stress. Conclusions Difficulty of care-giving tasks, difficult child behaviour during care-giving tasks, and level of child disability are the primary factors which contribute to parent stress. Implications of these findings for future research and clinical practice are outlined.

Predictors of osteoarthritis(OA) improvement in patients treated with Hylan G-F for knee OA.

Aim of study: Different criteria for treatment response were explored to identify predictors of OA improvement. Analyses were based on data from a previously reported 1-year randomized controlled trial of appropriate care with or without hylan G-F 20 in patients with knee OA. Methods: Five definitions of ‘‘patient responder’’ from baseline to month 12 were examined: at least 20% reduction in WOMAC pain score; at least 20% reduction in WOMAC pain score and at least 20% reduction in either the WOMAC stiffness or function score; OARSI responder criteria (Propositions A and B) for intra-articular drugs; and OMERACT-OARSI responder criteria (Proposition D). As an a posteriori analysis, multivariable logistic regression models for each definition of patient responder were developed using a forward selection method. The following variables were defined prior to modeling and considered in the model along with two-way interactions: age (O65 years), BMI, gender, X-ray grade (0, I, II vs III, IV), co-morbidity (1 or 2 conditions vs 3 or more), duration of OA in study knee (years), previous surgery of study knee, hylan G-F 20 injection technique, WOMAC pain, stiffness and function, and treatment group. Results: Hylan G-F 20 was a predictor of improvement for all patient responder definitions P ! 0.001; odds of improvement were 2.7 or higher for patients in the hylan G-F 20 group compared to appropriate care without hylan G-F 20. For three of the five patient responder definitions, X-ray grade was a predictor of improvement (P ! 0.10; lower X-ray grade increased the odds of improvement). For four of the five patient responder definitions, duration of OA was a predictor of improvement (P ! 0.10; shorter duration of OA increased the odds of improvement). Conclusion: Analyses showed that appropriate care with hylan G-F 20 is the dominant predictor of patient improvement. While high grade structural damage does not preclude a response, patients who are targeted early in the disease process when less structural damage has occurred, may have a greater chance of improvement.

Personality and goal orientation as predictors of performance in a learning context

The current study aimed to investigate and provide furthering evidence of individual differences as determinants of task performance. This research focused on the effects of the personality traits Openness to Experience and Neuroticism, and two goal orientation traits. Learning Orientation and Avoid Orientation, on task performance. The hypotheses addressed the predictability of the traits, the differential effects of personality and goal orientation traits, and the mediating effects of goal orientation on the relationship between personality and performance. The results were based on questionnaire responses completed by a sample of 103 students. Scores on a computerised Air Traffic Control (ATC) decision-making task were used as a measure of task performance. Learning Orientation was found to be a significant predictor of performance, whilst the effect of Neuroticism was 'approaching' significance. Results indicated strong support for the differential relationship between personality traits and corresponding goal orientation traits. The mediating relationship between Openness to Experience, Learning Orientation and performance was also found to be 'approaching' significance. Results were indicative of the influences of personality and goal orientation on consequent performance outcomes. Implications were discussed, as well as suggestions for possible future directions in research assessing the predictabilit)' of individual differences in learning contexts.

Feel it and deal with it: mental health practitioners' experiences of exposure to the trauma of survivor clients

Empathic engagement by the trauma therapist with another person's traumatic experiences is believed to create risks for the helping professional. Much attention has been focused upon the mental health professional experiencing symptoms of distress as a result of their exposure to the material of clients who survive traumatic incidents. This thesis contains the findings of a qualitative study that centres on a group of male mental health professionals and their experiences of exposure to the trauma material of survivor clients. The participants of the study practise within an internal Employee Assistance Program that provides, among other duties, a 24 hour, 7 day response to critical incidents to a heavy transport industry. Using semi-structured, in-depth interviews, the effects on the trauma therapists are explored by analysing their reactions to their survivor clients' accounts, the impact of these experiences upon their psychological schema, the organisational culture in which they practise and its influence upon their experiences and the methods participants use to cope with the psychological effects of exposure to trauma material. Participants' experiences are closely examined for critical comparisons with vicarious traumatization. Therapists' responses reveal their continued ability and motivation to empathically engage with the trauma material of survivor clients despite the potential risks.

Implementation of Triple P-Positive Parenting Program in Hong Kong: Predictors of programme completion and clinical outcomes

This study examined the effectiveness of the Triple P-Positive Parenting Program in a government child health service delivery context with Chinese parents in Hong Kong. Specifically, the study sought to identify pre-intervention variables that might predict programme outcomes such as, level of clinical improvement and programme completion. Participants were 661 parents of pre-school and primary aged children participating in a group version of the Triple P-Positive Parenting Program. There were significant decreases in disruptive child behaviours, levels of parenting stress, general stress and anxiety and an increase in parenting sense of competence. Greater change in reports of child behaviour problems was related to lower levels of family income, new immigrant family status, and higher pre-intervention levels of parenting stress. The present study provides a profile of parents who are most likely to benefit from parent training programmes.

Evidence for sensitisation of DNA to oxidative damage during isolation

The oxidative base lesion 8-oxo-deoxyguanosine (8-oxo-dG) has been identified in DNA isolated from normal tissue and may occur at elevated levels during disease. However, the use of phenol during DNA extraction may artificially elevate the detected levels of this lesion. Herein, we have performed a comparative methodological study using both pronase E and phenol extraction techniques; native or oxidatively stressed DNA was isolated to determine the validity of each extraction technique for the subsequent determination of 8-oxo-dG. Whilst the yields of DNA were comparable, after pronase E extraction there was no detectable induction of 8-oxo-dG in reextracted naked DNA or peripheral blood mononuclear cell DNA that had been oxidatively stressed. However, phenol extraction enhanced the basal levels of 8-oxo-dG detected, and also induced a significant increase in levels of the modified base after exposure to oxidative stress. The latter was dependent on the presence of foetal calf serum in the extracellular medium. We have confirmed that phenol extraction sensitises native DNA to subsequent oxidative damage. In addition, this work shows that the extent of sensitisation occurring during phenol extraction varies with the degree of oxidative damage already incurred and infers that labile guanine sites generated during oxidative stress may be detected as 8-oxo-dG residues after phenol extraction.

The social construction of sleep and work in the British print news media

This article presents a sociological study of sleep issues in the British print news media, with particular focus on the relationship between sleep, work and the changing demands of ‘flexible capitalism’. Drawing on over 1000 newspaper articles from 1984 to 2005, we explore how and why sleep is framed or constructed in terms of continuity and change (in British working life and work cultures) and, equally, viewed as a neglected component of our social lives which is too easily sacrificed to the demands of the 24/7 society, long hours culture and the struggle to create a harmonious work-life balance. This is particularly the case for certain British work cultures in which sleep has conflicting and contrasting associations. Finally, we reflect on the broader class-based discourses and debates that arise from certain workers having their sleep patterns increasingly scrutinized and regulated, and the role of the media in any ensuing sleep/work ‘crisis’.

Strategies and therapeutic opportunities for the delivery of drugs to the esophagus

Targeting of drugs and therapies locally to the esophagus is an important objective in the development of new and more effective dosage forms. Therapies that are retained within the oral cavity for both local and systemic action have been utilized for many years, although delivery to the esophagus has been far less reported. Esophageal disease states, including infections, motility disorders, gastric reflux, and cancers, would all benefit from localized drug delivery. Therefore, research in this area provides significant opportunities. The key limitation to effective drug delivery within the esophagus is sufficient retention at this site coupled with activity profiles to correspond with these retention times; therefore, a suitable formulation needs to provide the drug in a ready-to-work form at the site of action during the rapid transit through this organ. A successfully designed esophageal-targeted system can overcome these obstacles. This review presents a range of dosage form approaches for targeting the esophagus, including bioadhesive liquids and orally retained lozenges, chewing gums, gels, and films, as well as endoscopically delivered therapeutics. The techniques used to measure efficacy both in vitro and in vivo are also discussed. Drug delivery is a growing driver within the pharmaceutical industry and offers benefits both in terms of clinical efficacy, as well as in market positioning, as a means of extending a drug's exclusivity and profitability. Emerging systems that can be used to target the esophagus are reported within this review, as well as the potential of alternative formulations that offer benefits in this exciting area.

The contribution of modularity to green operations practices

This paper discusses the possible contributions from modularity and industrial condominiums towards enhancing environmental performance in the automotive industry. The research described in this study is underpinned by a review of journal articles and books on the topics of: modularity of production systems; green operations practices, and the automotive industry and sustainability. The methodology is based on theoretical analysis of the contribution of the modular production system characteristics used in the automotive industry for Green Operations Practices (GOP). The following GOPs were considered: green buildings, eco-design, green supply chains, greener manufacturing, and reverse logistics. The results are theoretical in nature; however, due to the small number of studies that investigate the relationship between modularity and sustainability, this work is relevant to increase knowledge in academic circles and among practitioners in order to understand the possible environmental benefits from modular production systems. For instance, based upon our analysis, we could deduce that the existing modular production systems in the automotive industry may contribute in different ways to the implementation of GOPs. In all types of modularity, product simplification through the use of modules can enhance environmental performance and facilitate further activities such as maintenance and repair contributing to a longer life of cars on the road. Moreover, modules will make automobiles easier to disassembly, so increasing the chances of reuse of valuable components and a better final disposal of scrap. Regarding the potential benefits of each type of modularity, it is expected that modular consortia will have a better integration of environmental practices with suppliers and seize on high efficiency during manufacturing and logistics compared with conventional production systems.

Soliton generation from randomly modulated return-to-zero pulses

We consider return-to-zero (RZ) pulses with random phase modulation propagating in a nonlinear channel (modelled by the integrable nonlinear Schrödinger equation, NLSE). We suggest two different models for the phase fluctuations of the optical field: (i) Gaussian short-correlated fluctuations and (ii) generalized telegraph process. Using the rectangular-shaped pulse form we demonstrate that the presence of phase fluctuations of both types strongly influences the number of solitons generated in the channel. It is also shown that increasing the correlation time for the random phase fluctuations affects the coherent content of a pulse in a non-trivial way. The result obtained has potential consequences for all-optical processing and design of optical decision elements.