Pharmacist-led feedback workshops increase appropriate prescribing of antimicrobials

Objectives To investigate whether and how structured feedback sessions can increase rates of appropriate antimicrobial prescribing by junior doctors.

Methods This was a mixed-methods study, with a conceptual orientation towards complexity and systems thinking. Fourteen junior doctors, in their first year of training, were randomized to intervention (feedback) and 21 to control (routine practice) groups in a single UK teaching hospital. Feedback on their antimicrobial prescribing was given, in writing and via group sessions. Pharmacists assessed the appropriateness of all new antimicrobial prescriptions 2 days per week for 6 months (46 days). The mean normalized prescribing rates of suboptimal to all prescribing were compared between groups using the t-test. Thematic analysis of qualitative interviews with 10 participants investigated whether and how the intervention had impact.

Results Data were collected on 204 prescriptions for 166 patients. For the intervention group, the mean normalized rate of suboptimal to all prescribing was 0.32 ± 0.36; for the control group, it was 0.68 ± 0.36. The normalized rates of suboptimal prescribing were significantly different between the groups (P = 0.0005). The qualitative data showed that individuals' prescribing behaviour was influenced by a complex series of dynamic interactions between individual and social variables, such as interplay between personal knowledge and the expectations of others.

Conclusions The feedback intervention increased appropriate prescribing by acting as a positive stimulus within a complex network of behavioural influences. Prescribing behaviour is adaptive and can be positively influenced by structured feedback. Changing doctors' perceptions of acceptable, typical and best practice could reduce suboptimal antimicrobial prescribing.

Schizophrenia risk from complex variation of complement component 4

Schizophrenia is a heritable brain illness with unknown pathogenic mechanisms. Schizophrenia's strongest genetic association at a population level involves variation in the major histocompatibility complex (MHC) locus, but the genes and molecular mechanisms accounting for this have been challenging to identify. Here we show that this association arises in part from many structurally diverse alleles of the complement component 4 (C4) genes. We found that these alleles generated widely varying levels of C4A and C4B expression in the brain, with each common C4 allele associating with schizophrenia in proportion to its tendency to generate greater expression of C4A. Human C4 protein localized to neuronal synapses, dendrites, axons, and cell bodies. In mice, C4 mediated synapse elimination during postnatal development. These results implicate excessive complement activity in the development of schizophrenia and may help explain the reduced numbers of synapses in the brains of individuals with schizophrenia.

ISCR and their association with antibiotic resistance genes

A prevalência de bactérias resistentes a antibióticos em ambiente hospitalar tem vindo a tornar-se dramática e preocupante a nível mundial. Contudo, com a utilização inadequada de antibióticos em áreas tão diversas como a veterinária, a aquacultura e a agricultura, esta deixou de estar confinada ao ambiente hospitalar, sendo o ambiente um reservatório natural de microganismos resistentes a estes compostos. O conhecimento detalhado dos determinantes de resistência a antibióticos presentes nestes ambientes, sejam estes genes de resistência ou estruturas envolvidas na sua mobilização, é fundamental, não só do ponto de vista do conhecimento como para a eventual implementação de medidas de contenção da sua disseminação. Neste contexto, são necessários estudos que permitam conhecer o panorama mais realista da distribuição destes determinantes de resistência a antibióticos, quer no meio ambiente quer no ambiente clínico. Assim, constituiu objectivo principal deste trabalho contribuir para o conhecimento do panorama actual da prevalência e distribuição dos elementos ISCR, bem como de outros determinantes de resistência a antibióticos em espécies de Gram-negativo clinicamente relevantes (Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii e Citrobacter freundii) recolhidas a partir de amostras de pacientes do Hospital Infante D. Pedro, EPE, Aveiro, Portugal, entre 2006 e 2008. Adicionalmente, foram também recolhidas bactérias de Gram-negativo do meio ambiente, a partir de amostras de águas e de vísceras de peixes, nas quais foram igualmente pesquisados os elementos acima referidos. À excepção dos isolados de E. coli e de Gramnegativo ambientais, todas as estirpes estudadas foram seleccionadas com base no seu perfil de multirresistência a antibióticos. Os resultados mostraram que em todas as espécies recolhidas no ambiente hospitalar foi detectada a presença de elementos ISCR, do tipo ISCR1 ou ISCR2. O elemento ISCR1, foi encontrado em isolados de E. coli, K. pneumoniae e C. freundii e o elemento ISCR2 em isolados de A. baumannii. Não foi detectada a presença de ISCRs nos isolados de Gram-negativo ambientais, o que sugere que a ocorrência dos mesmos é fortemente influenciada pela pressão selectiva exercida pelo ambiente em que os microrganismos se encontram. Genes qnr e integrões de classe 1 foram os determinantes de resistência mais frequentemente encontrados associados aos elementos ISCR1. Os vários determinantes de resistência foram encontrados em diferentes contextos genéticos e localizados em estruturas móveis, nomeadamente em plasmídeos. O elemento ISCR2 presente em isolados de A. baumannii encontra-se associado ao gene sul2 em todos os isolados, dentro de um mesmo contexto genético e com uma localização cromossomal. Contudo, o contexto genético encontrado nestes isolados é novo não tendo sido descrito até à data em outros microrganismos. O presente estudo constitui a primeira descrição de elementos ISCR intrinsecamente ligados a genes de resistência a antibióticos, em Portugal. Uma vez que estes elementos parecem ser responsáveis pela mobilização de um grande número de genes de resistência a antibióticos, a sua elevada incidência entre estirpes resistentes e multirresistentes, bem como a sua associação com genes de resistência é preocupante e requer vigilância.

Role of Automated Open Source Systems in the Intelligence Analysis of a High-Level Domain Expert

Design and Qualitative/Quantitative Analysis of Multi-Agent Spatial Simulation Library

Thesis (Master's)--University of Washington, 2012

'Incorrigibly Plural’: New Histories of Ulster and Northern Ireland’

Review article of Carson’s Army: The Ulster Volunteer Force, 1910–22. By Timothy Bowman. Manchester University Press, Manchester, 2007. 256 pp. ISBN 0719073715, £55. A History of the Northern Ireland Labour Party: Democratic Socialism and Sectarianism. By Aaron Edwards. Manchester University Press, Manchester, 2009. xiii + 240 pp. ISBN 0719078741, £60. Catholic Belfast and Nationalist Ireland in the Era of Joe Devlin 1871–1934. By A.C. Hepburn. Oxford University Press, Oxford, 2008. xix +307 pp. ISBN 019929884X, £55. The Big House in the North of Ireland: Land, Power and Social Elites, 1878–1960. By Olwen Purdue. University College Dublin Press, Dublin, 2009. xv + 297 pp. ISBN 978-1-906359-25-6, £24.

"24" Wind Ensemble, Campus Band, Concert Band, Symphonic Band, March 11, 2008

Concert program for '24' Wind Ensemble, Campus Band, Concert Band, Symphonic Band, March 11, 2008

The Wind Ensemble, December 4, 1991

Concert Program for The Wind Ensemble, December 4, 1991

From T cell “exhaustion” to anti-cancer immunity

The immune system has the potential to protect from malignant diseases for extended periods of time. Unfortunately, spontaneous immune responses are often inefficient. Significant effort is required to develop reliable, broadly applicable immunotherapies for cancer patients. A major innovation was transplantation with hematopoietic stem cells from genetically distinct donors for patients with hematologic malignancies. In this setting, donor T cells induce long-term remission by keeping cancer cells in check through powerful allogeneic graft-versus-leukemia effects. More recently, a long awaited breakthrough for patients with solid tissue cancers was achieved, by means of therapeutic blockade of T cell inhibitory receptors. In untreated cancer patients, T cells are dysfunctional and remain in a state of T cell "exhaustion". Nonetheless, they often retain a high potential for successful defense against cancer, indicating that many T cells are not entirely and irreversibly exhausted but can be mobilized to become highly functional. Novel antibody therapies that block inhibitory receptors can lead to strong activation of anti-tumor T cells, mediating clinically significant anti-cancer immunity for many years. Here we review these new treatments and the current knowledge on tumor antigen-specific T cells.

Réception de M. Herrick à l'Hôtel de Ville, 26/7/20, M. Herrick [signe le livre d'or] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 60228

26/7/20, à l'Hôtel de Ville [de Paris], réception de M. Myron T. Herrick : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 60224

Teachers' perspectives on the implementation of expectations-based curricula /

This qualitative study examines teachers' experiences implementing new standardized curricula in Ontario schools. This new curricula contained several policy changes and an expectations based format which directed what knowledge and skills students were to demonstrate in each subject. This level of specificity of subject-content served to control teachers in relation to curricula; however, data suggested that at the same time, teachers had enormous flexibility in terms of pedagogy. Four secondary teachers who were implementing a Grade 10 course in the 2000-2001 school year participated in the study. The qualitative framework supported the researcher's emphasis on examining the participants' perspectives on the implementation of expectation-based curricula. Data collected included transcripts from interviews conducted with teacher participants and a representative of the Ontario Ministry of Education and Training, field notes, and a research journal. Many of the factors often cited in the literature as influencing implementation practices were found to have affected the participants' experiences of curriculum implementation: time, professional development, and teachers' beliefs, particularly concerning students. In addition, the format of the policy documents proved to both control and free teachers during the implementation process. Participants believed that the number of specific expectations did not provide them an opportunity to add content to the curriculum; at the same time, teachers also noted that the general format of the policy document allowed them to direct instruction to match students' needs and their own teaching preferences. Alignment between teachers' beliefs about education and their understanding of the new curriculum affected the ways in which many participants adapted during the implementation process.

Mr. Pickering's speech in the Senate of the United States, on the resolution offered by Mr. Hillhouse to repeal the several acts laying an embargo, November 30, 1808. --

Caption title.