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

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

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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..

Heme Oxygenase-1 Expression Affects Murine Abdominal Aortic Aneurysm Progression.

Heme oxygenase-1 (HO-1), the rate-limiting enzyme in heme degradation, is a cytoprotective enzyme upregulated in the vasculature by increased flow and inflammatory stimuli. Human genetic data suggest that a diminished HO-1 expression may predispose one to abdominal aortic aneurysm (AAA) development. In addition, heme is known to strongly induce HO-1 expression. Utilizing the porcine pancreatic elastase (PPE) model of AAA induction in HO-1 heterozygous (HO-1+/-, HO-1 Het) mice, we found that a deficiency in HO-1 leads to augmented AAA development. Peritoneal macrophages from HO-1+/- mice showed increased gene expression of pro-inflammatory cytokines, including MCP-1, TNF-alpha, IL-1-beta, and IL-6, but decreased expression of anti-inflammatory cytokines IL-10 and TGF-beta. Furthermore, treatment with heme returned AAA progression in HO-1 Het mice to a wild-type profile. Using a second murine AAA model (Ang II-ApoE-/-), we showed that low doses of the HMG-CoA reductase inhibitor rosuvastatin can induce HO-1 expression in aortic tissue and suppress AAA progression in the absence of lipid lowering. Our results support those studies that suggest that pleiotropic statin effects might be beneficial in AAA, possibly through the upregulation of HO-1. Specific targeted therapies designed to induce HO-1 could become an adjunctive therapeutic strategy for the prevention of AAA disease

Diagnosis, prevention and treatment of hepatorenal syndrome in cirrhosis

Hepatorenal syndrome (HRS) is a serious complication of end-stage liver disease, occurring mainly in patients with advanced cirrhosis and ascites, who have marked circulatory dysfunction,1 as well as in patients with acute liver failure.2 In spite of its functional nature, HRS is associated with a poor prognosis,3 4 and the only effective treatment is liver transplantation. During the 56th Meeting of the American Association for the Study of Liver Diseases, the International Ascites Club held a Focused Study Group (FSG) on HRS for the purpose of reporting the results of an international workshop and to reach a consensus on a new definition, criteria for diagnosis and recommendations on HRS treatment. A similar workshop was held in Chicago in 1994 in which standardised nomenclature and diagnostic criteria for refractory ascites and HRS were established.5 The introduction of innovative treatments and improvements in our understanding of the pathogenesis of HRS during the previous decade led to an increasing need to undertake a new consensus meeting. This paper reports the scientific rationale behind the new definitions and recommendations. The international workshop included four issues debated by four panels of experts (see Acknowledgements). The issues were: (1) evidence-based HRS pathogenesis; (2) treatment of HRS using vasoconstrictors; (3) other HRS treatments using transjugular intrahepatic portosystemic stent-shunt (TIPS) and extracorporeal albumin dialysis (ECAD); and (4) new definitions and diagnostic criteria for HRS and recommendations for its treatment

Smad inhibitor induces CSC differentiation for effective chemosensitization in cyclin D1- and TGF-β/Smad-regulated liver cancer stem cell-like cells

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Extra argumentality - affectees, landmarks, and voice

This article investigates sentences with additional core arguments of a special type in three languages, viz. German, English, and Mandarin. These additional arguments, called extra arguments in the article, form a crosslinguistically homogeneous class by virtue of their structural and semantic similarities, with so-called "raised possessors" forming just a sub-group among them. Structurally, extra arguments may not be the most deeply embedded arguments in a sentence. Semantically, their referents are felt to stand in a specific relation to the referent of the/a more deeply embedded argument. There are two major thematic relations that are instantiated by extra arguments, viz. affectees and landmarks. These thematic role notions are justified in the context of and partly in contrast to, Dowty's (1991) proto-role approach. An affectee combines proto-agent with proto-patient properties in eventualities that are construed as involving causation. A landmark is a ground with respect to some spatial configuration denoted by the predication at hand, but a figure at the highest level of gestalt partitioning that is relevant in a clause. Thereby, both affectees and landmarks are inherently hybrid categories. The account of extra argumentality is couched in a neo-Davidsonian event semantics in the spirit of Kratzer (1996, 2003), and voice heads are assumed to introduce affectee arguments and landmark arguments right above VP

Threshold meson production and cosmic ray transport

An interesting accident of nature is that the peak of the cosmic ray spectrum, for both protons and heavier nuclei, occurs near the pion production threshold. The Boltzmann transport equation contains a term which is the cosmic ray flux multiplied by the cross section. Therefore when considering pion and kaon production from proton-proton reactions, small cross sections at low energy can be as important as larger cross sections at higher energy. This is also true for subthreshold kaon production in nuclear collisions, but not for subthreshold pion production.Comment: 9 pages, 1 figur