Positive behaviour in the early years : perceptions of staff, service providers and parents in managing and promoting positive behaviour in early years and early primary settings

The full report of research into positive behaviour in the early years: perceptions of staff, service providers and parents in managing and promoting positive behaviour in early years and early primary settings

Identifying which septic patients have increased mortality risk using severity scores:a cohort study

Background: Early aggressive therapy can reduce the mortality associated with severe sepsis but this relies on prompt recognition, which is hindered by variation among published severity criteria. Our aim was to test the performance of different severity scores in predicting mortality among a cohort of hospital inpatients with sepsis. Methods: We anonymously linked routine outcome data to a cohort of prospectively identified adult hospital inpatients with sepsis, and used logistic regression to identify associations between mortality and demographic variables, clinical factors including blood culture results, and six sets of severity criteria. We calculated performance characteristics, including area under receiver operating characteristic curves (AUROC), of each set of severity criteria in predicting mortality. Results: Overall mortality was 19.4% (124/640) at 30 days after sepsis onset. In adjusted analysis, older age (odds ratio 5.79 (95% CI 2.87-11.70) for ≥80y versus <60y), having been admitted as an emergency (OR 3.91 (1.31-11.70) versus electively), and longer inpatient stay prior to sepsis onset (OR 2.90 (1.41-5.94) for >21d versus <4d), were associated with increased 30 day mortality. Being in a surgical or orthopaedic, versus medical, ward was associated with lower mortality (OR 0.47 (0.27-0.81) and 0.26 (0.11-0.63), respectively). Blood culture results (positive vs. negative) were not significantly association with mortality. All severity scores predicted mortality but performance varied. The CURB65 community-acquired pneumonia severity score had the best performance characteristics (sensitivity 81%, specificity 52%, positive predictive value 29%, negative predictive value 92%, for 30 day mortality), including having the largest AUROC curve (0.72, 95% CI 0.67-0.77). Conclusions: The CURB65 pneumonia severity score outperformed five other severity scores in predicting risk of death among a cohort of hospital inpatients with sepsis. The utility of the CURB65 score for risk-stratifying patients with sepsis in clinical practice will depend on replicating these findings in a validation cohort including patients with sepsis on admission to hospital

A framework for ensuring a balanced accounting of the impact of antimicrobial stewardship interventions

Drawing on a Cochrane systematic review this paper examines the relatively limited range of outcomes measured in published evaluations of antimicrobial stewardship interventions (ASI) in hospitals. We describe a structured framework for considering the range of consequences that ASI can have, in terms of their desirability and the extent to which they were expected when planning an ASI: expected, desirable consequences (intervention goals); expected, undesirable consequences (intervention trade-offs); unexpected, undesirable consequences (unpleasant surprises); and unexpected, desirable consequences (pleasant surprises). Of 49 randomised controlled trials (RCTs) identified by the Cochrane review, 28 (57%) pre-specified increased length of stay and/or mortality as potential trade-offs of ASI, with measurement intended to provide reassurance about safety. In actuality, some studies found unexpected decreases in length of stay (a pleasant surprise). In contrast, only 11 (10%) of 110 interrupted time series (ITS) studies included any information about unintended consequences, with 10 examining unexpected, undesirable outcomes (unpleasant surprises) using case-control, qualitative or cohort designs. Overall, a large proportion of the ASI reported in the literature only assess impact on their targeted process goals – antimicrobial prescribing – with limited examination of other potential outcomes including microbial and clinical outcomes. Achieving a balanced accounting of the impact of an ASI requires careful consideration of expected undesirable effects (potential trade-offs) from the outset, and more consideration of unexpected effects after implementation (both pleasant and unpleasant surprises, although the latter will often be more important). The proposed framework supports the systematic consideration of all types of consequences of improvement before and after implementation

Synonymy and stratigraphic ranges of Belemnopsis in the Heterian and Ohauan Stages (Callovian-Tithonian), southwest Auckland, New Zealand.

Belemnopsis stevensi, Belemnopsis maccrawi, and Belemnopsis sp. A (Challinor 1979a) are synonymous; B. stevensi has priority. New belemnite material from Kawhia Harbour and Port Waikato, together with graphical study methods, indicates that many small fragmentary specimens associated with B. stevensi in the lower part of its stratigraphic range are probably the same taxon. B. stevensi has been found only in the Middle and Upper Heterian Stage (Lower Kimmeridgian) at Kawhia and only in the Lower Ohauan Stage (Upper Kimmeridgian) at Port Waikato. This apparently disjunct distribution is attributed to poor exposure in the relevant sections. Belemnopsis kiwiensis n.sp., Belemnopsis cf. sp. B, Belemnopsis sp. B, Belemnopsis sp. D, and Belemnopsis spp. are associated with B. stevensi near the lowest known point in its stratigraphic range. The distribution of stratigraphically useful belemnites within the Heterian and Ohauan Stages is: Conodicoelites spp. (Lower Heterian; correlated with Lower Callovian); Belemnopsis annae (Lower and Middle Heterian; Lower Callovian/Lower Kimmeridgian); Belemnopsis stevensi (Middle Heterian/Lower Ohauan; Kimmeridgian); Belemnopsis keari (Upper Heterian; Kimmeridgian); Belemnopsis trechmanni (Upper Ohauan; Upper Kimmeridgian/Middle Tithonian). The apparently extreme range of Belemnopsis annae remains unexplained. Klondyke Sandstone (new) is recognised as the basal member of Moewaka Formation (Port Waikato area)

Building a national Infection Intelligence Platform to improve antimicrobial stewardship and drive better patient outcomes:the Scottish experience

Background: The better use of new and emerging data streams to understand the epidemiology of infectious disease and to inform and evaluate antimicrobial stewardship improvement programmes is paramount in the global fight against antimicrobial resistance. Objectives: To create a national informatics platform that synergises the wealth of disjointed, infection-related health data, building intelligence capability that allows rapid enquiry, generation of new knowledge and feedback to clinicians and policy makers. Methods: A multi-stakeholder community, led by the Scottish Antimicrobial Prescribing Group, secured government funding to deliver a national program of work centred on three key aspects: technical platform development with record linkage capability across multiple datasets; a proportionate governance approach to enhance responsiveness; generation of new evidence to guide clinical practice. Results: The National Health Service Scotland Infection Intelligence Platform (IIP) is now hosted within the national health data repository to assure resilience and sustainability. New technical solutions include simplified “data views” of complex, linked datasets and embedded statistical programmes to enhance capability. These developments have enabled responsiveness, flexibility and robustness in conducting population-based studies including a focus on intended and unintended effects of antimicrobial stewardship interventions and quantification of infection risk factors and clinical outcomes. Conclusion: We have completed the build and test phase of IIP, overcoming the technical and governance challenges and produced new capability in infection informatics, generating new evidence for improved clinical practice. This provides a foundation for expansion and opportunity for global collaborations

Impact of antimicrobial stewardship interventions on <i>Clostridium difficile</i> infection and clinical outcomes:segmented regression analyses

Antimicrobial exposure is associated with increased risk of Clostridium difficile infection (CDI), but the impact of prescribing interventions on CDI and other outcomes is less clear

Evaluating 'Prefer not to say' Around Sensitive Disclosures

As people's offline and online lives become increasingly entwined, the sensitivity of personal information disclosed online is increasing. Disclosures often occur through structured disclosure fields (e.g., drop-down lists). Prior research suggests these fields may limit privacy, with non-disclosing users being presumed to be hiding undesirable information. We investigated this around HIV status disclosure in online dating apps used by men who have sex with men. Our online study asked participants (N=183) to rate profiles where HIV status was either disclosed or undisclosed. We tested three designs for displaying undisclosed fields. Visibility of undisclosed fields had a significant effect on the way profiles were rated, and other profile information (e.g., ethnicity) could affect inferences that develop around undisclosed information. Our research highlights complexities around designing for non-disclosure and questions the voluntary nature of these fields. Further work is outlined to ensure disclosure control is appropriately implemented around online sensitive information disclosures

Sparrows can't sing : East End kith and kinship in the 1960s

Sparrows Can’t Sing (1963) was the only feature film directed by the late and much lamented Joan Littlewood. Set and filmed in the East End, where she worked for many years, the film deserves more attention than it has hitherto received. Littlewood’s career spanned documentary (radio recordings made with Ewan MacColl in the North of England in the 1930s) to directing for the stage and the running of the Theatre Royal in London’s Stratford East, often selecting material which aroused memories in local audiences (Leach 2006: 142). Many of the actors trained in her Theatre Workshop subsequently became better known for their appearances on film and television. Littlewood herself directed hardly any material for the screen: Sparrows Can’t Sing and a 1964 series of television commercials for the British Egg Marketing Board, starring Theatre Workshop’s Avis Bunnage, were rare excursions into an area of practice which she found constraining and unamenable (Gable 1980: 32). The hybridity and singularity of Littlewood’s feature may answer, in some degree, for its subsequent neglect. However, Sparrows Can’t Sing makes a significant contribution to a group of films made in Britain in the 1960s which comment generally on changes in the urban and social fabric. It is especially worthy of consideration, I shall argue, for the use which Littlewood made of a particular community’s attitudes – sentimental and critical – to such changes and for its amalgamation of an attachment to documentary techniques (recording an aural landscape on location) with a preference for nonnaturalistic delivery in performance