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Our objective was to compare patterns of dental antibiotic prescribing in Australia, England, and North America (United States and British Columbia, Canada).
Population-level analysis of antibiotic prescription.
Outpatient prescribing by dentists in 2017.
Patients receiving an antibiotic dispensed by an outpatient pharmacy.
Prescription-based rates adjusted by population were compared overall and by antibiotic class. Contingency tables assessed differences in the proportion of antibiotic class by country.
In 2017, dentists in the United States had the highest antibiotic prescribing rate per 1,000 population and Australia had the lowest rate. The penicillin class, particularly amoxicillin, was the most frequently prescribed for all countries. The second most common agents prescribed were clindamycin in the United States and British Columbia (Canada) and metronidazole in Australia and England. Broad-spectrum agents, amoxicillin-clavulanic acid, and azithromycin were the highest in Australia and the United States, respectively.
Extreme differences exist in antibiotics prescribed by dentists in Australia, England, the United States, and British Columbia. The United States had twice the antibiotic prescription rate of Australia and the most frequently prescribed antibiotic in the US was clindamycin. Significant opportunities exist for the global dental community to update their prescribing behavior relating to second-line agents for penicillin allergic patients and to contribute to international efforts addressing antibiotic resistance. Patient safety improvements will result from optimizing dental antibiotic prescribing, especially for antibiotics associated with resistance (broad-spectrum agents) or C. difficile (clindamycin). Dental antibiotic stewardship programs are urgently needed worldwide.
This paper proposes a model for developmental psychopathology that is informed by recent research suggestive of a single model of mental health disorder (the p factor) and seeks to integrate the role of the wider social and cultural environment into our model, which has previously been more narrowly focused on the role of the immediate caregiving context. Informed by recently emerging thinking on the social and culturally driven nature of human cognitive development, the ways in which humans are primed to learn and communicate culture, and a mentalizing perspective on the highly intersubjective nature of our capacity for affect regulation and social functioning, we set out a cultural-developmental approach to psychopathology.
Unit cohesion may protect service member mental health by mitigating effects of combat exposure; however, questions remain about the origins of potential stress-buffering effects. We examined buffering effects associated with two forms of unit cohesion (peer-oriented horizontal cohesion and subordinate-leader vertical cohesion) defined as either individual-level or aggregated unit-level variables.
Longitudinal survey data from US Army soldiers who deployed to Afghanistan in 2012 were analyzed using mixed-effects regression. Models evaluated individual- and unit-level interaction effects of combat exposure and cohesion during deployment on symptoms of post-traumatic stress disorder (PTSD), depression, and suicidal ideation reported at 3 months post-deployment (model n's = 6684 to 6826). Given the small effective sample size (k = 89), the significance of unit-level interactions was evaluated at a 90% confidence level.
At the individual-level, buffering effects of horizontal cohesion were found for PTSD symptoms [B = −0.11, 95% CI (−0.18 to −0.04), p < 0.01] and depressive symptoms [B = −0.06, 95% CI (−0.10 to −0.01), p < 0.05]; while a buffering effect of vertical cohesion was observed for PTSD symptoms only [B = −0.03, 95% CI (−0.06 to −0.0001), p < 0.05]. At the unit-level, buffering effects of horizontal (but not vertical) cohesion were observed for PTSD symptoms [B = −0.91, 90% CI (−1.70 to −0.11), p = 0.06], depressive symptoms [B = −0.83, 90% CI (−1.24 to −0.41), p < 0.01], and suicidal ideation [B = −0.32, 90% CI (−0.62 to −0.01), p = 0.08].
Policies and interventions that enhance horizontal cohesion may protect combat-exposed units against post-deployment mental health problems. Efforts to support individual soldiers who report low levels of horizontal or vertical cohesion may also yield mental health benefits.
This rejoinder begins with an expression of gratitude and broad agreement with the two commentaries by Kenneth Levy and Nicholas Salsman. The rejoinder considers three main issues: (1) the fact of the range of psychodynamic treatments that have been found to be effective in the treatment of personality disorder (PD); (2) the value of considering a dimensional approach to psychopathology in general and PD more specifically, particularly in the context of recent work on the general psychopathology factor; and (3), the issue of transference and different ways of approaching it across different psychodynamic treatments.
This chapter gives an account of the different psychoanalytic traditions and their approaches to PD: the Kleinian/Bionian model, the British object relations perspective, Kohut’s self psychology, the structural object relations model, the interpersonal-relational approach, and mentalizing theory. The chapter goes on to describe two contemporary psychodynamic treatments, along with their evidence base: transference-focused therapy and mentalization-based treatment. Recent developments in the authors’ thinking in relation to PD are then described, partly in the context of recent work in the area of a general psychopathology or “p” factor. In particular, the authors discuss personality disorder in relation to epistemic trust, and suggest that psychopathology might be understood as a form of disordered social cognition, perpetuated by the obstacles to communication that these social cognitive difficulties create. It is postulated that effective therapeutic interventions for PD possess the shared characteristic of stimulating epistemic trust and creating a virtuous circle of improved social communication.
One of the foundations of product design is the division between production and design. This division manifests as designers aspiring to create fixed iconic archetypes and production replicates endlessly in thousands or millions. Today innovation and technological change are challenging this idea of product design and manufacturing. The evolution of Rapid Prototyping into Additive Manufacturing (AM), is challenging the notion of mass manufacture and consumer value. As AM advances in capability and capacity, the ability to economically manufacture products in low numbers with high degrees of personalisation poses questions of the accepted product development process. Removing the need for dedicated expensive tooling also eliminates the cyclical timescales and commitment to fixed designs that investment in tooling demands. The ability to alter designs arbitrarily, frequently and responsively means that the traditional design process need not be applied and because of this, design processes and practice might be radically different in the future. In this paper, we explore this possible evolution by drawing parallels with principles and development models found in software development.
This chapter examines the extent to which there is, or may be, accountability with regard to the exercise of such powers as a result of the administrative mechanism of judicial review. It examines the way in which judges, in exercising restraint, may hinder the bringing of successful review applications with regard to exercises of emergency powers. It also focuses on express attempts by the legislature to limit the availability of judicial review, in the form of privative clauses, and the possible impact of those attempts on the review of emergency powers. Doctrines relating to ‘justiciability’, ‘act of state, ‘deference’, and procedural fairness are highlighted.
This chapter examines the power of Australian governments, both federal and state, to address public disorder against a backdrop of recognised constitutional protections for political assembly, especially the judicially established implied freedom of political communication. The laws, statutory and common law, pertaining to unlawful assembly, anti-association legislative measures, sedition, and special public disorder emergency powers are scrutinised.
The chapter focuses on the constitutional and legal frameworks regulating the call-out of the Australian Defence Force in aid of the civil power. This topic has become more prominent as result of the rise of global terrorism. It examines the implications of the Lindt Café siege and the 1978 Sydney Hilton bombing. The constitutional provisions of section 119 are scrutinised to determine the framework under which the military forces are deployed to assist a state against domestic violence. The Defence Act 1903 (Cth) is discussed.
This chapter describes the sorts of emergencies which have been experienced in Australia, including the contemporary war on terrorism.It explores the definitional problems of 'emergency', the dangers of over-reaction to an emergency as exemplified by the experience in some countries. It makes reference to international norms regulating the exercise of emergency powers.
This chapter examines the panoply of special powers frameworks for dealing with civil emergencies, particularly environmental emergencies, chemical, biological, radiological and nuclear emergencies, and public and biosecurity emergencies. It also looks at ad-hoc legislation conferring special powers in respone to a particular situation of emergency.
This chapter discusses two vital legal weapons that were made available to the authorities to deal with dangers posed by terrorists in the wake of the September 11 attacks in the United States and the many bombing tragedies in a number of countries. It provides an account of how preventative detention measures were considered by the courts in Australia and the United Kingdom. Issues relating to the constitutional validity of preventative detention orders and control orders provided by federal legislation are canvassed by reference to the separation of judicial power doctrine. The persona designata doctrine and the incompatibility doctrine as expounded by the High Court are discussed. Particular attention is given to the landmark case of Thomas v. Mowbray, in which the validity of a control order authorised by a federal judge was upheld by the High Court. Attention is focused on the operation of the Kable principle to determine the validity of state legislation authorising preventative detention orders and control orders.
This chapter explores the executive powers of the Australian government that are of particular relevance in emergency contexts. It focuses on the contemporary interpretation of the High Court on the scope of section 61 of the Commonwealth Constitution, which is viewed as the ultimate source of all national executive power in Australia. It discusses the issue of whether the exercise of the executive power to requisition property for war or emergency purposes is subject to a requirement to pay just compensation. The relationship with the prerogative powers and the notion of a bundle of inherent powers arising from the Commonwealth’s status as a national government are explored. It engages in a discussion of recent cases in relation to measures taken to respond to the global financial crisis of 2007.