BackgroundExcessive use of antibiotics is worldwide the most important reason for development of antimicrobial resistance. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries. Initiatives have been taken to improve the quality of antibiotic prescribing in primary care, but only few studies have been designed to determine the effectiveness of multifaceted strategies across countries with different practice setting. The aim of this study was to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different health organization and different prevalence of antibiotic resistance.MethodsGPs from two Nordic countries, two Baltic Countries and two Hispano-American countries registered patients with respiratory tract infections (RTIs) in 2008 and 2009. After first registration they received individual prescriber feedback and they were offered an intervention programme that included training courses, clinical guidelines, posters for waiting rooms, patient brochures and access to point of care tests (Strep A and C-Reactive Protein). Antibiotic prescribing rates were compared before and after the intervention.ResultsA total of 440 GPs registered 47011 consultations; 24436 before the intervention (2008) and 22575 after the intervention (2009). After the intervention, the GPs significantly reduced the percentage of consultations resulting in an antibiotic prescription. In patients with lower RTI the GPs in Lithuania reduced the prescribing rate by 42%, in Russia by 25%, in Spain by 25%, and in Argentina by 9%. In patients with upper RTIs, the corresponding reductions in the antibiotic prescribing rates were in Lithania 20%, in Russia 15%, in Spain 9%, and in Argentina 5%.ConclusionA multifaceted intervention programme targeting GPs and patients and focusing on improving diagnostic procedures in patients with RTIs may lead to a marked reduction in antibiotic prescribing. The pragmatic before-after design used may suffer from some limitations and the reduction in antibiotic prescribing could be influenced by factors not related to the intervention.

BackgroundExcessive and inappropriate use of antibiotics is considered to be the most important reason for development of bacterial resistance to antibiotics. As antibiotic resistance may spread across borders, high prevalence countries may serve as a source of bacterial resistance for countries with a low prevalence. Therefore, bacterial resistance is an important issue with a potential serious impact on all countries.The majority of respiratory tract infections (RTIs) are treated in general practice. Most infections are caused by virus and antibiotics are therefore unlikely to have any clinical benefit. Several intervention initiatives have been taken to reduce the inappropriate use of antibiotics in primary health care, but the effectiveness of these interventions is only modest. Only few studies have been designed to determine the effectiveness of multifaceted strategies in countries with different practice setting. The aim of this study is to evaluate the impact of a multifaceted intervention targeting general practitioners (GPs) and patients in six countries with different prevalence of antibiotic resistance: Two Nordic countries (Denmark and Sweden), two Baltic Countries (Lithuania and Kaliningrad-Russia) and two Hispano-American countries (Spain and Argentina).Methods/DesignHAPPY AUDIT was initiated in 2008 and the project is still ongoing. The project includes 15 partners from 9 countries. GPs participating in HAPPY AUDIT will be audited by the Audit Project Odense (APO) method. The APO method will be used at a multinational level involving GPs from six countries with different cultural background and different organisation of primary health care. Research on the effect of the intervention will be performed by analysing audit registrations carried out before and after the intervention. The intervention includes training courses on management of RTIs, dissemination of clinical guidelines with recommendations for diagnosis and treatment, posters for the waiting room, brochures to patients and implementation of point of care tests (Strep A and CRP) to be used in the GPs'surgeries.To ensure public awareness of the risk of resistant bacteria, media campaigns targeting both professionals and the public will be developed and the results will be published and widely disseminated at a Working Conference hosted by the World Association of Family Doctors (WONCA-Europe) at the end of the project period.DiscussionHAPPY AUDIT is an EU-financed project with the aim of contributing to the battle against antibiotic resistance through quality improvement of GPs' diagnosis and treatment of RTIs through development of intervention programmes targeting GPs, parents of young children and healthy adults. It is hypothesized that the use of multifaceted strategies combining active intervention by GPs will be effective in reducing prescribing of unnecessary antibiotics for RTIs and improving the use of appropriate antibiotics in suspected bacterial infections.

Studies of echinoid microscopic anatomy over the last two centuries have created a number of inaccuracies and mistakes that have accumulated in the descriptions of the intricate organization of the coelomic system of Echinoidea. To clarify the situation, we reconstructed the axial complex and radial complex of the echinoid Strongylocentrotus pallidus. The water ring is located between the perivisceral coelom and the perioral coelom. The oral haemal ring lies between the coelothelia of the water-vascular, perivisceral, and perioral rings. The axial part of the axial organ communicates with the oral haemal ring in interradius CD, but the axial coelom does not form the axocoelomic perihaemal ring. The ventral intestinal haemal vessel originates from the oral haemal ring in radius A, and then branches into a network of capillaries, from which the dorsal intestinal vessel starts. The pericardial coelom envelopes the pericardial part of the axial organ, the lacunae of which communicate with the haemocoel of the body wall and with the axial part of the axial organ. The genital haemal ring and the dorsal intestinal vessel communicate with the axial organ. The genital coelom passes in the CD interradius on the side opposite to the hindgut. There is a somatocoelomic perihaemal ring, which sends a pair of coelomic outgrowths into each radius, accompanied by a radial haemal vessel in the oral part. The mistakes and inaccuracies of early descriptions of the echinoid axial complex are listed. The axial complex and associated structures of sea urchins are compared with other eleutherozoans.

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There are many problems associated with the development of remote gas condensate fields that can be alleviated by seamlessly integrating key engineering aspects such as recovery plan, production optimization, processing, waste management, and logistics. Production optimization requires monitoring of production oil, water, and gas rates along with reservoir conditions. This can prevent economic losses by providing early detection of reservoir problems like condensate banking. Multiphase flowmeters provide compact, cost effective well testing plus real time data for improved well performance analysis. Separation, feed preparation and processing in the vicinity of production sites is performed using compact modular equipment. Catalytic desulphurization ensures high quality treatment. New atmospheric pressure catalytic treatment technologies used for gas condensate and various quality oils enable production of diesel fuel (including Arctic) and high-octane gasoline. Location of fuels and lubricants (POL) production near oil and gas production sites can solve problems associated with delivering those supplies to Northern areas, ensure efficient sales of well production, enable year-round operation of special road machinery, and reduce operating costs. A closed loop system integrating production optimization, feed preparation technologies, modular processing systems, electric power generation using gas generators, associated natural gas conversion into synthetic gas and container-based wastewater treatment plants produces a powerful synergetic effect and offers opportunities to develop hard-to-reach areas. Integrated modular production systems will help unlock Siberia’s vast natural resources both hydrocarbon and non-hydrocarbon. The potential for local energy supply may be a key economic consideration for further production of Siberia’s mineral resources.