A whole-health-economy approach to antimicrobial stewardship: Analysis of current models and future direction.

Antimicrobial stewardship (AMS) strategies are widely implemented in single healthcare sectors and organisations; however, the extent and impact of integrated AMS initiatives across the whole health economy are unknown. Assessing degree of integration of AMS across the whole health economy and its impact is essential if we are to achieve a ‘One Health’ approach to addressing antimicrobial resistance (AMR), and therefore we searched systematically for and analysed published examples of integrated AMS initiatives to address this gap. Application of a system-level framework to analyse integration of AMS initiatives across and within healthcare sectors shows that integration is emerging but needs strengthening. Findings from a small number of evaluations in high-income countries suggest that antimicrobial prescribing and healthcare-associated infections can be reduced using a multisectoral integrated AMS approach. More robust research designs to evaluate and understand the impact of multisectoral integrated AMS are needed, particularly with respect to differing health systems in different countries and local organisational contexts. Our analysis highlights a number of challenges and ways forward for enhancing the delivery of AMS through an integrated approach

The Differences in Antibiotic Decision-making Between Acute Surgical and Acute Medical Teams: An Ethnographic Study of Culture and Team Dynamics

Background Cultural and social determinants influence antibiotic decision-making in hospitals. We investigated and compared cultural determinants of antibiotic decision-making in acute medical and surgical specialties. Methods An ethnographic observational study of antibiotic decision-making in acute medical and surgical teams at a London teaching hospital was conducted (August 2015–May 2017). Data collection included 500 hours of direct observations, and face-to-face interviews with 23 key informants. A grounded theory approach, aided by Nvivo 11 software, analyzed the emerging themes. An iterative and recursive process of analysis ensured saturation of the themes. The multiple modes of enquiry enabled cross-validation and triangulation of the findings. Results In medicine, accepted norms of the decision-making process are characterized as collectivist (input from pharmacists, infectious disease, and medical microbiology teams), rationalized, and policy-informed, with emphasis on de-escalation of therapy. The gaps in antibiotic decision-making in acute medicine occur chiefly in the transition between the emergency department and inpatient teams, where ownership of the antibiotic prescription is lost. In surgery, team priorities are split between 3 settings: operating room, outpatient clinic, and ward. Senior surgeons are often absent from the ward, leaving junior staff to make complex medical decisions. This results in defensive antibiotic decision-making, leading to prolonged and inappropriate antibiotic use. Conclusions In medicine, the legacy of infection diagnosis made in the emergency department determines antibiotic decision-making. In surgery, antibiotic decision-making is perceived as a nonsurgical intervention that can be delegated to junior staff or other specialties. Different, bespoke approaches to optimize antibiotic prescribing are therefore needed to address these specific challenges

Weighted multivariate curve resolution – alternating least squares based on sample relevance

Alternating least squares, within the multivariate curve resolution framework has seen a lot of practical applications and shows its distinction with its relatively simple and flexible implementation. However, the limitations of least squares should be considered carefully when deviating from the standard assumed data structure. Within this work we highlight the effects of noise in the presence of minor components, and we propose a novel weighting scheme within the weighted multivariate curve-resolution-alternating least squares framework, to resolve it. Two simulated and one Raman imaging case is investigated, by comparing the novel methodology against standard multivariate curve resolution-alternating least squares and essential spectral pixel selection. A trade-off is observed between current methods, while the novel weighting scheme demonstrates a balance, where the benefits of the previous two methods are retained

Pool boiling on modified surfaces using R-123

This article has been made available through the Brunel Open Access Publishing Fund.Saturated pool boiling of R-123 was investigated for five horizontal copper surfaces modified by different treatments, namely, an emery-polished surface, a fine sandblasted surface, a rough sandblasted surface, an electron beam-enhanced surface, and a sintered surface. Each 40-mm-diameter heating surface formed the upper face of an oxygen-free copper block, electrically heated by embedded cartridge heaters. The experiments were performed from the natural convection regime through nucleate boiling up to the critical heat flux, with both increasing and decreasing heat flux, at 1.01 bar, and additionally at 2 bar and 4 bar for the emery-polished surface. Significant enhancement of heat transfer with increasing surface modification was demonstrated, particularly for the electron beam-enhanced and sintered surfaces. The emery-polished and sandblasted surface results are compared with nucleate boiling correlations and other published data. © 2014 Syed W. Ahmad, John S. Lewis, Ryan J. McGlen, and Tassos G. Karayiannis Published with license by Taylor & Francis

Opportunities for system level improvement in antibiotic use across the surgical pathway

Optimizing antibiotic prescribing across the surgical pathway (before, during, and after surgery) is a key aspect of tackling important drivers of antimicrobial resistance and simultaneously decreasing the burden of infection at the global level. In the UK alone, 10 million patients undergo surgery every year, which is equivalent to 60% of the annual hospital admissions having a surgical intervention. The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections. Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively. Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease. The World Health Organization estimates SSI rates of up to 50% in postoperative surgical patients (depending on the type of surgery), with a particular problem in low- and middle-income countries, where SSIs are the most frequently reported healthcare-associated infections. Across European hospitals, SSIs alone comprise 19.6% of all healthcare-acquired infections. Much of the scientific research in infection management in surgery is related to infection prevention and control in the operating room, surgical prophylaxis, and the management of SSIs, with many studies focusing on infection within the 30-day postoperative period. However it is important to note that SSIs represent only one of the many types of infection that can occur postoperatively. This article provides an overview of the surgical pathway and considers infection management and antibiotic prescribing at each step of the pathway. The aim was to identify the implications for research and opportunities for system improvement

Thermalization through Hagedorn states - the importance of multiparticle collisions

Quick chemical equilibration times of hadrons within a hadron gas are explained dynamically using Hagedorn states, which drive particles into equilibrium close to the critical temperature. Within this scheme master equations are employed for the chemical equilibration of various hadronic particles like (strange) baryon and antibaryons. A comparison of the Hagedorn model to recent lattice results is made and it is found that for both Tc =176 MeV and Tc=196 MeV, the hadrons can reach chemical equilibrium almost immediately, well before the chemical freeze-out temperatures found in thermal fits for a hadron gas without Hagedorn states.Comment: 8 pages, 3 figures, talk presented at the International Conference on Strangeness in Quark Matter, Buzios, Rio de Janeiro, Brazil, Sept. 27 - Oct. 2, 200

Pengaruh Waktu Inkubasi terhadap Biokonversi Reject Nanas Menjadi Bioetanol

Bioethanol can be produced through a fermentation process materials containing starch, sugar and cellulose fibers by fermentation by microorganisms. Bioethanol can be used as solvents, materials manufacture of perfumes, flavorings, food coloring, and drugs, and even can be used as an alternative fuel. Bioethanol production is done by a process bacth or also called bulk process. The purpose of this study was to determine the effect of incubation time and also get the optimum concentration of ethanol in the manufacture of bioethanol from pineapple reject. Stages of the manufacturing process starts from the substrate pineapple reject juice. Effect of incubation time will be done in this study with variations of 24, 48, 72, 96 and 120 hours. The number of cells during the incubation period will be analyzed by measuring the dry weight of the cell. Fermentation will take place over 4 days (96 hours) with a variation of 12, 24, 36, 48, 60, 72, 84 and 96 hours with the help of Saccharomyces cerevisiae. The results showed that the best time of incubation occurred at 24 and 48 hours with each cell weight of 9.8 g/L and 10.1 g/L at 96 hours of fermentation time and 48 hours which produces bioethanol concentration of 7%

Neutrino oscillations from relativistic flavor currents

By resorting to recent results on the relativistic currents for mixed (flavor) fields, we calculate a space-time dependent neutrino oscillation formula in Quantum Field Theory. Our formulation provides an alternative to existing approaches for the derivation of space dependent oscillation formulas and it also accounts for the corrections due to the non-trivial nature of the flavor vacuum. By exploring different limits of our formula, we recover already known results. We study in detail the case of one-dimensional propagation with gaussian wavepackets both in the relativistic and in the non-relativistic regions: in the last case, numerical evaluations of our result show significant deviations from the standard formula.Comment: 16 pages, 4 figures, RevTe

Lack of analgesic efficacy in female rats of\ud the commonly recommended oral dose of\ud buprenorphine

Previous work in our laboratory showed that the recommended oral dose of buprenorphine (0.5 mg/kg) was not as effective\ud as the standard therapeutic subcutaneous dose for postoperative analgesia in male Long-Evans (hooded) and Sprague-Dawley (albino) rats. The aim of the current study was to extend this analysis to female rats. We measured the pain threshold in adult female rats in diestrus or proestrus before and 30 and 60 min after oral buprenorphine (0.5 mg/kg,), the standard subcutaneous dose of buprenorphine (0.05 mg/kg), or vehicle only (1 ml/kg each orally and subcutaneously). Female rats showed an increased pain threshold (analgesia) after subcutaneous buprenorphine but no change in pain threshold after either oral buprenorphine or vehicle only. Estrous cycle stage (proestrus versus diestrus) did not affect the analgesic effects of buprenorphine, but rats in proestrus showed significantly lower pain thresholds (less tolerance to pain) than did those in diestrus. These results show that the oral dose of buprenorphine recommended for postoperative analgesic care does not induce significant analgesia in female rats and therefore is not as effective as the standard subcutaneous dose