Risk perception of antimicrobial resistance by infection control specialists in Europe: a case-vignette study

Background Using case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients. Methods In this study, sixteen case-vignettes were developed to simulate hospitalised patient scenarios in the field of AMR and IC. A total of 245 IC specialists working in different hospitals from 15 European countries were contacted, among which 149 agreed to participate in the study. Using an online database, each participant scored five randomly-assigned case-vignettes, regarding the perceived risk associated with six different multidrug resistant organisms (MDRO). The intra-class correlation coefficient (ICC), varying from 0 (poor) to 1 (perfect), was used to assess the agreement for the risk on a 7-point Likert scale. High risk and low/neutral risk scorers were compared regarding their national, organisational and individual characteristics. Results Between January and May 2017, 149 participants scored 655 case-vignettes. The perceptions of the individual (clinical outcome) and collective (spread) risks were consistently lower than other MDRO for extended spectrum beta-lactamase producing Enterobacteriaceae cases and higher for carbapenemase producing Enterobacteriaceae (CPE) cases. Regarding CPE cases, answers were influenced more by the resistance pattern (93%) than for other MDRO. The risk associated with vancomycin resistant Enterococci cases was considered higher for the collective impact than for the individual outcome (63% vs 40%). The intra-country agreement regarding the individual risk was globally poor varying from 0.00 (ICC: 0–0.25) to 0.51 (0.18–0.85). The overall agreement across countries was poor at 0.20 (0.07–0.33). IC specialists working in hospitals preserved from MDROs perceived a higher individual (local, p = 0.01; national, p < 0.01) and collective risk (local and national p < 0.01) than those frequently exposed to bacteraemia. Conversely, IC specialists working in hospitals with a high MDRO clinical burden had a decreased risk perception. Conclusions The perception of the risk associated with AMR varied greatly across IC specialists and countries, relying on contextual factors including the epidemiology. IC specialists working in high prevalence areas may underestimate both the individual and collective risks, and might further negatively promote the MDRO spread. These finding highlight the need to shape local and national control strategies according to risk perceptions and contextual factors

Strengthening strategic management approaches to address antimicrobial resistance in global human health: a scoping review

Introduction The development and implementation of national strategic plans is a critical component towards successfully addressing antimicrobial resistance (AMR). This study aimed to review the scope and analytical depth of situation analyses conducted to address AMR in human health to inform the development and implementation of national strategic plans. Methods A systematic search of the literature was conducted to identify all studies since 2000, that have employed a situation analysis to address AMR. The included studies are analysed against frameworks for strategic analysis, primarily the PESTELI (Political, Economic, Sociological, Technological, Ecological, Legislative, Industry) framework, to understand the depth, scope and utility of current published approaches. Results 10 studies were included in the final review ranging from single country (6) to regional-level multicountry studies (4). 8 studies carried out documentary review, and 3 of these also included stakeholder interviews. 2 studies were based on expert opinion with no data collection. No study employed the PESTELI framework. Most studies (9) included analysis of the political domain and 1 study included 6 domains of the framework. Technological and industry analyses is a notable gap. Facilitators and inhibitors within the political and legislative domains were the most frequently reported. No facilitators were reported in the economic or industry domains but featured inhibiting factors including: lack of ring-fenced funding for surveillance, perverse financial incentives, cost-shifting to patients; joint-stock drug company ownership complicating regulations. Conclusion The PESTELI framework provides further opportunities to combat AMR using a systematic, strategic management approach, rather than a retrospective view. Future analysis of existing quantitative data with interviews of key strategic and operational stakeholders is needed to provide critical insights about where implementation efforts should be focussed, and also how to build contingency at the strategic level for agile responses to macro-level environmental influences

Pengaruh Pasar Timah Indonesia (Inatin) Terhadap Posisi Tawar Timah Indonesia

This research explain about the effect of local tin market establishment by government to Indonesias bargaining position in trading. The market was listed on future market, ICDX (Indonesia Commodity and Derivatives Exchange) with code INATIN to set the global price benchmark by requiring the metal be traded on this local exchange before export. The purpose of this regulation to make Indonesia as the largest exporter and the second big producer of tin in the world, the place for international price discovery and lead a fair value of tin in order to give advantadge for Indonesia which before Indonesia followed the London Metal Exchange as a international metal market. ICDX helps Indonesia government perform monitoring to the trading activities, price movement, and all market data. As neo-mercantilsm paradigm, government role is needed to increas income and maximize the benefits through policy as an economic protection. This term expresses Keynes theory about the importance of government intervention controlling market. Keynes states that government role can not be separated in economic of country. According to the theory, in summary this research shows Indonesia has better bargaining position to rise the price and volume on local exchange, as the effect of Indonesia government intevention through regulation of export tin in Permendag 32/M-DAG/PER/6/2013. This result is evidenced in tin price increas and LME tin stock depression. The research illustrates the effect of government protection in trading as a part of economy politic international.Key words: Indonesia Tin Market, tin export policy, London Metal Exchange, protectio

Studi Optimasi Pola Tanam Pada Daerah Irigasi Warujayeng Kertosono Dengan Program Linier

Daerah Irigasi Warujayeng Kertosono berada di wilayah Kabupaten Nganjuk yang melewati Kecamatan Tanjunganom, Kertosono, dan Lengkong dengan luas baku sawah 12,384 Ha. Sumber air irigasi dari Kali Brantas melalui Bendung Gerak Mrican dengan pengambilan dari pintu Mrican Kiri. Terbatasnya jumlah air di musim kemarau dapat mengurangi pemberian air ke sawah. Untuk memaksimalkan produksi tani perlu peningkatan produktivitas lahan dan pemberian air yang teratur sesuai dengan kebutuhan dan persediaan. Untuk analisa ini digunakan program linier Quantity Methods for Windows 3 dengan input kebutuhan air tiap jenis tanaman dan volume andalan sebagai kendala/batasan untuk pengoperasian program linier. Output dari program ini ialah luas sawah maksimum tiap jenis tanaman, musim tanamnya dan keuntungan hasil tani yang didapat. Dari beberapa alternatif rencana, didapat pola tanam yang menghasilkan keuntungan terbesar yaitu pola tanam padi-tebu, padi-palawija-tebu, palawija-tebu pada awal tanam Nopember 1 dengan keuntungan Rp. 281,541,700,000.00 dan intensitas tanam 300 %

Komunikasi Instruksional Instruktur di Lindz Yoga Studio Pekanbaru

Yoga is one of the sports or physic exercises which is most wanted and popular nowadays. Yoga combines or unites mind, body and soul only by doing movements (asana) along with breathing technique and meditation. Yoga is lead by an instructor who gives the instruction for the members. In giving the instruction, the instructor uses instructional communication in doing exercise process. The purpose of this research is to know the instructional method, instructional communication media, and the communication obstacles which happen in Yoga exercise process.This research belongs to quantitative research method by using symbolic approach. The informants of this research were 3 instructors and 3 members at Lindz Yoga studio Pekanbaru, while the object of this research was the instructors instructional communication at Lindz Yoga studio Pekanbaru. The data collection technique was used by observation, interview and documentation. In order to get data validity in this research, the researcher used the extension of participation and triangulation.The result of this research showed that the instructors instructional communication to the members in doing Yoga exercise used three instructional communications, such as command method, exercise method and question answer method. The media that used were audio media, aids media and picture media. The most use media and also effective in the usage are audio and aids media. The obstacles which happened in instructional communication are the sources obstacle, the channels obstacle, the communicants obstacle and psychological obstacle. Instructor as the communicator used verbal and nonverbal in the activity of instructional communication.Keyword : Yoga, instructional communication, Lindz Yoga studio Pekanbar

Active neutrino Oscillations and the SNO neutral Current measurement

We discuss the relation between the observed CC, ES, and NC fluxes with the flavor fractional content of the solar neutrino flux seen by SNO. By using existing estimates of the cross sections for the charged and neutral current reactions which take into account the detector resolution, we show how the forthcoming SNO rates unconstrained by the standard $^8$B shape could test the oscillations into active states. We perform a model independent analysis for the Super-K and SNO data, assuming a non distorted spectrum.Comment: 6pages, 4 figure

Prediction of Flow Pattern Behaviour Behind Square Cylinder using Computational Fluid Dynamic (CFD) Approach

The aim of this study is to investigate the flow pattern behaviour by using computational fluid dynamic (CFD) approach. The square profile was chosen in purpose to have a better understanding of the behaviour which is relevant to the engineering applications. Numerical simulation was performed on various turbulence models with the range of Reynolds number from 6000 to 80000 with three incidence angles of 0°, 15°, and 30°. Mesh dependency study was performed with coarse, base and fine meshes. Fine mesh and standard k–ω were chosen as the best meshing and turbulence model to perform the simulation due to the capability in terms of less absolute error on aerodynamic coefficient and clear flow visualisation capture. It was found that the average values of Strouhal number for square profile was 0.12. For this particular study, the changes of incidence angle and variation of Reynolds number gave a significant flow pattern behind a square profile. The size of the vortices became smaller and closer to the structure as the incidence angle increased. At high Reynolds number, it was also observed that the size of the vortices increased progressively. The prediction of flow pattern behind square cylinder was successfully determined by using CFD approach

A transferable prediction model of molecular adsorption on metals based on adsorbate and substrate properties

Surface adsorption is one of the fundamental processes in numerous fields, including catalysis, the environment, energy and medicine. The development of an adsorption model which provides an effective prediction of binding energy in minutes has been a long term goal in surface and interface science. The solution has been elusive as identifying the intrinsic determinants of the adsorption energy for various compositions, structures and environments is non-trivial. We introduce a new and flexible model for predicting adsorption energies to metal substrates. The model is based on easily computed, intrinsic properties of the substrate and adsorbate, which are the same for all the considered systems. It is parameterised using machine learning based on first-principles calculations of probe molecules (e.g., H2O, CO2, O2, N2) adsorbed to a range of pure metal substrates. The model predicts the computed dissociative adsorption energy to metal surfaces with a correlation coefficient of 0.93 and a mean absolute error of 0.77 eV for the large database of molecular adsorption energies provided by Catalysis-Hub.org which have a range of 15 eV. As the model is based on pre-computed quantities it provides near-instantaneous estimates of adsorption energies and it is sufficiently accurate to eliminate around 90% of candidates in screening study of new adsorbates. The model, therefore, significantly enhances current efforts to identify new molecular coatings in many applied research fields