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

Annealing-induced Fe oxide nanostructures on GaAs

We report the evolution of Fe oxide nanostructures on GaAs(100) upon pre- and post-growth annealing conditions. GaAs nanoscale pyramids were formed on the GaAs surface due to wet etching and thermal annealing. An 8.0-nm epitaxial Fe film was grown, oxidized, and annealed using a gradient temperature method. During the process the nanostripes were formed, and the evolution has been demonstrated using transmission and reflection high energy electron diffraction, and scanning electron microscopy. These nanostripes; exhibited uniaxial magnetic anisotropy. The formation of these nanostructures is attributed to surface anisotropy, which in addition could explain the observed uniaxial magnetic anisotropy

Performances of Tiger Shrimp Culture in Environmentally Friendly Ponds

Mangrove ecosystem plays an obvious role in maintaining the biological balance in the coastal environment where shrimp ponds are usually constructed. The removal of mangroves around shrimp ponds has frequently brought about harvest failure. The study evaluated the performance of tiger shrimp culture in ponds provided with water from a water body where there was mangrove vegetation (hereafter mangrove reservoir). Twelve ponds, each measuring 2,500 m2, were filled with seawater from the mangrove reservoir until the water depth of 100 cm and then stocked with 20-40 PL/m2. In the first six ponds, the bottom water was released into the reservoir when the water depth reached 140 cm and then the water depth was maintained at 100 cm. In the second six ponds, the water was released from the ponds until the water depth reached 60 cm and then refilled with reservoir water until a depth of 100 cm. Both treatment ponds received water from the reservoir which also received the wastewater. The feeds for the shrimps were broadcast into the ponds twice a day to meet the 3% shrimp biomass requirement, which adjusted every other week through sampling. The result showed that mangrove vegetation is capable of removing excessive nutrients, up to 70% for NO3- N and NH4 +-N, reducing PO4 =-P fluctuation, and producing bioactive compounds. In the second treatment ponds, shrimp mortality started to occur in day 28 and most died by day 54 after stocking due to white spot disease outbreak. Mass mortality took place 54 days after stocking in two out of six of the first treatment ponds

Writing Electronic Devices on Paper with Carbon Nanotube Ink

The normal paper used in any printer is among the cheapest flexible organic materials that exist. We demonstrate that we can print on paper high-frequency circuits tunable with an applied dc voltage. This is possible with the help of an ink containing functionalized carbon nanotubes and water. After the water is evaporated from the paper, the nanotubes remain steadily imprinted on paper, showing a semiconducting behaviour and tunable electrical properties

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

New "Square Root" Model of Lepton Family Cyclic Symmetry

Following the newly formulated notion of form invariance of the neutrino mass matrix, a complete model of leptons is constructed. It is based on a specific unitary 3 X 3 matrix U in family space, such that U^2 is the simple discrete symmetry nu_e to -nu_e, nu_mu to nu_tau. Thus U also generates the cyclic group Z_4. The charged-lepton mass matrix is nearly diagonal while the neutrino mass matrix is of the form suitable for explaining maximal (large) mixing in atmospheric (solar) neutrino oscillations in the context of three nearly degenerate neutrino masses. Observable lepton flavor violation is predicted. Quarks may be treated in the same way as the charged leptons.Comment: 10 pages, no figur

Brane-Bulk energy exchange and agegraphic dark energy

We consider the agegraphic models of dark energy in a braneworld scenario with brane-bulk energy exchange. We assume that the adiabatic equation for the dark matter is satisfied while it is violated for the agegraphic dark energy due to the energy exchange between the brane and the bulk. Our study shows that with the brane-bulk interaction, the equation of state parameter of agegraphic dark energy on the brane, $w_D$, can have a transition from normal state where $w_D >-1$ to the phantom regime where $w_D <-1$, while the effective equation of state for dark energy always satisfies $w^{\mathrm{eff}}_D\geq-1$.Comment: 13 pages, to appear in IJMP

Capacity of English NHS hospitals to monitor quality in infection prevention and control using a new European framework: a multilevel qualitative analysis

Objective:(1) To assess the extent to which current English national regulations/policies/guidelines and local hospital practices align with indicators suggested by a European review of effective strategies for infection prevention and control (IPC); (2) to examine the capacity of local hospitals to report on the indicators and current use of data to inform IPC management and practice. Design A national and local-level analysis of the 27 indicators was conducted. At the national level, documentary review of regulations/policies/guidelines was conducted. At the local level data collection comprised: (a) review of documentary sources from 14 hospitals, to determine the capacity to report performance against these indicators; (b) qualitative interviews with 3 senior managers from 5 hospitals and direct observation of hospital wards to find out if these indicators are used to improve IPC management and practice. Setting 2 acute English National Health Service (NHS) trusts and 1 NHS foundation trust (14 hospitals). Participants 3 senior managers from 5 hospitals for qualitative interviews. Primary and secondary outcome measures As primary outcome measures, a ‘Red-Amber-Green’ (RAG) rating was developed reflecting how well the indicators were included in national documents or their availability at the local organisational level. The current use of the indicators to inform IPC management and practice was also assessed. The main secondary outcome measure is any inconsistency between national and local RAG rating results. Results National regulations/policies/guidelines largely cover the suggested European indicators. The ability of individual hospitals to report some of the indicators at ward level varies across staff groups, which may mask required improvements. A reactive use of staffing-related indicators was observed rather than the suggested prospective strategic approach for IPC management. Conclusions For effective patient safety and infection prevention in English hospitals, routine and proactive approaches need to be developed. Our approach to evaluation can be extended to other country settings