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

Communication Disability in Fiji:Community Cultural Beliefs and Attitudes

Purpose: Beliefs about communication disability vary according to the cultural context, and influence people’s attitudes and help-seeking behaviour. Little is known about Fijians with communication disability or the communities in which they live, and specialist services for people with communication disability are yet to be established in Fiji. An understanding of Fijian beliefs about the causes of communication disability and attitudes towards people with communication disability may inform future service development. Method: An interpretivist qualitative research paradigm and the International Classification of Functioning, Disability and Health (ICF) framework informed this project’s design. Scenarios of adults and children with communication disability were presented to 144 participants, randomly sampled across multiple public spaces in two Fiji cities. Thematic analysis of responses to 15 survey questions revealed participant beliefs about the causes and attitudes towards people with communication disability. Results: Three clusters describing perceived causes emerged from the analysis - internal, external, and supernatural. Major clusters across child and adult scenarios were similar; however, response categories within the scenarios differed. Community attitudes to people with communication disability were predominantly negative. These community attitudes influenced individual participants’ beliefs about educational and employment opportunities for Fijians with communication disability. Conclusion: Determination and acknowledgement of individuals’ belief systems informs development of culturally appropriate intervention programmes and health promotion activities. Implications: Speech-language pathologists and other professionals working with Fijian communities should acknowledge community belief systems and develop culturally-specific health promotion activities, assessments, and interventions

Who the hell was that? Stories, bodies and actions in the world

This article explores a two-way relationship between stories and the experiential actions of bodies in the world. Through an autoethnographic approach, the article presents a series of interlinked story fragments in an effort to show and evoke a feel for the ways in which stories, bodies, and actions influence and shape each other over time. It offers some reflections on the experiences the stories portray from the perspective of a social constructionist conception of narrative theory and suggest that while stories exert a powerful influence on the actions of our bodies, our bodies intrude on or ‘talk back’ to this process because bodies have an existence beyond stories

The Quasar Pair Q 1634+267 A, B and the Binary QSO vs. Dark Lens Hypotheses

Deep HST/NICMOS H (F160W) band observations of the z=1.96 quasar pair Q 1634+267A,B reveal no signs of a lens galaxy to a 1 sigma threshold of approximately 22.5 mag. The minimum luminosity for a normal lens galaxy would be a 6L_* galaxy at z > 0.5, which is 650 times greater than our detection threshold. Our observation constrains the infrared mass-to-light ratio of any putative, early-type, lens galaxy to (M/L)_H > 690h_65 (1200h_65) for Omega_0=0.1 (1.0) and H_0=65h_65 km/s/Mpc. We would expect to detect a galaxy somewhere in the field because of the very strong Mg II absorption lines at z=1.1262 in the Q 1634+267 A spectrum, but the HST H-band, I-band (F785LP) and V-band (F555W) images require that any associated galaxy be very under-luminous less than 0.1 L^*_H (1.0 L^*_I) if it lies within less than 40 h^{-1} (100 h^{-1}) kpc from Q 1634+267 A,B. While the large image separation (3.86 arcsec) and the lack of a lens galaxy strongly favor interpreting Q 1634+267A,B as a binary quasar system, the spectral similarity remains a puzzle. We estimate that at most 0.06% of randomly selected quasar pairs would have spectra as similar to each other as the spectra of Q 1634+267 A and B. Moreover, spectral similarities observed for the 14 quasar pairs are significantly greater than would be expected for an equivalent sample of randomly selected field quasars. Depending on how strictly we define similarity, we estimate that only 0.01--3% of randomly drawn samples of 14 quasar pairs would have as many similar pairs as the observational sample.Comment: 24 pages, including 4 figures, LaTex, ApJ accepted, comments from the editor included, minor editorial change

AEGIS: Infrared Spectroscopy of An Infrared Luminous Lyman Break Galaxy at z=3.01

We report the detection of rest--frame 6.2 and 7.7 \micron emission features arising from Polycyclic Aromatic Hydrocarbons (PAH) in the Spitzer/IRS spectrum of an infrared-luminous Lyman break galaxy at z=3.01. This is currently the highest redshift galaxy where these PAH emission features have been detected. The total infrared luminosity inferred from the MIPS 24 \micron and radio flux density is 2$\times10^{13}$ L$_{\odot}$, which qualifies this object as a so--called hyperluminous infrared galaxy (HyLIRG). However, unlike local HyLIRGs which are generally associated with QSO/AGNs and have weak or absent PAH emission features, this HyLIRG has very strong 6.2 and 7.7 \micron PAH emission. We argue that intense star formation dominates the infrared emission of this source, although we cannot rule out the presence of a deeply obscured AGN. This LBG appears to be a distorted system in the HST ACS F606W and F814W images, possibly indicating that a significant merger or interaction is driving the large IR luminosity

PMN J1838-3427: A new gravitationally lensed quasar

We report the discovery of a new double-image quasar that was found during a search for gravitational lenses in the southern sky. Radio source PMN J1838-3427 is composed of two flat-spectrum components with separation 1", flux density ratio 14:1 and matching spectral indices, in VLA and VLBA images. Ground-based BRI images show the optical counterpart (total I=18.6) is also double with the same separation and position angle as the radio components. An HST/WFPC2 image reveals the lens galaxy. The optical flux ratio (27:1) is higher than the radio value probably due to differential extinction of the components by the lens galaxy. An optical spectrum of the bright component contains quasar emission lines at z=2.78 and several absorption features, including prominent Ly-alpha absorption. The lens galaxy redshift could not be measured but is estimated to be z=0.36 +/- 0.08. The image configuration is consistent with the simplest plausible models for the lens potential. The flat radio spectrum and observed variability of PMN J1838-3427 suggest the time delay between flux variations of the components is measurable, and could thus provide an independent measurement of H_0.Comment: 23 pages, incl. 6 figures, to appear in A.J.; replaced with accepted version; minor changes to text, improved figure

The host galaxies of three radio-loud quasars: 3C 48, 3C 345, and B2 1425+267

Observations with the Wide-Field/Planetary Camera-2 of the Hubble Space Telescope (HST) are presented for three radio-loud quasars: 3C 48 (z=0.367), B2 1425+267 (z=0.366), and 3C 345 (z=0.594). All three quasars have luminous (~4 L^*) galaxies as hosts, which are either elliptical (B2 1425+267 and 3C 345) or interacting (3C 48), and all hosts are 0.5 - 1.0 mag bluer in (V-I) than other galaxies with the same overall morphology at similar redshifts to the quasars. The host of 3C 48 has many H II regions and a very extended tidal tail. All nine of the radio-loud quasars studied here and in Bahcall et al. (1997) either have bright elliptical hosts or occur in interacting systems. There is a robust correlation between the radio emission of the quasar and the luminosity of host galaxy; the radio-loud quasars reside in galaxies that are on average about 1 mag brighter than hosts of the radio-quiet quasars.Comment: Accepted for publication in ApJ. 3 postscript and 3 jpeg figures. Original figures may be found in ftp://eku.sns.ias.edu/pub/sofia/RadioLoud