The Health Care Professional Antibiotic Resistance Awareness Scale v1: report on development and testing

As the threat of antimicrobial resistance (AMR) grows, multilateral bodies are mobilising support for national and global action. A cornerstone of action plans is to increase awareness of resistance amongst different groups, including human and animal health care professionals. Understanding current levels of awareness is required for targeting interventions as well as for assessing change. This project designed a questionnaire tool to assess awareness of AMR amongst HCPs in different low- and middle-income countries. The content of the questionnaire was developed through qualitative research, review of literature and existing tools, and expert consultations in a range of settings. The resulting set of 88 questions – to assess awareness, practice and context – were then piloted from April to September 2018 with human and animal health care professionals in six countries. A total of 1091 participants completed the survey online or on paper – 43 in Peru (human HCPs, in Spanish), 122 in Peru (animal HCPs, in Spanish), 112 in Nigeria (human HCPs, in English), 106 in Ghana (human HCPs, in English), 124 in Tanzania (human HCPs, in English) 40 in Tanzania (human HCPs, in KiSwahili), 253 in Vietnam (human HCPs, in Vietnamese), 183 in Vietnam (animal HCPs, in Vietnamese), and 43 in Thailand (animal HCPs, in Thai). The 49 items in the questionnaire intended to capture awareness and awareness-in-practice were evaluated using the psychometric analytic approach of Rasch Measurement Theory. A total of 23 items were retained after less well-performing items were removed, and the Rasch analysis was then re-run. The 23 items constitute the Health Care Professional (HCP) Antibiotic Resistance (ABR) Awareness Scale v1, to include four domains: awareness of mechanisms of antibiotic resistance; the ways antibiotic use drives antibiotic resistance; the ways antibiotic resistant infections can be transmitted and controlled; and how antibiotic resistance can be recognised. Overall, the 23-item HCP ABR Awareness Scale v1 performed sufficiently well to be used within certain parameters – in the languages tested and to perform within-country rather than between-country comparisons. It is also recommended that awareness is measured alongside practice and context indicators to capture practice in relation to antibiotic use as well as contextual factors that may explain levels of awareness

Immunomodulatory Therapy Reduces the Severity of Placental Lesions in Chronic Histiocytic Intervillositis

From Frontiers via Jisc Publications RouterHistory: collection 2021, received 2021-08-04, accepted 2021-09-23, epub 2021-10-18Publication status: PublishedChronic histiocytic intervillositis (CHI) is a rare, but highly recurrent inflammatory placental lesion wherein maternal macrophages infiltrate the intervillous space. Pregnancies with CHI are at high risk of fetal growth restriction, miscarriage or stillbirth. Presently, the diagnosis can only be made after histopathological examination of the placenta. Given its proposed immunological etiology, current treatments include aspirin, heparin, and immunomodulatory agents. However, the rationale for these medications is largely based upon small case series and reports as there is a lack of larger studies investigating treatment efficacy. Therefore, this study sought to determine whether inclusion of immunomodulatory medications was effective at reducing the severity of lesions and improving pregnancy outcomes in subsequent pregnancies. Thirty-three women with a history of CHI in at least one pregnancy (index case) were identified retrospectively through medical records. Twenty-eight participants presented with a first subsequent pregnancy and a further 11 with a second subsequent pregnancy at a specialist clinic for pregnancy after loss. Data on maternal demographics, medical history, medication, pregnancy outcome, and placental pathology was collected and compared between pregnancies. Twenty-seven (69%) subsequent pregnancies were treated with at least one or both of prednisolone and hydroxychloroquine. Inclusion of at least one immunomodulatory agent in treatment regimen resulted in an almost 25% increase in overall livebirth rate (61.5 vs. 86.2%). In women treated with immunomodulatory medication a greater proportion of placentas had reduced severity of lesions compared to those treated without (86.7 vs. 33.3%, respectively). A reduction in CHI severity was associated with a 62.3% improvement in livebirth rate compared to those where severity remained unchanged in relation to the index case. These data provide preliminary evidence that the use of immunomodulatory medication in the management of CHI improves histopathological lesions and the chance of livebirth in subsequent pregnancies. Due to CHI's rarity and ethical and feasibility issues, randomized controlled trials in affected women are challenging to conduct. As a result, collaboration between centers is required in future to increase study sample sizes and elucidate the mechanisms of hydroxychloroquine and prednisolone in reducing pathology

Awareness of antibiotic resistance: a tool for measurement among human and animal health care professionals in LMICs and UMICs

BACKGROUND: Raising awareness of antimicrobial resistance is a cornerstone of action plans to tackle this global One Health challenge. Tools that can reliably assess levels of awareness of antibiotic resistance (ABR) among human or animal healthcare professionals (HCPs) are required to guide and evaluate interventions. METHODS: We designed and tested an ABR awareness scale, a self-administered questionnaire completed by human and animal HCPs trained to prescribe and dispense antibiotics in six countries-Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru. Questionnaires also elicited demographic, practice, and contextual information. Psychometric analysis for the scale followed Rasch Measurement Theory. Bivariate analysis was carried out to identify factors associated with awareness scores. RESULTS: Overall, 941 HCPs (625 human and 316 animal) from Ghana, Nigeria, Tanzania, Vietnam, Thailand and Peru were included in the study. The 23-item ABR awareness scale had high-reliability coefficients (0.88 for human and 0.90 for animal HCPs) but performed better within countries than across countries. Median ABR awareness scores were 54.6-63.5 for human HCPs and 55.2-63.8 for animal HCPs (scale of 0-100). Physicians and veterinarians scored higher than other HCPs in every country tested. HCPs in this study reported working in contexts with limited laboratory infrastructures. More than 95% of HCPs were interested in receiving information or training on ABR and antimicrobial stewardship. CONCLUSION: HCPs' awareness of ABR can be reliably assessed with this validated 23-item scale within the countries tested. Using the scale alongside context questions and objective measurement of practices is recommended to inform interventions to improve antibiotic use

Synthesis of sea surface temperature and foraminifera stable isotope data spanning the mid-Pliocene warm period and early Pleistocene (PlioVAR)

The Pliocene Epoch (~2.6–5.3 million years ago, Ma) was characterized by a warmer than present climate with smaller Northern Hemisphere ice sheets, and therefore offers an example of a climate system in long-term equilibrium with current or predicted near-future carbon dioxide concentrations. The end of the Pliocene (~2.6 Ma) is marked by further ice-sheet expansion and intensification of glacial (cold) stages, referred to as the "intensification of Northern Hemisphere Glaciation" (iNHG). Here we present the data used to assess the spatial and temporal variability of ocean temperatures and ice-volume indicators through the late Pliocene and early Pleistocene (from 3.3 to 2.4 Ma) to determine the character of this climate transition. The data come from the Atlantic, Pacific, Indian and Southern Ocean, as well as some marginal seas. Here we present the synthesized alkenone sea-surface temperature, Mg/Ca sea-surface temperature, planktonic foraminifera d18O and benthic foraminifera d18O data which were used in our synthesis. Although the original data sets are largely published, here we present the alkenone SST records calculated using the BAYSPLINE calibration where these were not part of the original publication; the Mg/Ca-SST records where we revised the absolute SSTs; any data sets where we revised the age model