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Investigating the cultural and contextual determinants of antimicrobial stewardship programmes across low-, middle- and high-income countries—A qualitative study
Background
Most of the evidence on antimicrobial stewardship programmes (ASP) to help sustain the effectiveness of antimicrobials is generated in high income countries. We report a study investigating implementation of ASP in secondary care across low-, middle- and high-income countries. The objective of this study was to map the key contextual, including cultural, drivers of the development and implementation of ASP across different resource settings.
Materials and methods
Healthcare professionals responsible for implementing ASP in hospitals in England, France, Norway, India, and Burkina Faso were invited to participate in face-to face interviews. Field notes from observations, documentary evidence, and interview transcripts were analysed using grounded theory approach. The key emerging categories were analysed iteratively using constant comparison, initial coding, going back the field for further data collection, and focused coding. Theoretical sampling was applied until the categories were saturated. Cross-validation and triangulation of the findings were achieved through the multiple data sources.
Results
54 participants from 24 hospitals (England 9 participants/4 hospitals; Norway 13 participants/4 hospitals; France 9 participants/7 hospitals; India 13 participants/ 7 hospitals; Burkina Faso 8 participants/2 hospitals) were interviewed. Across Norway, France and England there was consistency in ASP structures. In India and Burkina Faso there were country level heterogeneity in ASP. State support for ASP was perceived as essential in countries where it is lacking (India, Burkina Faso), and where it was present, it was perceived as a barrier (England, France). Professional boundaries are one of the key cultural determinants dictating involvement in initiatives with doctors recognised as leaders in ASP. Nurse and pharmacist involvement was limited to England. The surgical specialty was identified as most difficult to engage with in each country. Despite challenges, one hospital in India provided the best example of interdisciplinary ASP, championed through organisational leadership.
Conclusions
ASP initiatives in this study were restricted by professional boundaries and hierarchies, with lack of engagement with the wider healthcare workforce. There needs to be promotion of interdisciplinary team work including pharmacists and nurses, depending on the available healthcare workforce in different countries, in ASP. The surgical pathway remains a hard to reach, but critical target for ASP globally. There is a need to develop contextually driven ASP targeting the surgical pathway in different resource settings
Rejection of randomly coinciding events in LiMoO scintillating bolometers using light detectors based on the Neganov-Luke effect
Random coincidences of nuclear events can be one of the main background
sources in low-temperature calorimetric experiments looking for neutrinoless
double-beta decay, especially in those searches based on scintillating
bolometers embedding the promising double-beta candidate Mo, because of
the relatively short half-life of the two-neutrino double-beta decay of this
nucleus. We show in this work that randomly coinciding events of the
two-neutrino double decay of Mo in enriched LiMoO
detectors can be effectively discriminated by pulse-shape analysis in the light
channel if the scintillating bolometer is provided with a Neganov-Luke light
detector, which can improve the signal-to-noise ratio by a large factor,
assumed here at the level of on the basis of preliminary
experimental results obtained with these devices. The achieved pile-up
rejection efficiency results in a very low contribution, of the order of counts/(keVkgy), to the background counting rate
in the region of interest for a large volume ( cm)
LiMoO detector. This background level is very encouraging in
view of a possible use of the LiMoO solution for a bolometric
tonne-scale next-generation experiment as that proposed in the CUPID project
Background suppression in massive TeO bolometers with Neganov-Luke amplified light detectors
Bolometric detectors are excellent devices for the investigation of
neutrinoless double-beta decay (0). The observation of such
decay would demonstrate the violation of lepton number, and at the same time it
would necessarily imply that neutrinos have a Majorana character. The
sensitivity of cryogenic detectors based on TeO is strongly limited by the
alpha background in the region of interest for the 0 of
Te. It has been demonstrated that particle discrimination in TeO
bolometers is possible measuring the Cherenkov light produced by particle
interactions. However an event-by-event discrimination with NTD-based light
detectors has to be demonstrated. We will discuss the performance of a
highly-sensitive light detector exploiting the Neganov-Luke effect for signal
amplification. The detector, being operated with NTD-thermistor and coupled to
a 750 g TeO crystal, shows the ability for an event-by-event identification
of electron/gamma and alpha particles. The extremely low detector baseline
noise, RMS 19 eV, demonstrates the possibility to enhance the sensitivity of
TeO-based 0 experiment to an unprecedented level
Radioactive contamination of ZnWO4 crystal scintillators
The radioactive contamination of ZnWO4 crystal scintillators has been
measured deep underground at the Gran Sasso National Laboratory (LNGS) of the
INFN in Italy with a total exposure 3197 kg x h. Monte Carlo simulation,
time-amplitude and pulse-shape analyses of the data have been applied to
estimate the radioactive contamination of the ZnWO4 samples. One of the ZnWO4
crystals has also been tested by ultra-low background gamma spectrometry. The
radioactive contaminations of the ZnWO4 samples do not exceed 0.002 -- 0.8
mBq/kg (depending on the radionuclide), the total alpha activity is in the
range: 0.2 - 2 mBq/kg. Particular radioactivity, beta active 65Zn and alpha
active 180W, has been detected. The effect of the re-crystallization on the
radiopurity of the ZnWO4 crystal has been studied. The radioactive
contamination of samples of the ceramic details of the set-ups used in the
crystals growth has been checked by low background gamma spectrometry. A
project scheme on further improvement of the radiopurity level of the ZnWO4
crystal scintillators is briefly addressed.Comment: 15 pages, 8 figures, 6 tables, submitted for publicatio
ZnO-based scintillating bolometers: New prospects to study double beta decay of Zn
The first detailed study on the performance of a ZnO-based cryogenic
scintillating bolometer as a detector to search for rare processes in zinc
isotopes was performed. A 7.2 g ZnO low-temperature detector, containing more
than 80\% of zinc in its mass, exhibits good energy resolution of baseline
noise 1.0--2.7 keV FWHM at various working temperatures resulting in a
low-energy threshold for the experiment, 2.0--6.0 keV. The light yield for
/ events was measured as 1.5(3) keV/MeV, while it varies for
particles in the range of 0.2--3.0 keV/MeV. The detector demonstrate
an effective identification of the / events from events
using time-properties of only heat signals. %(namely, Rise time parameter). The
radiopurity of the ZnO crystal was evaluated using the Inductively Coupled
Plasma Mass Spectrometry, an ultra-low-background High Purity Ge
-spectrometer, and bolometric measurements. Only limits were set at the
level of (1--100) mBq/kg on activities of \Nuc{K}{40},
\Nuc{Cs}{137} and daughter nuclides from the U/Th natural decay chains. The
total internal -activity was calculated to be 22(2) mBq/kg, with a
major contribution caused by 6(1) mBq/kg of \Nuc{Th}{232} and 12(2) mBq/kg of
\Nuc{U}{234}. Limits on double beta decay (DBD) processes in \Nuc{Zn}{64} and
\Nuc{Zn}{70} isotopes were set on the level of
-- yr for various decay modes profiting from 271
h of acquired background data in the above-ground lab. This study shows a good
potential for ZnO-based scintillating bolometers to search for DBD processes of
Zn isotopes, especially in \Nuc{Zn}{64}, with the most prominent spectral
features at 10--20 keV, like the two neutrino double electron capture. A
10 kg-scale experiment can reach the experimental sensitivity at the level of
yr.Comment: Prepared for submission to JINST; 27 pages, 9 figures, and 7 table
Proceedings of the third French-Ukrainian workshop on the instrumentation developments for HEP
The reports collected in these proceedings have been presented in the third
French-Ukrainian workshop on the instrumentation developments for high-energy
physics held at LAL, Orsay on October 15-16. The workshop was conducted in the
scope of the IDEATE International Associated Laboratory (LIA). Joint
developments between French and Ukrainian laboratories and universities as well
as new proposals have been discussed. The main topics of the papers presented
in the Proceedings are developments for accelerator and beam monitoring,
detector developments, joint developments for large-scale high-energy and
astroparticle physics projects, medical applications.Comment: 3rd French-Ukrainian workshop on the instrumentation developments for
High Energy Physics, October 15-16, 2015, LAL, Orsay, France, 94 page
First Results from the AMoRE-Pilot neutrinoless double beta decay experiment
The Advanced Molybdenum-based Rare process Experiment (AMoRE) aims to search
for neutrinoless double beta decay (0) of Mo with
100 kg of Mo-enriched molybdenum embedded in cryogenic detectors
with a dual heat and light readout. At the current, pilot stage of the AMoRE
project we employ six calcium molybdate crystals with a total mass of 1.9 kg,
produced from Ca-depleted calcium and Mo-enriched molybdenum
(CaMoO). The simultaneous detection of
heat(phonon) and scintillation (photon) signals is realized with high
resolution metallic magnetic calorimeter sensors that operate at milli-Kelvin
temperatures. This stage of the project is carried out in the Yangyang
underground laboratory at a depth of 700 m. We report first results from the
AMoRE-Pilot search with a 111 kgd live exposure of
CaMoO crystals. No evidence for
decay of Mo is found, and a upper limit is set for the
half-life of 0 of Mo of y at 90% C.L.. This limit corresponds to an effective
Majorana neutrino mass limit in the range eV
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