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 Li2_2100^{100}MoO4_4 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 $^{100}$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 $^{100}$Mo in enriched Li$_2$$^{100}$MoO$_4$ detectors can be effectively discriminated by pulse-shape analysis in the light channel if the scintillating bolometer is provided with a Neganov-Luke light detector, which can improve the signal-to-noise ratio by a large factor, assumed here at the level of $\sim 750$ on the basis of preliminary experimental results obtained with these devices. The achieved pile-up rejection efficiency results in a very low contribution, of the order of $\sim 6\times10^{-5}$ counts/(keV$\cdot$kg$\cdot$y), to the background counting rate in the region of interest for a large volume ($\sim 90$ cm$^3$) Li$_2$$^{100}$MoO$_4$ detector. This background level is very encouraging in view of a possible use of the Li$_2$$^{100}$MoO$_4$ solution for a bolometric tonne-scale next-generation experiment as that proposed in the CUPID project

Background suppression in massive TeO2_2 bolometers with Neganov-Luke amplified light detectors

Bolometric detectors are excellent devices for the investigation of neutrinoless double-beta decay (0$\nu\beta\beta$). 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$_2$ is strongly limited by the alpha background in the region of interest for the 0$\nu\beta\beta$ of $^{130}$Te. It has been demonstrated that particle discrimination in TeO$_2$ 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$_2$ 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$_2$-based 0$\nu\beta\beta$ 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 64^{64}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 $\beta$/$\gamma$ events was measured as 1.5(3) keV/MeV, while it varies for $\alpha$ particles in the range of 0.2--3.0 keV/MeV. The detector demonstrate an effective identification of the $\beta$/$\gamma$ events from $\alpha$ 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 $\gamma$-spectrometer, and bolometric measurements. Only limits were set at the level of $\mathcal{O}$(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 $\alpha$-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 $\mathcal{O}(10^{17}$--$10^{18})$ 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 $\sim$10--20 keV, like the two neutrino double electron capture. A 10 kg-scale experiment can reach the experimental sensitivity at the level of $\mathcal{O}(10^{24})$ 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$\nu\beta\beta$) of $^{100}$Mo with $\sim$100 kg of $^{100}$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 $^{48}$Ca-depleted calcium and $^{100}$Mo-enriched molybdenum ($^{48\textrm{depl}}$Ca$^{100}$MoO$_4$). 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 $0\nu\beta\beta$ search with a 111 kg$\cdot$d live exposure of $^{48\textrm{depl}}$Ca$^{100}$MoO$_4$ crystals. No evidence for $0\nu\beta\beta$ decay of $^{100}$Mo is found, and a upper limit is set for the half-life of 0$\nu\beta\beta$ of $^{100}$Mo of $T^{0\nu}_{1/2} > 9.5\times10^{22}$ y at 90% C.L.. This limit corresponds to an effective Majorana neutrino mass limit in the range $\langle m_{\beta\beta}\rangle\le(1.2-2.1)$ eV