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

First ozone reanalysis on Mars using SPICAM data

To further our understanding of important photochemical processes in the Martian atmosphere, a synthesis can be used to investigate the temporal and spatial agreement between model and observations and determine any possible causes of identified differences. In this study [1], we have assimilated, for the first time, total ozone into a Mars Global Circulation model (GCM) to study the ozone cycle

Conjugative transfer frequencies of mef(A)-containing Tn1207.3 to macrolide-susceptible Streptococcus pyogenes belonging to different emm types

The aim of this study was to examine the gene transfer potential of mef(A)-containing Tn120.3 to macrolide-susceptible Streptococcus pyogenes belonging to different emm types. Using the filter mating technique, Tn1207.3 was transferred by conjugation to 23 macrolide-susceptible recipients representing 11 emm types. PCR analysis confirmed the presence of the mef(A) gene and the comEC junction regions of the Tn1207.3 insertion in resultant transconjugants. Significant variation was found in the transfer frequency of Tn1207.3 to different Strep. pyogenes strains, and this phenomenon may contribute to the differences in mef(A) frequency observed among clinical isolates. Significance and Impact of the Study: The spread of antimicrobial resistance among pathogenic bacteria is an important problem, but the mechanisms of horizontal transfer between strains and species are often poorly understood. For instance, little is known on how macrolide resistance spreads between strains of the human pathogen Strep. pyogenes and why certain strains more commonly display resistance than others. Here, we show that Strep. pyogenes strains vary greatly in their ability to acquire a transposon encoding macrolide resistance by horizontal gene transfer in vitro. These data provide a novel insight into the transfer of antibiotic resistance between bacterial strains and offer an explanation for the differences in the frequency of resistance determinates and resistance seen among clinical isolates. © 2014 The Authors Letters in Applied Microbiology

Wolf-Rayets in IC10: Probing the Nearest Starburst

IC10 is the nearest starburst galaxy, as revealed both by its Halpha surface brightness and the large number of Wolf-Rayet stars (WRs) per unit area. The relative number of known WC- to WN-type WRs has been thought to be unusually high (~2), unexpected for IC10's metallicity. In this Letter we report the first results of a new and deeper survey for WRs in IC10. We sucessfully detected all of the spectroscopically known WRs, and based upon comparisons with a neighboring control field, estimate that the total number of WRs in IC10 is about 100. We present spectroscopic confirmation of two of our WR candidates, both of which are of WN type. Our photometric survey predicts that the actual WC/WN ratio is ~0.3. This makes the WC/WN ratio of IC 10 consistent with that expected for its metallicity, but greatly increases the already unusually high number of WRs, resulting in a surface density that is about 20 times higher than in the LMC. If the majority of these candidates are spectroscopically confirmed, IC10 must have an exceptional population of high mass stars.Comment: Accepted by ApJL; only minor correction in this versio

Sugar intake and dental decay : results from a national survey of children in Scotland

Peer reviewedPreprin

Dietary patterns of school-age children in Scotland : association with socio-economic indicators, physical activity and obesity

Peer reviewedPublisher PD

Quantum signatures of chaos in the dynamics of a trapped ion

We show how a nonlinear chaotic system, the parametrically kicked nonlinear oscillator, may be realised in the dynamics of a trapped, laser-cooled ion, interacting with a sequence of standing wave pulses. Unlike the original optical scheme [G.J.Milburn and C.A.Holmes, Phys. Rev A, 44, p4704, (1991)], the trapped ion enables strongly quantum dynamics with minimal dissipation. This should permit an experimental test of one of the quantum signatures of chaos; irregular collapse and revival dynamics of the average vibrational energy.Comment: 9 pages, 9 Postscript figures, Revtex, submitted to Phys. Rev.

The self-consistent gravitational self-force

I review the problem of motion for small bodies in General Relativity, with an emphasis on developing a self-consistent treatment of the gravitational self-force. An analysis of the various derivations extant in the literature leads me to formulate an asymptotic expansion in which the metric is expanded while a representative worldline is held fixed; I discuss the utility of this expansion for both exact point particles and asymptotically small bodies, contrasting it with a regular expansion in which both the metric and the worldline are expanded. Based on these preliminary analyses, I present a general method of deriving self-consistent equations of motion for arbitrarily structured (sufficiently compact) small bodies. My method utilizes two expansions: an inner expansion that keeps the size of the body fixed, and an outer expansion that lets the body shrink while holding its worldline fixed. By imposing the Lorenz gauge, I express the global solution to the Einstein equation in the outer expansion in terms of an integral over a worldtube of small radius surrounding the body. Appropriate boundary data on the tube are determined from a local-in-space expansion in a buffer region where both the inner and outer expansions are valid. This buffer-region expansion also results in an expression for the self-force in terms of irreducible pieces of the metric perturbation on the worldline. Based on the global solution, these pieces of the perturbation can be written in terms of a tail integral over the body's past history. This approach can be applied at any order to obtain a self-consistent approximation that is valid on long timescales, both near and far from the small body. I conclude by discussing possible extensions of my method and comparing it to alternative approaches.Comment: 44 pages, 4 figure