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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
Comparison of swarming, mating performance and longevity of males Anopheles coluzzii between individuals fed with different natural fruit juices in laboratory and semi-field conditions.
BACKGROUND: It is assumed that malaria vectors feed on locally available nectar sources to obtain energy. Sugar feeding is energetically critical for the Anopheles male swarming and mating activities. However, little is known about the impact of local nectar feeding on male physiological development and its consequences on male mosquito life traits in the malaria control context. This study aimed to evaluate the influence of local fruit juices on the life traits of males Anopheles coluzzii. METHODS: Swarming characteristics (number of males in swarm, number of mating pairs, and swarm duration) in semi-field conditions; mating rate and longevity in a laboratory setting were compared between males An. coluzzii fed exclusively with mango, papaya or banana juices. The trophic preference was investigated in semi-field conditions. RESULTS: The results of this study showed that in the laboratory, mosquitoes fed with papaya juices lived on average longer (10Â days) than those fed with banana or mango juices (5Â days) and had higher a mating rate (53%) than those fed with banana juice (40%). In the semi-field, the swarm size of mosquitoes fed with banana juice (85 males) was larger than that of mosquitoes fed with mango juice (60 males). The number of mating pairs formed from banana-fed male swarms (17 mating pairs) was higher than that formed from mango-fed male swarm (8 mating pairs). There was no difference in swarming duration between male treatments. Male mosquitoes had a preference for papaya and banana juices. CONCLUSIONS: The results indicate that the origin of plant-derived feeding is an important factor in the survival and reproduction of mosquitoes. This calls for further investigations of chemical contents of nectars and their impact on the physiological development of mosquitoes
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
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
Differential and comparative screening of cowpea varieties to Striga gesnerioides (Willd.) Vatke for race specific identification in Burkina Faso
Significant efforts have been made to develop cowpea ( Vigna
unguiculata (L.) Walp.) varieties resistant to Striga gesnerioides in
Burkina Faso. Despite these efforts, the resistant genotypes developed
still express differential responses to Striga gesnerioides in
different zones of the country. This suggests existence of
intraspecific variability within the parasite. The objective of this
study was to assess the intraspecific variability of cowpea genotypes
to Striga gesnerioides infection in Burkina Faso. Ten cowpea varieties
were screened over two consecutive years, under artificial infestation
with 30 ecotypes of Striga seeds at Kamboins\ue9 research station, in
a screenhouse in Burkina Faso. Cowpea varieties used included Moussa
local, Komsar\ue9 and KVx404-8-1, which are susceptible to all Striga
ecotypes; and varieties B301, IT93K-693-2 and IT82D-849, which are free
from all Striga ecotypes infestation. Cowpea varieties Tiligr\ue9,
524B, local Gorom and Niizw\ue8 had specific reactions depending on
the ecotypes. The study highlights the existence of varietal
specificities according to the geographical origin of Striga
gesnerioides seeds. The structuring of the intraspecific diversity
showed five biotypes, of which three were clearly identified as SG1,
SG5 and SG Kp races; and two biotypes could not be identified. Although
this study did not allow for a clear determination of the racial
affiliation of the two new biotypes, it offers the possibility of
developing new strategies to control Striga by focusing on the
selection of resistant varieties based on regional specificities of
Striga races in each agricultural zone.Des efforts importants ont \ue9t\ue9 consentis pour d\ue9velopper
des vari\ue9t\ue9s de ni\ue9b\ue9 r\ue9sistantes au Striga
gesnerioides . Malgr\ue9 ces efforts, les g\ue9notypes
r\ue9sistants d\ue9velopp\ue9s expriment des r\ue9ponses
diff\ue9rentielles au Striga gesnerioides dans diff\ue9rentes zones
du pays. Cela sugg\ue8re l\u2019existence d\u2019une
variabilit\ue9 intrasp\ue9cifique au sein du parasite.
D\u2019o\uf9 la n\ue9cessit\ue9 d\u2019\ue9valuer la
variabilit\ue9 intrasp\ue9cifique de Striga gesnerioides. Dix
vari\ue9t\ue9s de ni\ue9b\ue9 ont \ue9t\ue9 cribl\ue9es
sur deux ann\ue9es successives sous infestation artificielle avec 30
\ue9cotypes de Striga \ue0 la station de recherche de
Kamboins\ue9. Des pots en plastique ont \ue9t\ue9 utilis\ue9s
comme parcelles exp\ue9rimentales dispos\ue9es en blocs de Fisher
avec trois r\ue9p\ue9titions. Les vari\ue9t\ue9s Moussa Local,
Komsar\ue9 et KVx404-8-1 ont \ue9t\ue9 sensibles \ue0 tous les
\ue9cotypes tandis que les vari\ue9t\ue9s B301, IT93K-693-2 et
IT82D-849 ont \ue9t\ue9 exemptes de toute infestation. Les
vari\ue9t\ue9s Tiligr\ue9, 524B, Gorom local et Niizw\ue8 ont
eu des r\ue9actions sp\ue9cifiques en fonction des \ue9cotypes.
L\u2019\ue9tude a mis en \ue9vidence l\u2019existence de
sp\ue9cificit\ue9s vari\ue9tales selon les \ue9cotypes. La
structuration de la diversit\ue9 intrasp\ue9cifique a montr\ue9
cinq biotypes dont trois ont \ue9t\ue9 clairement identifi\ue9s
comme les races SG1, SG5 et SG Kp et deux n\u2019ont pas pu \ueatre
identifi\ue9s. Bien que cette \ue9tude n\u2019ait pas permis de
d\ue9terminer l\u2019appartenance raciale des deux nouveaux
biotypes, elle offre n\ue9anmoins la possibilit\ue9 de
d\ue9velopper de nouvelles strat\ue9gies de lutte contre Striga
gesnerioides en se concentrant sur la s\ue9lection de
vari\ue9t\ue9s r\ue9sistantes en fonction des
sp\ue9cificit\ue9s r\ue9gionales des races de Striga dans chaque
zone agricole
The African Network for Improved Diagnostics, Epidemiology and Management of common infectious Agents
In sub-Saharan Africa, acute respiratory infections (ARI), acute gastrointestinal infections (GI) and acute febrile disease of unknown cause (AFDUC) have a large disease burden, especially among children, while respective aetiologies often remain unresolved. The need for robust infectious disease surveillance to detect emerging pathogens along with common human pathogens has been highlighted by the ongoing novel coronavirus disease2019 (COVID-19) pandemic. The African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA) is a sentinel surveillance study on the aetiology and clinical characteristics of ARI, GI and AFDUC in sub-Saharan Africa.Peer Reviewe
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