Cost-minimization model of a multidisciplinary Antibiotic Stewardship Team based on a successful implementation on a urology ward of an academic hospital

BackgroundIn order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit, which was financially evaluated here to calculate the return on investment from a hospital perspective.MethodsEffects were evaluated by comparing audited patients with a historic cohort with the same diagnosis-related groups. Based upon this evaluation a cost-minimization model was created that can be used to predict the financial effects of a day 2 case-audit. Sensitivity analyses were performed to deal with uncertainties. Finally, the model was used to financially evaluate the A-Team.ResultsOne whole year including 114 patients was evaluated. Implementation costs were calculated to be (sic)17,732, which represent total costs spent to implement this A-Team. For this specific patient group admitted to a urology ward and consulted on day 2 by the A-Team, the model estimated total savings of (sic)60,306 after one year for this single department, leading to a return on investment of 5.9.ConclusionsThe implemented multi-disciplinary A-Team performing a day 2 case-audit in the hospital had a positive return on investment caused by a reduced length of stay due to a more appropriate antibiotic therapy. Based on the extensive data analysis, a model of this intervention could be constructed. This model could be used by other institutions, using their own data to estimate the effects of a day 2 case-audit in their hospital.</p

An integrated stewardship model: antimicrobial, infection prevention and diagnostic (AID)

Considering the threat of antimicrobial resistance and the difficulties it entails in treating infections, it is necessary to cross borders and approach infection management in an integrated, multidisciplinary manner. We propose the antimicrobial, infection prevention and diagnostic stewardship model comprising three intertwined programs: antimicrobial, infection prevention and diagnostic stewardship, involving all stakeholders. The focus is a so-called ‘theragnostics’ approach. This leads to a personalized infection management plan, improving patient care and minimizing resistance development. Furthermore, it is important that healthcare regions nationally and internationally work together, ensuring that the patient (and microorganism) transfers will not cause problems in a neighboring institution. This antimicrobial, infection prevention and diagnostic stewardship model can serve as a blue print to implement innovative, integrative infection management

A multi-center blinded study on the efficiency of phenotypic screening methods to detect glycopeptide intermediately susceptible Staphylococcus aureus (GISA) and heterogeneous GISA (h-GISA)

Contains fulltext : 52338.pdf (publisher's version ) (Open Access)BACKGROUNDS: To determine the true incidence of hGISA/GISA and its consequent clinical impact, methods must be defined that will reliably and reproducibly discriminate these resistant phenotypes from vancomycin susceptible S. aureus (VSSA). METHODS: This study assessed and compared the ability of eight Dutch laboratories under blinded conditions to discriminate VSSA from hGISA/GISA phenotypes and the intra- and inter-laboratory reproducibility of agar screening plates and the Etest method. A total of 25 blinded and unique strains (10 VSSA, 9 hGISA and 6 GISA) were categorized by the PAP-AUC method and PFGE typed to eliminate clonal duplication. All strains were deliberately added in quadruplets to evaluate intra-laboratory variability and reproducibility of the methods. Strains were tested using three agar screening methods, Brain Heart Infusion agar (BHI) + 6 microg/ml vancomycin, Mueller Hinton agar (MH) + 5 microg/ml vancomycin and MH + 5 microg/ml teicoplanin) and the Etest macromethod using a 2 McFarland inoculum. RESULTS AND DISCUSSION: The ability to detect the hGISA/GISA phenotypes varied significantly between methods and phenotypes. BHI vancomycin and MH vancomycin agar screens lacked the ability to detect hGISA. The MH teicoplanin agar screen was more sensitive but still inferior to Etest that had a sensitivity of 98.5% and 99.5%, for hGISA and GISA, respectively. Intra- and inter-laboratory reproducibility varied between methods with poorest performance seen with BHI vancomycin. CONCLUSION: This is the first multi-center blinded study to be undertaken evaluating various methods to detect GISA and hGISA. These data showed that the ability of clinical laboratories to detect GISA and hGISA varied considerably, and that screening plates with vancomycin have a poor performance in detecting hGISA

Human Rights Shaming Through INGOs and Foreign Aid Delivery

Does the ``shaming" of human rights violations influence foreign aid delivery decisions across OECD donor countries? We examine the effect of shaming, defined as targeted negative attention by human rights international nongovernmental organizations (INGOs), on donor decisions about how to deliver bilateral aid. We argue that INGO shaming of recipient countries leads donor governments, on average, to ``bypass" the recipient government in favor of non-state aid delivery channels, including international and local NGOs and international organizations (IOs). However, we expect this relationship to be conditional on a donor country's position in the international system. Minor power countries have limited influence in global affairs and are therefore more able to centrally promote human rights in their foreign policy. Major power countries, on the other hand, shape world politics and often confront ``realpolitik" concerns that may require government-to-government aid relations in the presence of INGO shaming. We expect aid officials of minor donor countries to be more likely to condition aid delivery decisions on human rights shaming than their counterparts of major donor countries. Using compositional data analysis, we test our argument using originally collected data on human rights shaming events in a time-series cross-sectional framework from 2004 to 2010. We find support for our hypotheses: On average, OECD donor governments increase the proportion of bypass when INGOs shame the recipient government. When differentiating between donor types we find that this finding holds for minor but not for major powers. These results add to both our understanding of the influences of aid allocation decision-making and our understanding of the role of INGOs on foreign-policy

Secretion of Novel SEL1L Endogenous Variants Is Promoted by ER Stress/UPR via Endosomes and Shed Vesicles in Human Cancer Cells

We describe here two novel endogenous variants of the human endoplasmic reticulum (ER) cargo receptor SEL1LA, designated p38 and p28. Biochemical and RNA interference studies in tumorigenic and non-tumorigenic cells indicate that p38 and p28 are N-terminal, ER-anchorless and more stable relative to the canonical transmembrane SEL1LA. P38 is expressed and constitutively secreted, with increase after ER stress, in the KMS11 myeloma line and in the breast cancer lines MCF7 and SKBr3, but not in the non-tumorigenic breast epithelial MCF10A line. P28 is detected only in the poorly differentiated SKBr3 cell line, where it is secreted after ER stress. Consistently with the presence of p38 and p28 in culture media, morphological studies of SKBr3 and KMS11 cells detect N-terminal SEL1L immunolabeling in secretory/degradative compartments and extracellularly-released membrane vesicles. Our findings suggest that the two new SEL1L variants are engaged in endosomal trafficking and secretion via vesicles, which could contribute to relieve ER stress in tumorigenic cells. P38 and p28 could therefore be relevant as diagnostic markers and/or therapeutic targets in cancer

Calibration of the CMS hadron calorimeters using proton-proton collision data at root s=13 TeV

Methods are presented for calibrating the hadron calorimeter system of theCMSetector at the LHC. The hadron calorimeters of the CMS experiment are sampling calorimeters of brass and scintillator, and are in the form of one central detector and two endcaps. These calorimeters cover pseudorapidities vertical bar eta vertical bar ee data. The energy scale of the outer calorimeters has been determined with test beam data and is confirmed through data with high transverse momentum jets. In this paper, we present the details of the calibration methods and accuracy.Peer reviewe

Force control of the interaction while skinning a pig fore-end

The skinning and defatting of pig legs is a labor intensive task, which the DeboFlex project focuses on to automate by replacing human workers by robotic manipulators. In this internship the necessity and influence of force control is investigated on the contact dynamics between the skinning tool and pig leg. An intuitive and simplified 6DOF (Degree of Freedom) model is derived to perform continuoustime simulations using a PERA (Philips Experimental Robotic Arm). An inner and outer control loop is used to respectively control the motion of the end-effector using independent joint control and the interaction force exercised on the pig leg using an impedance controller. Moreover a discrete-time implementation is realized in Gazebo, a robotic simulator. The developed software is compatible for real-time implementation. An impedance controller has been developed to shape the dynamic contact properties between skinner and pig leg. The controller parameters are dependent on the contact properties of the pig leg. Stability and robustness of the control structure is investigated. Furthermore, discrete-time simulations are performed for practical implementation. This research has shown several scenarios where force control shows huge potential and advantages. But before a fair assessment can be made whether force control is necessary, the contact properties and their variations have to be investigated