Comparison of X-ray diffraction measurement of residual elastic strains: monochromatic beam and image plate versus white beam energy-dispersive analysis

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Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries:results of an internet-based global point prevalence survey

Summary: Background: The Global Point Prevalence Survey (Global-PPS) established an international network of hospitals to measure antimicrobial prescribing and resistance worldwide. We aimed to assess antimicrobial prescribing and resistance in hospital inpatients. Methods: We used a standardised surveillance method to collect detailed data about antimicrobial prescribing and resistance from hospitals worldwide, which were grouped by UN region. The internet-based survey included all inpatients (adults, children, and neonates) receiving an antimicrobial who were on the ward at 0800 h on one specific day between January and September, 2015. Hospitals were classified as primary, secondary, tertiary (including infectious diseases hospitals), and paediatric hospitals. Five main ward types were defined: medical wards, surgical wards, intensive-care units, haematology oncology wards, and medical transplantation (bone marrow or solid transplants) wards. Data recorded included patient characteristics, antimicrobials received, diagnosis, therapeutic indication according to predefined lists, and markers of prescribing quality (eg, whether a stop or review date were recorded, and whether local prescribing guidelines existed and were adhered to). We report findings for adult inpatients. Findings: The Global-PPS for 2015 included adult data from 303 hospitals in 53 countries, including eight lower-middle-income and 17 upper-middle-income countries. 86 776 inpatients were admitted to 3315 adult wards, of whom 29 891 (34·4%) received at least one antimicrobial. 41 213 antimicrobial prescriptions were issued, of which 36 792 (89·3%) were antibacterial agents for systemic use. The top three antibiotics prescribed worldwide were penicillins with β-lactamase inhibitors, third-generation cephalosporins, and fluoroquinolones. Carbapenems were most frequently prescribed in Latin America and west and central Asia. Of patients who received at least one antimicrobial, 5926 (19·8%) received a targeted antibacterial treatment for systemic use, and 1769 (5·9%) received a treatment targeting at least one multidrug-resistant organism. The frequency of health-care-associated infections was highest in Latin America (1518 [11·9%]) and east and south Asia (5363 [10·1%]). Overall, the reason for treatment was recorded in 31 694 (76·9%) of antimicrobial prescriptions, and a stop or review date in 15 778 (38·3%). Local antibiotic guidelines were missing for 7050 (19·2%) of the 36 792 antibiotic prescriptions, and guideline compliance was 77·4%. Interpretation: The Global-PPS showed that worldwide surveillance can be accomplished with voluntary participation. It provided quantifiable measures to assess and compare the quantity and quality of antibiotic prescribing and resistance in hospital patients worldwide. These data will help to improve the quality of antibiotic prescribing through education and practice changes, particularly in low-income and middle-income countries that have no tools to monitor antibiotic prescribing in hospitals. Funding: bioMérieux

Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19).

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. METHODS: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. RESULTS: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. No recommendation was provided for 6 questions. The topics were: (1) infection control, (2) laboratory diagnosis and specimens, (3) hemodynamic support, (4) ventilatory support, and (5) COVID-19 therapy. CONCLUSION: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new recommendations in further releases of these guidelines

RECENT DEVELOPMENTS ON ALICE (ACCELERATORS AND LASERS IN COMBINED EXPERIMENTS) AT DARESBURY LABORATORY

Abstract Progress made in ALICE (Accelerators and Lasers In Combined Experiments) commissioning and a summary of the latest experimental results are presented in this paper. After an extensive work on beam loading effects in SC RF booster and linac cavities' conditioning, ALICE can now operate in full energy recovery mode at a bunch charge of 40pC, a beam energy of 27.5MeV and train lengths of up to 100µs. This improved operation of the machine has resulted in generation of coherentlyenhanced broadband terahertz radiation with an energy of several tens of microjoules per pulse and in successful demonstration of the Compton Back-Scattering x-ray source experiment. Experiments on the exposure of living cells to terahertz radiation have been started. These and other developments on ALICE are reported. MACHINE STATUS ALICE, an energy-recovery superconducting linac GaAs photocathode lifetime is now sufficiently long for routine ALICE operation at 40pC. Normally cathode recaesiation is performed once a month, when the quantum efficiency decreases from initial ~3% to below ~0.5%. Over the past year, a number of changes in gradient settings of SC cavities (booster and main linac) were made with the aim of optimising the RF set up and to accommodate limitations presented by the RF system. Each of these variations required significant changes in the overall machine set up. It can now be routinely operated at 27.5MeV with the total beam losses not exceeding 5 to 7%. The energy spectrum of the beam exiting the first cavity of the booster (BC1) with the second cavity (BC2) switched off (resulting in a beam energy of 3.9MeV, compared to the nominal injector energy of 6.5MeV) is shown i

Residual elastic strain due to laser shock peening: synchrotron diffraction measurement

Residual elastic strain in a thin slice parted off from a laser shock peened plate of titanium alloy Ti-6AI-4V was measured using high-energy diffraction on station 16.3 at SRS Daresbury. Diffraction peaks were collected for reflections (00.2), (10.1), (10.2), and (11.0) from the hcp (hexagonal close-packed) α-phase of the titanium alloy. Reference values of the lattice spacing for each of the reflections were found from the diffraction pattern collected from a stress-free sampling volume. The residual elastic strain values calculated on the basis of each reflection were then computed and plotted as a function of distance from the treated surface. Residual strain profiles show significant difference, reflecting the variation in the elastic and plastic with orientation of the grain, i.e. anisotropy. The average macroscopic residual elastic strain was therefore computed using an appropriate average, taking into account multiplicity of each reflection. Since the greatest contrast in elastic and plastic properties exists between directions (00.2) and (11.0), the difference between residual elastic strains measured for these reflections was plotted, together with the 'difference strain' between (00.2) and (10.1). These showed a very good correlation with the plastic strain profile introduced by laser shock peening

Epidemiology and treatment outcome of childhood tuberculosis in England and Wales: 1999–2006

Objective: To describe the recent trends in demographic, clinical and microbiological characteristics and outcome of treatment in paediatric cases of tuberculosis. Design: National surveillance study. Setting: England and Wales. Patients: All children under the age of 16 years reported with tuberculosis to the national enhanced surveillance system between 1999 and 2006 were included. Main outcome measures: Proportions, and rates of disease, by demographic characteristics, site of disease, diagnostic delay, culture confirmation, species, drug susceptibility and treatment outcome. Results: 3563 cases of tuberculosis in children were reported between 1999 and 2006. The incidence rate remained stable at around 4.3 per 100 000 (95% CI 4.1 to 4.4). Patients born outside the UK had a tuberculosis rate higher than children born in the UK (37 per 100 000 vs 2.5 per 100 000) and this rate increased over the period. Rates in the black African ethnic group were highest at 88 per 100 000. 60% of children had pulmonary disease, the commonest presentation, but only 948 (27%) had culture confirmed tuberculosis. The median time to diagnosis from onset of symptoms was 37 days (interquartile range 12–89). The proportions of cases with rifampicin, isoniazid and multi-drug resistant isolates were 2.4%, 9.3% and 2.3%, respectively. 88% of children completed treatment and less than 1% died. Conclusions: Overall rates of tuberculosis in children have remained stable, with the majority completing treatment. Rates are, however, highest in children not born in the UK, particularly among certain ethnic minority groups. Levels of drug resistance are also high

Energy calibration and full-pattern refinement for strain analysis using energy-dispersive and monochromatic X-ray diffraction

Precise channel-to-energy conversion is very important in full-pattern refinement in energy-dispersive X-ray diffraction. Careful examination shows that the channel-to-energy conversion is not entirely linear, which presents an obstacle to obtaining accurate quantitative data for lattice strains by pattern refinement. In order to establish an accurate quadratic channel-to-energy conversion function, a Matlab program was written to find the best quadratic coefficient and hence the whole energy conversion function. Then this energy conversion function was used to perform a whole-pattern fitting of the energy-dispersive X-ray diffraction pattern of a Ti64 sample. The strain across the Ti64 bar calculated from the fitting results has been compared with values obtained by single-wavelength X-ray diffraction utilizing a Laue monochromator. © 2005 International Union of Crystallography