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

Groupoids and an index theorem for conical pseudo-manifolds

We define an analytical index map and a topological index map for conical pseudomanifolds. These constructions generalize the analogous constructions used by Atiyah and Singer in the proof of their topological index theorem for a smooth, compact manifold $M$. A main ingredient is a non-commutative algebra that plays in our setting the role of $C_0(T^*M)$. We prove a Thom isomorphism between non-commutative algebras which gives a new example of wrong way functoriality in $K$-theory. We then give a new proof of the Atiyah-Singer index theorem using deformation groupoids and show how it generalizes to conical pseudomanifolds. We thus prove a topological index theorem for conical pseudomanifolds

Measurement of disruption forces in JET using fiber-optic sensors

Monitoring the forces induced on the vacuum vessel when a disruption occurs is essential for the protection of the machine. Since divertor coils have been installed in JET, during disruptions a significant difference between the forces measured on the top and the bottom of the machine has been observed. In order to investigate these further, optical fiber transducers FBGs (Fiber Bragg Gratings) were installed in addition to the currently used strain gauges. During VDE (Vertical Displacement Event) tests, these new transducers were used to measure different level of disruptions ranging from 80T up to 230T vertical forces. The results were then compared with the strain gauges. The FBG measurement was carried out using a broadband light source illuminating an array of 4 FBGs through a combination of directional couplers, connectors and fiber-optic cable. The forces measured both by FBG and by the strain gauges are within the same range, except for the initial swing where large random differences are observed. The tests have demonstrated that the FBG-based force measurement system has adequate resolution (±1.52strain corresponding to a force of 4kN due to the geometry of the leg) and measurement range (50002strain or 13000kN) for this application

Improper colourings inspired by Hadwiger’s conjecture

Hadwiger’s Conjecture asserts that every Kt-minor-free graph has a proper (t − 1)-colouring. We relax the conclusion in Hadwiger’s Conjecture via improper colourings. We prove that every Kt-minor-free graph is (2t − 2)-colourable with monochromatic components of order at most 1/2 (t − 2). This result has no more colours and much smaller monochromatic components than all previous results in this direction. We then prove that every Kt-minor-free graph is (t − 1)-colourable with monochromatic degree at most t − 2. This is the best known degree bound for such a result. Both these theorems are based on a decomposition method of independent interest. We give analogous results for Ks,t-minorfree graphs, which lead to improved bounds on generalised colouring numbers for these classes. Finally, we prove that graphs containing no Kt-immersion are 2-colourable with bounded monochromatic degree

Advanced breast cancer clinical nursing curriculum: review and recommendations

Purpose The needs and concerns of patients with advanced breast cancer are changing at every phase of the care intervention. Management and coordination of hospital resources and services are also steadily evolving. The objective of the present expert report is to define a new oncology nursing role specialising in advanced breast cancer, to help guide patients throughout the whole healthcare itinerary. Methods A group of eight experts in oncology nursing and medical oncology defined the content index of the curriculum document. A systematic review of bibliography was carried out, and the relevant contents were extracted. Based on these contents and the participants’ experience recommendations were formulated and validated through a Delphi questionnaire and a participative meeting. Results The advanced breast cancer clinical nurse (ABCCN) should develop a clinical, psychosocial role focused on coordinating patients in the healthcare network. The nurse would be in charge of evaluating and supervising the care administered and the healthcare resources used. The ABCCN should be aware and participate in the protocols and available resources, be able to solve conflicts, deal with burn-out signs and have clinical, coaching and team-working abilities. The proposed curriculum provides a specific process for the care of patients, as well as an implementation process. Conclusions The ABCCN’s role is crucial to assume the best care and the optimisation of available resources. This review and consensus document provides the required tools for the implementation in hospitalsThe development of this work has been possible thanks to the financial support of Novartis Oncolog

Variations in water use by a mature mangrove of Avicennia germinans, French Guiana

In the tropical intertidal zones, little is known on water uptake by mangroves. Transpiration rates are generally measured at leaf level, but few studies exist on water use at tree or stand levels. The objective of this study was to measure sap flow in trees of different sizes to appreciate the range of variation in water use that may exist in a site dominated by 80% mature Avicennia germinans. The results showed that from the dry to the wet season the mean water use increased from 3.2 to 5.3 dm3 d−1 in small trees (DBH ∼ 13 cm), from 11.5 to 30.8 dm3 d−1 in medium trees (∼24 cm) and from 40.8 to 64.1 dm3 d−1 in large ones (∼45 cm). Sapwood remained active up to a depth of 8 cm with radial variations within the stem. Weak correlations were obtained with VPD and net radiation. This study confirmed that transpiration was larger under low levels of salinity. Water use at stand level (∼1900 living stems ha−1) was estimated to be in the range of 5.8 to 11.8 m3 ha−1 d−1 according to the season

Selenoprotein gene nomenclature

The human genome contains 25 genes coding for selenocysteine-containing proteins (selenoproteins). These proteins are involved in a variety of functions, most notably redox homeostasis. Selenoprotein enzymes with known functions are designated according to these functions: TXNRD1, TXNRD2, and TXNRD3 (thioredoxin reductases), GPX1, GPX2, GPX3, GPX4 and GPX6 (glutathione peroxidases), DIO1, DIO2, and DIO3 (iodothyronine deiodinases), MSRB1 (methionine-R-sulfoxide reductase 1) and SEPHS2 (selenophosphate synthetase 2). Selenoproteins without known functions have traditionally been denoted by SEL or SEP symbols. However, these symbols are sometimes ambiguous and conflict with the approved nomenclature for several other genes. Therefore, there is a need to implement a rational and coherent nomenclature system for selenoprotein-encoding genes. Our solution is to use the root symbol SELENO followed by a letter. This nomenclature applies to SELENOF (selenoprotein F, the 15 kDa selenoprotein, SEP15), SELENOH (selenoprotein H, SELH, C11orf31), SELENOI (selenoprotein I, SELI, EPT1), SELENOK (selenoprotein K, SELK), SELENOM (selenoprotein M, SELM), SELENON (selenoprotein N, SEPN1, SELN), SELENOO (selenoprotein O, SELO), SELENOP (selenoprotein P, SeP, SEPP1, SELP), SELENOS (selenoprotein S, SELS, SEPS1, VIMP), SELENOT (selenoprotein T, SELT), SELENOV (selenoprotein V, SELV) and SELENOW (selenoprotein W, SELW, SEPW1). This system, approved by the HUGO Gene Nomenclature Committee, also resolves conflicting, missing and ambiguous designations for selenoprotein genes and is applicable to selenoproteins across vertebrates

A cohomological formula for the Atiyah-Patodi-Singer index on manifolds with boundary

International audienceWe give a cohomological formula for the index of a fully elliptic pseudodifferential operator on a manifold with boundary. As in the classic case of Atiyah-Singer, we use an embedding into an euclidean space to express the index as the integral of a cohomology class depending in this case on a noncommutative symbol, the integral being over a $C^\infty$-manifold called the singular normal bundle associated to the embedding. The formula is based on a K-theoretical Atiyah-Patodi-Singer theorem for manifolds with boundary that is drawn from Connes' tangent groupoid approach