Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review.

Background: Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods: MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results: Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions: Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa

A linearized kinetic theory of spin-1/2 particles in magnetized plasmas

We have considered linear kinetic theory including the electron spin properties in a magnetized plasma. The starting point is a mean field Vlasov-like equation, derived from a fully quantum mechanical treatment, where effects from the electron spin precession and the magnetic dipole force is taken into account. The general conductivity tensor is derived, including both the free current contribution, as well as the magnetization current associated with the spin contribution. We conclude the paper with an extensive discussion of the quantum-mechanical boundary where we list parameter conditions that must be satisfied for various quantum effects to be influential.Comment: 11 page

Nuevos conceptos en el ensayo Varestraint

En este trabajo se describen las modificaciones que se han hecho al ensayo Varesrrainr para obrener el máximo de información de una probeta. Se ensayaron aceros inoxidables del tipo 347 estándar y modificado, encontrando que la técnica usada puede detectar diferencias en la tendencia al agrietamiento de la zona fundida, zona afectada térmicamente del metal previamente fundido y del metal base

Restoration of peatlands and greenhouse gas balances

In this chapter the impact of peatland restoration on greenhouse gas fluxes is discussed based on a literature review. Casestudies are presented covering different peatland types, different regions and different starting conditions