Self-reported antibiotic stewardship and infection control measures from 57 intensive care units: An international ID-IRI survey

We explored the self-reported antibiotic stewardship (AS), and infection prevention and control (IPC) activities in intensive care units (ICUs) of different income settings. A cross-sectional study was conducted using an online questionnaire to collect data about IPC and AS measures in participating ICUs. The study participants were Infectious Diseases-International Research Initiative (IDI-IR) members, committed as per their institutional agreement form. We analyzed responses from 57 ICUs in 24 countries (Lower-middle income (LMI), n = 13; Upper-middle income (UMI), n = 33; High-income (HI), n = 11). This represented (similar to 5%) of centers represented in the ID-IRI. Surveillance programs were implemented in (76.9%-90.9%) of ICUs with fewer contact precaution measures in LMI ones (p = 0.02); (LMI:69.2%, UMI:97%, HI:100%). Participation in regional antimicrobial resistance programs was more significantly applied in HI (p = 0.02) (LMI:38.4%,UMI:81.8%,HI:72.2%). AS programs are implemented in 77.2% of institutions with AS champions in 66.7%. Infectious diseases physicians and microbiologists are members of many AS teams (59%&50%) respectively. Unqualified healthcare professionals(42.1%), and deficient incentives(28.1%) are the main barriers to implementing AS. We underscore the existing differences in IPC and AS programs' implementation, team composition, and faced barriers. Continuous collaboration and sharing best practices on APM is needed. The role of regional and international organizations should be encouraged. Global support for capacity building of healthcare practitioners is warranted. (C) 2022 Published by Elsevier Ltd on behalf of King Saud Bin Abdulaziz University for Health Sciences

Repeated Load Permanent Deformation Behavior of Mixes With and Wihtout Modified Bituments

Premature rutting in flexible pavement structure is being observed on most of the road network of Pakistan. It initiates primarily due to uncontrolled axle loading and high ambient temperatures. NHA (National Highway Authority), Pakistan has continuously been modifying aggregate gradations and penetration grade of bitumen, without any prior investigation of the mix behaviour under the prevailing axle load and environmental conditions of the country. A comprehensive laboratory investigation was carried out on six mixes ranging from finer to coarser. Specimens were subjected to cyclic loading on UTM-5P (Universal Testing Machine) to study the resistance against permanent deformation of the mixes at 25, 40 and 550C. At low temperatures and stress levels, both coarse and fine graded mixes showed less accumulated strain, whereas at higher temperatures and stress levels, coarse graded mix with PMB (Polymer Modified Bitumen) showed good resistance to permanent deformation

Effects of Mineral Filler to Polymer Modified Bitumen Ratio on the Design Properties of Hot Mix Asphalt and its Performance

Current development in the design of asphalt concrete especially in the upper layers of flexible pavements contains about acceptable proportion of mineral fillers passing 75?m (# 200) sieve, which contributes towards the mix cohesion, resistant to rutting and improves serviceability. Three filler to PMA (Polymer Modified Asphalt) ratios (i.e. 2.4, 3.4. and 4.4%) in Marshall Method of mix design were used in order to determine the optimum filler content at relatively low design asphalt contents (3.83%), for asphalt concrete having PMA and 100% lime stone dust. Designed mix was laid on Southbound Turnol Taxila National Highway Section (N-5), Pakistan as a trial in year 2003. The study reveals that filler to asphalt ratio affects the mix properties to a greater extent and mix laid at site have shown relatively better performance during its service life of initial four critical years. For coarse graded mixes with low asphalt contents, designed especially for heavy loading and high temperatures regions like Pakistan, filler to asphalt ratio less than equal to 1.0 yields better results

Modeling and Correlating Rut Depth Observed in Different Asphalt Mixture Performance Tests

The purpose of research is to model and correlate the laboratory rutting behavior of indigenous asphalt mixtures, prior to placing in the field. Extensive laboratory testing was carried out on thirty representative wearing course mixtures using two types of rutting performance tests i.e. CWTT (Cooper Wheel Tracking Tests), and APA (Asphalt Pavement Analyzer) tests. The mixture ranking is consistent for both laboratory performance tests at the tested temperature conditions of 40 and 50oC. Laboratory rutting prediction models have been developed by non-linear regression analysis technique. Significant independent variables involved in the model are temperature, number of passes in case of CWTT or number of cycles in case of APA tests, bitumen penetration value, and Flakiness index of coarse aggregates fraction. A strong relationship has been observed between measured and predicted values of rut depth in terms of R2 value of 0.92 and 0.95 for CWTT and APA tests, respectively. A reasonable empirical quadratic function correlation (R2 = 0.69) has been developed between rut depth of CWTT and rut depth in APA test

The distribution of new HIV infections by mode of exposure in Morocco.

OBJECTIVES: Building on a wealth of new empirical data, the objective of this study was to estimate the distribution of new HIV infections in Morocco by mode of exposure using the modes of transmission (MoT) mathematical model. METHODS: The MoT model was implemented within a collaboration with the Morocco Ministry of Health and the Joint United Nations Programme on HIV/AIDS. The model was parameterised through a comprehensive review and synthesis of HIV and risk behaviour data in Morocco, mainly through the Middle East and North Africa HIV/AIDS Synthesis Project. Uncertainty analyses were used to assess the reliability of and uncertainty around our calculated estimates. RESULTS: Female sex workers (FSWs), clients of FSWs, men who have sex with men (MSM) and injecting drug users (IDUs) contributed 14%, 24%, 14% and 7% of new HIV infections, respectively. Two-thirds (67%) of new HIV infections occurred among FSWs, clients of FSWs, MSM and IDUs, or among the stable sexual partners of these populations. Casual heterosexual sex contributed 7% of HIV infections. More than half (52%) of HIV incidence is among females, but 71% of these infections are due to an infected spouse. The vast majority of HIV infections among men (89%) are due to high-risk behaviour. A very small HIV incidence is predicted to arise from medical injections or blood transfusions (0.1%). CONCLUSIONS: The HIV epidemic in Morocco is driven by HIV incidence in high-risk population groups, with commercial heterosexual sex being the largest contributor to incidence. There is a need to focus HIV response more on these populations, mainly through proactive and sustainable HIV surveillance, and the expansion and increased geographical coverage of services such as condom promotion among FSWs, voluntary counselling and testing, harm reduction and treatment

Experimental Investigation into the Structural and Functional Performance of Graphene Nano-Platelet (GNP)-Doped Asphalt

With the increase in the demand for bitumen, it has become essential for pavement engineers to ensure that construction of sustainable pavements occurs. For a complete analysis of the pavement, both its structural and functional performances are considered. In this study, a novel material (i.e., Graphene Nano-Platelets (GNPs)) has been used to enhance both of the types of pavements’ performances. Two percentages of GNPs (i.e., 2% and 4% by the weight of the binder) were used for the modification of asphalt binder in order to achieve the desired Performance Grade. GNPs were homogeneously dispersed in the asphalt binder, which was validated by Scanning Electron Microscope (SEM) images and a Hot Storage Stability Test. To analyze the structural performance of the GNPs-doped asphalt, its rheology, resistance to permanent deformation, resistance to moisture damage, and bitumen-aggregate adhesive bond strength were studied. For the analysis of the functional performance, the skid resistance and polishing effect were studied using a British Pendulum Skid Resistance Tester. The results showed that GNPs improved not only the rutting resistance of the pavement but also its durability. The high surface area of GNPs increases the pavement’s bonding strength and makes the asphalt binder stiffer. GNPs also provide nano-texture to the pavement, which enhances its skid resistance. Thus, we can recommend GNPs as an all-around modifier that could improve not only the structural performance but also the functional performance of asphalt pavements

Performance Evaluation of Carbon Black Nano-Particle Reinforced Asphalt Mixture

Applications of nanotechnology in the pavement industry have increased rapidly during the last decade in order to enhance a pavement’s sustainability and durability. Conventional asphalt binder generally does not provide sufficient resistance against rutting at high temperatures. Carbon black nano-particles (CBNPs, produced by perennial mountain trees’ carbonization) were mixed into the performance grade (PG) 58 asphalt binder in this study. Conventional asphalt binder tests (penetration, ductility and softening point), frequency sweep, performance grading, and bitumen bond strength tests were conducted to study the enhancement in the properties of asphalt binder. Dynamic modulus and wheel tracking tests were also performed to investigate the effect of CBNPs on asphalt mixture properties. Experimental results demonstrated that preferred dosage of CBNPs in asphalt is 10% by weight of the bitumen. Results of scanning electron microscopy (SEM) and storage stability tests validated homogenous and stable dispersion of CBNPs in the asphalt binder. Asphalt mixtures became stiffer and resistant to rutting at high temperatures by addition of CBNPs in asphalt binder. Significant improvement in bitumen aggregate bond strength was also observed by incorporating CBNPs. It is concluded that CBNPs can be used to effectively enhance the high-temperature performance and consequently the sustainability of flexible pavements