Evaluating an antimicrobial stewardship programme implemented in an intensive care unit of a large academic hospital, using the RE-AIM framework

Background. The threat of antimicrobial resistance driven by inappropriate and unnecessary use of antimicrobials is a global issue of great concern. Evidence-based approaches to optimising antimicrobial prescribing to improve patient care while reducing the rate of antimicrobial resistance continue to be implemented worldwide. However, the successes or failures of implementation of such approaches are seldom evaluated.Objectives. To evaluate the impact of an implemented antimicrobial stewardship programme (ASP) in reducing the spread of antimicrobial resistance in the intensive care unit (ICU) of a large academic hospital using the RE-AIM framework.Methods. A descriptive quasi-experimental study was conducted with adult patients who had been admitted to the ICU of an academic hospital in Johannesburg, South Africa. Data were extracted from patients’ records using a structured questionnaire. Descriptive statistics of four RE-AIM dimensions (reach, effectiveness, adoption and implementation) and the overall impact of the implemented antimicrobial stewardship programme were calculated.Results. From the 59 participant records, 21 patients (35.6%) developed hospital-acquired infections and all were prescribed antimicrobials during their stay in the ICU. Twenty-seven pathogens (bacterial species) were isolated from samples acquired from the patients, including Staphylococcus aureus (n=6; 22.2%), Escherichia coli (n=4; 14.8%), Acinetobacter baumannii (n=4; 14.8%) and Streptococcus pnuemoniae (n=3; 11.11%), as well as 10 other bacterial species (37.0%) including Corynebacterium species, Enterococcus faecium, Haemophilus influenzae, Klebsiella species, Clostridium difficile and Salmonella species. Of the 27 pathogens isolated, 19 (70.4 %) were resistant to the prescribed antimicrobials. The overall impact of the ASP implemented in the studied facility was 67.2%.Conclusions. An ASP requires both thorough implementation and leadership support to have an impact in the reduction of antimicrobial resistance. Lack of leadership support poses a significant challenge to sustainability. There is an urgent need for behavioural change in hospital leadership

Illegal dumping challenges in West Rand District Municipalities (WRDM), South Africa

Abstract: Increased population and urban migration in the West Rand District Municipality (WRDM) have significantly contributed towards increased waste generation and associated challenges. Increased waste generation exerts pressure, difficulties and constraints in waste management in the district with regards to storage facilities, receptacles, removal services and transportation. The lack or absence of waste management services in addition to other factors are catalysts and drivers for illegal dumping. In WRDM, illegal dumping is a result of rising waste disposal tariffs, lack of storage facilities, disrupted waste collection schedules, unsafe and inaccessible dumbing sites particularly for in informal settlements. Illegal dumping is prevalent in low income and overpopulated areas. Ignorance, lack of minimum education and public awareness with regards to integrated waste management significantly contribute to illegal dumping which is threat to human life and the environment. Exploring energy and material recovery from waste opportunities plus recycling could contribute towards reduced illegal dumping

A review of waste tyre pyrolysis : a discussion and analysis

Abstract: Over the years, the prospective of end-of-life tyres as a source of fuel, a chemical feedstock and carbonaceous material through pyrolysis has been explored immensely. Through literature review evaluation and analysis, this paper aims to present and discuss the development of waste tyre pyrolysis process as well as the derived products with their possible application pathways. The various reactors that can be employed during the pyrolysis process are discussed. Furthermore, the different types of pyrolysis processes as well as their influence on product yield are highlighted. The paper drew the conclusion that the pyrolysis literature which has been continuously developed over the years emphasize the need to fully understand how operating conditions such as temperature, pressure, heating rate, retention time, feed size; material feed rate ; reactor selection and the type of pyrolysis influence the selection and optimization of product stream/s

Production of liquid fuels through pyrolysis of waste hydraulic oil

Abstract: Waste lubricants derived from crude oil have the potential to be converted into usable products through re-refining and regeneration. Pyrolysis is considered as one of the best treatment route as it does not produce any harmful by-products. The objective of this work was to recover liquid oils via pyrolysis. The oils could then be utilized as fuels or chemical feedstock. Slow and flash pyrolysis studies were carried out. The highest oil recovery of 65% was achieved at 500oC while a wider product range was produced at 600oC through flash pyrolysis. The product range included heavy, medium and light oils at compositions of 15.5%, 72.6% and 11.9% respectively

Enhanced Dynamic Bandwidth Allocation Algorithm for Intelligent Home Networks

Internet of Things (IoT) has been seen playing a tremendous change in the Information Technology (IT) environments, and thus its importance has also been realized and played a vital role within Intelligent Home Networks (IHNs). This is because IoT establishes a connection between things and the Internet by utilizing different sensing devices to implement the intelligence to deal with the identification and management of the connected things. IHNs use intelligent systems to perform their daily operations. Meanwhile, these networks ensure comfort, safety, healthcare, automation, energy conservation, and remote management to devices and users. Apart from that, these networks provide assistance in self-healing for faults, power outages, reconfigurations, and more. However, we have realized that more and advanced devices and services continue to be introduced and used in these networks. This has led to competitions of the limited available network resources, services, and bandwidth. In this paper, therefore, we present the design and implementation of a Novel Dynamic Bandwidth Allocation (NoDBA) algorithm to solve the performance bottleneck incurred with IHNs. The proposed algorithm deals with the management of bandwidth and its allocation. In the proposed algorithm, this study integrates two algorithms, namely; Offline Cooperative Algorithm (OCA) and Particle Swarm Optimization (PSO) to improve Quality of Service (QoS). PSO defines the priority limits for subnets and nodes in the network. Meanwhile, OCA facilitates dynamic bandwidth allocation in the network. The Network Simulator-2 (NS-2) was used to simulate and evaluate the NoDBA and it showed improved results compared to the traditional bandwidth allocation algorithms. The obtained results show an average throughput of 92%, average delay of 0.8 seconds, and saves energy consumption of 95% compared to Dynamic QoS-aware Bandwidth Allocation (DQBA) and Data-Driven Allocation (DDA).   Keywords: IHNs, Dynamic Bandwidth Allocation, PSO, OCA, Qo

Dual HLA B*42 and B*81-reactive T cell receptors recognize more diverse HIV-1 Gag escape variants

Closely related HLA alleles presenting similar HIV-1 epitopes can be associated with variable clinical outcome. Here the authors report their findings on CD8+ T cell responses to the HIV-1 Gag-p24 TL9 immunodominant epitope in the context of closely related protective and less protective HLA alleles, and their differential effect on viral contro

"They have this not care - don't care attitude:" A Mixed Methods Study Evaluating Community Readiness for Oral PrEP in Adolescent Girls and Young Women in a Rural Area of South Africa.

INTRODUCTION: Adolescent girls and young women (AGYW) remain disproportionately affected by HIV. In a rural area of South Africa with an annual incidence (2011-2015) of 5 and 7% per annum for 15-19 and 20-24-year olds respectively, oral pre-exposure prophylaxis (PrEP) could provide AGYW with a form of HIV prevention they can more easily control. Using quantitative and qualitative methods, we describe findings from a study conducted in 2017 that assessed knowledge of and attitudes toward PrEP to better understand community readiness for an AGYW PrEP rollout. METHODS: We used descriptive analysis of a quantitative demographic survey (n = 8,414 ages 15-86) to identify population awareness and early PrEP adopters. We also conducted semi-structured, in-depth interviews with a purposive sample of 52 potential PrEP gatekeepers (health care workers, community leaders) to assess their potential influence in an AGYW PrEP rollout and describe the current sexual health landscape. Interviews were recorded, transcribed, and iteratively coded to identify major themes. RESULTS: PrEP knowledge in the general population, measured through a demographic survey, was low (n = 125/8,414, 1.49% had heard of the drug). Medicalized delivery pathways created hostility to AGYW PrEP use. Key informants had higher levels of knowledge about PrEP and saw it as a needed intervention. Community norms around adolescent sexuality, which painted sexually active youth as irresponsible and disengaged from their own health, made many ambivalent towards a PrEP rollout to AGYW. Health care workers discussed ways to shame AGYW if they tried to access PrEP as they feared the drug would encourage promiscuity and "risky" behaviour. Others interviewed opposed provision on the basis of health care equity and feared PrEP would divert both drug and human resources from treatment programs. CONCLUSIONS: The health system in this poor, high-HIV incidence area had multiple barriers to a PrEP rollout to AGYW. Norms around adolescent sexuality and gatekeeper concerns that PrEP could divert health resources from treatment to prevention could create barriers to PrEP roll-out in this setting. Alternate modes of delivery, particularly those which are youth-led and demedicalize PrEP, must be explored

Challenges in recruiting children to a multidrug-resistant TB prevention trial

BACKGROUND: Recruitment to randomised clinical trials can be challenging and slow recruitment has serious consequences. This study aimed to summarise and reflect on the challenges in enrolling young children to a multidrug-resistant TB (MDR-TB) prevention trial in South Africa. METHODS: Recruitment to the Tuberculosis Child Multidrug-resistant Preventive Therapy Trial (TB-CHAMP) was tracked using an electronic recruiting platform, which was used to generate a recruiting flow diagram. Structured personnel questionnaires, meeting minutes and workshop notes were thematically analysed to elucidate barriers and solutions. RESULT: Of 3,682 (85.3%) adult rifampicin (RIF) resistant index cases with pre-screening outcomes, 1597 (43.4%) reported having no children under 5 years in the household and 562 (15.3%) were RIF-monoresistant. More than nine index cases were pre-screened for each child enrolled. Numerous barriers to recruitment were identified. Thorough recruitment planning, customised tracking data systems, a dedicated recruiting team with strong leadership, adequate resources to recruit across large geographic areas, and excellent relationships with routine TB services emerged as key factors to ensure successful recruitment. CONCLUSION: Recruitment of children into MDR-TB prevention trials can be difficult. Several MDR-TB prevention trials are underway, and lessons learnt from TB-CHAMP will be relevant to these and other TB prevention studies

Homogeneous Gold Catalysis through Relativistic Effects: Addition of Water to Propyne

In the catalytic addition of water to propyne the Au(III) catalyst is not stable under non-relativistic conditions and dissociates into a Au(I) compound and Cl2. This implies that one link in the chain of events in the catalytic cycle is broken and relativity may well be seen as the reason why Au(III) compounds are effective catalysts.Comment: 12 pages, 3 figures, 1 tabl

Sudden Intensity Increases and Radial Gradient Changes of Cosmic Ray MeV Electrons and Protons Observed at Voyager 1 beyond 111 AU in the Heliosheath

Voyager 1 has entered regions of different propagation conditions for energetic cosmic rays in the outer heliosheath beginning at a distance of about 111 AU from the Sun. This conclusion is based on the fact that the low energy 6-14 MeV galactic electron intensity suddenly increased by ~20% over a time period \leg 10 days and the electron radial intensity gradient abruptly decreased from ~19%/AU to ~8%/AU at 2009.7 at a radial distance of 111.2 AU. A sudden radial gradient change was also observed at this time for >200 MeV protons. The gradients were constant during the time period before and after the electron increase. At about 2011.2 at a distance of 116.6 AU a second abrupt intensity increase was observed, this time for both electrons and protons. The increase for electrons was ~25% and occurred over a time period ~15 days or less. For >200 MeV protons the increase at this time was ~5% (unusually large) and occurred over a longer time period ~50 days. Between about 2011.2 and 2011.6, radial intensity gradients ~18%/AU and 3%/AU were observed for electrons and protons, respectively. These gradients were very similar to those observed for these particles before the 1st sudden increase at 2009.7. These large positive gradients observed after 2011.2 indicate that V1, although it has entered a different propagation region, is still within the overall heliospheric modulating region at least up to a time ~2011.6 (118.0 AU). In this paper we will discuss these events in more detail and consider possibilities for their explanation that have recently been suggested.Comment: 13 pages, 2 figure