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

Search for double beta decay of 136^{136}Ce and 138^{138}Ce with HPGe gamma detector

Search for double $\beta$ decay of $^{136}$Ce and $^{138}$Ce was realized with 732 g of deeply purified cerium oxide sample measured over 1900 h with the help of an ultra-low background HPGe $\gamma$ detector with a volume of 465 cm$^3$ at the STELLA facility of the Gran Sasso National Laboratories of the INFN (Italy). New improved half-life limits on double beta processes in the cerium isotopes were set at the level of $\lim T_{1/2}\sim 10^{17}-10^{18}$~yr; many of them are even two orders of magnitude larger than the best previous results.Comment: 21 pages, 6 figures, 3 tables; version accepted for publication on Nucl. Phys.

Faecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in healthy volunteers and hospitalized patients in Ouagadougou, Burkina Faso: prevalence, resistance profile, and associated risk factors

Background: Extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) are a serious challenge to patients’ treatment. The aim of this study is to determine the prevalence of ESBL-PE, investigate the associated resistance, and analyze the associated risk factors for acquisition of ESBL-PE.Methodology: A cross-sectional study was conducted on healthy volunteers and inpatients. After obtaining informed consent, rectal swabs were collected from each participant for isolation of Enterobacteriaceae on Hektoen enteric agar containing 4µg/L cefotaxime. The Enterobacteriaceae isolates were identified using biochemical tests and ESBL production was confirmed by the double-disc synergy test of amoxicillin and clavulanic acid. Antibiotic susceptibility test of each isolate was done by the disc diffusion method and interpreted using the recommendations of the European Committee on Antimicrobial Susceptibility Testing (EUCAST) clinical  breakpoints version 5.0.Results: During the study period, prevalence of faecal ESBL-PE among the study participants was 54.5% (103/189); 53.5% among healthy volunteers and 55.7% among inpatients (p=0.87). The major ESBL-PE isolates was Escherichia coli (71%) followed by Klebsiella pneumoniae (16%). The isolates in hospitalized patients were resistant to norfloxacin (84.2%), cotrimoxazole (89.5%), and gentamicin (7.0%). The isolates from healthy volunteers were resistant to norfloxacin (86.2%), cotrimoxazole (82.8%), and gentamicin (1.7%).Gender, age, and previous antibiotic use were not significantly associated with carriage of ESBL-PE (p=0.51).Conclusion: The high prevalence of ESBL-PE in this study is worrying. There is an urgent need to develop measures to monitor and limit the spread of these multidrug-resistant organisms in healthcare facilities and the community in Burkina Faso. Keywords: faecal carriage, ESBL-PE, healthy volunteers, inpatients, Burkina Fas

Radioactive contamination of ZnWO4 crystal scintillators

The radioactive contamination of ZnWO4 crystal scintillators has been measured deep underground at the Gran Sasso National Laboratory (LNGS) of the INFN in Italy with a total exposure 3197 kg x h. Monte Carlo simulation, time-amplitude and pulse-shape analyses of the data have been applied to estimate the radioactive contamination of the ZnWO4 samples. One of the ZnWO4 crystals has also been tested by ultra-low background gamma spectrometry. The radioactive contaminations of the ZnWO4 samples do not exceed 0.002 -- 0.8 mBq/kg (depending on the radionuclide), the total alpha activity is in the range: 0.2 - 2 mBq/kg. Particular radioactivity, beta active 65Zn and alpha active 180W, has been detected. The effect of the re-crystallization on the radiopurity of the ZnWO4 crystal has been studied. The radioactive contamination of samples of the ceramic details of the set-ups used in the crystals growth has been checked by low background gamma spectrometry. A project scheme on further improvement of the radiopurity level of the ZnWO4 crystal scintillators is briefly addressed.Comment: 15 pages, 8 figures, 6 tables, submitted for publicatio

ZnO-based scintillating bolometers: New prospects to study double beta decay of 64^{64}Zn

The first detailed study on the performance of a ZnO-based cryogenic scintillating bolometer as a detector to search for rare processes in zinc isotopes was performed. A 7.2 g ZnO low-temperature detector, containing more than 80\% of zinc in its mass, exhibits good energy resolution of baseline noise 1.0--2.7 keV FWHM at various working temperatures resulting in a low-energy threshold for the experiment, 2.0--6.0 keV. The light yield for $\beta$/$\gamma$ events was measured as 1.5(3) keV/MeV, while it varies for $\alpha$ particles in the range of 0.2--3.0 keV/MeV. The detector demonstrate an effective identification of the $\beta$/$\gamma$ events from $\alpha$ events using time-properties of only heat signals. %(namely, Rise time parameter). The radiopurity of the ZnO crystal was evaluated using the Inductively Coupled Plasma Mass Spectrometry, an ultra-low-background High Purity Ge $\gamma$-spectrometer, and bolometric measurements. Only limits were set at the level of $\mathcal{O}$(1--100) mBq/kg on activities of \Nuc{K}{40}, \Nuc{Cs}{137} and daughter nuclides from the U/Th natural decay chains. The total internal $\alpha$-activity was calculated to be 22(2) mBq/kg, with a major contribution caused by 6(1) mBq/kg of \Nuc{Th}{232} and 12(2) mBq/kg of \Nuc{U}{234}. Limits on double beta decay (DBD) processes in \Nuc{Zn}{64} and \Nuc{Zn}{70} isotopes were set on the level of $\mathcal{O}(10^{17}$--$10^{18})$ yr for various decay modes profiting from 271 h of acquired background data in the above-ground lab. This study shows a good potential for ZnO-based scintillating bolometers to search for DBD processes of Zn isotopes, especially in \Nuc{Zn}{64}, with the most prominent spectral features at $\sim$10--20 keV, like the two neutrino double electron capture. A 10 kg-scale experiment can reach the experimental sensitivity at the level of $\mathcal{O}(10^{24})$ yr.Comment: Prepared for submission to JINST; 27 pages, 9 figures, and 7 table

First Results from the AMoRE-Pilot neutrinoless double beta decay experiment

The Advanced Molybdenum-based Rare process Experiment (AMoRE) aims to search for neutrinoless double beta decay (0$\nu\beta\beta$) of $^{100}$Mo with $\sim$100 kg of $^{100}$Mo-enriched molybdenum embedded in cryogenic detectors with a dual heat and light readout. At the current, pilot stage of the AMoRE project we employ six calcium molybdate crystals with a total mass of 1.9 kg, produced from $^{48}$Ca-depleted calcium and $^{100}$Mo-enriched molybdenum ($^{48\textrm{depl}}$Ca$^{100}$MoO$_4$). The simultaneous detection of heat(phonon) and scintillation (photon) signals is realized with high resolution metallic magnetic calorimeter sensors that operate at milli-Kelvin temperatures. This stage of the project is carried out in the Yangyang underground laboratory at a depth of 700 m. We report first results from the AMoRE-Pilot $0\nu\beta\beta$ search with a 111 kg$\cdot$d live exposure of $^{48\textrm{depl}}$Ca$^{100}$MoO$_4$ crystals. No evidence for $0\nu\beta\beta$ decay of $^{100}$Mo is found, and a upper limit is set for the half-life of 0$\nu\beta\beta$ of $^{100}$Mo of $T^{0\nu}_{1/2} > 9.5\times10^{22}$ y at 90% C.L.. This limit corresponds to an effective Majorana neutrino mass limit in the range $\langle m_{\beta\beta}\rangle\le(1.2-2.1)$ eV