Use of the WHO Access, Watch, and Reserve classification to define patterns of hospital antibiotic use (AWaRe): an analysis of paediatric survey data from 56 countries

BACKGROUND: Improving the quality of hospital antibiotic use is a major goal of WHO's global action plan to combat antimicrobial resistance. The WHO Essential Medicines List Access, Watch, and Reserve (AWaRe) classification could facilitate simple stewardship interventions that are widely applicable globally. We aimed to present data on patterns of paediatric AWaRe antibiotic use that could be used for local and national stewardship interventions. METHODS: 1-day point prevalence survey antibiotic prescription data were combined from two independent global networks: the Global Antimicrobial Resistance, Prescribing, and Efficacy in Neonates and Children and the Global Point Prevalence Survey on Antimicrobial Consumption and Resistance networks. We included hospital inpatients aged younger than 19 years receiving at least one antibiotic on the day of the survey. The WHO AWaRe classification was used to describe overall antibiotic use as assessed by the variation between use of Access, Watch, and Reserve antibiotics, for neonates and children and for the commonest clinical indications. FINDINGS: Of the 23 572 patients included from 56 countries, 18 305 were children (77·7%) and 5267 were neonates (22·3%). Access antibiotic use in children ranged from 7·8% (China) to 61·2% (Slovenia) of all antibiotic prescriptions. The use of Watch antibiotics in children was highest in Iran (77·3%) and lowest in Finland (23·0%). In neonates, Access antibiotic use was highest in Singapore (100·0%) and lowest in China (24·2%). Reserve antibiotic use was low in all countries. Major differences in clinical syndrome-specific patterns of AWaRe antibiotic use in lower respiratory tract infection and neonatal sepsis were observed between WHO regions and countries. INTERPRETATION: There is substantial global variation in the proportion of AWaRe antibiotics used in hospitalised neonates and children. The AWaRe classification could potentially be used as a simple traffic light metric of appropriate antibiotic use. Future efforts should focus on developing and evaluating paediatric antibiotic stewardship programmes on the basis of the AWaRe index. FUNDING: GARPEC was funded by the PENTA Foundation. GARPEC-China data collection was funded by the Sanming Project of Medicine in Shenzhen (SZSM2015120330). bioMérieux provided unrestricted funding support for the Global-PPS

The pattern of social media use and its association with academic performance among medical students

Item does not contain fulltextBACKGROUND: There are concerns that the use of social media (SM) among medical students could affect academic performance. The objectives of the study were to investigate the pattern and reasons for SM use and their association with academic performance. METHODS: A stratified random sample, frequency distribution and comparison of categorical variables with Chi-square and Fisher exact tests were used. RESULTS: Of the 97% who responded, 98% used SM. The most popular were Whatsapp (87.8%), You tube (60.8%) and Twitter (51.8%) for general use; while You tube (83.5%), Whatsapp (35.5%) and Twitter (35.3%) for learning. For general use, there was a significant higher number of visits to You tube and Facebook among male students, while the reverse was true for Instagram and Path. Around 71% visited SM >4 times/day and 55% spent 1-4 hours/day. The main reasons for SM use were entertainment (95.8%), staying up-to-date with news (88.3%), and socializing (85.5%); for academic studies (40%). There was no significant association between Grade Point Average and the frequency of daily SM use or use during lectures. CONCLUSIONS: While almost all the students used SM, only a minority used them for academic purposes. SM use was not associated with academic performance

Chemical Vapor Deposition Growth of Large Single-Crystal Mono‑, Bi‑, Tri-Layer Hexagonal Boron Nitride and Their Interlayer Stacking

Two-dimensional hexagonal boron nitride (h-BN) is a wide bandgap material which has promising mechanical and optical properties. Here we report the realization of an initial nucleation density of h-BN <1 per mm² using low-pressure chemical vapor deposition (CVD) on polycrystalline copper. This enabled wafer-scale CVD growth of single-crystal monolayer h-BN with a lateral size up to ∼300 μm, bilayer h-BN with a lateral size up to ∼60 μm, and trilayer h-BN with a lateral size up to ∼35 μm. Based on the large single-crystal monolayer h-BN domain, the sizes of the as-grown bi- and trilayer h-BN grains are 2 orders of magnitude larger than typical h-BN multilayer domains. In addition, we achieved coalesced h-BN films with an average grain size ∼100 μm. Various flake morphologies and their interlayer stacking configurations of bi- and trilayer h-BN domains were studied. Raman signatures of mono- and multilayer h-BN were investigated side by side in the same film. It was found that the Raman peak intensity can be used as a marker for the number of layers

Bandgap engineering of two-dimensional semiconductor materials

© 2020 Springer Nature Limited Semiconductors are the basis of many vital technologies such as electronics, computing, communications, optoelectronics, and sensing. Modern semiconductor technology can trace its origins to the invention of the point contact transistor in 1947. This demonstration paved the way for the development of discrete and integrated semiconductor devices and circuits that has helped to build a modern society where semiconductors are ubiquitous components of everyday life. A key property that determines the semiconductor electrical and optical properties is the bandgap. Beyond graphene, recently discovered two-dimensional (2D) materials possess semiconducting bandgaps ranging from the terahertz and mid-infrared in bilayer graphene and black phosphorus, visible in transition metal dichalcogenides, to the ultraviolet in hexagonal boron nitride. In particular, these 2D materials were demonstrated to exhibit highly tunable bandgaps, achieved via the control of layers number, heterostructuring, strain engineering, chemical doping, alloying, intercalation, substrate engineering, as well as an external electric field. We provide a review of the basic physical principles of these various techniques on the engineering of quasi-particle and optical bandgaps, their bandgap tunability, potentials and limitations in practical realization in future 2D device technologies.11Nsciescopu

Bandgap engineering of two-dimensional semiconductor materials

© 2020 Springer Nature Limited Semiconductors are the basis of many vital technologies such as electronics, computing, communications, optoelectronics, and sensing. Modern semiconductor technology can trace its origins to the invention of the point contact transistor in 1947. This demonstration paved the way for the development of discrete and integrated semiconductor devices and circuits that has helped to build a modern society where semiconductors are ubiquitous components of everyday life. A key property that determines the semiconductor electrical and optical properties is the bandgap. Beyond graphene, recently discovered two-dimensional (2D) materials possess semiconducting bandgaps ranging from the terahertz and mid-infrared in bilayer graphene and black phosphorus, visible in transition metal dichalcogenides, to the ultraviolet in hexagonal boron nitride. In particular, these 2D materials were demonstrated to exhibit highly tunable bandgaps, achieved via the control of layers number, heterostructuring, strain engineering, chemical doping, alloying, intercalation, substrate engineering, as well as an external electric field. We provide a review of the basic physical principles of these various techniques on the engineering of quasi-particle and optical bandgaps, their bandgap tunability, potentials and limitations in practical realization in future 2D device technologies.11Nsciescopu

Bandgap engineering of two-dimensional semiconductor materials

Semiconductors are the basis of many vital technologies such as electronics, computing, communications, optoelectronics, and sensing. Modern semiconductor technology can trace its origins to the invention of the point contact transistor in 1947. This demonstration paved the way for the development of discrete and integrated semiconductor devices and circuits that has helped to build a modern society where semiconductors are ubiquitous components of everyday life. A key property that determines the semiconductor electrical and optical properties is the bandgap. Beyond graphene, recently discovered two-dimensional (2D) materials possess semiconducting bandgaps ranging from the terahertz and mid-infrared in bilayer graphene and black phosphorus, visible in transition metal dichalcogenides, to the ultraviolet in hexagonal boron nitride. In particular, these 2D materials were demonstrated to exhibit highly tunable bandgaps, achieved via the control of layers number, heterostructuring, strain engineering, chemical doping, alloying, intercalation, substrate engineering, as well as an external electric field. We provide a review of the basic physical principles of these various techniques on the engineering of quasi-particle and optical bandgaps, their bandgap tunability, potentials and limitations in practical realization in future 2D device technologies

van der Waals Epitaxial Growth of Graphene on Sapphire by Chemical Vapor Deposition without a Metal Catalyst

van der Waals epitaxial growth of graphene on <i>c</i>-plane (0001) sapphire by CVD without a metal catalyst is presented. The effects of CH₄ partial pressure, growth temperature, and H₂/CH₄ ratio were investigated and growth conditions optimized. The formation of monolayer graphene was shown by Raman spectroscopy, optical transmission, grazing incidence X-ray diffraction (GIXRD), and low voltage transmission electron microscopy (LVTEM). Electrical analysis revealed that a room temperature Hall mobility above 2000 cm²/V·s was achieved, and the mobility and carrier type were correlated to growth conditions. Both GIXRD and LVTEM studies confirm a dominant crystal orientation (principally graphene [10–10] || sapphire [11–20]) for about 80–90% of the material concomitant with epitaxial growth. The initial phase of the nucleation and the lateral growth from the nucleation seeds were observed using atomic force microscopy. The initial nuclei density was ∼24 μm^–2, and a lateral growth rate of ∼82 nm/min was determined. Density functional theory calculations reveal that the binding between graphene and sapphire is dominated by weak dispersion interactions and indicate that the epitaxial relation as observed by GIXRD is due to preferential binding of small molecules on sapphire during early stages of graphene formation