Opportunities and challenges for improving antimicrobial stewardship in low and middle income countries ; lessons learnt from the maternal sepsis intervention in Western Uganda

This paper presents findings from an action-research intervention designed to identify ways of improving antimicrobial stewardship in a Ugandan Regional Referral Hospital. Building on an existing health partnership and extensive action-research on maternal health, it focused on maternal sepsis. Sepsis is one of the main causes of maternal mortality in Uganda and Surgical Site Infection, a major contributing factor. Post-natal wards also consume the largest volume of antibiotics. The findings from the Maternal Sepsis Intervention demonstrate the potential for remarkable changes in health worker behaviour through multi-disciplinary engagement. Nurses and midwives create the connective tissue linking pharmacy, laboratory scientists and junior doctors to support an evidence-based response to prescribing. These multi-disciplinary ‘huddles’ form a necessary, but insufficient, grounding for active clinical pharmacy. The impact on antimicrobial stewardship and maternal mortality and morbidity is ultimately limited by very poor and inconsistent access to antibiotics and supplies. Insufficient and predictable stock-outs undermine behaviour change frustrating health workers’ ability to exercise their knowledge and skill for the benefit of their patients. This escalates healthcare costs and contributes to Anti-Microbial Resistance

Geographic Variation in Alarm Calls of Gunnison\u27s Prairie Dogs

Geographic variation in alarm calls of Gunnison\u27s prairie dogs (Cynomys gunnisoni) was analyzed at regional and local scales. Alarm calls in response to a common stimulus (the same human) were recorded at four colonies near Flagstaff, Arizona, and at six sites throughout the southwestern United States. The acoustic structure of calls was analyzed for seven call variables. Regional differences fit the prediction of greater differences with increased geographical separation. Differences between colonies at a local scale were not related to geographical distance, suggesting that local dialects exist within a region. Differences in the level of predation by humans between colonies or habitat effects on sound propagation may explain variation in calls at the local level

Design, analysis and control of large transports so that control of engine thrust can be used as a back-up of the primary flight controls

A propulsion controlled aircraft (PCA) system has been developed at NASA Dryden Flight Research Center at Edwards Air Force Base, California, to provide safe, emergency landing capability should the primary flight control system of the aircraft fail. As a result of the successful PCA work being done at NASA Dryden, this project investigated the possibility of incorporating the PCA system as a backup flight control system in the design of a large, ultra-high capacity megatransport in such a way that flight path control using only the engines is not only possible, but meets MIL-Spec Level 1 or Level 2 handling quality requirements. An 800 passenger megatransport aircraft was designed and programmed into the NASA Dryden simulator. Many different analysis methods were used to evaluate the flying qualities of the megatransport while using engine thrust for flight path control, including: (1) Bode and root locus plot analysis to evaluate the frequency and damping ratio response of the megatransport; (2) analysis of actual simulator strip chart recordings to evaluate the time history response of the megatransport; and (3) analysis of Cooper-Harper pilot ratings by two NaSA test pilots

Anti-microbial resistance in global perspective

This open access book provides an accessible introduction to the mechanics of international development and global health text for policy-makers and students across a wide range of disciplines. Antimicrobial resistance is a major threat to the well-being of patients and health systems the world over. In fragile health systems so challenged, on a day-today basis, by the overwhelming burden of both infectious and non-communicable disease, it is easy to overlook the impacts of AMR. The Maternal Sepsis Intervention, focusing on a primary cause of maternal death in Uganda, demonstrates the systemic nature of AMR and the gains that can be made through improved Infection Prevention Control and direct engagement of laboratory testing in antibiotic prescribing

Enhancing skills to promote the utilization of medical laboratory equipment in low resource settings

Objective This study was to demonstrate the efficacy of an intervention model involving on-going skills enhancement of users, Biomedical Engineers and Technicians (BMETs) in enhancing the utilization of medical laboratory equipment in low resource settings. Methods In an action research study, the condition of 202 pieces of medical equipment in seven regional blood banks in the Uganda Blood Transfusion Service (UBTS) were studied prospectively from January 2018 to December 2018. Of these, 160 pieces were included in the intervention group where users and BMETs were mentored and trained in the use and preventive maintenance for all equipment types. A second group of 42 pieces of medical equipment which were not involved in the intervention program, were assessed for comparison. Twenty-one participants were interviewed to obtain detailed information about their experiences and the impact of the training interventions. Results The percentage of equipment in good working condition and in use in the intervention group improved from 60% to 74%, while the improvement recorded in the second group was slower (48% to 55%) over the one-year period. Equipment in the intervention group were three times more likely to be in good working condition and in use at the end of the study period with an odds ratio of 3.2 (95% CI: 1.49 to 6.83) and P value < 0.001. Conclusion The model applied by Knowledge for Change (K4C) that involves co-learning and mentorship of users and BMETs was successful and should be implemented in other health facilities in Low- and Middle-Income Countries

Lactate dehydrogenase is not a useful marker for relapse in patients on surveillance for stage I germ cell tumours

As part of surveillance protocols for stage I germ cell tumours, many centres routinely measure human chorionic gonadotrophin (HCG), alpha feto-protein (AFP) as well as lactate dehydrogenase (LDH). In conjunction with regular imaging and clinical examination, does routine measurement of LDH add anything to our relapse/pick up rate? Records of 494 patients at Mount Vernon Hospital who relapsed on surveillance between 1985 and 2005 were examined. Of the 494 patients who relapsed, 125 had raised LDH at the time of relapse. 112 of these had a concurrent rise in either AFP, HCG or both, 11 had their disease detected on CT before the rise in LDH, one had a clinically palpable para-aortic mass and the final patient complained of back pain and his retroperitoneal disease was thus discovered on imaging. Routine measurement of LDH in patients on surveillance for stage I germ cell tumours does not add to the early detection of relapse

Echoes of time. The mobility of Brazilian researchers and students in Portugal

A investigação que apresentamos, de caráter exploratório, recaiu sobre histórias biográficas de brasileiros que escolhem Portugal para prosseguir formação e ou investigação. Procura-se encontrar na sua experiência elos de ligação explicativos sobre as motivações e os processos que os trazem para Portugal, assim como as expetativas e os projetos que comportam para os seus futuros e que incluem, ou não, este país. Temos em conta, especialmente, a forma como essa narrativa transporta sentidos identitários decorrentes das formas de relacionamento intercultural e político entre Portugal e Brasil e formas de cooperação implícitas, assim como mapas representacionais acerca dos lugares de eleição para desenvolvimento de carreiras científicas e académicas. A nossa pesquisa incide sobre as informações recolhidas através de um inquérito por questionário e entrevistas realizadas junto de estudantes e bolseiros brasileiros em Portugal.We present an exploratory study that investigated biographical stories of Brazilians who choose to continue their education or develop research in Portugal. We sought to find in their experiences explanatory links connecting the motivations and processes that bring them to Portugal, as well as the expectations and projects that they hold for the future, which may include, or not, this country. We take into account, particularly, the way this narrative carries senses of identity arising from the forms of intercultural and political relationship between Portugal and Brazil, as well as implicit forms of cooperation and representations about the places chosen for the development of scientific and academic careers. Our research draws on information collected through a survey based on questionnaires and interviews with Brazilian students and scholarship holders in Portugal.(undefined

A consideration of the challenges involved in supervising international masters students

This paper explores the challenges facing supervisors of international postgraduate students at the dissertation stage of the masters programme. The central problems of time pressure, language difficulties, a lack of critical analysis and a prevalence of personal problems among international students are discussed. This paper makes recommendations for the improvement of language and critical thinking skills, and questions the future policy of language requirements at HE for international Masters students

Unsteady Two-Dimensional Orifice Flow: A Large-Size Experimental Investigation

Orifice flows were used as water clocks since the Antiquity up to the 16-th century. Today orifices and nozzles are used for measuring discharges. Most works were conducted with steady flow conditions and there is little information on the unsteady flow pattern. In this study, the writers describe an experimental investigation of an unsteady orifice flow discharging vertically. The study was conducted in a large-size facility with a rectangular orifice (0.75-m by 0.07-m) discharging up to 1.2 m3 in about 10 seconds. The study presents new information on the unsteady flow patterns, the discharge capacity and the velocity field in the reservoir. The results are compared with 'classical' orifice flow results