Setting up an outpatient parenteral antimicrobial therapy (OPAT) unit in Switzerland: review of the first 18 months of activity.

Outpatient parenteral antimicrobial therapy (OPAT) has been recognised as a useful, cost-effective and safe alternative to inpatient treatment, but no formal OPAT unit existed in Switzerland until recently. In December 2013 an OPAT unit was established at Lausanne University Hospital. We review here the experience of this new OPAT unit after 18 months of activity. Patient characteristics, clinical activities and outcomes were recorded prospectively. Need and acceptance was evaluated as number of OPAT courses administered and number of patients refusing OPAT. Safety and efficacy were evaluated as: (1) adverse events linked to antimicrobials and catheters, (2) re-admission to hospital, (3) rate of treatment failures and (4) mortality. Over 18 months, 179 courses of OPAT were administered. Acceptance was high with only four patients refusing OPAT. Urinary tract infections with resistant bacteria and musculoskeletal infections were the most common diagnoses. Self-administration of antibiotics using elastomeric pumps became rapidly the most frequently used approach. Sixteen patients presented with adverse events linked to antimicrobials and catheters. OPAT-related readmissions occurred in nine patients. The overall cure rate was 94 %. This study shows that OPAT is very well accepted by patients and medical staff, even in a setting which has not used this type of treatment approach until now. Self-administration using elastomeric pumps proved to be particularly useful, safe and efficient. OPAT offers a good alternative to hospitalisation for patients presenting with infections due to resistant bacteria that cannot be treated orally anymore and for difficult to treat infections

Healthcare-associated infections and antibiotic use in long-term care residents from two geographical regions in Switzerland.

The burden of healthcare-associated infections (HAIs) and antimicrobial use in Swiss long-term care facilities (LTCFs) is currently unknown. This study assessed the prevalence of HAIs and antibiotic use among LTCF residents in Switzerland. A point-prevalence study was undertaken in LTCFs in eastern and western Switzerland from August to October 2019 according to the 'Healthcare-associated infections in long-term care facilities' (HALT) protocol. Characteristics of residents (age, sex, wounds, dementia, indwelling catheters) and institutions (specific factors, geographic region) were assessed. LTCF residents were screened for HAIs and current antibiotic treatment. Personal and institutional factors associated with HAIs were assessed. In total, 1185 residents from 16 LTCFs (eight per geographic region) were screened for HAIs and antibiotic treatment. Median age was 87 years (interquartile range 79-91) and 71% were female. The prevalence of HAIs was 4.2% (west 4.3% vs east 4.2%; P=0.93), with mucocutaneous skin infections (36%) and respiratory tract infections (30%) being the most common. Independent risk factors for the presence of HAIs were presence of a chronic wound [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1-5.0; P=0.02] and being immobile (OR 1.8, 95% CI 1.0-3.3; P=0.04). Antibiotics were given to 2.9% of residents (west 3.9% vs east 1.8%; P=0.05) on the day of the survey. The most commonly prescribed antibiotics were amoxicillin-clavulanic acid and quinolones. The prevalence of HAIs in Swiss LTCFs is similar to that in other European countries, whereas antibiotic consumption is lower. Further point-prevalence surveys on a broader scale are recommended to improve understanding of the burden of HAIs and antibiotic consumption in this setting

Long-term heliomagnetic field variation based on cosmogenic 44Ti in meteorites

Reconstructions of the heliospheric magnetic field (HMF) in the past centuries are mainly based on the analysis of sunspot activity, geomagnetic data or on measurement of cosmogenic radioisotopes stored in terrestrial reservoirs (tree rings and ice cores). There are, however, significant discrepancies among the results obtained by various techniques using different proxies of solar magnetic activity. In this work, new results obtained from a unique approach based on the measurement of the cosmogenic 44Ti activity detected in meteorites are presented and compared with the most recent reconstructions of the near-Earth HMF strength. The very low level of 44Ti activity in several meteorites fallen in the last 250 years was determined by using gamma-ray spectrometers (HPGe+NaI) located in the underground laboratory of Monte dei Cappuccini (INAF-OATo) in Torino, Italy. This approach, specifically designed to overcome the main problems affecting other methods, yields a powerful independent tool to reconstruct the long-term evolution of the HMF through the last two and a half centuries

SOXS: a wide band spectrograph to follow up transients

SOXS (Son Of X-Shooter) will be a spectrograph for the ESO NTT telescope capable to cover the optical and NIR bands, based on the heritage of the X-Shooter at the ESO-VLT. SOXS will be built and run by an international consortium, carrying out rapid and longer term Target of Opportunity requests on a variety of astronomical objects. SOXS will observe all kind of transient and variable sources from different surveys. These will be a mixture of fast alerts (e.g. gamma-ray bursts, gravitational waves, neutrino events), mid-term alerts (e.g. supernovae, X-ray transients), fixed time events (e.g. close-by passage of minor bodies). While the focus is on transients and variables, still there is a wide range of other astrophysical targets and science topics that will benefit from SOXS. The design foresees a spectrograph with a Resolution-Slit product ~ 4500, capable of simultaneously observing over the entire band the complete spectral range from the U- to the H-band. The limiting magnitude of R~20 (1 hr at S/N~10) is suited to study transients identified from on-going imaging surveys. Light imaging capabilities in the optical band (grizy) are also envisaged to allow for multi-band photometry of the faintest transients. This paper outlines the status of the project, now in Final Design Phase.Comment: 12 pages, 14 figures, to be published in SPIE Proceedings 1070

Improvement of the extraction method of faint signals in γ -activity measurements of meteorites

The final publication is available at Springer via https://doi.org/10.1140/epjp/i2017-11556-yAt the underground laboratory of Monte dei Cappuccini (OATo-INAF) in Torino (Italy) we set up selective HPGe-NaI(Tl) spectrometers for measurements of cosmogenic radioisotopes in meteorites in order to study centennial-scale modulation of solar activity. 44 Ti is a suitable proxy for this timescale, but its detection is difficult due to the strong interference by naturally occurring 214 Bi. In order to optimize the extraction of the 44 Ti signal, we have developed software procedures specifically designed to improve selectivity of the Ge-NaI detectors coincidence

Antibiotic stability related to temperature variations in elastomeric pumps used for outpatient parenteral antimicrobial therapy (OPAT).

Elastomeric pumps can be used for the continuous administration of antimicrobials in the outpatient setting. A potentially limiting factor in their use is the stability of antimicrobials. To investigate under real-life conditions the temperature variations of antibiotic solutions contained in elastomeric pumps, and to examine under such conditions the stability of five antibiotics. Healthy volunteers carried the elastomeric pumps in carry pouches during their daily activities. A thermologger measured the temperatures every 15 min over 24 h. Antibiotic concentrations were measured by HPLC coupled to tandem MS. During daytime, the temperature of solutions in the pumps increased steadily, warming to >30°C. During the night, when the pumps were kept attached to the waist, the temperatures reached up to 33°C. The use of white carry pouches avoided excessive temperature increases. Over seven experiments, cefazolin, cefepime, piperacillin and tazobactam were found to be stable over 24 h. Flucloxacillin showed a mean decrease in concentration of 11% ( P  = 0.001). Real-life situations can cause significant temperature rises in elastomeric pumps, thereby potentially increasing the risk of antibiotic degradation. Patients should be instructed to avoid situations causing excessive temperature increases. Despite these temperature variations, cefazolin, cefepime, piperacillin and tazobactam were found to be stable over 24 h. A moderate degradation was noticed for flucloxacillin, albeit most probably not to an extent that might impair anti-infective efficacy

Longitud de rugosidad para el calor en condiciones de estabilidad atmosférica

Los coeficientes "volumétricos" de transporte para el calor dependen de la longitud de rugosidad respectiva. Esta longitud está definida como la altura en qué la temperatura del aire adquiere el mismo valor que la de superficie terrestre cuando el perfil térmico vertical es extrapolado hacia niveles inferiores. El proceso que condiciona esta altura es fundamentalmente de origen molecular. En este trabajo, en base a distintas ecuaciones, se estiman las longitudes de rugosidad para el calor en diferentes condiciones de estabilidad atmosférica utilizando los datos observacionales del Project Prairie Grass llevado a cabo en O'Neill, Nebraska (EEUU) en 1958. Se encuentra la relación entre esta longitud y el parámetro de estabilidad atmosférica de Monin-Obukhov, y se comparan los valores provenientes de la aplicación de las diferentes ecuaciones. Se encuentra que la longitud de rugosidad para el calor es potencialmente inversa al incremento de la estabilidad atmosférica.The volumetric coefficients for the trasportation of heat depend on the respective roughness length. This length is defined as the height in which air temperature reaches the same value as that of the surface when the vertical tempe rature profile is extrapolated to the lower levels. The process which conditions this height is mainly of molecular origin. In this paper, having as a base different equetions, we can estima te the roughness lengths for heat in different stable atmospheric conditions, using the observational facts (information) of the Pro ject Prairie Grass carried out in O’Neill, Nebraska (USA) in 1958. A functional relation is found between this length and the Monin - Obukhov atmospheric stability parameter and the values resulting from the application of the different equations are compared. it is then obtained that the roughness length for heat is potencia lly inverse to the increase of the atmospheric stability.Asociación Argentina de Geofísicos y Geodesta

Preterm Infants’ Follow-Up Program at a Public Hospital in Buenos Aires: Two-Decade Study

Objectives: To analyze temporal trends of mortality, morbidity, growth and neurodevelopment until 2 years of corrected age (CA) of very low birth weight infants (VLBWI) born between 1986- 2005 in Ramon Sardá Maternal Infant Hospital (RSMIH). Methods: Descriptive temporal trend study divided in 5 quinquenniums.1255 VLBWI were born at RSMIH between 1986-2005; 46 were excluded (genetic syndromes, major congenital malformations, confirmed intrauterine infections), 84 were referred out and 1125 were studied. Birth weight (BW), gestational age (GA); morbidity; growth; neurodevelopment at 1 and 2 years of CA; neurological and sensorial disorders, antenatal steroids use, breastfeeding; rehospitalizations; mothers´ age and years of schooling and Unsatisfied Basic Needs Index (UBNI) were recorded. Results: Survival rates increased during the last two periods, especially in <1000g BW infants despite the decrease in GA and BW. Children receiving surfactant (Sf), parenteral nutrition (PN) and antenatal steroids (AS) in the last quinquennium obtained better results in growth (40 weeks GA and 1 CA). The use of these therapies increased greatly in the last decade. Also breastfeeding at 40 weeks GA and 4 months tended to be better. Bronchopulmonary dysplasia (BPD) increased. Rehospitalizations (majorly attributable to lower tract infections) and UBNI stayed equal all along. Mothers’ years of schooling increased a little in the last two quinquenniums. Conclusion: In the last quinquennium children tended to be smaller in GA and BW due to an increase in the survival rate as a result of higher technology and appropriate interventions such as AS, PN, Sf, etc