Assessing the conversion of electronic medical record data into antibiotic stewardship indicators.

BACKGROUND Measuring the appropriateness of antibiotic use is crucial for antibiotic stewardship (ABS) programmes to identify targets for interventions. OBJECTIVES To assess the technical feasibility of converting electronic medical record (EMR) data into ABS indicators. METHODS In this observational feasibility study covering a period of 2 years, the EMRs of patients hospitalized at a large non-university hospital network and receiving at least one dose of a systemic antibiotic were included. ABS indicators measuring steps in the process of antibiotic prescription proposed by the literature were collected and rephrased or defined more specifically to be calculable if needed. Algorithms were programmed in R to convert EMR data into ABS indicators. The indicators were visualized in an interactive dashboard and the plausibility of each output value was assessed. RESULTS In total, data from 25 337 hospitalizations from 20 723 individual patients were analysed and visualized in an interactive dashboard. Algorithms could be programmed to compute 89% (25/28) of all pre-selected indicators assessing treatment decisions automatically out of EMR data, with good data quality for 46% (13/28) of these indicators. According to the data quality observed, the most important issues were (i) missing or meaningless information on indication (e.g. 'mild infection') and (ii) data processing issues such as insufficiently categorized metadata. CONCLUSIONS The calculation of indicators assessing treatment decisions from EMRs was feasible. However, better data structure and processing within EMR systems are crucial for improving the validity of the results

Structure and dynamics of the fullerene polymer Li4 C60 studied with neutron scattering

The two-dimensional polymer structure and lattice dynamics of the superionic conductor Li4 C60 are investigated by neutron diffraction and spectroscopy. The peculiar bonding architecture of this compound is definitely confirmed through the precise localisation of the carbon atoms involved in the intermolecular bonds. The spectral features of this phase are revealed through ab-initio lattice dynamics calculations and inelastic neutron scattering experiments. The neutron observables are found to be in very good agreement with the simulations which predict a partial charge transfer from the Li atoms to the C60 cage. The absence of a well defined band associated to one category of the Li atoms in the experimental spectrum suggests that this species is not ordered even at the lowest temperatures. The calculations predict an unstable Li sublattice at a temperature of 200 K, that we relate to the large ionic diffusivity of this system. This specificity is discussed in terms of coupling between the low frequency optic modes of the Li ions to the soft structure of the polymer.Comment: 29 pages, 13 Figure

Selective Spin-State Switch and Metal-Insulator Transition in \boldmath GdBaCo2O5.5\rm GdBaCo_2O_{5.5}

Ultra-high resolution synchrotron diffraction data for $\rm GdBaCo_2O_{5.5}$ throw new light on the metal-insulator transition of Co$^{3+}$ Ba-cobaltites. An anomalous expansion of CoO$_6$ octahedra is observed at the phase transition on heating, while CoO$_5$ pyramids show the normal shrinking at the closing of the gap. The insulator-to-metal transition is attributed to a sudden excitation of some electrons in the octahedra ($t_{2g}^6$ state) into the Co $e_g$ band (final $t_{2g}^4e_g^2$ state). The $t_{2g}^5e_g^1$ state in the pyramids does not change and the structural study also rules out a $d_{3x^2-r^2}/d_{3y^2-r^2}$ orbital ordering at $T_{MI}$.Comment: Phys. Rev. B (to appear

Domain Wall Spin Dynamics in Kagome Antiferromagnets

We report magnetization and neutron scattering measurements down to 60 mK on a new family of Fe based kagome antiferromagnets, in which a strong local spin anisotropy combined with a low exchange path network connectivity lead to domain walls intersecting the kagome planes through strings of free spins. These produce unfamiliar slow spin dynamics in the ordered phase, evolving from exchange-released spin-flips towards a cooperative behavior on decreasing the temperature, probably due to the onset of long-range dipolar interaction. A domain structure of independent magnetic grains is obtained that could be generic to other frustrated magnets.Comment: 5 pages, 4 figure

Antibiotic consumption in nursing homes of the Canton of Vaud: trends over the years 2009 - 2014

Background & Objectives: Excessive use of antibiotics in nursing homes was reported in several studies1-3. Surveillance of their use in nursing homes is essential to plan interventions fostering an appropriate use and to measure the impact of these interventions. The aims of the study were to describe the antibiotic consumption in nursing homes of the Canton of Vaud and to examine whether the antibiotic consumption was correlated to the urinary catheter use and to methicillin-resistant Staphylococcus aureus (MRSA) colonization. Methods: Data on the use of systemic antibiotics (class J01 of WHO Anatomical Therapeutic Chemical (ATC) system, 2015) were collected from the community pharmacies' annual invoice data including 13 nursing homes in 2009. The number of nursing homes in the database increased to 67 in 2014, representing 46% of all nursing homes of the Canton of Vaud and 54% of the available beds. Aggregated data were converted into defined daily doses (DDD) and antibiotic consumption expressed in number of defined daily doses per 1000 beds and per day (DDD/1000B/D). Proportion of urinary catheter use and MRSA colonization data were provided through a point prevalence study. Results: The total consumption of systemic antibiotics was 52.2 DDD/1000B/D in 2009 and 48.3 in 2014. Beta-lactam antibacterials other than penicillins, macrolides and other antibacterials (including nitrofurantoin) consumption increased resp. by 80%, 45% and 187% between 2009 and 2014, while the use of sulfonamides and trimethoprim decreased by 41%. Penicillin and quinolone use remained relatively stable between 2009 and 2014. Amoxicillin and clavulanic acid (oral) was the most common antibiotic prescribed (31% of the total use), followed by ciprofloxacin (oral) (20%) and nitrofurantoin (10%). Among nursing homes, we reported a large variation in antibiotic consumption from 6.8 to 164.6 DDD/1000B/D in 2014. No correlation was found between global antibiotic consumption and urinary catheter use and between quinolone consumption and proportion of MRSA in 2010 and 2011 (p>0.05). Discussion & Conclusions: This study is the first that analyzes longitudinal data of antibiotic consumption in nursing homes of the Canton of Vaud. The findings suggest that a large variation in antibiotic consumption exists among nursing homes. Thus, antibiotic stewardship programs should be implemented to promote a more accurate use

Comparison of hospital-wide and unit-specific cumulative antibiograms in hospital- and community-acquired infection

Background: Empirical antibacterial therapy in hospitals is usually guided by local epidemiologic features reflected by institutional cumulative antibiograms. We investigated additional information inferred by aggregating cumulative antibiograms by type of unit or according to the place of acquisition (i.e. community vs. hospital) of the bacteria. Materials and methods: Antimicrobial susceptibility rates of selected pathogens were collected over a 4-year period in an university-affiliated hospital. Hospital-wide antibiograms were compared with those selected by type of unit and sampling time (48h after hospital admission). Results: Strains isolated >48h after admission were less susceptible than those presumably arising from the community (48h after admission. When compared to hospital-wide antibiograms, susceptibility rates were lower in the ICU and surgical units for Escherichia coli to amoxicillin-clavulanate, enterococci to penicillin, and Pseudomonas aeruginosa to anti-pseudomonal beta-lactams, and in medical units for Staphylococcus aureus to oxacillin. In contrast, few differences were observed among strains isolated within 48h of admission. Conclusions: Hospital-wide antibiograms reflect the susceptibility pattern for a specific unit with respect to community-acquired, but not to hospital-acquired strains. Antibiograms adjusted to these parameters may be useful in guiding the choice of empirical antibacterial therap

Magnetically ordered and kagome quantum spin liquid states in the Zn-doped claringbullite series

Neutron scattering measurements have been performed on deuterated powder samples of claringbullite and Zn-doped claringbullite (Zn$_x$Cu$_{4-x}$(OD)$_{6}$FCl). At low temperatures, claringbullite Cu$_4$(OD)$_{6}$FCl forms a distorted pyrochlore lattice with long-range magnetic order and spin-wave-like magnetic excitations. Partial Zn doping leads to the nominal ZnCu$_3$(OD)$_{6}$FCl compound, a geometrically frustrated spin-1/2 kagome antiferromagnet that shows no transition to magnetic order down to 1.5 K. The magnetic excitations form a gapless continuum, a signature of fractional excitations in a quantum spin liquid.Comment: 8 pages, 5 figures, Supplemental Materia

Magnetic Structures of High Temperature Phases of TbBaCo2O5.5

Neutron diffraction studies have been carried out on a single crystal of oxygen-deficient perovskite TbBaCo2O5.5 in the temperature range of 7-370 K. There have been observed several magnetic or structural transitions. Among these, the existence of the transitions to the insulating phase from the metallic one at ~340 K, to the one with the ferromagnetic moment at ~280 K and possibly to the antiferromagnetic one at ~260 K, with decreasing temperature T correspond to those reported in former works. We have studied the magnetic structures at 270 K and 250 K and found that all Co3+ ions of the CoO6 octahedra are in the low spin state and those of the CoO5 pyramids carry spins which are possibly in the intermediate spin state. Non-collinear magnetic structures are proposed at these temperatures. Two other transitions have also been observed at the temperatures, ~100 K and ~250 K.Comment: 9 pages, 2 tables, 10 figure

Charge and Orbital Ordering and Spin State Transition Driven by Structural Distortion in YBaCo_2O_5

We have investigated electronic structures of antiferromagnetic YBaCo_2O_5 using the local spin-density approximation (LSDA) + U method. The charge and orbital ordered insulating ground state is correctly obtained with the strong on-site Coulomb interaction. Co^{2+} and Co^{3+} ions are found to be in the high spin (HS) and intermediate spin (IS) state, respectively. It is considered that the tetragonal to orthorhombic structural transition is responsible for the ordering phenomena and the spin states of Co ions. The large contribution of the orbital moment to the total magnetic moment indicates that the spin-orbit coupling is also important in YBaCo_2O_5.Comment: 4 pages including 4 figures, Submitted to Phys. Rev. Let