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Implementation research for the prevention of antimicrobial resistance and healthcare-associated infections; 2017 Geneva infection prevention and control (IPC)-think tank (part 1)
Background
Around 5–15% of all hospital patients worldwide suffer from healthcare-associated infections (HAIs), and years of excessive antimicrobial use in human and animal medicine have created emerging antimicrobial resistance (AMR). A considerable amount of evidence-based measures have been published to address these challenges, but the largest challenge seems to be their implementation.
Methods
In June 2017, a total of 42 experts convened at the Geneva IPC-Think Tank to discuss four domains in implementation science: 1) teaching implementation skills; 2) fostering implementation of IPC and antimicrobial stewardship (AMS) by policy making; 3) national/international actions to foster implementation skills; and 4) translational research bridging social sciences and clinical research in infection prevention and control (IPC) and AMR.
Results
Although neglected in the past, implementation skills have become a priority in IPC and AMS. They should now be part of any curriculum in health care, and IPC career paths should be created. Guidelines and policies should be aligned with each other and evidence-based, each document providing a section on implementing elements of IPC and AMS in patient care. International organisations should be advocates for IPC and AMS, framing them as patient safety issues and emphasizing the importance of implementation skills. Healthcare authorities at the national level should adopt a similar approach and provide legal frameworks, guidelines, and resources to allow better implementation of patient safety measures in IPC and AMS. Rather than repeating effectiveness studies in every setting, we should invest in methods to improve the implementation of evidence-based measures in different healthcare contexts. For this, we need to encourage and financially support collaborations between social sciences and clinical IPC research.
Conclusions
Experts of the 2017 Geneva Think Tank on IPC and AMS, CDC, and WHO agreed that sustained efforts on implementation of IPC and AMS strategies are required at international, country, and hospital management levels, to provide an adequate multimodal framework that addresses (not exclusively) leadership, resources, education and training for implementing IPC and AMS. Future strategies can build on this agreement to make strategies on IPC and AMS more effective
Nova light curves from the Solar Mass Ejection Imager (SMEI) - II. The extended catalogue
We present the results from observing nine Galactic novae in eruption with the Solar Mass Ejection Imager (SMEI) between 2004 and 2009. While many of these novae reached peak magnitudes that were either at or approaching the detection limits of SMEI, we were still able to produce light curves that in many cases contained more data at and around the initial rise, peak, and decline than those found in other variable star catalogs. For each nova, we obtained a peak time, maximum magnitude, and for several an estimate of the decline time (t2). Interestingly, although of lower quality than those found in Hounsell et al. (2010a), two of the light curves may indicate the presence of a pre-maximum halt. In addition the high cadence of the SMEI instrument has allowed the detection of low amplitude variations in at least one of the nova light curves
Neutrophils self-limit swarming to contain bacterial growth in vivo
Neutrophils communicate with each other to form swarms in infected organs. Coordination of this population response is critical for the elimination of bacteria and fungi. Using transgenic mice, we found that neutrophils have evolved an intrinsic mechanism to self-limit swarming and avoid uncontrolled aggregation during inflammation. G protein–coupled receptor (GPCR) desensitization acts as a negative feedback control to stop migration of neutrophils when they sense high concentrations of self-secreted attractants that initially amplify swarming. Interference with this process allows neutrophils to scan larger tissue areas for microbes. Unexpectedly, this does not benefit bacterial clearance as containment of proliferating bacteria by neutrophil clusters becomes impeded. Our data reveal how autosignaling stops self-organized swarming behavior and how the finely tuned balance of neutrophil chemotaxis and arrest counteracts bacterial escape
Solar-like oscillations in low-luminosity red giants: first results from Kepler
We have measured solar-like oscillations in red giants using time-series
photometry from the first 34 days of science operations of the Kepler Mission.
The light curves, obtained with 30-minute sampling, reveal clear oscillations
in a large sample of G and K giants, extending in luminosity from the red clump
down to the bottom of the giant branch. We confirm a strong correlation between
the large separation of the oscillations (Delta nu) and the frequency of
maximum power (nu_max). We focus on a sample of 50 low-luminosity stars (nu_max
> 100 muHz, L <~ 30 L_sun) having high signal-to-noise ratios and showing the
unambiguous signature of solar-like oscillations. These are H-shell-burning
stars, whose oscillations should be valuable for testing models of stellar
evolution and for constraining the star-formation rate in the local disk. We
use a new technique to compare stars on a single echelle diagram by scaling
their frequencies and find well-defined ridges corresponding to radial and
non-radial oscillations, including clear evidence for modes with angular degree
l=3. Measuring the small separation between l=0 and l=2 allows us to plot the
so-called C-D diagram of delta nu_02 versus Delta nu. The small separation
delta nu_01 of l=1 from the midpoint of adjacent l=0 modes is negative,
contrary to the Sun and solar-type stars. The ridge for l=1 is notably
broadened, which we attribute to mixed modes, confirming theoretical
predictions for low-luminosity giants. Overall, the results demonstrate the
tremendous potential of Kepler data for asteroseismology of red giants.Comment: accepted by ApJ Letters, to appear in special Kepler issue. Updated
reference
Offshore methane detection and quantification from space using sun glint measurements with the GHGSat constellation
The ability to detect and quantify methane emissions from offshore platforms is of considerable interest in providing actionable feedback to industrial operators. While satellites offer a distinctive advantage for remote sensing of offshore platforms which may otherwise be difficult to reach, offshore measurements of methane from satellite instruments in the shortwave infrared are challenging due to the low levels of diffuse sunlight reflected from water surfaces. Here, we use the GHGSat satellite constellation in a sun glint configuration to detect and quantify methane emissions from offshore targets around the world. We present a variety of examples of offshore methane plumes, including the largest single emission at (84 000 ± 24 000) kg h−1 observed by GHGSat from the Nord Stream 2 pipeline leak in 2022 and the smallest offshore emission measured from space at (180 ± 130) kg h−1 in the Gulf of Mexico. In addition, we provide an overview of the constellation's offshore measurement capabilities. We measure a median column precision of 2.1 % of the background methane column density and estimate a detection limit, from analytical modelling and orbital simulations, that varies between 160 and 600 kg h−1 depending on the latitude and season.</p
Hormonal signaling in cnidarians : do we understand the pathways well enough to know whether they are being disrupted?
Author Posting. © The Author, 2006. This is the author's version of the work. It is posted here by permission of Springer for personal use, not for redistribution. The definitive version was published in Ecotoxicology 16 (2007): 5-13, doi:10.1007/s10646-006-0121-1.Cnidarians occupy a key evolutionary position as basal metazoans and are ecologically
important as predators, prey and structure-builders. Bioregulatory molecules (e.g.,
amines, peptides and steroids) have been identified in cnidarians, but cnidarian signaling
pathways remain poorly characterized. Cnidarians, especially hydras, are regularly used
in toxicity testing, but few studies have used cnidarians in explicit testing for signal
disruption. Sublethal endpoints developed in cnidarians include budding, regeneration,
gametogenesis, mucus production and larval metamorphosis. Cnidarian genomic
databases, microarrays and other molecular tools are increasingly facilitating mechanistic
investigation of signaling pathways and signal disruption. Elucidation of cnidarian
signaling processes in a comparative context can provide insight into the evolution and
diversification of metazoan bioregulation. Characterizing signaling and signal disruption
in cnidarians may also provide unique opportunities for evaluating risk to valuable
marine resources, such as coral reefs
A critical review of the formation of mono- and dicarboxylated metabolic intermediates of alkylphenol polyethoxylates during wastewater treatment and their environmental significance
This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2010 Taylor & Francis.Alkylphenoxyacetic acids, the metabolic biodegradation products of alkylphenol ethoxylates, are commonly found in wastewaters and sewage effluents. These persistent hydrophilic derivatives possess intrinsic estrogenic activity, which can mimic natural hormones. Their concentrations increase through the sewage treatment works as a result of biodegradation and biotransformation, and when discharged can disrupt endocrine function in fish. These acidic metabolites represent the dominant alkylphenolic compounds found in wastewater effluent and their presence is cause for concern as, potentially, through further biotransformation and biodegradation, they can act as sources of nonylphenol, which is toxic and estrogenic. The authors aim to assess the mechanisms of formation as well as elimination of alkylphenoxyacetic acids within conventional sewage treatment works with the emphasis on the activated sludge process. In addition, they evaluate the various factors influencing their degradation and formation in laboratory scale and full-scale systems. The environmental implications of these compounds are considered, as is the need for tertiary treatment processes for their removal
Identifying change processes in group-based health behaviour-change interventions: development of the mechanisms of action in group-based interventions (MAGI) framework
Group-based interventions are widely used to promote health-related behaviour change. While processes operating in groups have been extensively described, it remains unclear how behaviour change is generated in group-based health-related behaviour-change interventions. Understanding how such interventions facilitate change is important to guide intervention design and process evaluations. We employed a mixed-methods approach to identify, map and define change processes operating in group-based behaviour-change interventions. We reviewed multidisciplinary literature on group dynamics, taxonomies of change technique categories, and measures of group processes. Using weight-loss groups as an exemplar, we also reviewed qualitative studies of participants' experiences and coded transcripts of 38 group sessions from three weight-loss interventions. Finally, we consulted group participants, facilitators and researchers about our developing synthesis of findings. The resulting 'Mechanisms of Action in Group-based Interventions' (MAGI) framework comprises six overarching categories: (1) group intervention design features, (2) facilitation techniques, (3) group dynamic and development processes, (4) inter-personal change processes, (5) selective intra-personal change processes operating in groups, and (6) contextual influences. The framework provides theoretical explanations of how change occurs in group-based behaviour-change interventions and can be applied to optimise their design and delivery, and to guide evaluation, facilitator training and further research
Characterisation of the muon beams for the Muon Ionisation Cooling Experiment
A novel single-particle technique to measure emittance has been developed and used to characterise seventeen different muon beams for the Muon Ionisation Cooling Experiment (MICE). The muon beams, whose mean momenta vary from 171 to 281 MeV/c, have emittances of approximately 1.2–2.3 π mm-rad horizontally and 0.6–1.0 π mm-rad vertically, a horizontal dispersion of 90–190 mm and momentum spreads of about 25 MeV/c. There is reasonable agreement between the measured parameters of the beams and the results of simulations. The beams are found to meet the requirements of MICE
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