Antibiotic prescribing for residents in long-term-care facilities across the UK

Background: Antimicrobial resistance (AMR) is a major public health problem. Elderly residents in long-term-care facilities (LTCFs) are frequently prescribed antibiotics, particularly for urinary tract infections. Optimizing appropriate antibiotic use in this vulnerable population requires close collaboration between NHS healthcare providers and LTCF providers. Objectives: Our aim was to identify and quantify antibiotic prescribing in elderly residents in UK LTCFs. This is part of a wider programme of work to understand opportunities for pharmacy teams in the community to support residents and carers. Methods: This was a retrospective longitudinal cohort study. Data were extracted from a national pharmacy chain database of prescriptions dispensed for elderly residents in UK LTCFs over 12 months (November 2016–October 2017). Results: Data were analysed for 341 536 residents in LTCFs across the four UK nations, from which a total of 544 796 antibiotic prescriptions were dispensed for 167 002 residents. The proportion of residents prescribed at least one antibiotic over the 12 month period varied by LTCF, by month and by country. Conclusions: Whilst national data sets on antibiotic prescribing are available for hospitals and primary care, this is the first report on antibiotic prescribing for LTCF residents across all four UK nations, and the largest reported data set in this setting. Half of LTCF residents were prescribed at least one antibiotic over the 12 months, suggesting that there is an opportunity to optimize antibiotic use in this vulnerable population to minimize the risk of AMR and treatment failure. Pharmacy teams are well placed to support prudent antibiotic prescribing and improved antimicrobial stewardship in this population

The Opacity of Spiral Galaxy Disks VIII: Structure of the Cold ISM

The quantity of dust in a spiral disk can be estimated using the dust's typical emission or the extinction of a known source. In this paper, we compare two techniques, one based on emission and one on absorption, applied on sections of fourteen disk galaxies. The two measurements reflect, respectively the average and apparent optical depth of a disk section. Hence, they depend differently on the average number and optical depth of ISM structures in the disk. The small scale geometry of the cold ISM is critical for accurate models of the overall energy budget of spiral disks. ISM geometry, relative contributions of different stellar populations and dust emissivity are all free parameters in galaxy Spectral Energy Distribution (SED) models; they are also sometimes degenerate, depending on wavelength coverage. Our aim is to constrain typical ISM geometry. The apparent optical depth measurement comes from the number of distant galaxies seen in HST images through the foreground disk. We measure the IR flux in images from the {\it Spitzer} Infrared Nearby Galaxy Survey in the same section of the disk that was covered by HST. A physical model of the dust is fit to the SED to estimate the dust surface density, mean temperature, and brightness in these disk sections. The surface density is subsequently converted into the average optical depth estimate. The two measurements generally agree. The ratios between the measured average and apparent optical depths of the disk sections imply optically thin clouds in these disks. Optically thick disks, are likely to have more than a single cloud along the line-of-sight.Comment: 31 pages, 5 figures, 4 tables, accepted for publication in A

TREC-Rio trial: a randomised controlled trial for rapid tranquillisation for agitated patients in emergency psychiatric rooms [ISRCTN44153243]

Agitated or violent patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians and clinical practice all differ. Systematic reviews show that all relevant studies are small and none are likely to have adequate power to show true differences between treatments. Worldwide, current treatment is not based on evidence from randomised trials. In Brazil, the combination haloperidol-promethazine is frequently used, but no studies involving this mix exist. TREC-Rio (Tranquilização Rápida-Ensaio Clínico [Translation: Rapid Tranquillisation-Clinical Trial]) will compare midazolam with haloperidol-promethazine mix for treatment of agitated patients in emergency psychiatric rooms of Rio de Janeiro, Brazil. TREC-Rio is a randomised, controlled, pragmatic and open study. Primary measure of outcome is tranquillisation at 20 minutes but effects on other measures of morbidity will also be assessed. TREC-Rio will involve the collaboration of as many health care professionals based in four psychiatric emergency rooms of Rio as possible. Because the design of this trial does not substantially complicate clinical management, and in several aspects simplifies it, the study can be large, and treatments used in everyday practice can be evaluated

Gaps in the cloud cover? Comparing extinction measures in spiral disks

Dust in galaxies can be mapped by either the FIR/sub-mm emission, the optical or infrared reddening of starlight, or the extinction of a known background source. We compare two dust extinction measurements for a set of fifteen sections in thirteen nearby galaxies, to determine the scale of the dusty ISM responsible for disk opacity: one using stellar reddening and the other a known background source. In our earlier papers, we presented extinction measurements of 29 galaxies, based on calibrated counts of distant background objects identified though foreground disks in HST/WFPC2 images. For the 13 galaxies that overlap with the Spitzer Infrared Nearby Galaxies Survey (SINGS), we now compare these results with those obtained from an I-L color map. Our goal is to determine whether or not a detected distant galaxy indicates a gap in the dusty ISM, and hence to better understand the nature and geometry of the disk extinction. We find that distant galaxies are predominantly in low-extinction sections marked by the color maps, indicating that their number depends both on the cloud cover of {\it Spitzer}-resolved dust structures --mostly the spiral arms--and a diffuse, unresolved underlying disk. We note that our infrared color map (E[I-L]) underestimates the overall dust presence in these disks severely, because it implicitly assumes the presence of a dust screen in front of the stellar distribution.Comment: 22 pages, 2 figures, 3 tables, accepted for publication in A

Particularly Efficient Star Formation in M33

The Star Formation (SF) rate in galaxies is an important parameter at all redshifts and evolutionary stages of galaxies. In order to understand the increased SF rates in intermediate redshift galaxies one possibility is to study star formation in local galaxies with properties frequently found at this earlier epoch like low metallicity and small size. We present sensitive observations of the molecular gas in M 33, a small Local Group spiral at a distance of 840 kpc which shares many of the characteristics of the intermediate redshift galaxies. The observations were carried out in the CO(2--1) line with the HERA heterodyne array on the IRAM 30 m telescope. A 11\arcmin$\times$22\arcmin region in the northern part of M 33 was observed, reaching a detection threshold of a few 10$^{3}$ \msol. The correlation in this field between the CO emission and tracers of SF (8\mum, 24\mum, \Ha, FUV) is excellent and CO is detected very far North, showing that molecular gas forms far out in the disk even in a small spiral with a subsolar metallicity. One major molecular cloud was discovered in an interarm region with no HI peak and little if any signs of SF -- without a complete survey this cloud would never have been found. The radial dependence of the CO emission has a scale length similar to the dust emission, less extended than the \Ha or FUV. If, however, the \ratioo ratio varies inversely with metallicity, then the scale length of the H$_2$ becomes similar to that of the \Ha or FUV. Comparing the SF rate to the H$_2$ mass shows that M 33, like the intermediate redshift galaxies it resembles, has a significantly higher SF efficiency than large local universe spirals.Comment: 16 pages, 15 figure

The stellar content, metallicity and ionization structure of HII regions

Observations of infrared fine-structure lines provide direct information on the metallicity and ionization structure of HII regions and indirectly on the hardness of the radiation field ionizing these nebulae. We have analyzed a sample of Galactic and Magellanic Cloud HII regions observed by the Infrared Space Observatory (ISO) to examine the interplay between stellar content, metallicity and the ionization structure of HII regions. The observed [SIV]10.5/[SIII]18.7 mum and [NeIII]15.5/[NeII]12.8 mum line ratios are shown to be highly correlated over more than two orders of magnitude. We have compared the observed line ratios to the results of photoionization models using different stellar energy distributions. The derived characteristics of the ionizing star depend critically on the adopted stellar model as well as the (stellar) metallicity. We have compared the stellar effective temperatures derived from these model studies for a few well-studied HII regions with published direct spectroscopic determinations of the spectral type of the ionizing stars. This comparison supports our interpretation that stellar and nebular metallicity influences the observed infrared ionic line ratios. We can explain the observed increase in degree of ionization, as traced by the [SIV]\[SIII] and [NeIII]\[NeII] line ratios, by the hardening of the radiation field due to the decrease of metallicity. The implications of our results for the determination of the ages of starbursts in starburst galaxies are assessed.Comment: 9 pages; accepted for publication in A&A; figure 3 modifie