Expert consensus regarding drivers of antimicrobial stewardship in companion animal veterinary practice: a Delphi study

Antimicrobial resistance (AMR) is a global challenge facing both human and animal healthcare professionals; an effective response to this threat requires a ‘One-Health’ approach to antimicrobial stewardship (AMS) to preserve important antibiotics for urgent clinical need. However, understanding of barriers and enablers to effective AMS behaviour in companion animal veterinary practice is currently limited. We conducted a Delphi study of 16 nationally recognised experts from UK-based veterinary policymakers, university academics and leaders of professional bodies. This Delphi study sought to identify veterinary behaviours which experts believe contribute to AMR and form vital aspects of AMS. Analysis of Delphi findings indicated a perceived hierarchy of behaviours, the most influential being antibiotic prescribing behaviours and interactions with clients. Other veterinary behaviours perceived as being important related to interactions with veterinary colleagues; infection control practices; and the use of diagnostic tests to confirm infection. Key barriers and enablers to AMS within each of these behavioural domains were identified. Specific interventions to address important barriers and enablers are recommended. To the authors’ knowledge, this is the first study to establish expert consensus at a national level about which ‘behaviours’ (aspects of veterinarian practice) should be targeted in relation to AMR and AMS in companion animal veterinary practice

An on-line training radial basis function neural network for optimum operation of the UPFC

The concept of Flexible A.C. Transmission Systems (FACTS) technology was developed to enhance the performance of electric power networks (both in steady-state and transient-state) and to make better utilization of existing power transmission facilities. The continuous improvement in power ratings and switching performance of power electronic devices together with advances in circuit design and control techniques are making this concept and devices employed in FACTS more commercially attractive. The Unified Power Flow Controller (UPFC) is one of the main FACTS devices that have a wide implication on the power transmission systems and distribution. The purpose of this paper is to explore the use of Radial Basis Function Neural Network (RBFNN) to control the operation of the UPFC in order to improve its dynamic performance. The performance of the proposed controller compares favourably with the conventional PI and the off-line trained controller. The simple structure of the proposed controller reduces the computational requirements and emphasizes its appropriateness for on-line operation. Real-time implementation of the controller is achieved through using dSPACE ds1103 control and data acquisition board. Simulation and experimental results are presented to demonstrate the robustness of the proposed controller against changes in the transmission system operating conditions

The social construction of the software operation: Reinforcing effects in metrics programs

In a large software company in Denmark, much effort was expended capturing metrics about the company’s software operation. The purpose of the metrics program was to change and improve the software operation. Writing software can be understood as a socially constructed practice, which can be analyzed using structuration theory. This structurational analysis showed that the company’s software operation followed an easily recognizable and widely understood pattern. The software operation was organized in terms of development projects leading to applications that then needed maintenance, and displayed a heavy focus on project development work and hitting the project deadline. Study of the metrics program (and the computer software underpinning it) revealed that the familiar pattern was also inscribed into the metrics software, heavily influencing the company’s metrics practice. Rather than challenge the underlying social practice of the software operation, the metrics program reinforced it by adopting the same underlying values. Our conclusion is that, under these circumstances, metrics programs are unlikely to result in radical changes to the software operation, and are best suited to small, incremental improvements

Optimization and evaluation of Flexicult(®) Vet for detection, identification and antimicrobial susceptibility testing of bacterial uropathogens in small animal veterinary practice

BACKGROUND: Urinary tract infection (UTI) is a common reason for antimicrobial prescription in dogs and cats. The objective of this study was to optimize and evaluate a culture-based point-of-care test for detection, identification and antimicrobial susceptibility testing of bacterial uro-pathogens in veterinary practice. METHODS: Seventy-two urine samples from dogs and cats with suspected UTI presenting to seven veterinary facilities were used by clinical staff and an investigator to estimate sensitivity and specificity of Flexicult Vet A compared to laboratory reference standards for culture and susceptibility testing. Subsequently, the test was modified by inclusion of an oxacillin-containing compartment for detection of methicillin-resistant staphylococci. The performance of the modified product (Flexicult Vet B) for susceptibility testing was evaluated in vitro using a collection of 110 clinical isolates. RESULTS: Bacteriuria was reported by the laboratory in 25 (35 %) samples from the field study. The sensitivity and specificity of Flexicult Vet A for detection of bacteriuria were 83 and 100 %, respectively. Bacterial species were correctly identified in 53 and 100 % of the positive samples by clinical staff and the investigator, respectively. The susceptibility results were interpreted correctly by clinical staff for 70 % of the 94 drug-strain combinations. Higher percentages of correct interpretation were observed when the results were interpreted by the investigator in both the field (76 %) and the in vitro study (94 %). The most frequent errors were false resistance to β-lactams (ampicillin, amoxicillin-clavulanate and cephalotin) in Escherichia coli for Flexicult Vet A, and false amoxicillin-clavulanate resistance in E. coli and false ampicillin susceptibility in Staphylococcus pseudintermedius for Flexicult Vet B. The latter error can be prevented by categorizing staphylococcal strains growing in the oxacillin compartment as resistant to all β-lactams. CONCLUSIONS: Despite the shortcomings regarding species identification by clinical staff and β-lactam susceptibility testing of E. coli, Flexicult Vet B (commercial name Flexicult(®) Vet) is a time- and cost-effective point-of-care test to guide antimicrobial choice and facilitate implementation of antimicrobial use guidelines for treatment of UTIs in small animals, provided that clinical staff is adequately trained to interpret the results and that clinics meet minimum standards to operate in-house culture