Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review.

Background: Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods: MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results: Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions: Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa

Nuevos conceptos en el ensayo Varestraint

En este trabajo se describen las modificaciones que se han hecho al ensayo Varesrrainr para obrener el máximo de información de una probeta. Se ensayaron aceros inoxidables del tipo 347 estándar y modificado, encontrando que la técnica usada puede detectar diferencias en la tendencia al agrietamiento de la zona fundida, zona afectada térmicamente del metal previamente fundido y del metal base

A linearized kinetic theory of spin-1/2 particles in magnetized plasmas

We have considered linear kinetic theory including the electron spin properties in a magnetized plasma. The starting point is a mean field Vlasov-like equation, derived from a fully quantum mechanical treatment, where effects from the electron spin precession and the magnetic dipole force is taken into account. The general conductivity tensor is derived, including both the free current contribution, as well as the magnetization current associated with the spin contribution. We conclude the paper with an extensive discussion of the quantum-mechanical boundary where we list parameter conditions that must be satisfied for various quantum effects to be influential.Comment: 11 page

Restoration of peatlands and greenhouse gas balances

In this chapter the impact of peatland restoration on greenhouse gas fluxes is discussed based on a literature review. Casestudies are presented covering different peatland types, different regions and different starting conditions

Methyl methanesulfonate (MMS) produces heat-labile DNA damage but no detectable in vivo DNA double-strand breaks

Homologous recombination (HR) deficient cells are sensitive to methyl methanesulfonate (MMS). HR is usually involved in the repair of DNA double-strand breaks (DSBs) in Saccharomyces cerevisiae implying that MMS somehow induces DSBs in vivo. Indeed there is evidence, based on pulsed-field gel electrophoresis (PFGE), that MMS causes DNA fragmentation. However, the mechanism through which MMS induces DSBs has not been demonstrated. Here, we show that DNA fragmentation following MMS treatment, and detected by PFGE is not the consequence of production of cellular DSBs. Instead, DSBs seen following MMS treatment are produced during sample preparation where heat-labile methylated DNA is converted into DSBs. Furthermore, we show that the repair of MMS-induced heat-labile damage requires the base excision repair protein XRCC1, and is independent of HR in both S.cerevisiae and mammalian cells. We speculate that the reason for recombination-deficient cells being sensitive to MMS is due to the role of HR in repair of MMS-induced stalled replication forks, rather than for repair of cellular DSBs or heat-labile damage

New Measurement of Compton Scattering from the Deuteron and an Improved Extraction of the Neutron Electromagnetic Polarizabilities

The electromagnetic polarizabilities of the nucleon are fundamental properties that describe its response to external electric and magnetic fields. They can be extracted from Compton-scattering data --- and have been, with good accuracy, in the case of the proton. In contradistinction, information for the neutron requires the use of Compton scattering from nuclear targets. Here we report a new measurement of elastic photon scattering from deuterium using quasimonoenergetic tagged photons at the MAX IV Laboratory in Lund, Sweden. These first new data in more than a decade effectively double the world dataset. Their energy range overlaps with previous experiments and extends it by 20 MeV to higher energies. An analysis using Chiral Effective Field Theory with dynamical \Delta(1232) degrees of freedom shows the data are consistent with and within the world dataset. After demonstrating that the fit is consistent with the Baldin sum rule, extracting values for the isoscalar nucleon polarizabilities and combining them with a recent result for the proton, we obtain the neutron polarizabilities as \alpha_n = [11.55 +/- 1.25(stat) +/- 0.2(BSR) +/- 0.8(th)] X 10^{-4} fm^3 and \beta_n = [3.65 -/+ 1.25(stat) +/- 0.2(BSR) -/+ 0.8(th)] X 10^{-4} fm3, with \chi^2 = 45.2 for 44 degrees of freedom.Comment: 6 pages, 3 figures, comments from Physical Review Letters Referees addresse

Tunneling broadening of vibrational sidebands in molecular transistors

Transport through molecular quantum dots coupled to a single vibration mode is studied in the case with strong coupling to the leads. We use an expansion in the correlation between electrons on the molecule and electrons in the leads and show that the tunneling broadening is strongly suppressed by the combination of the Pauli principle and the quantization of the oscillator. As a consequence the first Frank-Condon step is sharper than the higher order ones, and its width, when compared to the bare tunneling strength, is reduced by the overlap between the groundstates of the displaced and the non-displaced oscillator.Comment: 8 pages, 3 figures. PRB, in pres

Superconducting single-mode contact as a microwave-activated quantum interferometer

The dynamics of a superconducting quantum point contact biased at subgap voltages is shown to be strongly affected by a microwave electromagnetic field. Interference among a sequence of temporally localized, microwave-induced Landau-Zener transitions between current carrying Andreev levels results in energy absorption and in an increase of the subgap current by several orders of magnitude. The contact is an interferometer in the sense that the current is an oscillatory function of the inverse bias voltage. Possible applications to Andreev-level spectroscopy and microwave detection are discussed

Controlled dephasing of Andreev states in superconducting quantum point-contacts

We have studied the relaxation and dephasing processes in a superconducting quantum point contact induced by the interaction with an electromagnetic environment. Based on a density matrix approach we obtain the rates for the dissipative dynamics as function of the transmission, the phase difference on the contact and the external impedance. Our calculation allows to determine the appropriate range of parameters for the observation of coherent oscillations in the current through the contact.Comment: 8 pages, 2 figures. To appear in Physical Review