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Synaptic Launch Potentiation at Ageing Oral Ribbon Synapses.
BACKGROUND Third-generation cephalosporins (3GC) remain the first-choice empiric antibiotic for severe infection in many sub-Saharan African hospitals. In Malawi, limited availability of alternatives, mean that strategies to prevent spread of 3GC-resistance (3GC-R) are imperative, however suitable approaches to antimicrobial stewardship (AMS) in low-income settings are not well studied. METHODS We introduced an AMS intervention to Queen Elizabeth Central Hospital (QECH) in Blantyre. The intervention consisted of a smartphone prescribing application and regular point-prevalence surveys (PPS) with prescriber feedback. We evaluate the effects of the intervention on 3GC usage and on cost of providing antibiotics. Using thematic analysis of semi-structured interviews and participant observations, we additionally evaluate the acceptability of the stewardship program. RESULTS The proportion of antibiotic prescriptions for a 3GC reduced from 193/241 (80.1%) to 177/330 (53.6%) (percentage decrease 26.5% [95%CI; 18.7 to 34.1]) with no change in case-fatality rate. Cost analysis estimated annual savings of US$15,000. Qualitative research revealed trust in the guideline and found its accessibility through smartphones helpful to guide clinical decisions. Operational health-system barriers and hierarchal clinical relationships lead to continued reliance on 3GC. CONCLUSIONS We report the successful introduction of an antimicrobial stewardship approach in Malawi. By focusing on pragmatic interventions and simple aims, we demonstrate the feasibility, acceptability and cost-saving of a stewardship program where resources are limited. In doing so, we provide a suitable starting point for expansion of AMS interventions in this and other low-income settings. © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.Gamma-ray dose rates have been measured in the indoor and outdoor air of Hassan City. The measurements were done from 25 locations of Hassan City at 1 m above the ground surface for radiometric, geophysical and environmental surveys using a lightweight portable radiation survey meter (scintillometer). The meter reading fluctuates around a mean value and is proportional to the count rate detected by the unit. This is because of the random nature of radioactivity. In the present study, the absorbed gamma dose rates in indoor and outdoor air varies from 69 ± 2 to 481 ± 18 nGy h-1 with a geometric mean of 180 ± 6 nGy h-1 and 20 ± 0 to 371 ± 14 nGy h-1 with a geometric mean of 107 ± 3 nGy h-1. The annual effective gamma dose rates in indoor and outdoor air varies from 0.34 to 2.36 mSv y-1 with a geometric mean of 0.88 mSv y-1 and 0.02 to 0.45 mSv y-1 with a geometric mean of 0.12 mSv y-1. The gamma dose rates of Hassan City is higher compared to the world average value and lower when compared to other locations of India. © The Author(s) 2020. Published by Oxford University Press. All rights reserved. For Permissions, please email [email protected] of helmets used in contact sports has been driven by the necessity of preventing traumatic head injuries. Manufacturing standards and pass or fail grading systems help ensure that protective headgear can be manufactured to withstand large impacts, but design standards do no account for impacts resulting in subconcussive episodes and the effects of cumulative impacts on its user. Thus, it is important to explore new design parameters, such as the frequency-domain measures of transmissibility and mechanical impedance that are based on energy absorption from a range of impact loads. Within the experimentally determined frequency range of interest, transmissibilities above unity were found in the 0-40 Hz range with the magnitude characteristics varying considerably with impact location. Similar variability with location was observed for the mechanical impedance, which ranged from 9 N/m to 50 N/m. Additional research is required to further understand how changes in the components or materials of the components will affect the performance of helmets, and how they may be used to reduce both transmissibility and dynamic impedance. Copyright (c) 2020 by ASME.QUALITY CHALLENGE The Sierra Leone (SL) Ministry of Health and Sanitation's National Infection Prevention and Control Unit (NIPCU) launched National Infection and Prevention Control (IPC) Policy and Guidelines in 2015, but a 2017 assessment found suboptimal compliance with standards on environmental cleanliness (EC), waste disposal (WD) and personal protective equipment (PPE) use. METHODS ICAP at Columbia University (ICAP), NIPCU and the Centers for Disease Control and Prevention (CDC) designed and implemented a Rapid Improvement Model (RIM) quality improvement (QI) initiative with a compressed timeframe of 6 months to improve EC, WD and PPE at eight purposively selected health facilities (HFs). Targets were collaboratively developed, and a 37-item checklist was designed to monitor performance. HF teams received QI training and weekly coaching and convened monthly to review progress and exchange best practices. MSDC-0160 purchase At the final learning session, a "harvest package" of the most effective ideas and tools was developed for use at additional HFs. RESULTS The RIM resulted in marked improvement in WD and EC performance and modest improvement in PPE. Aggregate compliance for the 37 indicators increased from 67 to 96% over the course of 4 months, with all HFs showing improvement. Average PPE compliance improved from 85 to 89%, WD from 63 to 99% and EC from 51 to 99%. LESSONS LEARNED The RIM QIC approach is feasible and effective in SL's austere health system and led to marked improvement in IPC performance. The best practices are being scaled up and the RIM QIC methodology is being applied to other domains. © The Author(s) 2020. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail [email protected] Prior research has linked subjective features of social situations with short-term changes in affect (e.g., across days, hours), but little is known about the directionality of such links. Our study examined the concurrent and lead-lag relationships between social contact satisfaction and affect in the flow of daily life. METHOD Using ecological momentary assessment (EMA), wherein 78 late-middle-aged and older adults reported on 2,739 social contacts (average 5.02 per day, SD = 2.95) across seven consecutive days, we examined how the level of social contact satisfaction was concurrently and prospectively associated with affect (high-arousal and low-arousal positive affect, high-arousal and low-arousal negative affect). RESULTS Higher contact satisfaction was concurrently associated with more high- and low-arousal positive affect and less high- and low-arousal negative affect. The influence of contact satisfaction remains for predicting greater low-arousal positive affect (quietness, calmness) during the next social contact.
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