Antimicrobial stewardship programs (ASPs) positively impact patient care, but metrics to assess ASP impact are poorly defined. We used a modified Delphi approach to select relevant metrics for ...assessing patient-level interventions in acute-care settings for the purposes of internal program decision making. An expert panel rated 90 candidate metrics on a 9-point Likert scale for association with 4 criteria: improved antimicrobiol prescribing, improved patient care, utility in targeting stewardship efforts, and feasibility in hospitals with electronic health records. Experts further refined, added, or removed metrics during structured teleconferences and re-rated the retained metrics. Six metrics were rated >6 in all criteria: 2 measures of Clostridium difficile incidence, incidence of drug-resistant pathogens, days of therapy over admissions, days of therapy over patient days, and redundant therapy events. Fourteen metrics rated >6 in all criteria except feasibility were identified as targets for future development.
ABSTRACT
We cross-match between the WISE All-Sky and PS1 3π DR2 source catalogues. The resulting catalogue has 354 590 570 objects, significantly fewer than the parent PS1 catalogue, but its ...combination of optical and infrared colours facilitate both better source classification and photometric redshift estimation. We perform a neural network-based classification of the objects into galaxies, quasars, and stars, then run neural network-based photometric redshift estimation for the galaxies. The star sample purity and quasar sample completeness measures improve substantially, and the resulting photo-z’s are significantly more accurate in terms of statistical scatter and bias than those calculated from PS1 properties alone. The catalogue will be a basis for future large-scale structure studies, and will be made available as a high-level science product via the Mikulski Archive for Space Telescopes.
Abstract
In recent years, the global public health community has increasingly recognized the importance of antimicrobial stewardship (AMS) in the fight to improve outcomes, decrease costs, and curb ...increases in antimicrobial resistance around the world. However, the subject of antifungal stewardship (AFS) has received less attention. While the principles of AMS guidelines likely apply to stewarding of antifungal agents, there are additional considerations unique to AFS and the complex field of fungal infections that require specific recommendations. In this article, we review the literature on AMS best practices and discuss AFS through the lens of the global core elements of AMS. We offer recommendations for best practices in AFS based on a synthesis of this evidence by an interdisciplinary expert panel of members of the Mycoses Study Group Education and Research Consortium. We also discuss research directions in this rapidly evolving field. AFS is an emerging and important component of AMS, yet requires special considerations in certain areas such as expertise, education, interventions to optimize utilization, therapeutic drug monitoring, and data analysis and reporting.
By controlling and changing how antimicrobial agents are selected and administered, antimicrobial stewardship programs (ASPs) aim to prevent or slow the emergence of antimicrobial resistance; ...optimize the selection, dosing, and duration of antimicrobial therapy; reduce the incidence of drug-related adverse events; and lower rates of morbidity and mortality, length of hospitalization, and costs. There is an abundant and growing body of evidence demonstrating that ASPs change the quantity and quality of antimicrobial prescriptions; however, measuring whether, when, and how ASPs improve patient outcomes and change patterns of antimicrobial resistance—which is the ultimate goals of ASPs—has been difficult, but the totality of evidence indicates that ASPs are capable of achieving these goals. In this article, we review the existing data on ASPs and their effects on patient care and antimicrobial resistance, as well as strategies for establishing ASPs in different types of hospitals.
Saving freshwater from salts Cañedo-Argüelles, M.; Hawkins, C. P.; Kefford, B. J. ...
Science (American Association for the Advancement of Science),
02/2016, Letnik:
351, Številka:
6276
Journal Article
Recenzirano
Ion-specific standards are needed to protect biodiversity
Many human activities—like agriculture and resource extraction—are increasing the total concentration of dissolved inorganic salts (i.e., ...salinity) in freshwaters. Increasing salinity can have adverse effects on human health (
1
); increase the costs of water treatment for human consumption; and damage infrastructure e.g., amounting to $700 million per year in the Border Rivers catchment, Australia (
2
). It can also reduce freshwater biodiversity (
3
); alter ecosystem functions (
4
); and affect economic well-being by altering ecosystem goods and services (e.g., fisheries collapse). Yet water-quality legislation and regulations that target salinity typically focus on drinking water and irrigation water, which does not automatically protect biodiversity. For example, specific electrical conductivities (a proxy for salinity) of 2 mS/cm can be acceptable for drinking and irrigation but could extirpate many freshwater insect species (
3
). We argue that salinity standards for specific ions and ion mixtures, not just for total salinity, should be developed and legally enforced to protect freshwater life and ecosystem services. We identify barriers to setting such standards and recommend management guidelines.
Abstract
Background
Antimicrobial stewardship programs (ASPs) promote the principle of de-escalation: moving from broad- to narrow-spectrum agents and stopping antibiotics when no longer indicated. A ...standard, objective definition of de-escalation applied to electronic data could be useful for ASP assessments.
Methods
We derived an electronic definition of antibiotic de-escalation and performed a retrospective study among 5 hospitals. Antibiotics were ranked into 4 categories: narrow-spectrum, broad-spectrum, extended-spectrum, and agents targeted for protection. Eligible adult patients were cared for on inpatient units, had antibiotic therapy for at least 2 days, and were hospitalized for at least 3 days after starting antibiotics. Number of antibiotics and rank were assessed at 2 time points: day of antibiotic initiation and either day of discharge or day 5. De-escalation was defined as reduction in either the number of antibiotics or rank. Escalation was an increase in either number or rank. Unchanged was either no change or discordant directions of change. We summarized outcomes among hospitals, units, and diagnoses.
Results
Among 39 226 eligible admissions, de-escalation occurred in 14 138 (36%), escalation in 5129 (13%), and antibiotics were unchanged in 19 959 (51%). De-escalation varied among hospitals (median, 37%; range, 31–39%, P < .001). Diagnoses with lower de-escalation rates included intra-abdominal (23%) and skin and soft tissue (28%) infections. Critical care had higher rates of both de-escalation and escalation compared with wards.
Conclusions
Our electronic de-escalation metric demonstrated variation among hospitals, units, and diagnoses. This metric may be useful for assessing stewardship opportunities and impact.
De-escalation of antibiotics is a key principle of antibiotic stewardship, yet there is no standard definition. We proposed an objective, electronic definition of antibiotic de-escalation and present the distribution among infection diagnoses and its variability among hospitals and units.
To promote the judicious use of antimicrobials and preserve their usefulness in the setting of growing resistance, a number of policy-making bodies and professional societies have advocated the ...development of antimicrobial stewardship programs. Although these programs have been implemented at many institutions in the United States, their impact has been difficult to measure. Current recommendations advocate the use of both outcome and process measures as metrics for antimicrobial stewardship. Although patient outcome metrics have the greatest impact on the quality of care, the literature shows that antimicrobial use and costs are the indicators measured most frequently by institutions to justify the effectiveness of antimicrobial stewardship programs. The measurement of more meaningful outcomes has been constrained by difficulties inherent to these measures, lack of funding and resources, and inadequate study designs. Antimicrobial stewardship can be made more credible by refocusing the antimicrobial review process to target specific disease states, reassessing the usefulness of current metrics, and integrating antimicrobial stewardship program initiatives into institutional quality and safety efforts.
Testing the metabolic theory of ecology Price, Charles A.; Weitz, Joshua S; Savage, Van M. ...
Ecology letters,
December 2012, Letnik:
15, Številka:
12
Journal Article
Recenzirano
The metabolic theory of ecology (MTE) predicts the effects of body size and temperature on metabolism through considerations of vascular distribution networks and biochemical kinetics. MTE has also ...been extended to characterise processes from cellular to global levels. MTE has generated both enthusiasm and controversy across a broad range of research areas. However, most efforts that claim to validate or invalidate MTE have focused on testing predictions. We argue that critical evaluation of MTE also requires strong tests of both its theoretical foundations and simplifying assumptions. To this end, we synthesise available information and find that MTE's original derivations require additional assumptions to obtain the full scope of attendant predictions. Moreover, although some of MTE's simplifying assumptions are well supported by data, others are inconsistent with empirical tests and even more remain untested. Further, although many predictions are empirically supported on average, work remains to explain the often large variability in data. We suggest that greater effort be focused on evaluating MTE's underlying theory and simplifying assumptions to help delineate the scope of MTE, generate new theory and shed light on fundamental aspects of biological form and function.
Online misogyny has become a fixture in female politicians' lives. Backlash theory suggests that it may represent a threat response prompted by female politicians' counterstereotypical, power-seeking ...behaviors. We investigated this hypothesis by analyzing Twitter references to Hillary Clinton before, during, and after her presidential campaign. We collected a corpus of over 9 million tweets from 2014 to 2018 that referred to Hillary Clinton, and employed an interrupted time series analysis on the relative frequency of misogynistic language within the corpus. Prior to 2015, the level of misogyny associated with Clinton decreased over time, but this trend reversed when she announced her presidential campaign. During the campaign, misogyny steadily increased and only plateaued after the election, when the threat of her electoral success had subsided. These findings are consistent with the notion that online misogyny towards female political nominees is a form of backlash prompted by their ambition for power in the political arena.
Abstract
Background
Individual hospitals may lack expertise, data resources, and educational tools to support antimicrobial stewardship programs (ASP).
Methods
We established a collaborative, ...consultative network focused on hospital ASP implementation. Services included on-site expert consultation, shared database for routine feedback and benchmarking, and educational programs. We performed a retrospective, longitudinal analysis of antimicrobial use (AU) in 17 hospitals that participated for at least 36 months during 2013–2018. ASP practice was assessed using structured interviews. Segmented regression estimated change in facility-wide AU after a 1-year assessment, planning, and intervention initiation period. Year 1 AU trend (1–12 months) and AU trend following the first year (13–42 months) were compared using relative rates (RR). Monthly AU rates were measured in days of therapy (DOT) per 1000 patient days for overall AU, specific agents, and agent groups.
Results
Analyzed data included over 2.5 million DOT and almost 3 million patient-days. Participating hospitals increased ASP-focused activities over time. Network-wide overall AU trends were flat during the first 12 months after network entry but decreased thereafter (RR month 42 vs month 13, 0.95, 95% confidence interval CI: .91–.99). Large variation was seen in hospital-specific AU. Fluoroquinolone use was stable during year 1 and then dropped significantly. Other agent groups demonstrated a nonsignificant downward trajectory after year 1.
Conclusions
Network hospitals increased ASP activities and demonstrated decline in AU over a 42-month period. A collaborative, consultative network is a unique model in which hospitals can access ASP implementation expertise to support long-term program growth.
Community hospitals participated in a collaborative network focused on antibiotic stewardship program implementation with access to shared data infrastructure, educational materials, and expert consultants. Network hospitals demonstrated increased stewardship-focused activities and decline in antibiotic use over a 42-month period.
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