What is antimicrobial stewardship? Dyar, O.J.; Huttner, B.; Schouten, J. ...
Clinical microbiology and infection,
11/2017, Letnik:
23, Številka:
11
Journal Article
Recenzirano
Odprti dostop
The use of the term ‘antimicrobial stewardship’ has grown exponentially in recent years, typically referring to programmes and interventions that aim to optimize antimicrobial use. Although ...antimicrobial stewardship originated within human healthcare, it is increasingly applied in broader contexts including animal health and One Health. As the use of the term ‘antimicrobial stewardship’ becomes more common, it is important to consider what antimicrobial stewardship is, as well as what it is not.
To review the emergence and evolution of the term ‘antimicrobial stewardship’.
We searched and reviewed existing literature and official documents, which mostly focused on antibiotics. We contacted the authors of the first publications that mentioned antimicrobial stewardship.
We describe the historical background behind how antimicrobial stewardship came into use in clinical settings. We discuss challenges emerging from the varied descriptions of antimicrobial stewardship in the literature, including an over-emphasis on individual prescriptions, an under-emphasis on the societal implications of antimicrobial use, and language translation problems.
To help address these challenges, we suggest viewing antimicrobial stewardship as a strategy, a coherent set of actions which promote using antimicrobials responsibly. We stress the continuous need for ‘responsible use’ to be defined and translated into context-specific and time-specific actions. Furthermore, we present examples of actions that can be undertaken within antimicrobial stewardship across human and animal health.
Solvent addition significantly improved the selectivity to HMF in the aqueous phase dehydration of fructose over zeolite catalysts. The solvent not only improves the selectivity by extraction of the ...HMF produced, but also changes the intrinsic activity of the catalyst. Display omitted
► Solvent addition in fructose dehydration to improve hydroxymethylfurfural selectivity. ► Zeolites MOR, ZSM-5 and BEA were used as catalysts. ► The effect is due to interaction of internal and external acid sites with solvent. ► The selectivity to HMF decreases in order MOR>ZSM-5>BEA>amorphous aluminosilicate. ► This row corresponds to decrease in the strength of the acid sites.
The effect of organic solvent addition during dehydration of fructose over zeolites has been investigated as a way to enhance the 5-hydroxymethylfurfural (HMF) selectivity. The catalysts were characterized by chemical analysis, XRD, nitrogen adsorption–desorption and TPD NH3. The selectivity of HMF formation during the addition of methyl isobutyl ketone (MIBK) is significantly increased, but its effect decreases in the order: MOR>ZSM-5>BEA>amorphous aluminosilicate, which corresponds to the order of the decrease in the strength of the acid sites. An initial increase in the selectivity to HMF over zeolites after addition of organic solvent is attributed to the suppression of humins formation due to filling of the pores of zeolite with MIBK. Testing of silylated samples with deactivated surface acid sites indicates that in a biphasic system, the increase in the selectivity at higher conversions is induced by suppression by the solvent of the activity of external acid sites responsible for the unselective transformation of fructose.
This paper presents a performance analysis for the autothermal reforming process of methane in a fixed bed reformer for hydrogen production. The process is simulated using a 1-D heterogeneous reactor ...model under small-scale conditions. The model accounts for mass and thermal dispersion in the axial direction, axial pressure distribution, and interfacial and intraparticle transport. The process performance under dynamic and steady state conditions is analyzed with respect to key operational parameters: temperatures of gas feed and catalyst bed, oxygen/carbon and steam/carbon ratios, gas hourly space velocity (GHSV), and feed contaminations. The influence of these parameters on gas temperature, methane conversion, hydrogen yield and purity, and reforming efficiency is investigated. An optimal operational window of a GHSV range from 1050 to 14,000
h
−1, steam/carbon molar ratio of 4.5–6.0, and oxygen/carbon molar ratio of 0.45–0.55 is obtained to achieve a high conversion level of 93%, hydrogen purity of 73% on dry basis, thermal reformer efficiency of 78%, and a yield of 2.6
mole hydrogen per 1
mole of methane fed. The simulation studies are performed using gas feed temperature and pressure of 500
°C and 1.5
bar, respectively.
We describe a new method for relative quantification of 40 different DNA sequences in an easy to perform reaction requiring only 20 ng of human DNA. Applications shown of this multiplex ...ligation-dependent probe amplification (MLPA) technique include the detection of exon deletions and duplications in the human BRCA1, MSH2 and MLH1 genes, detection of trisomies such as Down’s syndrome, characterisation of chromosomal aberrations in cell lines and tumour samples and SNP/mutation detection. Relative quantification of mRNAs by MLPA will be described elsewhere. In MLPA, not sample nucleic acids but probes added to the samples are amplified and quantified. Amplification of probes by PCR depends on the presence of probe target sequences in the sample. Each probe consists of two oligonucleotides, one synthetic and one M13 derived, that hybridise to adjacent sites of the target sequence. Such hybridised probe oligonucleotides are ligated, permitting subsequent amplification. All ligated probes have identical end sequences, permitting simultaneous PCR amplification using only one primer pair. Each probe gives rise to an amplification product of unique size between 130 and 480 bp. Probe target sequences are small (50–70 nt). The prerequisite of a ligation reaction provides the opportunity to discriminate single nucleotide differences.
Diet, alcohol, cigarette smoking, physical inactivity, and body mass index have been studied as risk factors for renal cell cancer (RCC). The joint effects of these lifestyle factors, captured as ...Healthy Lifestyle Index (HLI), were examined in one previous study. This study aims to investigate the association between HLI score and RCC risk in the prospective Netherlands Cohort Study (NLCS).
A case-cohort analysis (3,767 subcohort members, 485 cases) was conducted using NLCS data (n = 120,852). Data on aforementioned risk factors was used to calculate HLI score, ranging 0-20, with higher scores reflecting healthier lifestyles. RCC occurrence was obtained by record linkage to cancer registries. Multivariable-adjusted proportional hazard models were used to calculate Hazard Ratios (HR) and 95% Confidence Intervals (95%CI).
Compared to participants in the unhealthiest HLI category, participants within the healthiest category had a lower RCC risk (HR = 0.79, 95%CI = 0.56-1.10, p for trend 0.045). A standard deviation (± 3-unit) increase in HLI score was not statistically significantly associated with a lower RCC risk (HR = 0.92, 95%CI = 0.83-1.01). This association was stronger after excluding diet or alcohol from the score, although confidence intervals overlap.
Adherence to a healthy lifestyle was weakly, though not statistically significantly, associated with a lower RCC risk.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary
In this small cross-sectional study of predominantly well-treated participants with relatively short-term type 2 diabetes duration, HbA1c > 7% (53 mmol/mol) was associated with lower cortical ...density and thickness and higher cortical porosity at the distal radius, lower trabecular thickness at the distal tibia, and higher trabecular number at both sites.
Introduction
To examine the association between diabetes status and volumetric bone mineral density (vBMD), bone microarchitecture and strength of the distal radius and tibia as assessed with HR-pQCT. Additionally—in participants with type 2 diabetes (T2DM), to examine the association between HbA1c, diabetes duration, and microvascular disease (MVD) and bone parameters.
Methods
Cross-sectional data from 410 (radius) and 198 (tibia) participants of The Maastricht Study (mean age 58 year, 51% female). Diabetes status (normal glucose metabolism, prediabetes, or T2DM) was based on an oral glucose tolerance test and medication history.
Results
After full adjustment, prediabetes and T2DM were not associated with vBMD, bone microarchitecture, and strength of the radius and tibia, except for lower trabecular number (Tb.N) of the tibia (− 4%) in prediabetes and smaller cross-sectional area of the tibia (− 7%) in T2DM. In T2DM, HbA1c > 7% was associated with lower cortical vBMD (− 5%), cortical thickness (− 16%), higher cortical porosity (+ 20%) and Tb.N (+ 9%) of the radius, and higher Tb.N (+ 9%) and lower trabecular thickness (− 13%) of the tibia. Diabetes duration > 5 years was associated with higher Tb.N (+ 6%) of the radius. The presence of MVD was not associated with any bone parameters.
Conclusions
In this study with predominantly well-treated T2DM participants with relatively short-term diabetes duration, inadequate blood glucose control was negatively associated with cortical bone measures of the radius. In contrast, trabecular number was increased at both sites. Studies of larger sample size are warranted for more detailed investigations of bone density and bone quality in patients with T2DM.
Background: Several studies have found an effect on mortality of between-city contrasts in long-term exposure to air pollution. The effect of within-city contrasts is still poorly understood. ...Objectives: We studied the association between long-term exposure to traffic-related air pollution and mortality in a Dutch cohort. Methods: We used data from an ongoing cohort study on diet and cancer with 120,852 subjects who were followed from 1987 to 1996. Exposure to black smoke (BS), nitrogen dioxide, sulfur dioxide, and particulate matter ≤ 2.5 microm$({\rm{PM}}_{2.5} ),$as well as various exposure variables related to traffic, were estimated at the home address. We conducted Cox analyses in the full cohort adjusting for age, sex, smoking, and area-level socioeconomic status. Results: Traffic intensity on the nearest road was independently associated with mortality. Relative risks (95% confidence intervals) for a 10-microg/m? increase in BS concentrations (difference between 5th and 95th percentile) were 1.05 (1.00-1.11) for natural cause, 1.04 (0.95-1.13) for cardiovascular, 1.22 (0.99-1.50) for respiratory, 1.03 (0.88-1.20) for lung cancer, and 1.04 (0.97-1.12) for mortality other than cardiovascular, respiratory, or lung cancer. Results were similar for NO2 and${\rm{PM}}_{2.5} ,$but no associations were found for SO2. Conclusions: Traffic-related air pollution and several traffic exposure variables were associated with mortality in the full cohort. Relative risks were generally small. Associations between natural-cause and respiratory mortality were statistically significant for NO2 and BS. These results add to the evidence that long-term exposure to ambient air pollution is associated with increased mortality.
The adsorption kinetics of hydrogen and hydroxyl on Pt(111) and stepped Ptn(111) × (110) electrodes with n = 29, 9, and 4 in acidic and alkaline electrolytes have been studied using impedance ...spectroscopy. We found a potential dependent charge transfer resistance, R(ct), (∼30 Ω cm(2) to ∼1 kΩ cm(2)) for hydrogen underpotential deposition in alkaline media (0.05 M NaOH), whereas in acidic media (0.025 M HClO(4)) R(ct) was too low to be determined accurately. Assuming simple (mean field) isotherms to fit our data, we obtain repulsive interactions between H(upd) at the (111) terrace and effective attractive interactions at the steps. The adsorption of OH on (111) terraces is fast in both acidic and alkaline media.
It is generally believed that domestication and breeding of plants has led to genetic erosion, including loss of nutritional value and resistances to diseases, especially in tomato. We studied the ...diversity dynamics of greenhouse tomato varieties in NW Europe, especially The Netherlands, over the last seven decades. According to the used SNP array, the genetic diversity was indeed very low during the 1960s, but is now eight times higher when compared to that dip. The pressure since the 1970s to apply less pesticides led to the introgression of many disease resistances from wild relatives, representing the first boost of genetic diversity. In Europe a second boost ensued, largely driven by German popular media who named poor tasting tomatoes
(water bombs). The subsequent collapse of Dutch tomato exports to Germany fueled breeding for fruit flavor, further increasing diversity since the 1990s. The increased diversity in composition of aroma volatiles observed starting from 1990s may reflect the efforts of breeders to improve fruit quality. Specific groups of aroma compounds showed different quantitative trend over the decades studied. Our study provides compelling evidence that breeding has increased the diversity of tomato varieties considerably since the 1970s.
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