A point prevalence survey of antibiotic prescriptions: benchmarking and patterns of use

center dot Inappropriate antimicrobial use has been associated with increased morbidity and hospital costs.

Antimicrobial prescribing in Nursing Homes in Northern Ireland: Results of Two Point-Prevalence Surveys

BACKGROUND: In 2005, the European Commission recommended that all member states should establish or strengthen surveillance systems for monitoring the use of antimicrobial agents. There is no evidence in the literature of any surveillance studies having been specifically conducted in nursing homes (NHs) in Northern Ireland (NI).

OBJECTIVE: The aim of this study was to determine the prevalence of antimicrobial prescribing and its relationship with certain factors (e.g. indwelling urinary catheterization, urinary incontinence, disorientation, etc.) in NH residents in NI.

METHODS: This project was carried out in NI as part of a wider European study under the protocols of the European Surveillance of Antimicrobial Consumption group. Two point-prevalence surveys (PPSs) were conducted in 30 NHs in April and November 2009. Data were obtained from nursing notes, medication administration records and staff in relation to antimicrobial prescribing, facility and resident characteristics and were analysed descriptively.

RESULTS: The point prevalence of antimicrobial prescribing was 13.2% in April 2009 and 10.7% in November 2009, with a 10-fold difference existing between the NHs with the highest and lowest antimicrobial prescribing prevalence during both PPSs. The same NH had the highest rate of antimicrobial prescribing during both April (30.6%) and November (26.0%). The group of antimicrobials most commonly prescribed was the penicillins (April 28.6%, November 27.5%) whilst the most prevalent individual antimicrobial prescribed was trimethoprim (April 21.3%, November 24.3%). The majority of antimicrobials were prescribed for the purpose of preventing urinary tract infections (UTIs) in both April (37.8%) and in November (46.7%), with 5% of all participating residents being prescribed an antimicrobial for this reason. Some (20%) antimicrobials were prescribed at inappropriate doses, particularly those which were used for the purpose of preventing UTIs. Indwelling urinary catheterization and wounds were significant risk factors for antimicrobial use in April [odds ratio {OR} (95% CI) 2.0 (1.1, 3.5) and 1.8 (1.1, 3.0), respectively] but not in November 2009 [OR (95% CI) 1.6 (0.8, 3.2) and 1.2 (0.7, 2.2), respectively]. Other resident factors, e.g. disorientation, immobility and incontinence, were not associated with antimicrobial use. Furthermore, none of the NH characteristics investigated (e.g. number of beds, hospitalization episodes, number of general practitioners, etc.) were found to be associated with antimicrobial use in either April or November 2009.

CONCLUSIONS: This study has identified a high overall rate of antimicrobial use in NHs in NI, with variability evident both within and between homes. More research is needed to understand which factors influence antimicrobial use and to determine the appropriateness of antimicrobial prescribing in this population in general and more specifically in the management of recurrent UTIs.

Performance models of storage contention in cloud environments

We propose simple models to predict the performance degradation of disk requests due to storage device contention in consolidated virtualized environments. Model parameters can be deduced from measurements obtained inside Virtual Machines (VMs) from a system where a single VM accesses a remote storage server. The parameterized model can then be used to predict the effect of storage contention when multiple VMs are consolidated on the same server. We first propose a trace-driven approach that evaluates a queueing network with fair share scheduling using simulation. The model parameters consider Virtual Machine Monitor level disk access optimizations and rely on a calibration technique. We further present a measurement-based approach that allows a distinct characterization of read/write performance attributes. In particular, we define simple linear prediction models for I/O request mean response times, throughputs and read/write mixes, as well as a simulation model for predicting response time distributions. We found our models to be effective in predicting such quantities across a range of synthetic and emulated application workloads. 

Molecular abundances in the magellanic clouds III. LIRS 36, a star-forming region in the Small Magellanic Cloud

Detections of CO, CS, SO, C2H, HCO+, HCN, HNC, H2CO, and C3H2 are reported from LIRS 36, a star-forming region in the Small Magellanic Cloud. (CO)-O-18, NO, CH3OH, and most notably CN have not been detected, while the rare isotopes (CO)-C-13 and, tentatively, (CS)-S-34 ar,seen. This is so far the most extensive molecular multiline study of an interstellar medium with a heavy element depletion exceeding a factor of four.

Molecular abundances in the magellanic clouds .1. A multiline study of five cloud cores

Nine H II regions of the LMC were mapped in (CO)-C-13(1-0) and three in (CO)-C-12(1-0) to study the physical properties of the interstellar medium in the Magellanic Clouds. For N113 the molecular core is found to have a peak position which differs from that of the associated H II region by 20 ''. Toward this molecular core the (CO)-C-12 and (CO)-C-13 peak T-MB line temperatures of 7.3 K and 1.2 K are the highest so far found in the Magellanic Clouds. The molecular concentrations associated with N113, N44BC, N159HW, and N214DE in the LMC and LIRS 36 in the SMC were investigated in a variety of molecular species to study the chemical properties of the interstellar medium. I(HCO+)/I(HCN) and I(HCN)/I(HNC) intensity ratios as well as lower limits to the I((CO)-C-13)/I((CO)-O-18) ratio were derived for the rotational 1-0 transitions. Generally, HCO+ is stronger than HCN, and HCN is stronger than HNC. The high relative HCO+ intensities are consistent with a high ionization flux from supernovae remnants and young stars, possibly coupled with a large extent of the HCO+ emission region. The bulk of the HCN arises from relatively compact dense cloud cores. Warm or shocked gas enhances HCN relative to HNC. From chemical model calculations it is predicted that I(HCN)/I(HNC) close to one should be obtained with higher angular resolution (less than or similar to 30 '') toward the cloud cores. Comparing virial masses with those obtained from the integrated CO intensity provides an H-2 mass-to-CO luminosity conversion factor of 1.8 x 10(20) mol cm(-2) (K km s(-1))(-1) for N113 and 2.4 x 10(20) mol cm(-2) (K km s(-1))(-1) for N44BC. This is consistent with values derived for the Galactic disk.

THE EFFECT OF VARYING COSMIC-RAY IONIZATION RATES ON DARK CLOUD CHEMISTRY

We investigate the effects of varying the cosmic ray ionization rate in chemical models of dense interstellar clouds. In the absence of such ionization, a scenario which may be applicable to dark cloud cores, we find that chemi-ionization is able to drive a limited ion-neutral chemistry. Models of clouds in starburst galaxies, which may have enhanced cosmic ray fluxes, are also investigated and enable an upper limit to be derived for the cosmic ray ionization rate in M82. The derived value, which is about 700 times the typical value for Galactic molecular clouds, is in good agreement with that necessary to explain the recent observations of C I in this galaxy.

The VLT-FLAMES survey of massive stars: wind properties and evolution of hot massive stars in the Large Magellanic Cloud

We have studied the optical spectra of a sample of 28 O- and early B-type stars in the Large Magellanic Cloud, 22 of which are associated with the young star forming region N11. Our observations sample the central associations of LH9 and LH10, and the surrounding regions. Stellar parameters are determined using an automated fitting method ( Mokiem et al. 2005), which combines the stellar atmosphere code fastwind ( Puls et al. 2005) with the genetic algorithm based optimisation routine PIKAIA ( Charbonneau 1995). We derive an age of 7.0 +/- 1.0 and 3.0 +/- 1.0 Myr for LH9 and LH10, respectively. The age difference and relative distance of the associations are consistent with a sequential star formation scenario in which stellar activity in LH9 triggered the formation of LH10. Our sample contains four stars of spectral type O2. From helium and hydrogen line fitting we find the hottest three of these stars to be similar to 49- 54 kK ( compared to similar to 45- 46 kK for O3 stars). Detailed determination of the helium mass fraction reveals that the masses of helium enriched dwarfs and giants derived in our spectroscopic analysis are systematically lower than those implied by non-rotating evolutionary tracks. We interpret this as evidence for efficient rotationally enhanced mixing leading to the surfacing of primary helium and to an increase of the stellar luminosity. This result is consistent with findings for SMC stars by Mokiem et al. ( 2006). For bright giants and supergiants no such mass discrepancy is found; these stars therefore appear to follow tracks of modestly or non-rotating objects. The set of programme stars was sufficiently large to establish the mass loss rates of OB stars in this Z similar to 1/2 Z(circle dot) environment sufficiently accurate to allow for a quantitative comparison with similar objects in the Galaxy and the SMC. The mass loss properties are found to be intermediate to massive stars in the Galaxy and SMC. Comparing the derived modified wind momenta D-mom as a function of luminosity with predictions for LMC metallicities by Vink et al. ( 2001) yields good agreement in the entire luminosity range that was investigated, i.e. 5.0