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.

Classical novae from the POINT-AGAPE microlensing survey of M31 - II. Rate and statistical characteristics of the nova population

The POINT-AGAPE (Pixel-lensing Observations with the Isaac Newton Telescope-Andromeda Galaxy Amplified Pixels Experiment) survey is an optical search for gravitational microlensing events towards the Andromeda galaxy (M31). As well as microlensing, the survey is sensitive to many different classes of variable stars and transients. In our first paper of this series, we reported the detection of 20 classical novae (CNe) observed in Sloan r' and i' passbands.

POINT-AGAPE pixel lensing survey of M31 - Evidence for a MACHO contribution to galactic halos

The POINT-AGAPE collaboration is carrying out a search for gravitational microlensing toward M31 to reveal galactic dark matter in the form of MACHOs (Massive Astrophysical Compact Halo Objects) in the halos of the Milky Way and M31. A high-threshold analysis of 3 years of data yields 6 bright, short- duration microlensing events, which are confronted to a simulation of the observations and the analysis. The observed signal is much larger than expected from self lensing alone and we conclude, at the 95% confidence level, that at least 20% of the halo mass in the direction of M31 must be in the form of MACHOs if their average mass lies in the range 0.5-1 M-circle dot. This lower bound drops to 8% for MACHOs with masses similar to 0.01 M-circle dot. In addition, we discuss a likely binary microlensing candidate with caustic crossing. Its location, some 32' away from the centre of M31, supports our conclusion that we are detecting a MACHO signal in the direction of M31.

The POINT-AGAPE survey - II. An unrestricted search for microlensing events towards M31

An automated search is carried out for microlensing events using a catalogue of 44 554 variable superpixel light curves derived from our 3-yr monitoring programme of M31. Each step of our candidate selection is objective and reproducible by a computer. Our search is unrestricted, in the sense that it has no explicit time-scale cut. So, it must overcome the awkward problem of distinguishing long time-scale microlensing events from long-period stellar variables.

Classical novae from the POINT-AGAPE microlensing survey of M31 - I. The nova catalogue

The POINT-AGAPE (Pixel-lensing Observations with the Isaac Newton Telescope-Andromeda Galaxy Amplified Pixels Experiment) survey is an optical search for gravitational microlensing events towards the Andromeda galaxy (M31). As well as microlensing, the survey is sensitive to many different classes of variable stars and transients. Here we describe the automated detection and selection pipeline used to identify M31 classical novae (CNe) and we present the resulting catalogue of 20 CN candidates observed over three seasons. CNe are observed both in the bulge region as well as over a wide area of the M31 disc. Nine of the CNe are caught during the final rise phase and all are well sampled in at least two colours. The excellent light-curve coverage has allowed us to detect and classify CNe over a wide range of speed class, from very fast to very slow. Among the light curves is a moderately fast CN exhibiting entry into a deep transition minimum, followed by its final decline. We have also observed in detail a very slow CN which faded by only 0.01 mag d(-1) over a 150-d period. We detect other interesting variable objects, including one of the longest period and most luminous Mira variables. The CN catalogue constitutes a uniquely well-sampled and objectively-selected data set with which to study the statistical properties of CNe in M31, such as the global nova rate, the reliability of novae as standard-candle distance indicators and the dependence of the nova population on stellar environment. The findings of this statistical study will be reported in a follow-up paper.

The POINT-AGAPE survey - I. The variable stars in M31

For the purposes of identifying microlensing events, the POINT-AGAPE collaboration has been monitoring the Andromeda galaxy (M31) for three seasons (1999-2001) with the Wide Field Camera on the Isaac Newton Telescope. In each season, data are taken for one hour per night for roughly 60 nights during the six months that M31 is visible. The two 33 x 33 arcmin(2) fields of view straddle the central bulge, northwards and southwards. We have calculated the locations, periods and brightness of 35 414 variable stars in M31 as a by-product of the microlensing search. The variables are classified according to their period and brightness. Rough correspondences with classical types of variable star (such as Population I and II Cepheids, Miras and semiregular long-period variables) are established. The spatial distribution of Population I Cepheids is clearly associated with the spiral arms, while the central concentration of the Miras and long-period variables varies noticeably, the brighter and the shorter period Miras being much more centrally concentrated.

The POINT-AGAPE survey: 4 high signal-to-noise microlensing candidates detected towards M 31

We have carried out a survey of the Andromeda galaxy for unresolved microlensing (pixel lensing). We present a subset of four short timescale, high signal-to-noise microlensing candidates found by imposing severe selection criteria: the source flux variation exceeds the flux of an R = 21 magnitude star and the full width at half maximum timescale is less than 25 days. Remarkably, in three out of four cases, we have been able to measure or strongly constrain the Einstein crossing time of the event. One event, which lies projected on the M 31 bulge, is almost certainly due to a stellar lens in the bulge of M 31. The other three candidates can be explained either by stars in M 31 and M 32 or by MACHOs.

A short-timescale candidate microlensing event in the point-agape pixel lensing survey of M31

We report the discovery of a short-duration microlensing candidate in the northern field of the POINT-AGAPE pixel lensing survey toward M31. Almost certainly, the source star has been identified on Hubble Space Telescope archival images, allowing us to infer an Einstein crossing time of t(E) = 10.4 days, a maximum magnification of A(max) similar to 18, and a lens-source proper motion mu (rel) > 0.3 mu as day(-1). The event has a projected separation of 8' from the center of M31, beyond the bulk of the stellar lens population. There are three plausible identifications/locations for the lensing object: a massive compact halo object (MACHO) in either M31 or the Milky Way, or a star in the M31 disk. The most probable mass is 0.06 M-. for an M31 MACHO, 0.02 M-. for a Milky Way MACHO, and 0.2 M-. for an M31 stellar lens. While the stellar interpretation is possible, the MACHO interpretation is the most probable for halo fractions above 20%.

CHARACTERIZATION OF A LASER-PRODUCED PLASMA USING THE TECHNIQUE OF POINT-PROJECTION ABSORPTION-SPECTROSCOPY

The technique of point-projection spectroscopy has been shown to be applicable to the study of expanding aluminum plasmas generated by approximately 80 ps laser pulses incident on massive, aluminum stripe targets of approximately 125-mu-m width. Targets were irradiated at an intensity of 2.5 +/- 0.5 x 10(13) W/cm2 in a line focus geometry and under conditions similar to those of interest in x-ray laser schemes. Hydrogenic and heliumlike aluminum resonance lines were observed in absorption using a quasicontinuous uranium back-lighter plasma. Using a pentaerythrital Bragg crystal as the dispersive element, a resolving power of approximately 3500 was achieved with spatial resolution at the 5-mu-m level in frame times of the order of 100 ps. Reduction of the data for times up to 150 ps after the peak of the incident laser pulse produced estimates of the temperature and ion densities present, as a function of space and time. The one-dimensional Lagrangian hydrodynamic code MEDUSA coupled to the atomic physics non-local-thermodynamic-equilibrium ionized material package was used to simulate the experiment in planar geometry and has been shown to be consistent with the measurements.