Evaluating Scalable Distributed Erlang for Scalability and Reliability

Large scale servers with hundreds of hosts and tens of thousands of cores are becoming common. To exploit these platforms software must be both scalable and reliable, and distributed actor languages like Erlang are a proven technology in this area. While distributed Erlang conceptually supports the engineering of large scale reliable systems, in practice it has some scalability limits that force developers to depart from the standard language mechanisms at scale. In earlier work we have explored these scalability limitations, and addressed them by providing a Scalable Distributed (SD) Erlang library that partitions the network of Erlang Virtual Machines (VMs) into scalable groups (s_groups). This paper presents the first systematic evaluation of SD Erlang s_groups and associated tools, and how they can be used. We present a comprehensive evaluation of the scalability and reliability of SD Erlang using three typical benchmarks and a case study. We demonstrate that s_groups improve the scalability of reliable and unreliable Erlang applications on up to 256 hosts (6,144 cores). We show that SD Erlang preserves the class-leading distributed Erlang reliability model, but scales far better than the standard model. We present a novel, systematic, and tool-supported approach for refactoring distributed Erlang applications into SD Erlang. We outline the new and improved monitoring, debugging and deployment tools for large scale SD Erlang applications. We demonstrate the scaling characteristics of key tools on systems comprising up to 10 K Erlang VMs

ESGAP inventory of target indicators assessing antibiotic prescriptions: A cross-sectional survey

Background A variety of indicators is commonly used to monitor antibiotic prescriptions as part of national antimicrobial stewardship (AMS) programmes. Objectives To make an inventory of indicators that assess antibiotic prescriptions and are linked to specific targets and incentives, at a national level. Methods A cross-sectional survey (three-item questionnaire) was conducted in 2017 among all ESGAP (ESCMID Study Group for Antimicrobial stewardshiP) members, coming from 23 European countries and 16 non-European countries. Results Almost all (20/23, 87%) European countries belonging to the ESGAP network participated, as well as one non-European country. Computerized systems routinely linking antibiotic prescriptions to clinical diagnoses were reported for only two countries (Turkey and Croatia). Only 6/21 (29%) countries had national indicators with both clear targets and incentives (Bulgaria, Croatia, France, the Netherlands, Norway and Portugal). We identified a total of 21 different indicators used in these countries, 16 concerning inpatients (9 quality indicators and 7 quantity metrics) and 8 concerning outpatients (all quantity metrics); some indicators were used in both settings. Three types of incentives were used: financing mechanism, hospitals' accreditation and public reporting. Some respondents reported that such indicators with both clear targets and incentives were used at a regional level in their country (e.g. Andalusia in Spain and England in the UK). Conclusions National indicators, with clear targets and incentives, are not commonly used in Europe and we observed wide variations between countries regarding the selected indicators, the units of measure and the chosen targets

Organization and training at national level of antimicrobial stewardship and infection control activities in Europe: an ESCMID cross-sectional survey

Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking