Antibiotic resistance: how did we get here and what can we do?

Executive summary Does antibiotic resistance exist? Yes. It is a worsening phenomenon seen all over the world, including Australia. What are the implications of antibiotic resistance? Infection with antibiotic-resistant bacteria is associated with longer length of stay in hospitals and higher death rates. This amounts to significant financial costs; the European Union, for example, spends €1.5 billion annually on antibiotic-resistant infections. Significant indirect costs can also arise from antibiotic-resistant infections when they adversely affect other areas of medicine, for example, transplant medicine, surgery and chemotherapy. How did we get here? Antibiotic resistance has many causes but the most important ones include: excessive and inappropriate antibiotic use among humans and animals (including ‘over-the-counter’ antibiotic use), global trade, global travel, medical tourism, environmental contamination with antibiotics, and a decline in new antibiotic development. What can we do? Because there are multiple causes, a multi-pronged solution is required. The ‘EVADES BUGS’ strategy seeks to address the core problems: Education, Vaccine development, Animal health, Diagnostics, Environmental controls, Surveillance, Better antibiotics, Universal infection control and hand hygiene, Government and political will, Stewardship of antibiotics in hospitals. Many superbugs arrive here from overseas as a consequence of global trade and global travel. As a result, Australia must play a global role in addressing the issue as well as a local one. Implementing the EVADES BUGS strategy would require activity across portfolios (for example, Health, Trade, Agriculture, Environment, Tourism, Customs). Therefore, it is worth considering the establishment of a single coordinating body, such as an Australian Centre for Disease Control, to take responsibility for the strategy as part of a broader focus on monitoring and responding to communicable diseases

High Throughput Virtual Screening with Data Level Parallelism in Multi-core Processors

Improving the throughput of molecular docking, a computationally intensive phase of the virtual screening process, is a highly sought area of research since it has a significant weight in the drug designing process. With such improvements, the world might find cures for incurable diseases like HIV disease and Cancer sooner. Our approach presented in this paper is to utilize a multi-core environment to introduce Data Level Parallelism (DLP) to the Autodock Vina software, which is a widely used for molecular docking software. Autodock Vina already exploits Instruction Level Parallelism (ILP) in multi-core environments and therefore optimized for such environments. However, with the results we have obtained, it can be clearly seen that our approach has enhanced the throughput of the already optimized software by more than six times. This will dramatically reduce the time consumed for the lead identification phase in drug designing along with the shift in the processor technology from multi-core to many-core of the current era. Therefore, we believe that the contribution of this project will effectively make it possible to expand the number of small molecules docked against a drug target and improving the chances to design drugs for incurable diseases.Comment: Information and Automation for Sustainability (ICIAfS), 2012 IEEE 6th International Conference o

Viscous effects in planar magnetic X-point reconnection

The impact of viscous dissipation is considered on magnetic reconnection in closed line-tied magnetic X-points. It is shown that viscous effects can provide fast energy dissipation for disturbances which do not alter the initial X-point topology. If the X-point topology is altered, then the rate of viscous dissipation depends on both the perturbed topology and the relative magnitudes of viscosity and electric resistivity. New solutions are demonstrated, which derive from the combination of resistive and viscous effects. The solutions are characterized by monotonically decaying modes which are qualitatively different from the previously known oscillatory modes in nonviscous resistive X-point reconnection. These results suggest that viscous heating in magnetic X-points may be an important effect in solar flares

Intuition in Nursing Practice : Knowledge, Experience, and Clinical Decision Making

Intuition is a commonly used aspect in nursing practice. As the evidence based practice is the prominent practice today, the intuition based practice is hidden and somewhat devalued. Although it is difficult to define due to its nature, intuition is an essential part of effective clinical decision making. This research is an inductive qualitative content analysis that focuses on novice nurse and expert nurse, and their use of intuition based on knowledge and experience. Benner’s From Novice to Expert theory as well as Carper’s Fundamental Patterns of Knowing in Nursing theory form the theoretical framework of this research. Benner’s theory talks about five stages of nurses’ professional development, whereas Carper’s theory focuses on the different ways of knowing in nursing profession. The aim is to define intuition, knowing, and clinical decision making. In addition, this research describes the impact of knowledge and experience on intuition and clinical decision making related to novice nurse and expert nurse. The research material consists of 20 scholarly articles, for instance from Sage and Research gate. Although intuition has been used by nurses in practice every day, the attention given to this kind of nursing practice is too little. Therefore, this subject area has not been researched enough. The research shows that intuition is a complex term to define. It can be seen as unconscious awareness of reasoning, a sixth sense, or a gut-feeling. It is used during nursing practice in clinical decision making. Intuition is mainly used by expert nurses, but unlike in Benner’s model, also novice nurses can use it, especially if they have some previously gained life experience. Knowledge and experience are the most influencing factors on intuition. Therefore, gaining nursing intuition requires a good knowledge base and clinical experience. Other factors affecting successful clinical decision making are the different aspects of knowing that include, for instance, knowing the self, the profession, and the patient

Infrastructure facilities for deep-sea and off-shore fishing

The author presents a brief account of the infrastructure facilities required for the fishing industry. He describes those facilities presently available in Sri Lanka, and those that are under construction, and gives a few suggestions indicating the nature of infrastructure facilities that are vital to the local situation at its present stage of development. The principal facilities discussed are (1) fish landing places; (2) unloading handling facilities; (3) vessel servicing facilities; and (4) navigation aids

Implementation of the WHO safe childbirth checklist program at a tertiary care setting in Sri Lanka: a developing country experience

BACKGROUND: To study institutionalization of the World Health Organization’s Safe Childbirth Checklist (SCC) in a tertiary care center in Sri Lanka. METHOD: A hospital-based, prospective observational study was conducted in the De Soysa Hospital for Women, Colombo, Sri Lanka. Healthcare workers were educated regarding the SCC, which was to be used for each woman admitted to the labor room during the study period. A qualitatively pretested, self-administered questionnaire was given to all nursing and midwifery staff to assess knowledge and attitudes towards the checklist. Each item of the SCC was reviewed for adherence. RESULTS: A total of 824 births in which the checklist used were studied. There were a total of births 1800 during the period, giving an adoption rate of 45.8%. Out of the 170 health workers in the hospital (nurses, midwives and nurse midwives) 98 answered the questionnaire (response rate = 57.6%). The average number of childbirth practices checked in the checklist was 21 out of 29 (95% CI 20.2, 21.3). Educating the mother to seek help during labor, after delivery and after discharge from hospital, seeking an assistant during labor, early breast-feeding, maternal HIV infection and discussing contraceptive options were checked least often. The mean level of knowledge on the checklist among health workers was 60.1% (95% CI 57.2, 63.1). Attitudes for acceptance of using the checklist were satisfactory. Average adherence to checklist practices was 71.3%. Sixty eight (69.4%) agreed that the Checklist stimulates inter-personal communication and teamwork. Increased workload, poor enthusiasm of health workers towards new additions to their routine schedule and level of user-friendliness of Checklist were limitations to its greater use. CONCLUSIONS: Amongst users, the attitude towards the checklist was satisfactory. Adoption rate amongst all workers was 45.8% and knowledge regarding the checklist was 60.1%. These two factors are probably linked. Therefore prior to introducing it to a facility awareness about the value and correct use of the SCC needs to be increased, while giving attention to satisfactory staffing levels

The effect of a postpartum IUD intervention on counseling and choice: Evidence from a cluster-randomized stepped-wedge trial in Sri Lanka

BACKGROUND: The International Federation of Gynaecology and Obstetrics (FIGO), in collaboration with the Sri Lankan College of Obstetrics and Gynaecologists (SLCOG), launched an initiative in 2014 to institutionalize immediate postpartum IUD (PPIUD) services as a routine part of antenatal counseling and delivery room services in Sri Lanka. In this study, we evaluate the effect of the FIGO-SLCOG PPIUD intervention in six hospitals by means of a cluster-randomized stepped-wedge trial. METHODS/DESIGN: Six hospitals were randomized into two groups of three using matched pairs. Following a 3-month baseline period, the intervention was administered to the first group, while the second group received the intervention after 9 months of baseline data collection. We collected data from 39,084 women who delivered in these hospitals between September 2015 and January 2017. We conduct an intent-to-treat (ITT) analysis to determine the impact of the intervention on PPIUD counseling and choice of PPIUD, as measured by consent to receive a PPIUD, as well as PPIUD uptake (insertion following delivery). We also investigate how factors related to counseling, such as counseling timing and quality, are linked to choice of PPIUD. RESULTS: We find that the intervention increased rates of counseling, from an average counseling rate of 12% in all hospitals prior to the intervention to an average rate of 51% in all hospitals after the rollout of the intervention (0.307; 95% CI 0.148-0.465). In contrast, we find the impact of the intervention on choice of PPIUD to be less robust and mixed, with 4.1% of women choosing PPIUD prior to the intervention compared to 9.8% of women choosing PPIUD after the rollout of the intervention (0.027; 95% CI 0.000-0.054). CONCLUSIONS: This study demonstrates that incorporating PPIUD services into postpartum care is feasible and potentially effective. Taking the evidence on both counseling and choice of PPIUD together, we find that the intervention had a generally positive impact on receipt of PPIUD counseling and, to a lesser degree, on choice of the PPIUD. Nevertheless, it is clear that the intervention's effectiveness can be improved to be able to meet the demand for postpartum family planning of women. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02718222 . Registered on 11 March 2016 (retrospectively registered).Published version and Accepted manuscript versions

Monetary Poverty Estimates in Sri Lanka: Selected Issues

"This paper provides an introduction to poverty-related data available in Sri Lanka and monetary measurements of poverty carried out using this data. The lack of an official poverty line in Sri Lanka until June 2004 has over time generated a number of poverty lines and corresponding poverty measures. While these poverty measures have provided a good base for poverty analysis, the paper also touches on the problems generated by the use of multiple methods. The release of the official poverty line by the Department of Census and Statistics can be seen as a major step forward in the debate on poverty measurement in Sri Lanka.

Non-equilibrium oxidation states of zirconium during early stages of metal oxidation

The chemical state of Zr during the initial, self-limiting stage of oxidation on single crystal zirconium (0001), with oxide thickness on the order of 1 nm, was probed by synchrotron x-ray photoelectron spectroscopy. Quantitative analysis of the Zr 3d spectrum by the spectrum reconstruction method demonstrated the formation of Zr[superscript 1+], Zr[superscript 2+], and Zr[superscript 3+] as non-equilibrium oxidation states, in addition to Zr[superscript 4+] in the stoichiometric ZrO2. This finding resolves the long-debated question of whether it is possible to form any valence states between Zr[superscript 0] and Zr[superscript 4+] at the metal-oxide interface. The presence of local strong electric fields and the minimization of interfacial energy are assessed and demonstrated as mechanisms that can drive the formation of these non-equilibrium valence states of Zr.United States. Department of Energy. Office of Basic Energy Sciences(Contract No. DE-AC02-98CH10886