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Background: Advances in secondary stroke prevention, including direct oral anticoagulants (DOACs), dual antiplatelet therapies (DAPT), and cardiovascular risk management, have changed costs over the past decade. This study aimed to evaluate annual treatment costs and trends in drug-based secondary prophylaxis after ischemic strokes. Methods: Annual treatment costs were evaluated using the net costs per defined daily dosage (DDD) of discharge medications for ischemic stroke patients treated in 2020 at the University Hospital Frankfurt, Germany. Evaluated drugs included acetylsalicylic acid, adenosine diphosphate inhibitors, DOACs, vitamin K antagonists, lipid-lowering drugs (LLD), antihypertensives (AHT), and oral antidiabetics (OD). Kruskal–Wallis test examined intergroup differences in substance groups and stroke etiologies. DDD development between 2004 and 2021 was further evaluated for significant trend changes using an interrupted time series analysis. Results: The study included 422 patients (70.5 ± 12.9 years, 43.1% female). Etiologies divided into large-artery atherosclerosis (29.9%), cardioembolic (25.6%), cryptogenic (26.8%), and small-vessel disease (17.8%). The total estimated annual drug expenditure was € 241,808; of which 51.6% was due to DOACs (median € 1157 [Q1–Q3:1157–1157], p < 0.006), 20.0% to AHTs (€127.8 [76.7–189.8]), 15.7% to ODs (€525.6 [76.7–641.5]), and 8.7% to LLDs (€43.8 [43.8–43.8]). Cardioembolic strokes had the highest annual costs per patient (€1328.6 [1169.0–1403.4]) with higher expenditure for DOACs (p < 0.001) and AHTs (p < 0.026). DAPT costs were highest for large-vessel strokes (p < 0.001) and accounted for 2.5% of total costs. There was a significant trend change in DDDs for clopidogrel in 2010 (p < 0.001), for prasugrel in 2017 (p < 0.001), for ASA in 2015 (p < 0.001) and for DOACs in 2012 (p = 0.017). Conclusions: DOACs for cardioembolic strokes were the primary cost driver in drug-based secondary stroke prevention, whereas permanent ASA and DAPT only accounted for a minor cost proportion. LLDs were associated with lower costs than AHTs and ODs. There were significant changes in DDDs for the respective substances, whereas the costs for DOACs as the most expensive pharmaceuticals remained widely stable across the last decade. [ABSTRACT FROM AUTHOR]

Abstract Background Advances in secondary stroke prevention, including direct oral anticoagulants (DOACs), dual antiplatelet therapies (DAPT), and cardiovascular risk management, have changed costs over the past decade. This study aimed to evaluate annual treatment costs and trends in drug-based secondary prophylaxis after ischemic strokes. Methods Annual treatment costs were evaluated using the net costs per defined daily dosage (DDD) of discharge medications for ischemic stroke patients treated in 2020 at the University Hospital Frankfurt, Germany. Evaluated drugs included acetylsalicylic acid, adenosine diphosphate inhibitors, DOACs, vitamin K antagonists, lipid-lowering drugs (LLD), antihypertensives (AHT), and oral antidiabetics (OD). Kruskal–Wallis test examined intergroup differences in substance groups and stroke etiologies. DDD development between 2004 and 2021 was further evaluated for significant trend changes using an interrupted time series analysis. Results The study included 422 patients (70.5 ± 12.9 years, 43.1% female). Etiologies divided into large-artery atherosclerosis (29.9%), cardioembolic (25.6%), cryptogenic (26.8%), and small-vessel disease (17.8%). The total estimated annual drug expenditure was € 241,808; of which 51.6% was due to DOACs (median € 1157 [Q1–Q3:1157–1157], p

AbstractDuring a 1-year study, organic aerosol indoor air samples were collected from sites in a library in Rio de Janeiro, Brazil. Indoor air is a cause for public concern in Brazil. This study presents an indoor air survey wherein the concentrations of aliphatic hydrocarbons, phthalates, phenyl phosphates, aldehydes, limonene, organic acids, and particulate matter were determined. Acids were estimated to be ranging between 0.01 and 30.26 ng m−3, whereas furfural ranged between 0.5 and 3.6 g m−3. Compounds such as furfural, hexanal, benzaldehyde, and vanillin were only detected indoors. Results showed that total suspended particle concentrations were higher outdoors than indoors. Interestingly, 1, 1, 1-trichloro-2, 2-bischlorophenylethane (DDT), and its derivatives were also present. Pesticides are used in libraries to control paper-degrading pests. Therefore, DDT and other chemicals remain nondegraded and pollute the library rooms. This study demonstrates the relevance of monitoring indoor air quality in libraries and the pollutants that can affect the well-being of occupants. Moreover, indoor air quality monitoring can provide early warning to library managers about the effects of indoor air characteristics on unprotected and/or preserved items. [ABSTRACT FROM AUTHOR]

Monitoring antimicrobial consumption is essential for evaluating antibiotic stewardship programs and controlling resistance. In Vietnam, Defined Daily Dose (DDD) is prioritized over Day of Therapy (DOT) for antimicrobial surveillance due to resource constraints and hospital data retrieval challenges. However, compared to DOT, DDD has been criticized due to its unrepresentativeness when relying on pre-defined values and undefined in pediatric patients. This study aimed to compare DDD and DOT metrics of antimicrobials for determining the optimal metric for resource allocation. We retrospectively analyzed clinical and administrative data of inpatients receiving antimicrobials at two tertiary hospitals from 01/2017 to 12/2020. Our primary outcome was the differences between antimicrobial use measured by DDDs per 1000 patient-days (DDD/1000PDs) and DOTs per 1000 patient-days (DOT/1000PDs) across periods and age-specific groups. We assessed the relationship between DDD- and DOT-based metrics over time using linear regression. Cohen's d was used to evaluate the standardized mean differences between DDDs and DOTs among pediatric and adult inpatients. Two hospitals recorded 1011.68 and 1036.76 DDD/1000PDs, exceeding DOT estimates (920.87 and 838.44 DOT/1000PDs, respectively). DDD- and DOT- metrics showed significant linear relationships for most antimicrobials, except for cefuroxime, ceftriaxone, and linezolid. DDD/1000PDs of fluoroquinolone use surpassed DOT/1000PDs (p < 0.001), indicating the administered daily doses often greater than the DDD value assigned by the World Health Organization (WHO-DDD). Carbapenem use showed comparable results between DOT and DDD because the daily dose aligned with WHO-DDD and these antibiotics were mainly used in adult inpatients. Pediatric and adult inpatients displayed DDD and DOT differences, particularly in glycopeptides, with a small effect size of d=0.18 in children and a large one of d=0.96 in adults. We suggest using DDD to measure the consumption of last-resort antibiotics efficiently. Additionally, DOT should be prioritized to prevent overestimating consumption levels in frequently used antimicrobial groups like fluoroquinolones. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic affected the epidemiology of infectious diseases and changed the operation of health care systems and health care seeking behavior. Our study aimed to analyze the utilization of systemic antibiotics in ambulatory care in Hungary after the COVID-19 pandemic and compare it to the period before COVID. We defined three periods (24 months each): Before COVID, COVID, and After COVID. Monthly trends in systemic antibiotic (J01) use were calculated using the WHO ATC-DDD index and expressed as DDD/1000 inhabitants/day (DID) and number of exposed patients per active agent. The data were further categorized by the WHO AWaRe classification. In the After COVID period, we detected almost the same (11.61 vs. 11.11 DID) mean monthly use of systemic antibiotics in ambulatory care compared to the Before COVID period. We observed a decrease in the seasonality index in the After COVID period (46.86% vs. 39.86%). In the After COVID period, the use of cephalosporins and quinolones decreased significantly, while in the case of macrolides, a significant increase was observed compared to the Before COVID period, with excessive azithromycin use (66,869 vs. 97,367 exposed patients). This study demonstrated significant changes in the pattern of ambulatory care antibiotic use in Hungary. [ABSTRACT FROM AUTHOR]

Salah H Elsafi,1 Saleh H Almutairi,2 Mujahid A Alsulaimani,3 Salma AlBahrani,4 Thekra N Al-Maqati,1 Wafa K Alanazi,2 Mohammed N Alanazi,2 Abdullah A Alamri,2 Majed Hamoud Alkhathami,5 Rakkad A Alshammari,5 Naif F Alharbi,5 Yaser A Al Naam1 1Clinical Laboratory Sciences. Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia; 2Pharmacy Services Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia; 3Basic Medical Unit, Prince Sultan Military College of Health Sciences, Dhahran, Saudia Arabia; 4Infectious Disease Unit, Specialty Internal Medicine, King Fahhd Military Medical Complex, Dhahran Saudi Arabia; College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudia Arabia; 5Department of Support Services, Prince Sultan Military College of Health Sciences, Dhahran, Saudia ArabiaCorrespondence: Yaser A Al Naam, Prince Sultan Military College of Health Sciences, P. O Box 33048, Dammam, 31448, Saudia Arabia, Email yaser@psmchs.edu.saBackground: Earlier reports suggested high rates of antibiotic utilization among COVID-19 patients despite the lack of direct evidence of their activity against viral pathogens. Different trends in antibiotic consumption during 2020 compared to 2019 have been reported.Purpose: The objective of this study is to assess the impact of COVID-19 pandemic on antibiotic consumption in the presence of active Antibiotic Stewardship Program.Methods: This study represented a five years assessment of the consumption of the commonly prescribed antibiotics measured as DDDs/100-Bed Days. We analyzed the data by using nonparametric Friedman and Friedman tests to compare the antibiotic consumption before and during the three subsequent waves of COVID-19.Results: Antibiotic consumption through the DDDs/100-BD has shown reduction in the median of antibiotics consumption of most antibiotics during the period of COVID-19 as compared to the pre-COVID-19 period, which was significant for meropenem and ciprofloxacin, except colomycin that slightly increased. Significant reduction in the consumption of imipenem and meropenem during the second and third waves as compared to the pre-COVID period. Throughout the years, significant reductions were observed between 2018 and 2019 (p=< .001), 2018 and 2020 (p=0.008), and 2018 and 2022 (p=0.002).Conclusion: The reduction in antibiotic consumption is attributed to the strong influence if the ASP and the reluctance of people to visit hospitals during the COVID-19 pandemic. Other related COVID-19 precautions such as physical distance, good hand hygiene, facemasks, that resulted in the prevention of secondary bacterial infections have contributed to the reduction in antibiotic utilization during the pandemic.Keywords: antimicrobial stewardship, ASP, COVID-19, defined daily doses, DDD, antibiotic consumption, Saudi Arabia

Introduction: Multi-drug-resistant (MDR) Pseudomonas aeruginosa is a dangerous pathogen causing nosocomial infection, particularly in low-and middle-income countries like Brazil. This retrospective study at a Brazilian university hospital examined the relationship between antimicrobial use and MDR-P. aeruginosa. Methodology: Data was collected from 358 patients with non-repetitive P. aeruginosa infections from 2009 to 2019. Antibiotic use was measured in grams and expressed as defined daily dose (DDD) per 1000 patient-days for meropenem, imipenem, polymyxin, and tigecycline. Results: Extensively drug-resistant (XDR) P. aeruginosa occurred in 36.1%, and MDR in 32.6% of cases. Risk factors for XDR infection were hospitalization prior to infection (OR = 0.9901), intensive care unit (ICU) admission (OR = 0.4766), previous antibiotic use (OR = 1.4417), and use of cefepime (OR = 0.3883). Over the ten-year period, utilization of the monitored antibiotics increased, and there was a positive correlation between the rise in MDR-P. aeruginosa and the consumption of ceftriaxone, imipenem, meropenem, and polymyxin B. The 30-day mortality rate was 40.0% for all patients and 41.0% for those infected with XDR-P. aeruginosa. Conclusions: This study highlights the negative impact of the indiscriminate use of antimicrobials, which has led to a significant increase in multidrug-resistant P. aeruginosa strains in hospitals. [ABSTRACT FROM AUTHOR]

The prescription of homeopathic remedies at the expense of the statutory health insurance (SHI) system in Germany has been criticized for years due to a lack of evidence. Now, on the planned abolition of the reimbursement of homeopathic medicines in Germany, the debate on this topic has been reignited. The aim of this paper is to show the costs and their development over time incurred by homeopathic remedies in the healthcare system from 1985 to 2021. For this purpose, 15 selected homeopathic medicines were chosen from the drug prescription report (Arzneiverordnungsreport) and analyzed with regard to their development of DDD (Defined Daily Dose) using data from the Wissenschaftliches Institut der Ortskrankenkassen (WidO, Scientific Institute of the General Local Health Insurance Funds) and compared with their respective rational pharmacological alternatives. The price comparison was based on the DDD costs and the pharmacy retail price of the smallest packaging in each case. The clinical study situation for the preparations was also analyzed. For this purpose, the clinical studies provided by the manufacturer and those on PubMed were divided into evidence levels and analyzed. In addition, the presentation of homeopathic remedies on company websites, in online pharmacies, in specialist information and package leaflets was analyzed with regard to side effects, interactions, indication, and information on the alleged effect/proof of efficacy. In many media, information on homeopathic medicines remained incomplete, and non-compliance with the Therapeutic Product Advertising Act (Heilmittelwerbegesetz) was noted. Naming of the products if often very suggestive, too. Manufacturers' claims of efficacy go far beyond what can be considered proven in terms of evidence-based medicine and the quality of most clinical studies is poor. Homeopathic remedies are on average significantly more expensive than their rational pharmacological alternatives. Furthermore, DDD costs have continued to rise over the years analyzed. In aggregate, from a pharmacoeconomic, legal, and scientific perspective, abolition of reimbursement of homeopathic medicines in Germany at the expense of the SHI system is well justified. [ABSTRACT FROM AUTHOR]

While the literature shows that stricter environmental regulations deter exports and inward foreign direct investment (FDI), few studies examine the impacts on outward FDI, especially for developing countries. In this paper, we analyse this issue in the context of China, which is the largest developing country in terms of FDI. We collect the transaction-level data of all the overseas mergers and acquisitions (M&As) by Chinese firms from 2000 to 2019. For the identification of the causal effect, we exploit the implementation of the Environmental Protection Law in 2015 as a quasi-natural experiment and carry out the difference-in-difference-in-differences analysis (DDD). The results show significant impacts of stricter environmental regulations on outward FDI. When the provincial emission reduction target increases by 10% points, the number of overseas M&A transactions in the high-polluting industries has increased by 32 every year since 2015. Moreover, the investments are more likely towards countries with better environmental protection. This suggests that firms aim at gaining cleaner technologies via M&As rather than transferring pollution abroad. [ABSTRACT FROM AUTHOR]

Background: Single chamber atrial pacemaker should be sufficient for patients with sinus node dysfunction (SND) with normal atrioventricular (AV) conduction. However, most patients undergo dual chamber pacemaker implantation because of concern of new onset AV block. The annual incidence of new AV block has been reported from 0.6 to 4.4 % in various studies. Objectives: Our aim is to assess mode survival in sinus node dysfunction with normal AV conduction patients implanted with AAIR. Methods: Patients who underwent single chamber atrial pacemaker implantation for SND with normal AV conduction between January 2014 and December 2021 were followed up for pacemaker device change, new onset AV block, bundle branch block, atrial fibrillation (AF), lead complications, reoperation and mortality rate. Results: A total of 113 patients underwent single chamber atrial pacemaker implantation for SND during the study period. Mean age was 55.6 ± 12.7 years. During a mean follow up of 48.7 ± 24.9 months, none of the patients required pacemaker device change to VVIR/DDDR. Nine patients underwent reoperation, 5 for lead dislodgment, 1 for high threshold, 1 for pocket site erosion and 3 for pulse generator change. None developed AV block or AF with slow ventricular rate. Only 4 patients developed AF (3 paroxysmal,1 permanent). There were 3 deaths during follow up and none were sudden deaths. Conclusion: Single chamber atrial pacing is an acceptable mode of pacing in patients with SND in developing countries. Development of AV conduction abnormalities is rare in this relatively younger population.

The COVID-19 pandemic affected the epidemiology of infectious diseases and changed the operation of health care systems and health care seeking behavior. Our study aimed to analyze the utilization of systemic antibiotics in ambulatory care in Hungary after the COVID-19 pandemic and compare it to the period before COVID. We defined three periods (24 months each): Before COVID, COVID, and After COVID. Monthly trends in systemic antibiotic (J01) use were calculated using the WHO ATC-DDD index and expressed as DDD/1000 inhabitants/day (DID) and number of exposed patients per active agent. The data were further categorized by the WHO AWaRe classification. In the After COVID period, we detected almost the same (11.61 vs. 11.11 DID) mean monthly use of systemic antibiotics in ambulatory care compared to the Before COVID period. We observed a decrease in the seasonality index in the After COVID period (46.86% vs. 39.86%). In the After COVID period, the use of cephalosporins and quinolones decreased significantly, while in the case of macrolides, a significant increase was observed compared to the Before COVID period, with excessive azithromycin use (66,869 vs. 97,367 exposed patients). This study demonstrated significant changes in the pattern of ambulatory care antibiotic use in Hungary.

Pneumonia caused more than 2,56 million deaths in 2017 worldwide. With the high number of pneumonia sufferers, the use of antibiotics will also increase. This study aims to describe the quantity of antibiotic use in pneumonia patients using the Systematic Literature Review method. The literature search was conducted through the PubMed, Sciencedirect, Mendeley, BMC, and Google Scholar databases. The literature used is a journal of the last 10 years that discusses the use of antibiotics in pneumonia patients calculated by the ATC/DDD system. Of the total 19 journals included in the study, 8 journals were from Indonesia. A total of 5 journals discussed antibiotics used in CAP (Community-Acquired Pneumonia), 2 journals in HAP (Hospital-Acquired Pneumonia), 2 journals in VAP (Ventilator-Associated Pneumonia), 2 journals were non-specific, and the remainder covered several types of pneumonia. The class of antibiotics with the highest DDD value is fluoroquinolones, with an average use of 41,81 DDD/100 patient-days; 17,29 DDD/100 bed days; and 0,0696 DDD/1000 inhabitants per day, and third-generation cephalosporins, with an average use of 15,86 DDD/100 patient-days and 28,31 DDD/100 bed days. The antibiotic with the highest DDD value was levofloxacin, with an average use of 31,29 DDD/100 patient-days; 12,22 DDD/100 bed days; and 0,0612 DDD/1000 inhabitants per day, and ceftriaxone, with an average use of 12,51 DDD/100 patient-days and 26,33 DDD/100 bed days. The most widely used antibiotics in the treatment of CAP and HAP are third-generation cephalosporins, while penicillin is the most commonly used in VAP. [ABSTRACT FROM AUTHOR]

The technique of colour EM that was recently developed enabled localisation of specific macromolecules/proteins of interest by the targeted deposition of diaminobenzidine (DAB) conjugated to lanthanide chelates. By acquiring lanthanide elemental maps by energy-filtered transmission electron microscopy (EFTEM) and overlaying them in pseudo-colour over the conventional greyscale TEM image, a colour EM image is generated. This provides a powerful tool for visualising subcellular component/s, by the ability to clearly distinguish them from the general staining of the endogenous cellular material. Previously, the lanthanide elemental maps were acquired at the high-loss M4,5 edge (excitation of 3d electrons), where the characteristic signal is extremely low and required considerably long exposures. In this paper, we explore the possibility of acquiring the elemental maps of lanthanides at their N4,5 edge (excitation of 4d electrons), which occurring at a much lower energy-loss regime, thereby contains significantly greater total characteristic signal owing to the higher inelastic scattering cross-sections at the N4,5 edge. Acquiring EFTEM lanthanide elemental maps at the N4,5 edge instead of the M4,5 edge, provides ∼4× increase in signal-to-noise and ∼2× increase in resolution. However, the interpretation of the lanthanide maps acquired at the N4,5 edge by the traditional 3-window method, is complicated due to the broad shape of the edge profile and the lower signal-above-background ratio. Most of these problems can be circumvented by the acquisition of elemental maps with the more sophisticated technique of EFTEM Spectrum Imaging (EFTEM SI). Here, we also report the chemical synthesis of novel second-generation DAB lanthanide metal chelate conjugates that contain 2 lanthanide ions per DAB molecule in comparison with 0.5 lanthanide ion per DAB in the first generation. Thereby, fourfold more Ln3+ per oxidised DAB would be deposited providing significant amplification of signal. This paper applies the colour EM technique at the intermediate-loss energy-loss regime to three different cellular targets, namely using mitochondrial matrix-directed APEX2, histone H2B-Nucleosome and EdU-DNA. All the examples shown in the paper are single colour EM images only.

Green finance is attracting a substantial amount of attention as an essential way to achieve green development. Through a sample of Chinese non-financial A-share listed companies from 2012 to 2020, we use the implementation of the green finance reform and innovation (GFRI) pilot zone policy that was introduced by the Chinese government in 2017 as a quasi-natural experiment and constructs a difference-in-differences-in-differences (DDD) model. The empirical evidence shows that the implementation of green finance reduces the total factor productivity (TFP) of heavily polluting enterprises in pilot zones. Our mechanism analysis shows that the GFRI pilot policy affects the TFP of enterprises through financing constraints and environmental protection investment rather than technological innovation. The heterogeneity analysis finds that the inhibitory effect of the GFRI pilot policy is more prominent in private enterprises, large enterprises, capital intensive enterprises, and small environmental responsibility enterprises. Further, the mechanism heterogeneity of the financing constraints analyses show that the GFRI pilot policy exerts greater levels of pressure on the financing constraints of private enterprises, large enterprises, and small environmental responsibility enterprises. The mechanism heterogeneity of the environmental investment analyses show that the GFRI pilot policy encourages environmental investment in private enterprises, small and medium enterprises, and small environmental responsibility enterprises. Our study provides evidence to support the expansion and promotion of GFRI and useful guidance on ways to implement green transformation in enterprises. [ABSTRACT FROM AUTHOR]

Background: the objective of this study was to propose a methodology for the assessment of antimicrobial consumption (AMC) in pediatric inpatients and to estimate variances in consumption levels in multi-field hospitals with pediatric inpatients, calculated by means of the pediatric-adjusted methodology vs. the conventional methodology. Methods: the pediatric-adjusted methodology based on the conventional ATC/DDD method and children's DDDs (cDDD) for antimicrobials were proposed and validated in a series of probabilistic sensitivity analyses of real clinical data extracted from the receipt notes of three multi-field hospitals. Differences in AMC in multi-field hospitals with pediatric inpatients, calculated by means of the proposed methodology vs. the conventional methodology, were assessed for a virtual cohort of inpatients, with the pediatric share increasing by 1%. Results: in children ≤12 years old, assessment by the standard methodology resulted in a 59% underestimation of AMC from the levels based on prescribed doses, vs. a 25% underestimation for the proposed methodology. In a mixed-age virtual population of inpatients, the underestimation of consumption levels rose to 321% for the ATC/DDD methodology compared to the proposed one. Conclusions: the proposed methodology demonstrated a higher accuracy of AMC estimates compared to the conventional one and can be considered for the quantification of antimicrobial utilization in pediatric institutions and multi-field hospitals with a substantial share of pediatric inpatients. [ABSTRACT FROM AUTHOR]

In surficial sediments of Lake Piediluco, a small, riverine, regulated and heavily modified water body in the Central Italian Apennines, contamination by persistent organochlorine pollutants (POPs) was assessed. During spring and autumn, six representative points were investigated. Reflecting a substantial zonation of pollution within this aquatic ecosystem, concentrations were found to vary from site to site. OCPs, particularly DDT and its metabolites DDE and DDD, were detected at varying frequencies and concentrations from 0.301 to 8.185 ng/g d.w., whilst total PCBs (Σ50 congeners) were from 0.570 to 10.206 ng/g d.w. Although both PCB congener-specific and homolog patterns suggest a prevalent presence of Aroclors 1254 and 1260, a more limited likely contribution of 1248 technical mixture is not to be excluded. In the western area of the lake, affected daily by continuous basin water remixing for hydroelectricity production, major seasonal differences in OCP concentrations were found. Conversely, the eastern area was typified by low seasonal fluctuation and small variation among sites. Regardless of either collection site or seasonality, polychlorinated-p-dioxin and furan (PCDD/Fs) contamination were below 8.3 pg WHO-TEQ/g. In contrast to the present study, POP pollution from PCBs, PCDD/Fs and some DDT-derived pollutants has not been investigated so far. Nevertheless, the concentrations are typical of low-polluted or pristine area lakes and are consistently lower than those of other Italian lakes of greater size and depth (e.g., Como, Garda and Maggiore). The physical and chemical properties of investigated analytes are more consistent with probable diffuse point source contamination originating from the catchment area, rather than from atmospheric depositions by regional or long-range transports. Finally, according to the international sediment quality guidelines (SQGs), Piediluco sediments pose a low risk to sediment-dwelling organisms and, more generally, to the wildlife of such aquatic ecosystems. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015–December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, −26.3%), and quinolones (J01M, −36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year's monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods' monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged. [ABSTRACT FROM AUTHOR]

The open literature was searched for laboratory toxicity data for marine/estuarine organisms exposed to dichlorodiphenyltrichloroethane (DDT) and its degradation products of dichlorodiphenyldichloroethylene (DDE), dichlorodiphenyldichloroethane (DDD), dichlorodiphenylchloroethylene (DDMU), and dichlorodiphenylchloroethane (DDMS). The goal of the review was to determine water-column toxicity values that could be used for porewater-based assessment of sediment toxicity. Data for individual compounds (and isomers thereof) in this group were very limited; most available data were for mixtures of multiple compounds, some defined and others undefined. Further, the majority of relevant studies involved exposure to spiked or field-contaminated sediment (rather than waterborne exposure), which requires inferring concentration in porewater from bulk sediment. Comparing data on the basis of effect concentrations for water or inferred concentration in sediment pore water, the lower reported effect concentrations were in the range of 0.05 to 0.1 µg/L, generally in studies of longer duration and/or evaluating sub-lethal effects. Because field exposures are generally to mixtures of these compounds in varied proportions, additional data on chemical-specific toxicity would aid in pore-water based toxicity assessment for marine/estuarine sediments contaminated with DDT-related chemicals. [ABSTRACT FROM AUTHOR]

Relevance. Studies devoted to the assessment of consumption, as well as to the issues of pharmacosafety of nonsteroidal anti-inflammatory drugs, are limited at the national level in the Russian Federation. The study of these issues will determine the general trends of consumption and prescription of this group of drugs.Aim. To assess the consumption pattern of NSAIDs in the Russian Federation in the period from 2010 to 2020.Methods. Information was searched using data from the state register of drugs (GRLS) as well as national database downloads (automated information system of Roszdravnadzor; AIS RZN). To estimate the consumption of the main INN from the group of NSAIDs for the period 2010–2020 the information on the sales volume of all trade names, sold for sale in the Russian Federation was unloaded from the database of IQVIA Solutions Ltd. and analyzed.Results. The analysis showed that the first place by total amount of consumption was occupied by acetylsalicylic acid (5 953 058 854); second place — paracetamol (4 635 122 085); third place — ibuprofen (3 230 415 088); fourth place — metamizole (4 172 344 008); fifth place — ketorolac (91 617 809,04); sixth — nimesulide (69 761 7481,8). The claimed INNs showed a slightly different distribution when calculating the DDDs/P (patient-year) totals, namely, in descending order, nimesulide, ketorolac, ibuprofen, acetylsalicylic acid, paracetamol, and methamisole.Conclusion. The indicated levels of consumption do not correlate with the data of the national database “Pharmacovigilance”, which indicates insufficient post-marketing monitoring of the safety profiles of the indicated medicines.

An antimicrobial consumption (AMC) study was performed in Trinidad and Tobago at the Eastern Regional Health Authority (ERHA). A retrospective, cross-sectional survey was conducted from 1 November 2021 to 30 March 2022. Dosage and package types of amoxicillin, azithromycin, co-amoxiclav, cefuroxime, ciprofloxacin, levofloxacin, moxifloxacin, nitrofurantoin and co-trimoxazole were investigated. Consumption was measured using the World Health Organization's Antimicrobial Resistance and Consumption Surveillance System methodology version 1.0, as defined daily doses (DDD) per 1000 population per day (DID). They were also analyzed using the 'Access', 'Watch' and 'Reserve' classifications. In the ERHA, AMC ranged from 6.9 DID to 4.6 DID. With regards to intravenous formulations, the 'Watch' group displayed increased consumption, from 0.160 DID in 2017 to 0.238 DID in 2019, followed by a subsequent drop in consumption with the onset of the COVID-19 pandemic. Oral co-amoxiclav, oral cefuroxime, oral azithromycin and oral co-trimoxazole were the most highly consumed antibiotics. The hospital started off as the higher consumer of antibiotics, but this changed to the community. The consumption of 'Watch' group antibiotics increased from 2017 to 2021, with a drop in consumption of 'Access' antibiotics and at the onset of COVID-19. Consumption of oral azithromycin was higher in 2021 than 2020. [ABSTRACT FROM AUTHOR]

ABSTRACT: Objectives: Consumption trends of four broad-spectrum antimicrobials and their correlation with antimicrobial resistance in Gram-negative bacilli (GNB) from 2013–2017 within intensive care units (ICUs) were explored. Methods: Consumption of meropenem (MEM), polymyxin B (PMB), piperacillin/tazobactam (TZP) and cefepime (FEP) in defined daily doses per 1000 patient-days (DDD/1000PD) was measured. Infection-related GNB isolates were grouped according to specific resistance profiles. Time series of antimicrobial consumption and their parametric correlation with each grouped resistant GNB were explored. Results: A total of 1423 GNB were evaluated. A significant linear decline in consumption was observed for MEM [slope –3.88, 95% confidence interval (CI) –4.96 to –2.81; P < 0.0001] and PMB (slope –3.51, 95% CI –5.528 to –1.495; P = 0.0009). A significant decline in MEM-non-susceptible Acinetobacter spp. (R2 = 0.476; P = 0.006) and an increase in FEP-non-susceptible Escherichia coli (R2 = 0.124; P = 0.006) was observed. A significant correlation between MEM consumption and MEM-non-susceptible Acinetobacter spp. (r = 0.43; P = 0.001) was observed. MEM consumption and MEM-non-susceptible Acinetobacter spp. showed a positive correlation. Conclusion: Reduction in the consumption of broad-spectrum antimicrobials may alter the frequency of infection-related isolates and their antimicrobial resistance profiles.

Monitoring antibiotic use in the pediatric population is a challenge, especially when determining a relationship between specific pathogens, infections, and antibiotic use. We retrospectively analyzed the consumption of anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs from 2017 to 2021 at Istituto Giannina Gaslini by means of defined daily dose (DDD) adopted for adults by World Health Organization. We observed a statistically significant increase in the use of daptomycin and ceftaroline, combined with a decrease in the use of vancomycin. In the same period, we observed an increase in the proportion of bloodstream infections due to MRSA with vancomycin minimally inhibitory concentration (MIC mg/L) = 1, that represented the 100% of cases in 2021. This aspect was combined with the observation that in the 59% of cases, where vancomycin plasma concentrations were evaluated, it was not possible to achieve a ratio of the 24-h area under the concentration–time curve and MIC (AUC0–24/MIC) of vancomycin ≥ 400 mg/L. This study confirms that DDD can be used in pediatrics to monitor antibiotic consumption in relationship with infections epidemiology. Moreover, it describes the presence of vancomycin MIC creep for MRSA also in pediatrics and the difficulties in obtaining effective vancomycin plasma concentrations in children. [ABSTRACT FROM AUTHOR]

Promoting coordinated and environmentally sustainable development of the Chinese economy is one of the primary tasks at the moment, as well as one of the sustainable development goals of the United Nations. The Resource-saving and Environment-friendly Society (RES) has created a pilot promotion policy aimed at China, with the goal of supporting the sustainable development of economic production activities while preserving natural ecosystems. In this investigation, we used the global Malmquist–Luenberger index with a slack-based measure of the directional distance function to calculate the industrial green total factor productivity (IGTFP) of 105 prefecture-level cities along the Yangtze River from 2004 to 2019; IGTFP was used as a proxy for sustainable development. Then, by considering the RES construction as a quasi-natural experiment, we used propensity score matching difference-in-differences (PSM-DID) to determine the effect of RES construction on sustainable development of the Yangtze River economic belt. We also employed the mediating effect model and triple difference (DDD) model to further analyze the mechanisms underlying the heterogeneous impacts of different urban characteristics. The results revealed three key findings. (1) According to the IGTFP calculation results, RES construction can effectively promote green technological progress while inhibiting green technological efficiency. (2) After carrying out a series of robustness tests, we found that RES construction increased the IGTFP of pilot cities by 4%, indicating that RES construction can significantly promote the sustainable development of pilot cities along the Yangtze River. (3) The results of the mechanism analysis showed that RES construction had a significantly positive impact on sustainable development through technological innovation, human capital, energy conservation, and emission control. In terms of different urban characteristics, the RES construction promoted sustainable development in first-tier cities, second-tier cities, and resource-based cities. We summarized the practical experience of the RES construction as a typical pilot promotion policy. It provides an empirical basis for planning the construction of eco-friendly urban areas in the 21st century and responding to the international community's sustainable development goals from a Chinese perspective. [ABSTRACT FROM AUTHOR]

Purpose: River impoundments disrupt natural water flow patterns and sediment distribution throughout the impacted reach, which often results in a damaging effect on aquatic ecosystems. Dam removal can release sediments that may contain fugitive agricultural nutrients and organochlorine pesticide residues (OCPRs). Methods: Sediment samples from an impoundment on the Oostanaula Creek (HUC 03,565,432) in Athens, Tennessee, were obtained, as were surface soil samples from the agricultural watershed. A subset of cores were used for simulated weathering, and all samples were extracted and analyzed for nutrients and OCPRs. Results: The impoundment sediments tested low in P and K, but sediment pore water contained elevated concentrations of NO3, NH4, and SO4 relative to reservoir water. Endrin aldehyde and p,p'-DDD were commonly detected in sediment and soil, while aldrin, dieldrin, and p,p'-DDE occurred in a smaller number of samples. When detected, dieldrin and endrin aldehyde frequently exceeded the threshold effect concentration (TEC), but never exceeded the probable effect concentration (PEC) in the sediment samples; p,p'-DDD always exceeded TEC and exceeded PEC in 49% of the sediment samples. The concentrations of NO3 and NH4 in the weathered sediment leachates were similar to those in the reservoir water, and NH4 became the dominant cation in leachates at the conclusion of simulated weathering. Weathering decreased sediment p,p'-DDD concentrations to less than the PEC; however, the concentrations of other OCPRs were not influenced. Conclusion: The dam sediments may have harmful effects on sediment-dwelling organisms and a long-term impact on stream reclamation following low-head dam removal. [ABSTRACT FROM AUTHOR]

Background: Exposure to dichlorodiphenyltrichloroethane (DDT), a potent lipophilic organochlorine pesticide, has long been linked as a risk factor for type 2 diabetes mellitus (T2DM). However, its presence in the adipose tissues of the T2DM subjects has not been explored in the Indian population, where this long-banned pesticide is still in use. The present study was conducted to evaluate the possible association of DDT and its metabolites in obese and non-obese T2DM subjects. Methods: Subjects with normal glucose tolerance (n = 50) and T2DM (n = 50) were divided into equal numbers in obese and non-obese groups. Their plasma glucose levels, HbA1c, and lipid profile were measured. The adipose tissues were collected intraoperatively, and DDT and its metabolites were measured using a gas chromatograph equipped with an electron capture detector. Results: Obese subjects, irrespective of their glycemic status, and T2DM subjects had higher concentrations of DDT. p, p′ DDT was found to increase the odds for diabetes, and o, p′ DDT for central obesity. p, p′ DDD was also strongly correlated with central obesity, glycemic parameters, and triglycerides. Conclusion: The excess deposition of p, p′ DDD, o, p′ DDT, and p, p′ DDT in obese subjects may proceed to T2DM by disrupting triglycerides and glycemic parameters.

Laleh Mahmoudi,1 Alireza Sepasian,1 Dena Firouzabadi,1,* Ali Akbari2,* 1Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran; 2Department of Anesthesiology, Medical School, Shiraz University of Medical Sciences, Shiraz, Iran*These authors contributed equally to this workCorrespondence: Ali AkbariDepartment of Anesthesiology, Medical School, Shiraz University of Medical Sciences, Shiraz, IranTel/ Fax +98 713 212 5400Email akbaria@sums.ac.irDena FirouzabadiDepartment of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IranTel +98-7132424128Fax +98-7132424126Email firouzabad@sums.ac.irBackground: Inappropriate use of antimicrobials (AM) is a major concern worldwide that leads to the propagation of antimicrobial resistance (AMR). In addition to its clinical implications, AMR imposes an economic burden on communities, especially developing countries with more infectious diseases and less available resources. Antimicrobial stewardship programs (ASPs) have been found to be effective in reducing AMR. This study was designed to evaluate the effect of implementing an ASP in reducing AM consumption, its economic burden, and AMR as a consecutive result.Materials and Methods: Consumption of caspofungin, amphotericin B, voriconazole, colistin, linezolid, vancomycin, and carbapenems was compared in a prospective cross-sectional study between two time periods introduced as pre- and post-ASP. Drug use density presented as anatomical therapeutic chemical (ATC)/defined daily doses (DDD) and normalized per 1000 bed days, cost savings, and AMR patterns were evaluated.Results: A total of 9400 AM prescriptions were analyzed during a 2-year period. Consumption measured in DDD/1000 bed days dropped by 24.8, 25.0, 35.3, 47.0, 39.2, 10.5, and 23.2 percent for amphotericin B, caspofungin, colistin, voriconazole, meropenem, imipenem, and vancomycin, respectively. Linezolid consumption increased by 26.8% after implementing ASP. The expenditure of target AMs in the average value of USD decreased by 41.3% after the intervention compared to the time before using ASP (P-value=0.001). Implementing ASP also increased AM susceptibility of Pseudomonas aeruginosa, while the susceptibility of methicillin-resistant Staphylococcus aureus did not change significantly.Conclusion: The results of this study suggest that establishment of ASP can lead to a reduction in improper administration of AMs and their expenditure resulting in economic benefit and lowering AMR at hospitals with minimum resources. Clinical pharmacists’ role was critical to the success of this ASP and was uniquely empowered at our center.Keywords: antimicrobial stewardship programs, appropriate prescribing, antimicrobial use, DDD, defined daily dose

The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015–December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, −26.3%), and quinolones (J01M, −36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year’s monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods’ monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged.

Mycobacterium leprae was detected by optical microscopy, fluorescent in situ hybridization, and molecular detection in feces collected for the diagnosis of Entamoeba coli enteritis in a leprosy patient in Burkina Faso. This observation raises questions about the role of fecal excretion of M. leprae in the natural history and diagnosis of leprosy.

Whether firms’ environmental pollution can be fundamentally curbed depends to a large extent on the implementation of environmental policies by local governments. Previous studies have paid more attention to the impact of local governments’ relaxation of environmental regulations on firms’ pollution behaviors, but attention has not yet been paid to the impact of local governments’ environmental regulatory incentives on firms’ green innovation. Based on the exogenous policy impact of Ambient Air Quality Standards, this article studied the impact of the change of local governments’ governance motivation caused by the implementation of the new air quality standards on enterprises’ green innovation. Based on the data of Chinese A-share listed firms from 2004 to 2018 and using a difference-in-difference-in-differences (DDD) method, this study tested the influence of local governments’ environmental governance pressure on firms’ green innovation by comparing whether the number of enterprises applying for green inventions changed before and after the application of the new standards, between pilot cities and other cities, and between high and low polluting industries. The results showed that after the implementation of the first phase of the new standards in 2012, the‘ crowding-out effect’ of local governments’ environmental governance pressure on the green innovation of heavily polluting enterprises in 74 pilot cities was significantly higher than that of low polluting enterprises, and the robustness test results were still robust. The heterogeneity analysis revealed that the‘ crowding-out effect' was no longer significant after the second phase of the new standards were implemented in 190 pilot cities in 2013. Compared with non-state-owned enterprises, the ‘crowding-out effect’ of local governments’ environmental governance pressure on state-owned heavy-pollution enterprises was more significant. From the perspective of influence mechanisms, the‘ crowding-out effect’ was the result of the crowding out of green innovation resources caused by the substantial increase in environmental protection investment in heavily polluting enterprises in the pilot cities. In the second phase of the implementation of the new standards in pilot cities, the‘ crowding-out effect’ on firms’ green innovation was no longer significant because the heavily polluting enterprises ceased to significantly increase their environmental protection investment. This means that the central government’s formulation of reasonable environmental regulations could effectively stimulate local governments’ environmental governance motives. Therefore, local governments need to increase environmental protection subsidies and green innovation resource support for heavily polluting enterprises to effectively alleviate the green innovation resources crowded out by companies’ substantial increases in environmental protection investment. [ABSTRACT FROM AUTHOR]

A new method for accelerated biodegradation, also called bioremediation, of toxic organic compounds in situ is presented. The method uses a combination of all the important factors discovered by research in biodegradation the last decades. Organic molecules are present everywhere, often in toxic concentration. The polluted areas are so vast, that is seems impossible to clear the land. An important example of this is DDT and other organic pesticides, that have been spread in hundreds of millions of tons on farmland and still remain there in high concentrations - 50 years after they were banned. Biodegradation is fast, effective, cheap and sustainable. The half-lifes of toxic molecules are taken down from decades (20-30 years for DDT) to a year or less. The factors found to be important for biodegradation in situ are: a high content of nutrition rich substrate (≥10%), water, oxygen, iron, earth worms and low pH. These factors must all be carefully regulated. The organic substrate must release its nutrients slowly. We use warm-composted manure with bedding of straw or wood chips from chicken, cow or horse. We use "spot treatment" combined with gradually going deeper into the soil, thus "planning" of the polluted ground. The presented method degrades synthetic, toxic, organic compounds: polycyclic aromatic hydrocarbons (PAHs), organochlorine insecticides, organophosphate and carbamate insecticides, organic herbicides, and dioxin contaminant of herbicides and wood preservatives. Small organic molecules can also be processed. The broad applicability makes the presented method unique. The presented method is compatible with organic farming. The article gives an example of how to apply the method on a DDT-polluted farm with old orchards at lake Åsnen in Southern Sweden. [ABSTRACT FROM AUTHOR]

Although approximately 123 million people may be exposed to high levels of insecticides through the use of indoor residual spraying (IRS) for malaria control, few studies exist on indoor insecticide contamination due to IRS and its relationship with human exposure. In the present study, we developed a sampling method to collect undisturbed dust from 50 homes in Limpopo, South Africa, a region where dichlorodiphenyltrichloroethane (DDT) has been used in IRS programs to prevent malaria for ~70years. We quantified DDT and its degradation products, dichlorodiphenyldichloroethylene (DDE), and dichlorodiphenyldichloroethane (DDD) in dust samples to determine dust loading levels and compared these levels to paired serum concentrations of p,p'-DDT and p,p'-DDE in women residents. p,p'-DDT and p,p'-DDE had the highest detection frequencies in both dust (58% and 34% detection, respectively) and serum samples (98% and 100% detection, respectively). Significantly higher detection frequencies for o,p'-DDT, p,p'-DDE, and p,p'-DDD were observed in dust samples collected in buildings that had been previously sprayed for malaria control. We also observed a significant, positive association between dust loading and serum concentrations of p,p'-DDT and p,p'-DDE (Spearman's rho=0.68 and 0.54, respectively). Despite the low detection frequency in dust, our results indicate that undisturbed dust may be a good metric to quantify long-term home exposure to DDT-related compounds and that contamination of the home environment may be an important determinant/source of DDT and DDE exposure.

Monitoring antibiotic use in the pediatric population is a challenge, especially when determining a relationship between specific pathogens, infections, and antibiotic use. We retrospectively analyzed the consumption of anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs from 2017 to 2021 at Istituto Giannina Gaslini by means of defined daily dose (DDD) adopted for adults by World Health Organization. We observed a statistically significant increase in the use of daptomycin and ceftaroline, combined with a decrease in the use of vancomycin. In the same period, we observed an increase in the proportion of bloodstream infections due to MRSA with vancomycin minimally inhibitory concentration (MIC mg/L) = 1, that represented the 100% of cases in 2021. This aspect was combined with the observation that in the 59% of cases, where vancomycin plasma concentrations were evaluated, it was not possible to achieve a ratio of the 24-h area under the concentration–time curve and MIC (AUC0–24/MIC) of vancomycin ≥ 400 mg/L. This study confirms that DDD can be used in pediatrics to monitor antibiotic consumption in relationship with infections epidemiology. Moreover, it describes the presence of vancomycin MIC creep for MRSA also in pediatrics and the difficulties in obtaining effective vancomycin plasma concentrations in children.

Monitoring of antibiotic consumption is one of the basic tools of the strategies to combat antibiotic resistance, is an integral part of the antibiotic stewardships and helps to ensure the rational antibiotic therapy. It is used to describe the structure and dynamics of antibacterials usage. The defined daily dose (DDD) methodology and ATC (anatomical, therapeutic and chemical) classification used in the monitoring programs determine the reliability of the analyzed data and enable the comparison of the antibiotic consumption between departments, centers and regions.

Energy filtered transmission electron microscopy techniques are regularly used to build elemental maps of spatially distributed nanoparticles in materials and biological specimens. When working with thick biological sections, electron energy loss spectroscopy techniques involving core-loss electrons often require exposures exceeding several minutes to provide sufficient signal to noise. Image quality with these long exposures is often compromised by specimen drift, which results in blurring and reduced resolution. To mitigate drift artifacts, a series of short exposure images can be acquired, aligned, and merged to form a single image. For samples where the target elements have extremely low signal yields, the use of charge coupled device (CCD)-based detectors for this purpose can be problematic. At short acquisition times, the images produced by CCDs can be noisy and may contain fixed pattern artifacts that impact subsequent correlative alignment. Here we report on the use of direct electron detection devices (DDD's) to increase the signal to noise as compared with CCD's. A 3× improvement in signal is reported with a DDD versus a comparably formatted CCD, with equivalent dose on each detector. With the fast rolling-readout design of the DDD, the duty cycle provides a major benefit, as there is no dead time between successive frames.

Objective: To find out the pattern of antibiotic utilization in intensive care unit (ICU). The high use of antibiotics in intensive care may increase antibiotic resistance. Methods: This was a retrospective study with total sampling method from patients who were treated in ICU in the period of January to June 2016. Selected data is processed using the Anatomical Therapeutic Chemical (ATC) Classification/Defined Daily Dose (DDD) system as an international measurement standard for analyzing and comparing usage applied by the WHO. Results: The results showed that of the 57 medical records collected, the total antibiotic use was 295.72 DDD/100 bed-days. Levofloxacin, meropenem, ceftriaxone, ceftazidime, and metronidazole were the five maximally utilized antibiotics with 143.18, 49.88, 30.62, 19.74, dan 16.99 DDD/100 bed-days respectively. Conclusion: The most frequently used of antibiotics is ceftriaxone, used in 54.39% of patients. Whereas in number, the most widely used antibiotic is levofloxacin with a total of 143.18 DDD/100 bed-days.

Introduction: different antimicrobial stewardship programs are fundamental to improve clinical results in patients. Objectives: to determine the impact on amikacin and ceftriaxone consumption, in addition to knowing changes in sensitivity of the main agents in the emergency unit of the Carlos van Buren Hospital in Valparaíso, Chile, after the implementation of a treatment guide for pyelonephritis. Materials and methods: quasi-experimental before/after study. A treatment guide was implemented for pyelonephritis. The guide was sent by WhatsApp to all clinicians in the emergency unit. Following the intervention, amikacin and ceftriaxone defined daily dose (DDD) were measured and compared with the DDD for the same months of the previous year. In addition, the sensitivity of E.coli, K. pneumonia and P.mirabilis isolated from urine cultures was extracted. Results: after the intervention there was a sustained increase of the DDD of amikacin and a decrease in the DDD of ceftriaxone in the months studied period. K. pneumoniae maintained its sensitivity to amikacin and increased it to cefotaxime, ertapenem, and meropenem. Conclusions: The guide’s implementation for treatment of high UTI in the emergency unit of the Carlos van Buren hospital increased the consumption of amikacin and decreased that of ceftriaxone. K. pneumoniae increased its sensitivity to cefotaxime, ertapenem and meropenem.

To quantify antimicrobial use in inpatients setting as part of antimicrobial stewardship program surveillance. Antimicrobial use was obtained using a pre-designed data collection form in this point prevalence study. Setting: The study was conducted in a tertiary academic hospital in the North of Jordan on 13 August 2018. Main outcome measures: antimicrobial use was determined using two methods: defined daily use (DDD) and days of therapy (DOT). This study identified antimicrobial use in 144 patients. Carbapenems, glycopeptides, and piperacillin-tazobactam were the most utilized antimicrobials in the inpatients' setting in both measures DDD and DOT. The highest prescription rate of antibiotics was in the internal medicine wards (49.8 DDD/100 admissions), followed by surgery wards (33.2 DDD/100 admissions) and intensive care unit (20.6 DDD/100 admissions). This surveillance study addressed patterns of antimicrobial usage in inpatients settings in a tertiary care hospital in Jordan. This practice is feasible and could be adopted routinely by antimicrobial stewardship programs. [ABSTRACT FROM AUTHOR]

Purpose: To examine the pattern of antibiotic and painkiller prescriptions per diagnosis by dentists. Materials and Methods: A cross-sectional study was conducted in Karachi, Pakistan. Dentists in the outpatient departments of the Dr. Isharat-ul-Ebad Khan Institute of Oral Health Sciences (DIKIOHS) filled out a form for each patient visiting during a two-week period. The form included: personal history of the patient, i.e. name, age, sex and education, patient's complaint(s), medical history, dental history, full examination of the teeth and oral cavity, treatment need as far as different specialties are concerned, investigations, provisional diagnosis and treatment given. The WHO ATC system for drug classification was used. The number of prescriptions and defined daily doses (DDD) were recorded. Results: A total of 709 patient forms (355 for male patients and 354 for female patients) were collected and included in the analysis. Of these, 123 (17%) included antibiotics and 455 (64%) painkillers. Caries/pulpitis was the most common diagnosis (n = 222; 31% of cases), of which 48 (21%) were prescribed antibiotics. Amoxicillin and metronidazole were the most common antibiotics prescribed for this diagnosis (n = 25); for caries/pulpitis diagnosis, 44 DDD/100 patients were prescribed. This was also the diagnosis for which painkiller prescription was most common (n = 191; 86%), with 102 DDD/100 patients. Conclusion: Our study shows the prescription pattern of antibiotics and painkillers by dentists in Pakistan for the first time. There is a clear need to emphasise correct diagnostic methods and develop contextualised prescription guidelines and educational initiatives, so that the optimum effect of antibiotics and painkillers will be achieved without compromising patients' health. [ABSTRACT FROM AUTHOR]

Introduction The antipsychotic dosage of Chinese schizophrenia patients has rarely been studied, although nonstandard dosage has impact on prognosis. Objectives To describe the dosage of antipsychotics in China routine practice. Methods This was a retrospective cohort study using de-identified data from a Chinese mental health hospital. The included patients were adults (≥18 years) with at least one diagnosis of schizophrenia (ICD-10: F20) and one prescription of any antipsychotic between 2014 and 2019. Date of first identified antipsychotic prescription was defined as index date, patients were followed up until last prescription of antipsychotics, end of 2019, or discontinuation (>60 days without antipsychotic prescription), whichever was earliest. Dosage was summarized using defined daily dose (DDD), calculated by cumulative average daily dose (CAD) with a unit of DDDs/day, i.e., total DDDs of all antipsychotics in follow-up period divided by total days of follow-up. CAD was categorized into low (1.5 DDDs/day) groups. Results 13554 patients were included with an average follow-up of 269.9 days. Median CAD was 0.8 DDDs/day (IQR=0.5-1.3), patients with hospitalization during follow-up and used multiple antipsychotics at the same time had larger median CAD, 1.0 DDDs/day and 1.2 DDDs/days, respectively. There were 3245 (23.9%), 7627 (56.3%), and 2682 (19.8%) patients in low, moderate, and high groups, respectively. The median CAD of high dosage group was 2.5 DDDs/day (IQR=1.9-10.5). Conclusions CAD of most Chinese schizophrenia patients was low or moderate. Association between CAD and hospitalization and multiple concurrent antipsychotics merit further research.

Some developed economies have run emission trading scheme (ETS) to mitigate carbon emissions. However, we know little about the effectiveness and heterogeneity of ETS in a context of developing economy. This paper evaluates the effectiveness and heterogeneity of China's pilot ETS, the first ETS run in a developing economy. Difference-in-difference (DID) and difference-in-difference-in-difference (DDD) methods are employed to analyze provincial industrial-level data. The heterogeneity of ETS effects is also explored from regional and industrial perspectives. The empirical results show that the pilot ETS can effectively reduce pilot industries' carbon emissions. The reduction effect of the pilot ETS has a substantial heterogeneity for different pilot provinces and industries. Carbon emissions are reduced by the pilot ETS through technological innovation and the adjustment of industrial structure. The empirical results suggest that policymakers may consider establishing a national ETS and differentiating carbon quota allowance in covered regions and industries in the current pilot ETS. [ABSTRACT FROM AUTHOR]

The use of antibiotics in primary health care, especially in the treatment of urinary tract infections (UTI), is one that is controlled by WHO. To support WHO's antibiotic resistance control program through the GLASS program, data on antibiotic resistance in Indonesia needs to be researched and reported as one of the national awareness systems. This research aimed to map the microbe patterns in primary health care in Yogyakarta City as a consideration for the guideline of empiric antibiotic therapy in urinary tract infections. Research on antibiotic resistance patterns in UTI therapy was carried out prospectively in March to August 2019 at primary health care (PHC) Jetis, Yogyakarta city. Patients who met the inclusion criteria were patients treated at PHC Jetis in Yogyakarta, aged> 18 years and were given antibiotics. The culture and susceptibility of the patients' urine specimen were examined at Microbiology Laboratory of the Faculty of Medicine, Public Health and Nursing of UGM Yogyakarta. Meanwhile, the calculation of DDD antibiotics was carried out for the use of UTI antibiotics from 1st January to 31st December, 2019. A total of 76.9% of UTI patients received empiric antibiotics cotrimoxazole according to the therapy guidelines in primary health care and the national formulary. The results of culture examination of urine specimens observed that most of them (94%) were E. coli. Almost all tested antibiotics still showed> 80% susceptibility to E. coli, except for ampicillin. The DDD antibiotics for UTI therapy, namely; cotrimoxazole, ciprofloxacin and ampicillin were very low, less than 4. [ABSTRACT FROM AUTHOR]