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Antibiotic Prescribing Patterns in Adult Patients According to the WHO AWaRe Classification: A Multi-Facility Cross-Sectional Study in Primary Healthcare Hospitals in Lusaka, Zambia

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Pharmacology & Pharmacy 2022年第10期13卷 379-392页

作者： Steward Mudenda Mary Chomba Billy Chabalenge Christabel Nang’andu Hikaambo Michelo Banda Victor Daka Annie Zulu Abraham Mukesela Maxwell Kasonde Peter Lukonde Enock Chikatula lloyd matowe Ronald Kampamba Mutati Tyson Lungwani Muungo Tobela Mudenda Shafiq Mohamed Scott Matafwali Department of Pharmacy School of Health Sciences University of Zambia Lusaka Zambia Department of Medicines Control Zambia Medicines Regulatory Authority Lusaka Zambia Department of Public Health Michael Chilufya Sata School of Medicine Copperbelt University Ndola Zambia Bell Pharmacy Kabulonga Centro Mall Lusaka Zambia Ministry of Health Headquarters Ndeke House Lusaka Zambia Department of Pharmacy Levy Mwanawasa University Teaching Hospital Lusaka Zambia Faculty of Pharmacy School of Pharmacy Eden University Lusaka Zambia Department of Pathology Ndola Teaching Hospital Ndola Zambia Remedium Pharmaceuticals Limited Lusaka Zambia Clinical Research Department Faculty of Infectious and Tropical Diseases London School of Hygiene & Tropical Medicine London UK

Introduction: Indiscriminate prescribing and using of antibiotics have led to the development of antimicrobial resistance (AMR). To reduce this problem, the World Health Organization (WHO) developed the “Access”, “Watch”, and “Reserve” (AWaRe) classification of antibiotics that promotes antimicrobial stewardship (AMS). In Zambia, there are gaps in practice regarding prescribing of antibiotics based on the AWaRe protocol. This study assessed antibiotic prescribing patterns in adult in-patients in selected primary healthcare hospitals in Lusaka, Zambia. Materials and Methods: This retrospective cross-sectional study was conducted using 388 patient medical files from September 2021 to November 2021, five primary healthcare hospitals namely;Chawama, Matero, Chilenje, Kanyama, and Chipata. Data analysis was performed using the Statistical Package for Social Sciences version 23. Results: Of the selected medical files, 52.3% (n = 203) were for male patients. Overall, the prevalence of antibiotic use was 82.5% (n = 320) which was higher than the WHO recommendation of a less than 30% threshold. The most prescribed antibiotic was ceftriaxone (20.3%), a Watch group antibiotic, followed by metronidazole (17.8%) and sulfamethoxazole/trimethoprim (16.3%), both belonging to the Access group. Furthermore, of the total antibiotics prescribed, 41.9% were prescribed without adhering to the standard treatment guidelines. Conclusion: This study found a high prescription of antibiotics (82.5%) that can be linked to non-adherence to the standard treatment guidelines in primary healthcare hospitals. The most prescribed antibiotic was ceftriaxone which belongs to the Watch group, raising a lot of concerns. There is a need for rational prescribing of antibiotics and implementation of AMS programs in healthcare facilities in Zambia, and this may promote surveillance of irrational prescribing and help reduce AMR in the future.

关键词： Antibiotic Prescribing Antimicrobial Resistance Antimicrobial Stewardship AWaRe Classification Prescribing Patterns Primary Healthcare Surveillance Zambia

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CFD-DEM simulation of Small-Scale Challenge Problem 1 with EMMS bubble-based structure-dependent drag coefficient

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Particuology 2021年第2期19卷 48-61页

作者： Musango Lungu John Siame lloyd Mukosha Multiphase Flow Research Group Chemical Engineering DepartmentSchool of Mines and Mineral SciencesCopperbelt UniversityKitwe 10101Zambia

In this study,the energy minimization multi-scale(EMMS)/Bubbling model is coupled with the computational fluid dynamics/discrete element method(CFD-DEM)model via a structure-dependent drag coefficient to simulate the National Energy Technology Laboratory(NETL)small-scale challenge problem using the open-source multiphase flow code *** numerical predictions are compared against particle velocity measurements obtained from high-speed particle image velocimetry(HSPIV)and differential pressure *** drag-reduction effect of the EMMS bubble-based drag coefficient is observed to significantly improve predictions of the horizontal particle velocity and granular temperature when compared to several other drag coefficients tested;however,the vertical particle velocity and pressure fluctuation characteristic predictions are *** drag-reduction effect is characterized by a reduction in the sizes of slugs or voids,as identified through spectral decomposition of the pressure ***,this study shows great promise in employing drag coefficients,developed via multi-scale approaches(such as the EMMS paradigm),in CFD-DEM models.

关键词： CFD-DEM Drag model EMMS/Bubbling model Fluidization Multi-scale

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Arabidopsis Mutants and the Network of M icrotu bu le-Associated Functions

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Molecular Plant 2008年第6期1卷 888-898页

作者： Henrik Buschmann Clive W. lloyd Department of Cell and Developmental Biology John Innes Centre 1 Colney Lane Norwich NR4 7UH UK

In early eukaryotes, the microtubule system was engaged in mitosis, intracellular transport, and flagellumbased motility. In the plant lineage, the evolution of a multicellular body involved the conservation of some core functions, the loss of others, and the elaboration of new microtubule functions associated with the multicellular plant habit. This diversification is reflected by the presence of both conserved （animal/fungi-like） and novel （plant-like） sequences encoding microtubule-related functions in the Arabidopsis genome. The collection of microtubule mutants has grown rapidly over recent years. These mutants present a wide range of phenotypes, consistent with the hypothesis of a functional diversification of the microtubule system. In this review, we focus on mutant analysis and, in particular, discuss double mutant analysis as a valuable tool for pinpointing pathways of gene function. A future challenge will be to define the complete network of genetic and physical interactions of microtubule function in plants. In addition to reviewing recent progress in the functional analysis of the ＇MAPome＇, we present an online database of Arabidopsis mutants impaired in microtubule functions.

关键词： cell division cell morphogenesis cytoskeleton genetics development Arabidopsis.

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Observer error in vegetation surveys:a review

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Journal of Plant Ecology 2016年第4期9卷 367-379页

作者： lloyd W.Morrison Department of Biology Missouri State University901 S.National AvenueSpringfieldMO 65897USA National Park Service Heartland Inventory and Monitoring Program6424 W.Farm Road 182RepublicMO 65738USA

Aims Vegetation sampling employing observers is prone to both inter-observer and intra-observer *** types of errors are common:(i)overlooking error(*** observing species actually present),(ii)misidentification error(*** correctly identifying species)and(iii)estimation error(*** accurately estimating abundance).I conducted a literature review of 59 articles that provided quantitative estimates or statistical inferences regarding observer error in vegetation *** FindingsAlmost all studies(92%)that tested for a statistically significant effect of observer error found at least one significant *** surveys of species composition,mean pseudoturnover(the percentage of species overlooked by one observer but not another)was 10-30%.Species misidentification rates were on the order of 5-10%.The mean coefficient of variation(CV)among observers in surveys of vegetation cover was often several hundred%for species with low cover,although CVs of 25-50%were more representative of species with mean covers of>50%.A variety of metrics and indices(including commonly used diversity indices)and multivariate data analysis techniques(including ordinations and classifications)were found to be sensitive to observer *** of error commonly include both characteristics of the vegetation(*** size of populations,rarity,morphology,phenology)and attributes of the observers(*** fatigue,personal biases,differences in experience,physical stress).The use of multiple observers,additional training including active feedback approaches,and continual evaluation and calibration among observers are recommended as strategies to reduce observer error in vegetation surveys.

关键词： interobserver error intraobserver error misidentification pseudoturnover vegetation sampling

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Nestedness in insular floras:spatiotemporal variation and underlying mechanisms

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Journal of Plant Ecology 2013年第6期6卷 480-488页

作者： lloyd W.Morrison Department of Biology Missouri State University901 S.National AvenueSpringfieldMO 65897USA

Aims Nestedness is a characteristic of insular metacommunity *** few studies,however,have attempted to evaluate temporal changes in nestedness,or elucidate the mechanisms underlying nestedness.I evaluated both spatial and temporal patterns of nestedness in the insular floras of four archipelagoes of small islands in the Bahamas and the potential underlying environmental *** The NODF(a nestedness metric based on overlap and decreasing fill)and the matrix temperature measure,T,were used to quantify nestedness in insular floras on small islands near Abaco,Andros,Great Exuma and the Exuma Cays,*** different null models were employed for each nestedness *** environmental variables were evaluated in relation to nestedness by ordering islands according to gradients and recalculating NODF *** Findings All archipelagoes were significantly *** among sites contributed more to overall nestedness than did nestedness among *** scores varied among archipelagoes,but were surprisingly constant over *** islands by vegetated area yielded the highest nestedness scores for three archipelagoes;ordering islands by protection from exposure yielded the highest nestedness score for one *** scores varied little over time even though species compositions changed,indicating that extinctions occurred in a deterministic *** relative importance of area suggests extinction is an important mechanism in producing *** to determine the relative importance of immigrations or extinctions requires some assumptions,however,and both processes are likely cumulative in most cases.

关键词： Bahamas environmental gradient insular floras nestedness NODF metric

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Chebfun and numerical quadrature

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Science China Mathematics 2012年第9期55卷 1749-1760页

作者： HALE Nicholas TREFETHEN lloyd N Mathematical Institute University of OxfordOxford OX1 3LBUK

Chebfun is a Matlab-based software system that overloads Matlab's discrete operations for vectors and matrices to analogous continuous operations for functions and *** begin by describing Chebfun's fast capabilities for Clenshaw-Curtis and also Gauss-Legendre,-Jacobi,-Hermite,and-Laguerre quadrature,based on algorithms of Waldvogel and Glaser,Liu and *** we consider how such methods can be applied to quadrature problems including 2D integrals over rectangles,fractional derivatives and integrals,functions defined on unbounded intervals,and the fast computation of weights for barycentric interpolation.

关键词： Chebfun Clenshaw-Curtis quadrature Gauss quadrature barycentric interpolation formula Riemann-Liouville integral fractional calculus

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Intervention at an early threshold for post-hemorrhagic ventricular dilatation in preterm infants: a systematic review and meta-analysis

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World Journal of Pediatrics 2024年第8期20卷 774-786页

作者： Patrick Blundell lloyd Abood Mallinath Chakraborty Sujoy Banerjee Regional Neonatal Intensive Care Unit University Hospital of WalesCardiffUK Neonatal Unit Singleton HospitalSwanseaSA28QAUK Centre for Medical Education School of MedicineCardiff UniversityCardiffUK

Background Very few adequately powered studies exploring early thresholds for intervention in the management of post-hemorrhagic ventricular dilatation(PHVD)in preterm infants have identified consistent neurodevelopmental advantages at 12–30 *** aimed to conduct a meta-analysis on the efficacy and safety of early versus conservative thresholds for intervention,primarily aimed at normalizing cerebrospinal fluid(CSF)pressure,in the management of PHVD in preterm *** Multiple databases were searched for eligible papers,and prospective randomized trials involving preterm infants were *** results are expressed as relative risks(RRs)with 95%confidence intervals(CIs).The main outcome was survival without moderate-to-severe neurodevelopmental impairment at 12–30 *** Ten articles representing seven randomized trials comparing early versus conservative thresholds for interventions were *** trials(n=545 infants)reported no difference in the main outcome between early and conservative groups[RR 0.99(0.71,1.37)].Sensitivity analysis excluding data from a medication trial did not alter the main outcome[RR 1.15(0.95,1.39)].Infants in the early threshold group received significantly more interventions[RR 1.48(1.05,2.09)].Deaths before discharge/during the initial study period[RR 1.04(0.70,1.54)]or a composite of death or shunt insertion[RR 1.04(0.86,1.27)]were comparable between the two *** Early intervention for PHVD,before a clinical or ultrasound threshold is met,leads to additional clinical procedures but does not improve survival without moderate–severe neurodevelopmental impairment at 12–30 *** should be exercised in interpreting these results due to significant variation between the studies.

关键词： Hydrocephalus Intraventricular hemorrhage Lumbar puncture Mortality Neurodevelopment Preterm infants

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Thermomechanical analysis of long-term global modal and local deformation measurements of the Kishwaukee Bridge using the bootstrap

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Earthquake Engineering and Engineering Vibration 2004年第1期3卷 107-115页

作者： George M.lloyd Ming L.Wang Department of Civil and Material Engineering University of Illinois at Chicago

In this paper we present a comparative analysis of global frequency and local deformation data for a large concrete bridge. The asymptotic probability distributions of the central statistics are presented, and compared with empirical bootstrap estimates. Bootstrapped distributions are calculated from reference data obtained during 1999–2000 and used to develop change-point alarm criteria for the structure, using reasonable sensitivity measures developed from FEM simulations and structural analysis. The implications of the frequency data are discussed in conjunction with the strain and displacement measurements in order to discern if the load carrying capacity of the bridge has been affected. The critical need for more advanced temperature compensation models for large structures continually in thermal disequilibrium is discussed.

关键词： thermomechanical effects bootstrap methods local & global monitoring long term measurement concrete bridge

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Treatment of Helicobacter pylori in surgical practice:A randomised trial of triple versus quadruple therapy in a rural district general hospital

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World Journal of Gastroenterology 2008年第24期14卷 3855-3860页

作者： Siok Siong Ching Sivakumaran Sabanathan lloyd R Jenkinson Clinical Research Fellow in General Surgery Leeds General Infirmary Department of Surgery Ysbyty Gwynedd

AIM: To compare a lansoprazole-based triple versus quadruple therapy for Helicobacter pylori (H pylori) eradication with emphasis on side effect prof ile,patient compliance and eradication rate at a rural district general hospital in Wales,United Kingdom. METHODS: One hundred one patients with H pylori infection were included in the study. Patients were randomised to receive triple therapy comprising of lansoprazole 30 mg,amoxycillin 1 g,clarithromycin 500 mg,all b.d. (LAC),or quadruple therapy comprising of lansoprazole 30 mg b.d.,metronidazole 500 mg t.d.s.,bismuth subcitrate 240 mg b.d.,and tetracycline chloride 500 mg q.d.s. (LMBT). Cure was defi ned as a negative 13C urea breath test 2 mo after treatment. RESULTS: Seven patients were withdrawn after randomisation. Fifty patients were assigned to LAC group and 44 to LMBT group. The intention-to-treat cure rates were 92% and 91%,whereas the per-protocol cure rates were 92% and 97%,respectively. Side effects were common,with 56% experiencingmoderate to severe symptoms in the LAC group and 59% in the LMBT group. Symptoms of vomiting,diarrhoea and black stools were significantly more common in the LMBT group. Patient compliance was 100% for triple therapy and 86% for quadruple therapy (P < 0.01). One-third of patients in both groups were still taking acid-reducing medications at six-month follow-up. CONCLUSION: One-week triple and quadruple therapies have similar intention-to-treat eradication rates. Certain side effects are more common with quadruple therapy,which can compromise patient compliance. Patient education or modifi cations to the regimen are alternative options to improve compliance of the quadruple regimen.

关键词： Helicobacter pylori Triple therapy Quadruple therapy Side effects Treatment compliance Eradication rate

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Reliability of the Brownish-flanked Bush Warbler's soft song in male-male conflict

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Chinese Birds 2015年第2期6卷 107-112页

作者： Canwei Xia Boye Liu Daiping Wang Huw lloyd Yanyun Zhang Ministry of Education Key Laboratory for Biodiversity and Ecological Engineering College of Life Sciences Beijing Normal University Division of Biology and Conservation Ecology School of Science and the Environment Manchester Metropolitan University

Background: Soft song is a low-amplitude song produced by many birds. Recent studies have confirmed that soft song is an aggressive signal. For example, the Brownish-flanked Bush Warblers Cettia fortipes use soft song in male-male conflicts, particularly prior to attacks. Although stable signaling systems require that signals be honest on average,models predict that cheating is an acceptable strategy for some individuals or in some ***: This study aimed to test the reliability of soft song as an aggressive signal in the brownish-flanked bush warbler. We used mounted specimens accompanied by broadcast songs or soft songs to simulate a male attempting to invade an existing ***: We found the mounted specimen that coupled playback of soft songs suffered more and quicker attacks from the territory owner and that the relationship between soft song and subsequent attack in the territory owner was far from perfect. We observed territory owners that both over-signaled(i.e., produced soft song but did not attack) and under-signaled(i.e., attacked without producing soft song). Under-signaling territory owners were relatively more commonly than were over-signaling territory owners, particularly in simulated intrusion that coupled playback of soft song with a mount ***: We discuss the cost of producing soft song and the potential benefit of the unreliable use of soft song and propose a new hypothesis for under-signaling with soft song; i.e., under-signaling territory owners might benefit from taking the initiative in fights.

关键词： Aggressive signal Brownish-flanked Bush Warbler Cost Reliability Soft song

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