Search results for: rural population participation

Authors: Caroline F. Moeser

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The skin-gut axis defines the relationship between the intestinal microbiota and the development of pathological skin diseases. Low diversity within the gut can predispose to the development of allergic skin conditions, and a greater diversity of the gastrointestinal microflora has been associated with a reduction of skin flares in people with atopic dermatitis. Manipulation of the gut microflora has been used as a treatment option for several conditions in people, but there is limited data available on the use of faecal transplantation as a preventative measure in either people or dogs. Six, 4-month-old pups from a litter of ten were presented for diarrhea and/or signs of skin disease (chronic scratching, otitis externa). Of these pups, two were given probiotics with a resultant resolution of diarrhea. The other four pups were given faecal transplantation, either as a sole treatment or in combination with other treatments. Follow-up on the litter of ten pups was performed at 18 months of age. At this stage, the four pups that had received faecal transplantation had resolved all clinical signs and had no recurrence of either skin or gastrointestinal symptoms. Of the remaining six pups from the litter, all had developed at least one episode of Malassezia otitis externa within the period of 5 months to 18 months of age. Two pups had developed two Malassezia otitis infections, and one had developed three Malassezia otitis infections during this period. Favrot’s criteria for the diagnosis of canine atopic dermatitis include chronic or recurrent Malassezia infections by the age of three years. Early results from this litter predict a reduction in the development of canine atopic disease in dogs given faecal microbial transplantation. Follow-up studies at three years of age and within a larger population of dogs can enhance understanding of the impact of early faecal transplantation in the prevention of canine atopic dermatitis.

Keywords: canine atopic dermatitis, faecal microbial transplant, skin-gut axis, otitis

Procedia PDF Downloads 157

Authors: Lily Yarney, Emmanuel M. Y. Seidu, Thomas Chireh Kuusaanu, Belinda Adzimah-Yeboah

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Healthcare delivery is labor-intensive; the role of the health worker is, therefore, indispensable in maintaining and improving individual and population health. In Ghana, doctor-patient ratio is 1:10,450, with a disproportionate tilt in favor of the relatively resource rich southern part of the country. The Upper West Region located in Northern Ghana, is among the poorest regions in the country. The study was aimed at finding out the reasons why medical doctors are unwilling to accept postings to the Upper West Region where their services are needed most despite some efforts to attract, motivate and retain them. Current initiatives by the Ministry of Health and its partners to attract and retain doctors in the region were also examined. Qualitative methodology was employed with an in-depth interview guide to collect data. Sixteen respondents comprising medical doctors, health managers, and other health-related partners purposively selected took part in the study. Data were recorded, transcribed, coded, and categorized into themes in tandem with the objectives of the study. The study found that medical doctors are unwilling to take up appointments in the Upper West Region because of limited opportunities for career and continuing professional development, poor financial inducement, and weak leadership, among other important contextual social and cultural factors. Critical success factors to surmount these challenges include concessions and sponsorship for medical specialization training for doctors and clear implementable national and local policies on postings.

Keywords: attraction, retention, medical doctors, deprived regions, Ghana

Procedia PDF Downloads 108

Authors: Shah Abid

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Leishmaniasis is a collection of zoonotic infections that affect the viscera, skin, and mucous membrane and are spread by several species of female sandflies in the subfamily phlebotominae. The study's goal was to assess the prevalence of Cutaneous Leishmaniasis in District Kurram using descriptive and cross-sectional methods. From December 2022 to May 2023, the study was carried out at Tehsil Head Quarter (THQ) Hospital, Sadda, District Kurram in the Dermatology Department. The disease was identified using a laboratory method based on clinical manifestations of leishmaniasis. A clean slide's surface was applied to the scraped-off portion of the lesions and rubbed over the blood to make a smear on the slide. The slides were methanol-fixed, stained with traditional Giemsa, and meticulously examined at high magnification to search for LD bodies. The necessary information, such as residence area, lesion kind and location, age, sex, and the total number of lesions, was meticulously acquired. During the time of the investigation, 393 instances of cutaneous leishmaniasis were observed. 1 year to 70 years old was the age range (mean age: 35.45). The age group that was most severely impacted, 16 years and older, had 23 (11.67%) children with this condition. Male to female ratio was 9.7:10. Most of the cases (n=52, 26.29%), were reported in the month of May. Majority of the patients 102 (51.77%) had lesion on face. 42 (16.73) patients had multiple lesions on their body. Face was the most common site followed by lower limbs 93 (37.05). Weekly intralesional injections of sodium stibogluconate (glucantime) were administered to all patients. Without any noticeable adverse effects, all patients had positive responses to the treatment. The condition affects adults more commonly than children, according to analysis of the combined results, and it is more common in women than in men.

Keywords: District Kurram, cutaneous leishmaniasis, zoonosis, glucantime

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Authors: Zylfi Shehu, Shpetim Madani, Bashkim Delia

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Context: The study focuses on the interest and engagement of high school students in Tirana, Albania, in physical activity, sports, and foreign languages. It acknowledges the numerous physiological benefits of physical activity, such as cardiovascular health and improved mood. It also recognizes the importance of physical activity in childhood and adolescence for proper skeletal development and long-term health. Research Aim: The main purpose of the study is to investigate and analyze the preferences and interests of male and female high school students in Tirana regarding their functional development, physical activity, sports participation, and choice of foreign languages. The aim is to provide insights for the students and teachers to guide future objectives and improve the quality of physical education. Methodology: The study employed a survey-based approach, targeting both male and female students in public high schools in Tirana. A total of 410 students aged 15 to 19 years old, participated in the study. The data collected from the survey were processed using Excel and presented through tables and graphs. Findings: The results revealed that team sports were more favored by the students, with football being the preferred choice among males, while basketball and volleyball were more popular among females. Additionally, English was found to be the most preferred foreign language, selected by a higher percentage of females (38.57%) compared to males (16.90%). German followed as the second preferred language. Theoretical Importance: This study contributes to the understanding of students' interests in physical activity, sports, and foreign languages in Tirana's high schools. The findings highlight the need to focus on specific sports and languages to cater to students' preferences and guide future educational objectives. It also emphasizes the importance of physical education in promoting students' overall well-being and highlights potential areas for policy and program improvement. Data Collection and Analysis Procedures: The study collected data through surveys administered to high school students in Tirana. The survey responses were processed and analyzed using Excel, and the findings were presented through tables and graphs. The data analysis allowed for the identification of preferences and trends among male and female students, providing valuable insights for future decision-making. Question Addressed: The study aimed to address the question of high school students' interest in physical activity, sports, and foreign languages. It sought to understand the preferences and choices made by students in Tirana and investigate factors such as gender, family income, and accessibility to extracurricular sports activities. Conclusion: The study revealed that high school students in Tirana show a preference for team sports, with football being the most favored among males and basketball and volleyball among females. English was found to be the most preferred foreign language. The findings provide important insights for educators and policymakers to enhance physical education programs and consider students' preferences and interests to foster a more effective learning environment. The study also emphasizes the importance of physical activity and sports in promoting students' physical and mental well-being.

Keywords: female, male, foreign languages, sports, physical education, high school students

Procedia PDF Downloads 93

Authors: Kateryna Kulyk

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Anti-corruption education is an integral element of the corruption prevention mechanism of any state. Effective implementation of anti-corruption policy is impossible without awareness-raising activities. Information campaigns should target different social groups and aim to reduce tolerance to any form of corruption. Today, Ukraine and Lithuania have all the necessary infrastructure to actively work in this direction. Anti-corruption measures and building a society resistant to corruption are particularly important in the context of martial law in Ukraine and the state of emergency in Lithuania, as these conditions increase the risks of corrupt practices. To implement this area of activity, it is recommended to actively involve all state and local authorities, business representatives, non-governmental organisations, and all interested citizens. As of today, educational institutions, specialised anti-corruption bodies, and the public are already involved in this process. The purpose of the research is to draw public attention to the need and importance of obtaining basic knowledge on combating and preventing corruption, even in a state of emergency or martial law. This topic remains relevant even during the period of a state of emergency or martial law, as the risk of corrupt practices increases during these periods. The study is based on a comprehensive analysis of the anti-corruption policies of Ukraine and Lithuania, sociological research, and our own survey of anti-corruption experts. Legislation, reports of anti-corruption bodies and civil society organisations were analysed. We also conducted an anonymous survey of 13 anti-corruption experts on the most important anti-corruption measures in the countries studied. The main contribution of the research is to draw attention to the problem of low awareness of the population of countries about the importance of anti-corruption education as one of the necessary conditions for reducing corruption practices.

Keywords: corruption, prevention and combating of corruption, education, anti-corruption education, martial law, state of emergency

Procedia PDF Downloads 34

Authors: Alyaa Farouk AbdelFattah Ibrahim, Agnes Monica, Dolores I. Cabansag

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The prevalence of diabetes mellitus is reaching epidemic proportions in many parts of the world causing an increasing public health concern. Cases of Type 2 diabetes are rapidly increasing in the Middle East region. Deprived of lifestyle deviations, a section of the Middle East’s inhabitants will be pretentious by 2035. As all sociocultural factors have created unhealthy lifestyles, which have become part of the social norms within Saudi society, thereby increased the prevalence of sedentary lifestyle and obesity in women living in Saudi Arabia. So, this study aimed to assess the impact of diabetes mellitus on quality of life of female nursing students in King Saud bin Abdulaziz University for Health Sciences, Riyadh. In a crossectional study design, 151 nursing students at King Saud bin Abdulaziz University for health sciences in Riyadh were included in the study. Biosociodemographic questionnaire and Short-Form 36 (SF-36) Health Related Quality of life Survey Arabic version were used for data collection, and all included students were screened for random blood glucose level. Results depicted that among 151 subjects included in the study 17 (11.3%) had diagnosed medical problems, and 29.4% of those participants with medical problems were diabetics. Univariate regression model for the relation between diabetes mellitus and overall percent score of SF-36 health survey domains showed no statistically significant difference between diabetic and non-diabetic subjects 0.990(0.931-1.053). In conclusion, although the diabetes prevalence was high among the study subjects it did not affect their quality of life may be due to age of the study population.

Keywords: diabetes mellitus, diabetes prevalence, quality of life, university students' health

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Authors: Yue Huang, Hongcheng Gan

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The new urbanization pattern has led to a rapid growth in demand for short-distance intercity travel, and the emergence of new travel modes has also increased the variety of intercity travel options. In previous studies on intercity travel mode choice behavior, the impact of functional amenities of travel mode and travelers’ long-term personality characteristics has rarely been considered, and empirical results have typically been calibrated using revealed preference (RP) or stated preference (SP) data. This study designed a questionnaire that combines the RP and SP experiment from the perspective of a trip chain combining inner-city and intercity mobility, with consideration for the actual condition of the Huainan-Hefei traffic corridor. On the basis of RP/SP fusion data, a hybrid choice model considering both random taste heterogeneity and psychological characteristics was established to investigate travelers’ mode choice behavior for traditional train, high-speed rail, intercity bus, private car, and intercity online car-hailing. The findings show that intercity time and cost exert the greatest influence on mode choice, with significant heterogeneity across the population. Although inner-city cost does not demonstrate a significant influence, inner-city time plays an important role. Service attributes of travel mode, such as catering and hygiene services, as well as free wireless network supply, only play a minor role in mode selection. Finally, our study demonstrates that safety-seeking tendency, hedonism, and introversion all have differential and significant effects on intercity travel mode choice.

Keywords: intercity travel mode choice, stated preference survey, hybrid choice model, RP/SP fusion data, psychological latent variable, heterogeneity

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Authors: N. Haj Salem, M. Belhadj, S. Ben Jomâa, S. Saadi, R. Dhouieb, A. Chadly

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Introduction: Sudden death in young is seen as a dramatic phenomenon requiring knowledge of its impact and determining their causes. Aim: We aim to study the epidemiological characteristics of sudden death in young, and to discuss the mechanism and the importance of autopsy in these situations. Material and methods: We performed a retrospective cohort study using autopsy data from the department of forensic medicine at the University Hospital of Fattouma Bourguiba, Monastir-Tunisia. A review of all autopsies performed during 23 years was done. In each case, clinical information and circumstances of death were obtained. We have included all sudden death in persons aged between 1 year and 35 years for the male and from one year to 45 years for female. We collected 312 cases of sudden death during the studied period. The collected data were processed using SPSS 20. The significance level was set at 0.05. Results: Thirty-two cases of cardiac ischemic sudden death have been collected. Myocardial infarction was the second cause of sudden death in young patients. There was a male predominance. The most affected subjects were aged between 25-45 years. The death occurred more frequently at rest. Coronary artery disease has been discovered in twenty-four cases (75%). A severe coronary artery disease was observed in two children with medical history of familial hypercholesterolemia. The myocardial infarction occurred in healthy coronary arteries in eight cases. An anomalous course of coronary arteries, in particular, myocardial bridging, was found in eight cases (25%). Toxicological screening was negative in all cases. Second cause of death was hypertrophic cardiomyopathy. Neurological and respiratory causes of death were implicated respectively in 10% and 15%. Conclusion: Identifying epidemiological characteristics of sudden death in this population is important for guiding approaches to prevention that must be based on dietary hygienic measures and the control of cardiovascular risk factors.

Keywords: autopsy, cardiac death, sudden death, young

Procedia PDF Downloads 238

Authors: Wondale Getinet Alemu, Lillian Mwanri, Clemence Due, Telake Azale, Anna Ziersch

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Background: Mental illness is one of the most severe, chronic, and disabling public health problems that affect patients' Quality of life (QoL). Improving the QoL for people with mental illness is one of the most critical steps in stopping disease progression and avoiding complications of mental illness. Therefore, we aimed to assess the QoL and its determinants in patients with mental illness in outpatient clinics in Northwest Ethiopia in 2023. Methods: A facility-based cross-sectional study was conducted among people with mental illness in an outpatient clinic in Ethiopia. The sampling interval was decided by dividing the total number of study participants who had a follow-up appointment during the data collection period (2400) by the total sample size of 638, with the starting point selected by lottery method. The interviewer-administered WHOQOL BREF-26 tool was used to measure the QoL of people with mental illness. The domains and Health-Related Quality of Life (HRQoL) were identified. The indirect and direct effects of variables were calculated using structural equation modeling with SPSS-28 and Amos-28 software. A p-value of < 0.05 and a 95% CI were used to evaluate statistical significance. Results: A total of 636 (99.7%) participants responded and completed the WHOQOL-BREF questionnaire. The mean score of overall HRQoL of people with mental illness in the outpatient clinic was (49.6 ± 10 Sd). The highest QoL was found in the physical health domain (50.67 ±9.5 Sd), and the lowest mean QoL was found in the psychological health domain (48.41±10 Sd). Rural residents, drug nonadherence, suicidal ideation, not getting counseling, moderate or severe subjective severity, the family does not participate in patient care, and a family history of mental illness had an indirect negative effect on HRQoL. Alcohol use and psychological health domain had a direct positive effect on QoL. Furthermore, objective severity of illness, having low self-esteem, and having a history of mental illness in the family had both direct and indirect effects on QoL. Furthermore, sociodemographic factors (residence, educational status, marital status), social support-related factors (self-esteem, family not participating in patient care), substance use factors (alcohol use, tobacco use,) and clinical factors (objective and subjective severity of illness, not getting counseling, suicidal ideation, number of episodes, comorbid illness, family history of mental illness, poor drug adherence) directly and indirectly affected QoL. Conclusions: In this study, the QoL of people with mental illness was poor, with the psychological health domain being the most affected. Sociodemographic factors, social support-related factors, drug use factors, and clinical factors directly and indirectly, affect QoL through the mediator variables of physical health domains, psychological health domains, social relation health domains, and environmental health domains. In order to improve the QoL of people with mental illnesses, we recommend that emphasis be given to addressing the scourge of mental health, including the development of policy and practice drivers that address the above-identified factors.

Keywords: quality of life, mental wellbeing, mental illness, mental disorder, Ethiopia

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Authors: Mahesh K. Jat, Ankan Jana, Mahender Choudhary

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Rapid population and economic growth resulted in changes in large-scale land use land cover (LULC) changes. Changes in the biophysical properties of the Earth's surface and its impact on climate are of primary concern nowadays. Different approaches, ranging from location-based relationships or modelling earth surface - atmospheric interaction through modelling techniques like surface energy balance (SEB) are used in the recent past to examine the relationship between changes in Earth surface land cover and climatic characteristics like temperature and precipitation. A remote sensing-based model i.e., Surface Energy Balance Algorithm for Land (SEBAL), has been used to estimate the surface heat fluxes over Mahi Bajaj Sagar catchment (India) from 2001 to 2020. Landsat ETM and OLI satellite data are used to model the SEB of the area. Changes in observed precipitation and temperature, obtained from India Meteorological Department (IMD) have been correlated with changes in surface heat fluxes to understand the relative contributions of LULC change in changing these climatic variables. Results indicate a noticeable impact of LULC changes on climatic variables, which are aligned with respective changes in SEB components. Results suggest that precipitation increases at a rate of 20 mm/year. The maximum and minimum temperature decreases and increases at 0.007 ℃ /year and 0.02 ℃ /year, respectively. The average temperature increases at 0.009 ℃ /year. Changes in latent heat flux and sensible heat flux positively correlate with precipitation and temperature, respectively. Variation in surface heat fluxes influences the climate parameters and is an adequate reason for climate change. So, SEB modelling is helpful to understand the LULC change and its impact on climate.

Keywords: LULC, sensible heat flux, latent heat flux, SEBAL, landsat, precipitation, temperature

Procedia PDF Downloads 115

Authors: Farideh Gheitasi, Amir Hossain Jaberansari, Payam Abedini

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The World Health Organization (WHO) Manifesto for Safe Communities states that "All human beings have an equal right to health and safety". The purpose of a safe Community is to minimize the damages threatening people. It seems that not sufficient attention has been given to relate environment and objectives of the safe Community. The reason for that can be assigned to the lack of enough information about environmental parameters and their relation with indices of the safe community like type and effect time of damages resulting from air pollution. Air pollution can be characterized as one of main environmental problems of Tehran. This problem is mostly due to the special geographic and climate situation, high population density and irregular growth in the number of vehicles. This paper is aimed at investigating the necessity of considering environmental factors to obtain a safe community through determining the effects of environmental pollution, particularly air pollution, on 490000 elders (+65) of Tehran. The methodology used in this study was on the basis of Random sampling and social surveying. The number of questionnaires was determined to be 321 through using Cochran method and the questionnaires were filled out by elders during personal interviews. The analysis of obtained results indicated that elders believe the major effects of air pollution include heart and respiratory diseases, obligation to stay at home on polluted days and its associated mental problems. Moreover, it was found that there is direct link between the number of polluted days and mortality frequency of elders. Having an environmental view may have an appreciable influence on the qualitative and quantitative development of activities and also facilitate obtaining the goals of the Safe Communities. In addition to reduce damages caused by pollutions, this view will encourage friends of the environment to cooperate with authorities of the safe community.

Keywords: air pollution, elderly people, environment, waste management

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Authors: Sakina Boufarsi, Mehmet Emre Aysu, Behiye Isik Aksulu

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Morocco appears to be on its way to eradicating all of the country's slums by assuring the resettlement and improvement of all affected households' living circumstances through the VSB “Villes sans Bidonvilles” program established in 2004 to eradicate the slums in Morocco. Although many attempts have been made to curb their growth none have proven to be a permanent accomplishment. In Morocco, resettlement projects through satellite towns are perceived as the answer to the problem of the slums. However, the new satellite towns are the good intention of the program VSB, but they are environmentally unsustainable, socially isolated and culturally inappropriate, such conditions imposed continuous readjustments of the slum upgrading program. Although slum research is ongoing, they primarily concentrated on two constructs: exploring socio-economic and policy problems and analyzing physical characteristics. Considering that the two constructs mentioned are crucial, this study will demonstrate that a more systematic approach is needed to eradicate them efficiently. The slums issues in Casablanca are a solution that the poor devise for themselves due to government bureaucracy and failing housing policies, they reflect governments' incapacity to respond to urban development’s requiring decent housing for the vulnerable population. This issue will be addressed by exploring the previous strategies and analyzing in detail the strengths and shortcomings of the recent VSB Program. In addition to a comprehensive overview of the slums' situations by combining the social and physical characteristics through Erhamna case study in Sidi Moumen district for a deeper understanding, and therefore to direct improved and valuable recommendations to address the slum problem at all levels.

Keywords: Casablanca slums, resettlement projects, eradication of slums, satellite town, VSB program

Procedia PDF Downloads 174

Authors: Joy Ghosh, Debasmita Biswas

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The road network of any area is the most important indicator of regional planning. For proper utilization of urban road networks, the structural parameters such as connectivity and accessibility should be analyzed and evaluated. This paper aims to explain the application of GIS on urban road network connectivity and accessibility analysis with a case study of Chandannagar City. This paper has been made to analyze the road network connectivity through various connectivity measurements like the total number of nodes and links, Cyclomatic Number, Alpha Index, Beta Index, Gamma index, Eta index, Pi index, Theta Index, and Aggregated Transport Score, Road Density based on existing road network in Chandannagar city in India. Accessibility is measured through the shortest Path Matrix, associate Number, and Shimbel Index. Various urban services, such as schools, banks, Hospitals, petrol pumps, ATMs, police stations, theatres, parks, etc., are considered for the accessibility analysis for each ward. This paper also highlights the relationship between urban land use/ land cover (LULC) and urban road network and population density using various spatial and statistical measurements. The datasets were collected through a field survey of 33 wards of the Chandannagar Municipal Corporation area, and the secondary data were collected through an open street map and satellite image of LANDSAT8 OLI & TIRS from USGS. Chandannagar was actually once a French colony, and at that time, various sort of planning was applied, but now Chandannagar city continues to grow haphazardly because that city is facing some problems; the knowledge gained from this paper helps to create a more efficient and accessible road network. Therefore, it would be suggested that some wards need to improve their connectivity and accessibility for the future growth and development of Chandannagar.

Keywords: accessibility, connectivity, transport, road network

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Authors: Eric Gismondi, Aurelie Bigot-Clivot

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Endocrine disruptors (EDCs) are well known to disrupt the development and the reproduction of exposed organisms. Although this point has been studied in vertebrate models, the limited knowledge of the endocrine system of invertebrates makes the evaluation of EDCs effects difficult. However, invertebrates represent the major part of aquatic ecosystems, such as amphipods Gammaridea, which are crucial for their functioning (e.g., litter degradation, food resource). Moreover, gammarids are hosts of parasites such as vertically-transmitted microsporidia (microsporidia VT), which could be confounding factors in assessment of EDC effects. Indeed, some microsporidia VT could have endocrine effects by their own present in the host since it was observed for example, a feminization of juvenile males, which become phenotypic females. This work evaluated the impact of ethinylestradiol (EE₂, estrogenic), cyproterone acetate (CPA, anti-androgenic), 4-hydroxytamoxifen (4HT, anti-estrogenic) and 17α-methyltestosterone (17MT - androgenic), on the 20-hydroxyecdysone concentration (i.e. 20HE - molt process) and the vitellogenin gene expression (i.e. reproduction) in the freshwater amphipod Gammarus pulex, after a 96h laboratory exposure. In addition, the presence of microsporidia VT was verified in order to analyze the effect of this confounding factor. Results of this study shown that, although endocrine systems of invertebrates and vertebrates are different, EDCs proved in vertebrates could also affect biological functions hormonally controlled in invertebrates. Indeed, the molt process of crustaceans was disrupted in the first stage (i.e. 20-HE concentration) and therefore, could affect, at the long term, the population dynamic. In addition, it was observed that G. pulex was differently impacted according to the gender and parasitism, which underline the importance to take into account these confounding factors to better evaluate the EDCs impact on invertebrate populations.

Keywords: endocrine disruption, gammarus sp., molt, parasitism

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Authors: Kimberly Samaha

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The Bio-Hub Ecosystem model was developed to address a critical area of concern within the global energy market regarding biomass as a feedstock for power plants. Yet the lack of an economically-viable business model for bioenergy facilities has resulted in the continuation of idled and decommissioned plants. This study analyzed data and submittals to the Born Global Maine Innovation Challenge. The Innovation Challenge was a global innovation challenge to identify process innovations that could address a ‘whole-tree’ approach of maximizing the products, byproducts, energy value and process slip-streams into a circular zero-waste design. Participating companies were at various stages of developing bioproducts and included biofuels, lignin-based products, carbon capture platforms and biochar used as both a filtration medium and as a soil amendment product. This case study shows the QCA (Qualitative Comparative Analysis) methodology of the prequalification process and the resulting techno-economic model that was developed for the maximizing profitability of the Bio-Hub Ecosystem through continuous expansion of system waste streams into valuable process inputs for co-hosts. A full site plan for the integration of co-hosts (biorefinery, land-based shrimp and salmon aquaculture farms, a tomato green-house and a hops farm) at an operating forestry-based biomass to energy plant in West Enfield, Maine USA. This model and process for evaluating the profitability not only proposes models for integration of forestry, aquaculture and agriculture in cradle-to-cradle linkages of what have typically been linear systems, but the proposal also allows for the early measurement of the circularity and impact of resource use and investment risk mitigation, for these systems. In this particular study, profitability is assessed at two levels CAPEX (Capital Expenditures) and in OPEX (Operating Expenditures). Given that these projects start with repurposing facilities where the industrial level infrastructure is already built, permitted and interconnected to the grid, the addition of co-hosts first realizes a dramatic reduction in permitting, development times and costs. In addition, using the biomass energy plant’s waste streams such as heat, hot water, CO₂ and fly ash as valuable inputs to their operations and a significant decrease in the OPEX costs, increasing overall profitability to each of the co-hosts bottom line. This case study utilizes a proprietary techno-economic model to demonstrate how utilizing waste streams of a biomass energy plant and/or biorefinery, results in significant reduction in OPEX for both the biomass plants and the agriculture and aquaculture co-hosts. Economically viable Bio-Hubs with favorable environmental and community impacts may prove critical in garnering local and federal government support for pilot programs and more wide-scale adoption, especially for those living in severely economically depressed rural areas where aging industrial sites have been shuttered and local economies devastated.

Keywords: bio-economy, biomass energy, financing, zero-waste

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Authors: Rima Younis

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Agro-ecology is considered one of the agricultural approaches that is spreading across the world due to the practical solutions it provides that are in harmony with nature. These solutions target many agricultural problems, food production issues, and climate change. Agriculture and fertile soil in particular, play a vital role when it comes to food security and climate change. The organic substances, which mainly consist of carbon, in the soil contribute to the ecological system through 4 elements: Resistance to soil erosion, conserving water in soil, increasing soil fertility, and improving the biodiversity in it. Any small changes to the carbon storage in soil have a tremendous impact on both agricultural productivity and the greenhouse gas cycle, which is what agro-ecology aims to achieve. The importance of agro-ecology lies here, as it helps increase organic matter/carbon in the soil, on an ongoing basis, 15-20 times higher than nature’s rate in producing organic matter. Agro-ecology is set to increase the production of crops free of chemicals, develop organic matter, and establish carbon in soil, thus being a factor in limiting climate change, not just mitigating or adapting. Under the events of the rapid increase in population and the need to feed humans, agro-ecology stands in the first place as it surpasses the productivity of chemical agriculture per unit area, according to international and local experience. The introduction of agro-ecology to Palestine started 15 years ago, with modest beginnings faced with a lot of criticism and opposition, but is currently experiencing rapid growth among farmers and is becoming accepted among specialists. Even though the number of agro-ecologist farmers is still small, it reflects a state of turnover into a more sustainable, less polluting agriculture that works on renewing life and the elements of nature.

Keywords: toward to solidarity economy, food sovereignty, the introduction of agro-ecology to Palestine, the importance of agro-ecology

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Authors: Manjula Weerasekera, Chris Sissons, Lisa Wong, Sally Anderson, Ann Holmes, Richard Cannon

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The aim of this study was to characterize bacterial population and yeasts in saliva by Polymerase chain reaction followed by denaturing gradient gel electrophoresis (PCR-DGGE) and measure yeast levels by culture. PCR-DGGE was performed to identify oral bacteria and yeasts in 24 saliva samples. DNA was extracted and used to generate DNA amplicons of the V2–V3 hypervariable region of the bacterial 16S rDNA gene using PCR. Further universal primers targeting the large subunit rDNA gene (25S-28S) of fungi were used to amplify yeasts present in human saliva. Resulting PCR products were subjected to denaturing gradient gel electrophoresis using Universal mutation detection system. DGGE bands were extracted and sequenced using Sanger method. A potential relationship was evaluated between groups of bacteria identified by cluster analysis of DGGE fingerprints with the yeast levels and with their diversity. Significant interpersonal variation of salivary microbiome was observed. Cluster and principal component analysis of the bacterial DGGE patterns yielded three significant major clusters, and outliers. Seventeen of the 24 (71%) saliva samples were yeast positive going up to 10³ cfu/mL. Predominately, C. albicans, and six other species of yeast were detected. The presence, amount and species of yeast showed no clear relationship to the bacterial clusters. Microbial community in saliva showed a significant variation between individuals. A lack of association between yeasts and the bacterial fingerprints in saliva suggests the significant ecological person-specific independence in highly complex oral biofilm systems under normal oral conditions.

Keywords: bacteria, denaturing gradient gel electrophoresis, oral biofilm, yeasts

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Authors: Kiyanoush Ghalavand

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We have a complex paradox in the agriculture and environment sectors in the age of technology. In the one side, the achievements of the science and information ages are shaping to come that is very dangerous than ever last decades. The progress of the past decades is historic, connecting people, empowering individuals, groups, and states, and lifting a thousand people out of land and poverty in the process. Floods are the most frequent natural hazards damaging and recurring of all disasters in Iran. Additionally, floods are morphing into new and even more devastating forms in recent years. Khuzestan and Lorestan Provinces experienced heavy rains that began on March 28, 2019, and led to unprecedented widespread flooding and landslides across the provinces. The study was based on both secondary and primary data. For the present study, a questionnaire-based primary survey was conducted. Data were collected by using a specially designed questionnaire and other instruments, such as focus groups, interview schedules, inception workshops, and roundtable discussions with stakeholders at different levels. Farmers in Khuzestan and Lorestan provinces were the statistical population for this study. Data were analyzed with several software such as ATLASti, NVivo SPSS Win, ،E-Views. According to a factorial analysis conducted for the present study, 10 groups of factors were categorized climatic, economic, cultural, supportive, instructive, planning, military, policymaking, geographical, and human factors. They estimated 71.6 percent of explanatory factors of flood management obstacles in the agricultural sector in Lorestan and Khuzestan provinces. Several recommendations were finally made based on the study findings.

Keywords: chaos theory, natural hazards, risks, environmental risks, paradox

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Authors: Hannah Yael Ephraim

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During reproductive age (between 15 and 44), women are particularly susceptible to psychiatric illness. Depression and anxiety disorders are especially common for women during reproductive age. Women of reproductive age are also at greater risk for multiple physical conditions during this time. Existing literature focuses on the impact of mental health on physical health, showing that people with anxiety and depression repeatedly show greater physical health risk among those with developing chronic medical illness. However, there is limited research on the impact physical health has on mental health in women of reproductive age, a large and vulnerable population. For this reason, the current study seeks to ask the following questions: are women of reproductive age with a diagnosis of a chronic physical condition more likely to experience symptoms of mental illness than women without a diagnosis of a chronic physical condition? Does the type of physical illness relate to signs and symptoms of depression and anxiety? A quasi-experimental research design was implemented to compare the mental health outcomes of women with the diagnosis of chronic medical conditions and women without the diagnosis of a chronic medical condition. Quantitative data was collected through an anonymous ten-minute Qualtrics survey. The survey was sent out through multiple online platforms. The sample includes two groups of women: one group with the diagnosis of a chronic medical illness, and one group without a diagnosis and/or symptoms (N = 541). Participants identify as a woman and are between the ages of 15 and 44. A comparison of women with a diagnosis of a chronic physical condition and those without a diagnosis will be conducted to explore differences in depression and anxiety symptoms between women with and without a chronic medical diagnosis. The impact race, SES, and occupation will also be addressed in relation to anxiety and/or depression in women of reproductive age. This study will further the understanding of the relationship between mental illness in women of reproductive age with chronic medical conditions. The results of this study will have implications for the integration of mental health care in women’s health centers and perhaps training of clinicians and physicians providing psychological and medical care to women of reproductive age.

Keywords: mental health, physical health, reproductive age, women

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Authors: Sujata Mukherjee, Arunavo Mukherjee

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Water covers 70 per cent of our planet; however, freshwater is incredibly rare, and scarce has been listed as the highest impact global risk. The problems related to freshwater scarcity multiplies with the human population having more than doubled coupled with climate change, changing water cycles leading to droughts and floods and a rise in water pollution. Businesses, governments, and local communities are constrained by water scarcity and are facing growing challenges to their growth and sustainability. Water foot printing as an indicator for water use was introduced in 2002. Business water footprint measures the total water consumed to produce the goods and services it provides. It is a combination of the water that goes into the production and manufacturing of a product or service and the water used throughout the supply chain, as well as during the use of the product. A case study approach was applied describing the efforts of Tata Steel. It is based on a series of semi-structured in-depth interviews with top executives of the company as well as observation and content analysis of internal and external documents about the company’s efforts in sustainable water management. Tata Steel draws water required for industrial use from surface water sources, primarily perennial rivers and streams, internal reservoirs and water from municipal sources. The focus of the present study was to explore Tata Steel’s engagement in sustainable water management focusing on water foot printing accounting as a tool to account for water use in the steel supply chain at its Jamshedpur plant. The findings enabled the researchers to conclude that no sources of water are adversely affected by the company’s production of steel at Jamshedpur.

Keywords: sustainability, corporate responsibility water management, risk management, business engagement

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Authors: S. MacDougall-Davis, S. Wysling, R. Willmore

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Background: The application of good non-technical skills, also known as crew resource management (CRM), is central to the delivery of safe, effective healthcare. The authors have been running remote trauma courses for over 10 years, primarily focussing on developing participants’ CRM in time-critical, high-stress clinical situations. The course has undergone an iterative process over the past 10 years. We employ a number of experiential learning techniques for improving CRM, including small group workshops, military command tasks, high fidelity simulations with reflective debriefs, and a ‘flipped classroom’, where participants are asked to create their own simulations and assess and debrief their colleagues’ CRM. We created a randomised simulation study to assess the impact of our course on UK medical students’ CRM, both at an individual and a teams level. Methods: Sixteen students took part. Four clinical scenarios were devised, designed to be of similar urgency and complexity. Professional moulage effects and experienced clinical actors were used to increase fidelity and to further simulate high-stress environments. Participants were block randomised into teams of 4; each team was randomly assigned to one pre-course simulation. They then underwent our 5 day remote trauma CRM course. Post-course, students were re-randomised into four new teams; each was randomly assigned to a post-course simulation. All simulations were videoed. The footage was reviewed by two independent CRM-trained assessors, who were blinded to the before/after the status of the simulations. Assessors used the internationally validated team emergency assessment measure (TEAM) to evaluate key areas of team performance, as well as a global outcome rating. Prior to the study, assessors had scored two unrelated scenarios using the same assessment tool, demonstrating 89% concordance. Participants also completed pre- and post-course questionnaires. Likert scales were used to rate individuals’ perceived NTS ability and their confidence to work in a team in time-critical, high-stress situations. Results: Following participation in the course, a significant improvement in CRM was observed in all areas of team performance. Furthermore, the global outcome rating for team performance was markedly improved (40-70%; mean 55%), thus demonstrating an impact at Level 4 of Kirkpatrick’s hierarchy. At an individual level, participants’ self-perceived CRM improved markedly after the course (35-70% absolute improvement; mean 55%), as did their confidence to work in a team in high-stress situations. Conclusion: Our study demonstrates that with a short, cost-effective course, using easily reproducible teaching sessions, it is possible to significantly improve participants’ CRM skills, both at an individual and, perhaps more importantly, at a teams level. The successful functioning of multi-disciplinary teams is vital in a healthcare setting, particularly in high-stress, time-critical situations. Good CRM is of paramount importance in these scenarios. The authors believe that these concepts should be introduced from the earliest stages of medical education, thus promoting a culture of effective CRM and embedding an early appreciation of the importance of these skills in enabling safe and effective healthcare.

Keywords: crew resource management, non-technical skills, training, simulation

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Authors: M. Jaculine Mary

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Today electronic resources are considered as an integral part of information sources to impart efficient services to the people aspiring to acquire knowledge in different fields. E-resources are those resources which include documents in e-format that can be accessed via the Internet in a digital library environment. The present study focuses on accessibility and use of e-resources by faculty and research scholars of academic libraries of Coimbatore, TamilNadu, India. The main objectives are to identify their purpose of using e-resources, know the users’ Information and Communication Technology (ICT) skills, identify satisfaction level of availability of e-resources, use of different e-resources, overall user satisfaction of using e-resources, impact of e-resources on their research and problems faced by them in the access of e-resources. The research methodology adopted to collect data for this study includes analysis of survey reports carried out by distributing questionnaires to the users. The findings of the research are based on the study of responses received from questionnaires distributed to a sample population of 200 users. Among the 200 respondents, 55 percent of research students and 45 percent of faculty members were users of e-resources. It was found that a majority of the users agreed that relevant, updated information at a fast pace had influenced them to use e-resources. Most of the respondents were of the view that more numbers of computers in the library would facilitate quick learning. Academic libraries have to take steps to arrange various training and orientation programmes for research students and faculty members to use the availability of e-resources. This study helps the librarian in planning and development of e-resources to provide modern services to their users of libraries. The study recommends that measures should be taken to increase the accessibility level of e-resource services among the information seekers for increasing the best usage of available electronic resources in the academic libraries.

Keywords: academic libraries, accessibility, electronic resources, satisfaction level, survey

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Authors: Helen Huang, Francisco Javier Quesada Ocet, Blanca Quesada Oce, Javier Jimenez Bello, Victor Palanca Gil, Alba Cervero Rubio, Ana Paya Chaume, Alejandro Herreros-Pomares, Fernando Vidal-Vanaclocha, Rafael Paya Serrano, Aurelio Quesada Dorador, Monica Soliman

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Background: Cancer favors both the pro-inflammatory state and autonomic dysfunction, two important mechanisms in the genesis of AF. Atrial remodeling might be caused as a result of paraneoplastic conditions or the result of direct expression of neoplasia. Here, we hypothesize that cancer, through inflammatory mediators, may favor the appearance of AF and patients with the first episode of AF could have a higher risk of developing cancer. Method: Data was collected from patients who attended the emergency department of our hospital for the first episode of AF, diagnosed electrocardiographically, between 2010-2015 (n = 712). The minimum follow-up was 2 years, recording the appearance of cancer, total mortality, recurrences of AF and other events. Patients who developed cancer and those who did not during the 2 years after the onset of AF were compared, as well as with the incidence of cancer in Spain in 2012. Results: After 2 years, 35 patients (4.91%) were diagnosed with cancer, with an annual incidence of 2.45%. Hematological neoplasms were the most frequent (34.28%). The cancer group was older (76.68 +/-12.75 years vs 74.16 +/-12.71; p <0.05) and had fewer typical symptoms (palpitations) (33.38% vs 14.28% , p <0.05). The incidence of cancer in Spain during 2012 was 0.46%, much lower than our sample. When comparing the incidence by age, these differences were maintained both in those over 65 years of age and in those under 65 years of age (2.17% vs. 0.28%; 0.28% vs. 0.18% respectively). Discussion: Therefore, a high incidence of cancer in patients with the first episode of AF was observed (the annual incidence of 2.45% after the onset of AF is 6.1 times that of the general population). After the evaluation of patients with AF in their first detected episode, surveillance of the appearance of cancer should be considered in clinical practice.

Keywords: cancer, cardiovascular outcomes, atrial fibrillation, inflammation

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Authors: Marco Vinicio Félix Lerma, Efrain Rubio Rosas, Fernando Ricardez Rueda, Victor Manuel Castaño Meneses

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This paper reports a spectral analysis of the exposure levels of radiofrequency electromagnetic fields originating from a wide variety of telecommunications sources present in an urban area of Lagos de Moreno, Jalisco, Mexico. The electromagnetic characterization of the urban zone under study was carried out by measurements in 118 sites. Measurements of TETRA,ISM434, LTE800, ISM868, GSM900, GSM1800, 3G UMTS,4G UMTS, Wlan2.4, LTE2.6, DECT, VHF Television and FM radio signals were performed at distances ranging over 10 to 1000m from 87 broadcasting towers concentrated in an urban area of about 3 hectares. The aim of these measurements is the evaluation of the electromagnetic fields power levels generated by communication systems because of their interaction with the human body. We found that in certain regions the general public exposure limits determined by ICNIRP (International Commission of Non Ionizing Radiation Protection) are overpassed from 5% up to 61% of the upper values, indicating an imminent health public hazard, whereas in other regions we found that these limits are not overpassed. This work proposes an electromagnetic pollution classification for urban zones according with ICNIRP standards. We conclude that the urban zone under study presents diverse levels of pollution and that in certain regions an electromagnetic shielding solution is needed in order to safeguard the health of the population that lives there. A practical solution in the form of paint coatings and fiber curtains for the buildings present in this zone is also proposed.

Keywords: electromagnetic field, telecommunication systems, electropollution, health hazards

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Authors: Ahmad Alsolami, Darren Mundy, Manuel Hernandez-Perez

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Social media networks, such as Twitter, offer the perfect opportunity to either positively or negatively affect political attitudes on large audiences. A most important factor contributing to this effect is the existence of influential users, who have developed a reputation for their awareness and experience on specific subjects. Therefore, knowledge of the mechanisms to identify influential users on social media is vital for understanding their effect on their audience. The concept of the influential user is based on the pioneering work of Katz and Lazarsfeld (1959), who created the concept of opinion leaders' to indicate that ideas first flow from mass media to opinion leaders and then to the rest of the population. Hence, the objective of this research was to provide reliable and accurate structural mechanisms to identify influential users, which could be applied to different platforms, places, and subjects. Twitter was selected as the platform of interest, and Saudi Arabia as the context for the investigation. These were selected because Saudi Arabia has a large number of Twitter users, some of whom are considerably active in setting agendas and disseminating ideas. The study considered the scientific methods that have been used to identify public opinion leaders before, utilizing metrics software on Twitter. The key findings propose multiple novel metrics to compare Twitter influencers, including the number of followers, social authority and the use of political hashtags, and four secondary filtering measures. Thus, using ratio and percentage calculations to classify the most influential users, Twitter accounts were filtered, analyzed and included. The structured approach is used as a mechanism to explore the top ten influencers on Twitter from the political domain in Saudi Arabia.

Keywords: twitter, influencers, structured mechanism, Saudi Arabia

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Authors: Ghada M. R. Koura, Mohamed N. Mohamed, Ahmed M. F. El Shiwi

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Chronic mechanical Low back dysfunction (CMLBD) is the most common problem of the working-age population in modern industrial sociaty; it causes a substantial economic burden due to the wide use of medical services and absence from work. Aim of work: the aim of this study was to investigate the effect of positional release technique on patients with chronic mechanical low back pain. Materials and Methods: Thirty two patients from both sexes were diagnosed with CMLBP, aged 20 to 45 years and were divided randomly into two equal groups; sixteen patients each; group A (control group) received therapeutic exercises that include (Stretch and Strength exercises for back and abdominal muscles). Group B (experimental group) received therapeutic exercises with positional release technique; treatment was applied 3 days/week for 4 weeks. Pain was measured by Visual Analogue Scale, Lumbar range of motion was measured by Inclinometer and Functional disability was measured by Oswestry disability scale. Measurements were taken at two intervals pre-treatment and post-treatment. Results: Data obtained was analyzed via paired and unpaired t-Test. There were statistical differences between the 2 groups, where the experimental group showed greater improvement than control group. Conclusion: Positional release technique is considered as an effective treatment for reducing pain, functional disability and increasing lumbar range of motion in individuals with chronic mechanical low back pain.

Keywords: chronic mechanical low back pain, traditional physical therapy program, positional release technique, randomized controlled trial

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Authors: Ash Ahmed, Fraser Hyndman, Heni Fitriani, John Kamau

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The highway pavement is the biggest structural asset a government can construct and maintain. Concrete rigid pavements are used to carry traffic in large volumes across countries safely and efficiently. Pavement quality concrete mixes have high levels of cement which contribute to up to 10% of global CO₂ emissions. Currently the UK specifies (ground granulated blastfurnace slag) GGBS and (pulverised fuel ash) PFA to reduce the quantity of cement used in pavement construction. GGBS and PFA come from heavy industry that should not be relied upon to improve the sustainability of construction materials. This report shows that cement in pavement quality concrete can be replaced with rice husk ash (RHA) without causing adverse effects to the mechanical properties required for highways. RHA comes from the food production industry and is vital for the growing global population. It is thus a socially responsible objective to use a pozzolan in highway pavement construction that is sourced from an environmentally friendly industry. The report investigates the properties of RHA mixes and compares them to existing pavement quality mixes already used and specified. The report found that sieving RHA and not grinding it gives the best performance. Due to the low density of RHA the investigation found that replacing cement by volume rather than weight provided the best results. Findings showed that CEM II mixed with 20% RHA meets the required specification for pavement quality concrete and mitigates using the comparative CEM I. The investigation also notes that RHA is observed to be more reactive with CEM II rather than CEM I and suits early strength gains required for pavement construction. The report concludes that RHA is a sustainable material that reduces the embodied CO₂ of pavement quality concrete, which is well suited for UK highway specifications and has the potential to improve the lives of people living in the developing countries.

Keywords: pavement, pozzolan, rice husk ash, sustainable concrete

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Authors: Madhur Verma, Meena Rajput, Kamal Kishore

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Background: The general view that obesity is a problem of prosperous Western countries has been repealed with substantial evidence showing that middle-income countries like India are now at the heart of a fat explosion. Neck circumference has evolved as a promising index to measure obesity, because of the convenience of its use, even in culture sensitive population. Objectives: To determine whether neck circumference (NC) was associated with overweight and obesity and contributed to the prediction like other classical anthropometric indices. Methodology: Cross-sectional study consisting of 1080 adults (> 19 years) selected through Multi-stage random sampling between August 2013 and September 2014 using the pretested semi-structured questionnaire. After recruitment, the demographic and anthropometric parameters [BMI, Waist & Hip Circumference (WC, HC), Waist to hip ratio (WHR), waist to height ratio (WHtR), body fat percentage (BF %), neck circumference (NC)] were recorded & calculated as per standard procedures. Analysis was done using appropriate statistical tests. (SPSS, version 21.) Results: Mean age of study participants was 44.55+15.65 years. Overall prevalence of overweight & obesity as per modified criteria for Asian Indians (BMI ≥ 23 kg/m2) was 49.62% (Females-51.48%; Males-47.77%). Also, number of participants having high WHR, WHtR, BF%, WC & NC was 827(76.57%), 530(49.07%), 513(47.5%), 537(49.72%) & 376(34.81%) respectively. Variation of NC, BMI & BF% with age was non- significant. In both the genders, as per the Pearson’s correlational analysis, neck circumference was positively correlated with BMI (men, r=0.670 {p < 0.05}; women, r=0.564 {p < 0.05}), BF% (men, r=0.407 {p < 0.05}; women, r= 0.283 {p < 0.05}), WC (men, r=0.598{p < 0.05}; women, r=0.615 {p < 0.05}), HC (men, r=0.512{p < 0.05}; women, r=0.523{p < 0.05}), WHR (men, r= 0.380{p > 0.05}; women, r=0.022{p > 0.05}) & WHtR (men, r=0.318 {p < 0.05}; women, r=0.396{p < 0.05}). On ROC analysis, NC showed good discriminatory power to identify obesity with AUC (AUC for males: 0.822 & females: 0.873; p- value < 0.001) with maximum sensitivity and specificity at a cut-off value of 36.55 cms for males & 34.05cms for females. Conclusion: NC has fair validity as a community-based screener for overweight and obese individuals in the study context and has also correlated well with other classical indices.

Keywords: neck circumference, obesity, anthropometric indices, body fat percentage

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Authors: Karina Reiter, Stefan Dullinger, Christoph Plutzar, Dietmar Moser

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Due to population growth and changing patterns of production and consumption, the demand for natural resources and, as a result, the pressure on Earth’s ecosystems are growing. Biodiversity mapping can be a useful tool for assessing species endangerment or detecting hotspots of extinction risks. This paper explores the benefits of using the change in trophic energy flows as a consequence of the human alteration of the biosphere in biodiversity mapping. To this end, multiple linear regression models were developed to explain species richness in areas where there is no human influence (i.e. wilderness) for three taxonomic groups (birds, mammals, amphibians). The models were then applied to predict (I) potential global species richness using potential natural vegetation (NPPpot) and (II) global ‘actual’ species richness after biomass appropriation using NPP remaining in ecosystems after harvest (NPPeco). By calculating the difference between predicted potential and predicted actual species numbers, maps of estimated species richness loss were generated. Results show that biomass appropriation for human use can indeed be linked to biodiversity loss. Areas for which the models predicted high species loss coincide with areas where species endangerment and extinctions are recorded to be particularly high by the International Union for Conservation of Nature and Natural Resources (IUCN). Furthermore, the analysis revealed that while the species distribution maps of the IUCN Red List of Threatened Species used for this research can determine hotspots of biodiversity loss in large parts of the world, the classification system for threatened and extinct species needs to be revised to better reflect local risks of extinction.

Keywords: biodiversity loss, biomass harvest, human appropriation of net primary production, species richness

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Authors: Phenphak Horadee, Rodchares Hanrinth, Saithip Suttiruksa

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Inappropriate use of antibiotics has happened in several hospitals, Thailand. Drug use evaluation (DUE) is one strategy to overcome this difficulty. However, most community hospitals still encounter incomplete evaluation resulting overuse of antibiotics with high cost. Consequently, drug-resistant bacteria have been rising due to inappropriate antibiotic use. The aim of this study was to involve stakeholders in conceptualizing, developing, and prioritizing a feasible intervention strategy to promote and support appropriate antibiotic prescribing in a community hospital, Thailand. Study antibiotics included four antibiotics such as Meropenem, Piperacillin/tazobactam, Amoxicillin/clavulanic acid, and Vancomycin. The study was conducted for the 1-year period between March 1, 2018, and March 31, 2019, in a community hospital in the northeastern part of Thailand. Concept mapping was used in a purposive sample, including doctors (one was an administrator), pharmacists, and nurses who involving drug use evaluation of antibiotics. In-depth interviews for each participant and survey research were conducted to seek the problems for inappropriate use of antibiotics based on drug use evaluation system. Seventy-seven percent of DUE reported appropriate antibiotic prescribing, which still did not reach the goal of 80 percent appropriateness. Meropenem led other antibiotics for inappropriate prescribing. The causes of the unsuccessful DUE program were classified into three themes such as personnel, lack of public relation and communication, and unsupported policy and impractical regulations. During the first meeting, stakeholders (n = 21) expressed the generation of interventions. During the second meeting, participants who were almost the same group of people in the first meeting (n = 21) were requested to independently rate the feasibility and importance of each idea and to categorize them into relevant clusters to facilitate multidimensional scaling and hierarchical cluster analysis. The outputs of analysis included the idealist, cluster list, point map, point rating map, cluster map, and cluster rating map. All of these were distributed to participants (n = 21) during the third meeting to reach consensus on an intervention model. The final proposed intervention strategy included 29 feasible and crucial interventions in seven clusters: development of information technology system, establishing policy and taking it into the action plan, proactive public relations of the policy, action plan and workflow, in cooperation of multidisciplinary teams in drug use evaluation, work review and evaluation with performance reporting, promoting and developing professional and clinical skill for staff with training programs, and developing practical drug use evaluation guideline for antibiotics. These interventions are relevant and fit to several intervention strategies for antibiotic stewardship program in many international organizations such as participation of the multidisciplinary team, developing information technology to support antibiotic smart use, and communication. These interventions were prioritized for implementation over a 1-year period. Once the possibility of each activity or plan is set up, the proposed program could be applied and integrated into hospital policy after evaluating plans. Effectiveness of each intervention could be promoted to other community hospitals to promote and support antibiotic smart use.

Keywords: antibiotic, concept mapping, drug use evaluation, multidisciplinary teams

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