Search results for: carbapenem stewardship

Authors: Xiaomin Zhong, Alexander Pate, Ya-Ting Yang, Ali Fahmi, Darren M. Ashcroft, Ben Goldacre, Brian Mackenna, Amir Mehrkar, Sebastian C. J. Bacon, Jon Massey, Louis Fisher, Peter Inglesby, Kieran Hand, Tjeerd van Staa, Victoria Palin

Abstract:

Background: This study aimed to predict risks of potentially inappropriate antibiotic type and repeat prescribing and assess changes during COVID-19. Methods: With the approval of NHS England, we used the OpenSAFELY platform to access the TPP SystmOne electronic health record (EHR) system and selected patients prescribed antibiotics from 2019 to 2021. Multinomial logistic regression models predicted the patient’s probability of receiving an inappropriate antibiotic type or repeating the antibiotic course for each common infection. Findings: The population included 9.1 million patients with 29.2 million antibiotic prescriptions. 29.1% of prescriptions were identified as repeat prescribing. Those with same-day incident infection coded in the EHR had considerably lower rates of repeat prescribing (18.0%), and 8.6% had a potentially inappropriate type. No major changes in the rates of repeat antibiotic prescribing during COVID-19 were found. In the ten risk prediction models, good levels of calibration and moderate levels of discrimination were found. Important predictors included age, prior antibiotic prescribing, and region. Patients varied in their predicted risks. For sore throat, the range from 2.5 to 97.5th percentile was 2.7 to 23.5% (inappropriate type) and 6.0 to 27.2% (repeat prescription). For otitis externa, these numbers were 25.9 to 63.9% and 8.5 to 37.1%, respectively. Interpretation: Our study found no evidence of changes in the level of inappropriate or repeat antibiotic prescribing after the start of COVID-19. Repeat antibiotic prescribing was frequent and varied according to regional and patient characteristics. There is a need for treatment guidelines to be developed around antibiotic failure and clinicians provided with individualised patient information.

Keywords: antibiotics, infection, COVID-19 pandemic, antibiotic stewardship, primary care

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Authors: Miroslava Markovic, Snezana Rajkovic, Ljubinko Rakonjac, Aleksandar Lucic

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Oak powdery mildew is a serious problem on seedlings in nurseries as well as on naturally and artificially introduced progeny. The experiments were set on oak seedlings in two nurseries located in Central Serbia, where control of oak powdery mildew Microsphaera alphitoides Griff. et Maubl. had been conducted through alternative protection measures by means of various dosages of AQ-10 biofungicide, with and without added polymer (which has so far never been used in this country for control of oak powdery mildew). Simultaneous testing was conducted on the efficiency of a chemical sulphur-based preparation (used in this area for many years as a measure of suppression of powdery mildews, without the possibility of developing resistance of the pathogen to the active matter). To date, the Republic of Serbia has registered no fungicides for suppression of pathogens in the forest ecosystems. In order to introduce proper use of new disease-fighting agents into a country, certain relevant principles, requirements and criteria prescribed by the Forest Stewardship Council (FSC) must be observed, primarily with respect to measures of assessment and mitigation of risks, the list of dangerous and highly dangerous pesticides with the possibility of alternative protection. One of the main goals of the research was adjustment of the protective measures to the FSC policy through selection of eco-toxicologically favourable fungicides, given the fact that only preparations named on the list of permitted active matters are approved for use in certified forests. The results of the research have demonstrated that AQ-10 biofungicide can be used as a part of integrated disease management programmes as an alternative, through application of several treatments during vegetation and combination with other active matters registered for these purposes, so as to curtail the use of standard fungicides for control of powdery mildews on oak seedlings in nurseries. The best results in suppression of oak powdery mildew were attained through use of AQ-10 biofungicide (dose 50 or 70g/ha) with added polymer Nu Film-17 (dose 1.0 or 1.5 l/ha). If the treatment is applied at the appropriate time, even fewer number of treatments and smaller doses will be just as efficient.

Keywords: oak powdery mildew, biofungicides, polymers, Microsphaera alphitoides

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Authors: Abu Samah Abdul Khalim, Hamzah Khali Aziz

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Tropical forests in Malaysia safeguard enormous biological diversity while providing crucial benefits and services for the sustainable development of human communities. They are highly significant globally, both for their diverse and threatened species and as representative unique ecosystems. In order to promote the conservation and sustainable management of forest in this country, the Forestry Department (FD) is using ITTO guidelines on managing the forest under the Sustainable Forest Management practice (SFM). The fundamental principles of SFM are the sustained provision of products, goods and services; economic viability, social acceptability and the minimization of environmental/ecological impacts. With increased awareness and recognition of the importance of tropical forests and biodiversity in the global environment, efforts have been made to classify forests and natural areas with unique values or properties in a universally accepted scale. In line with that the concept of High Conservation Value Forest (HCVF) first used by the Forest Stewardship Council (FSC) in 1999, has been adopted and included as Principle ‘9’ in the Malaysia Criteria and Indicators for Forest Management Certification (MC&I 2002). The MC&I 2002 is a standard used for assessing forest management practices of the Forest Management Unit (FMU) level for purpose of certification. The key to the concept of HCVF is identification of HCVs of the forest. This paper highlighted initiative taken by the Forestry Department Peninsular Malaysia in establishing and managing HCVF areas within the Permanent Forest Reserves (PFE). To date almost all states forestry department in Peninsular Malaysia have established HCVFs in their respective states under different categories. Among others, the establishments of HCVF in this country are related to the importance of conserving biological diversity of the flora in the natural forest in particular endemic and threatened species such as Shorea bentongensis. As such it is anticipated that by taking this important initiatives, it will promote the conservation of biological diversity in the PFE of Peninsular Malaysia in line with the Sustainable Forest Management practice.

Keywords: high conservation value forest, sustainable forest management, forest management certification, Peninsular Malaysia

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Authors: Ana Karaman, Dmitriy Gaevoy

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Successful and effective governing boards play an essential role in higher education by providing essential oversight and helping to steer the direction of an institution while creating and maintaining a thriving culture of stewardship. A well-functioning board can also help mitigate conflicts of interest, ensure responsible use of an organization's assets, and maintain institutional transparency. However, boards’ functions in higher education are inhibited by the presence of information asymmetry between the board and management. Board members typically have little specific knowledge about the business side of the higher education, in general, and an institution under their oversight in particular. As a result, boards often must rely on the discretion of the institutional upper administration as to what type of pertinent information being disclosed to the board. The phenomenon of information asymmetry is not unique to the higher education and has been studied previously in the context of both corporate and non-for-profit boards. Various board characteristics have been analyzed with respect to mitigating the information asymmetry between an organizational board and management. For example, it has been argued that such board characteristics as its greater size, independence, and a higher proportion of female members tend to reduce information asymmetry by raising levels of information disclosure and organizational transparency. This paper explores the phenomenon of information asymmetry between boards and management in the context of higher education. In our analysis, we propose a heat map of information asymmetry based on the categories of board competencies in higher education. The proposed heat map is based on the assessment of potential risks to both the boards and its institutions. It employs an assumption that a potential risk created by the presence of information asymmetry varies in its magnitude across various areas of boards’ competencies. Then, we explore the role of board members’ training in mitigating information asymmetry between the boards and the management by increasing the level of information disclosure and enhancing transparency in management communication with the boards. The paper seeks to demonstrate how appropriate training can provide board members with an adequate preparation to request a sufficient level of information disclose and transparency by arming them with knowledge of what questions to ask of the management.

Keywords: higher education, governing boards information asymmetry, board competencies, board training

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Authors: Mohd Zaki Hamzah, Roslan Rani, Ahmad Bazli Razali, Satiful Bahri Mamat, Abdul Hadi Ripin, Mohd Harun Esa

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Ever since 1901, forest management and silviculture practices in Malaysia have been frequently reviewed and updated to take into account changes in forest conditions, markets, timber demand/supply and technical advances that can be achieved in industrial processes, logging and forest harvesting, and currently, the forest management system practiced in Peninsular Malaysia is the Selective Management System (SMS) which was introduced in 1978. This system requires the selection of management regime (felling) based on Pre-Felling Forest Inventory (Pre-F) data to ensure economical harvesting and also ensuring adequate standing stands for subsequent rounds of felling, while maintaining ecological balance and environmental quality. SMS regulates forest harvesting through area and volume controls, with the cutting cycle 30 years. Most of the forest management units (FMU) (in Peninsular Malaysia) implementing SMS have been certified by Forest Stewardship Council (FSC) and/or Program for Endorsement of Forest Certification (PEFC), and one such FMU belongs to Kumpulan Pengurusan Kayu Kayan Terengganu (KPKKT). KPKKT, a timber management subsidiary of Golden Pharos Berhad (GPB), adopts the SMS to manage its 108,900 ha of timber concessionary areas in its role as logs’ supplier for the consumption of three subsidiaries of GPB. KPKKT is also responsible for the sustainable development and management of its concession in accordance with the Sustainable Forest Management (SFM) standards to ensure that it addresses the loss of forest cover and forest degradation, forest-based economic, social and environmental benefits, and ecologically protecting forests while mobilising financial resources for the implementation of sustainable forest management planning, harvesting, monitoring and the marketing of products. This paper will detail out the management and harvesting guidelines imposed by the controlling government agency, and harvesting processes taken by KPKKT to comply with guidelines and eventually supplying timber to the relevant subsidiaries (downstream mills under GPB).

Keywords: sustainable forest management, silviculture, reduce impact logging, forest certification

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Authors: Ming-Jyh Chen, Wen-Ming Huang, Yi-Chu Liu, Li-Hui Yang

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Introduction: Social responsibility is the key to sustainable organizational development. Under the ground Green Health Hospital Declaration signed by our superintendent, we have launched comprehensive energy conservation management in medical services, the community, and the staff’s life. To execute environment-friendly promotion with robust strategies, we build up a low-carbon medical system and community with smart green public construction promotion as well as intensifying energy conservation education and communication. Purpose/Methods: With the support of the board and the superintendent, we construct an energy management team, commencing with an environment-friendly system, management, education, and ISO 50001 energy management system; we have ameliorated energy performance and energy efficiency and continuing. Results: In the year 2021, we have achieved multiple goals. The energy management system efficiently controls diesel, natural gas, and electricity usage. About 5% of the consumption is saved when compared to the numbers from 2018 and 2021. Our company develops intelligent services and promotes various paperless electronic operations to provide people with a vibrant and environmentally friendly lifestyle. The goal is to save 68.6% on printing and photocopying by reducing 35.15 million sheets of paper yearly. We strengthen the concept of environmental protection classification among colleagues. In the past two years, the amount of resource recycling has reached more than 650 tons, and the resource recycling rate has reached 70%. The annual growth rate of waste recycling is about 28 metric tons. Conclusions: To build a green medical system with “high efficacy, high value, low carbon, low reliance,” energy stewardship, economic prosperity, and social responsibility are our principles when it comes to formulation of energy conservation management strategies, converting limited sources to efficient usage, developing clean energy, and continuing with sustainable energy.

Keywords: energy efficiency, environmental education, green hospital, sustainable development

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Authors: Ola A. Nassr, Ali M. Abd Alridha, Rua A. Naser, Rasha S. Abbas

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Background: Excessive and inappropriate use of antimicrobial agents among hospitalized patients remains an important patient safety and public health issue worldwide. Not only does this behavior incur unnecessary cost but it is also associated with increased morbidity and mortality. The objective of this study is to obtain an insight into the prescribing patterns of antibiotics in surgical and medical wards, to help identify a scope for improvement in service delivery. Method: A simple point prevalence survey included a convenience sample of 200 patients admitted to medical and surgical wards in a government teaching hospital in Baghdad between October 2017 and April 2018. Data were collected by a trained pharmacy intern using a standardized form. Patient’s demographics and details of the prescribed antibiotics, including dose, frequency of dosing and route of administration, were reported. Patients were included if they had been admitted at least 24 hours before the survey. Patients under 18 years of age, having a diagnosis of cancer or shock, or being admitted to the intensive care unit, were excluded. Data were checked and entered by the authors into Excel and were subjected to frequency analysis, which was carried out on anonymized data to protect patient confidentiality. Results: Overall, 88.5% of patients (n=177) received 293 antibiotics during their hospital admission, with a small variation between wards (80%-97%). The average number of antibiotics prescribed per patient was 1.65, ranging from 1.3 for medical patients to 1.95 for surgical patients. Parenteral third-generation cephalosporins were the most commonly prescribed at a rate of 54.3% (n=159) followed by nitroimidazole 29.4% (n=86), quinolones 7.5% (n=22) and macrolides 4.4% (n=13), while carbapenems and aminoglycosides were the least prescribed together accounting for only 4.4% (n=13). The intravenous route was the most common route of administration, used for 96.6% of patients (n=171). Indications were reported in only 63.8% of cases. Culture to identify pathogenic organisms was employed in only 0.5% of cases. Conclusion: Broad-spectrum antibiotics are prescribed at an alarming rate. This practice may provoke antibiotic resistance and adversely affect the patient outcome. Implementation of an antibiotic stewardship program is warranted to enhance the efficacy, safety and cost-effectiveness of antimicrobial agents.

Keywords: Acute care, Antibiotic misuse, Iraq, Prescribing

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Authors: Mehdi Soula, Yosra Mani, Estelle Saras, Antoine Drapeau, Raoudha Grami, Mahjoub Aouni, Jean-Yves Madec, Marisa Haenni, Wejdene Mansour

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Multi-resistance to antibiotics in gram-negative bacilli and particularly in enterobacteriaceae, has become frequent in hospitals in Tunisia. However, data on antibiotic resistant bacteria in aquatic products are scarce. The aims of this study are to estimate the proportion of ESBL- and carbapenemase-producing Enterobacterales in seafood (clams and fish) in Tunisia and to molecularly characterize the collected isolates. Two types of seafood were sampled in unrelated markets in four different regions in Tunisia (641 pieces of farmed fish and 1075 mediterranean clams divided into 215 pools, and each pool contained 5 pieces). Once purchased, all samples were incubated in tubes containing peptone salt broth for 24 to 48h at 37°C. After incubation, overnight cultures were isolated on selective MacConkey agar plates supplemented with either imipenem or cefotaxime, identified using API20E test strips (bioMérieux, Marcy-l’Étoile, France) and confirmed by Maldi-TOF MS. Antimicrobial susceptibility was determined by the disk diffusion method on Mueller-Hinton agar plates and results were interpreted according to CA-SFM 2021. ESBL-producing Enterobacterales were detected using the Double Disc Synergy Test (DDST). Carbapenem-resistance was detected using an ertapenem disk and was respectively confirmed using the ROSCO KPC/MBL and OXA-48 Confirm Kit (ROSCO Diagnostica, Taastrup, Denmark). DNA was extracted using a NucleoSpin Microbial DNA extraction kit (Macherey-Nagel, Hoerdt, France), according to the manufacturer’s instructions. Resistance genes were determined using the CGE online tools. The replicon content and plasmid formula were identified from the WGS data using PlasmidFinder 2.0.1 and pMLST 2.0. From farmed fishes, nine ESBL-producing strains (9/641, 1.4%) were isolated, which were identified as E. coli (n=6) and K. pneumoniae (n=3). Among the 215 pools of 5 clams analyzed, 18 ESBL-producing isolates were identified, including 14 E. coli and 4 K. pneumoniae. A low isolation rate of ESBL-producing Enterobacterales was detected 1.6% (18/1075) in clam pools. In fish, the ESBL phenotype was due to the presence of the blaCTX-M-15 gene in all nine isolates, but no carbapenemase gene was identified. In clams, the predominant ESBL phenotype was blaCTX-M-1 (n=6/18). blaCPE (NDM1, OXA48) was detected only in 3 isolates ‘K. pneumoniae isolates’. Replicon typing on the strains carring the ESBL and carbapenemase gene revelead that the major type plasmid carried ESBL were IncF (42.3%) [n=11/26]. In all, our results suggest that seafood can be a reservoir of multi-drug resistant bacteria, most probably of human origin but also by the selection pressure of antibiotic. Our findings raise concerns that seafood bought for consumption may serve as potential reservoirs of AMR genes and pose serious threat to public health.

Keywords: BLSE, carbapenemase, enterobacterales, tunisian seafood

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Authors: H. Akhloufi, M. Hulscher, J. M. Prins, I. H. Van Der Sijs, D. Melles, A. Verbon

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Background: A timely switch from intravenous to oral antibiotic therapy has many advantages, such as reduced incidence of IV-line related infections, a decreased hospital length of stay and less workload for healthcare professionals with equivalent patient safety. Additionally, numerous studies have demonstrated significant decreases in costs of a timely intravenous to oral antibiotic therapy switch, while maintaining efficacy and safety. However, a considerable variation in iv to oral antibiotic switch therapy criteria has been described in literature. Here, we report the development of a set of iv to oral switch criteria that are generally applicable in all hospitals. Material/methods: A RAND-modified Delphi procedure, which was composed of 3 rounds, was used. This Delphi procedure is a widely used structured process to develop consensus using multiple rounds of questionnaires within a qualified panel of selected experts. The international expert panel was multidisciplinary and composed out of clinical microbiologists, infectious disease consultants and clinical pharmacists. This panel of 19 experts appraised 6 major intravenous to oral antibiotic switch therapy criteria and operationalized these criteria using 41 measurable conditions extracted from the literature. The procedure to select a concise set of iv to oral switch criteria included 2 questionnaire rounds and a face-to-face meeting. Results: The procedure resulted in the selection of 16 measurable conditions, which operationalize 6 major intravenous to oral antibiotic switch therapy criteria. The following 6 major switch therapy criteria were selected: (1) Vital signs should be good or improving when bad. (2) Signs and symptoms related to the infection have to be resolved or improved. (3) The gastrointestinal tract has to be intact and functioning. (4) The oral route should not be compromised. (5) Absence of contra-indicated infections. (6) An oral variant of the antibiotic with good bioavailability has to exist. Conclusions: This systematic stepwise method which combined evidence and expert opinion resulted in a feasible set of 6 major intravenous to oral antibiotic switch therapy criteria operationalized by 16 measurable conditions. This set of early antibiotic iv to oral switch criteria can be used in daily practice in all adult hospital patients. Future use in audits and as rules in computer assisted decision support systems will lead to improvement of antimicrobial steward ship programs.

Keywords: antibiotic resistance, antibiotic stewardship, intravenous to oral, switch therapy

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Authors: T. Mcgraw, F. N. Morin, N. Desai

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Background: Antimicrobial resistance is a critical issue in global health care and a significant contributor to increased patient morbidity and mortality. Suspected urinary tract infection (UTI) is a key area of inappropriate antibiotic prescription in pediatrics. Management patterns of infectious diseases have been shown to vary by provider type within a single setting. The aim of this study was to assess compliance with national UTI management guidelines by nurse practitioners in a pediatric emergency department (ED). Methods: This was a post-hoc analysis of a retrospective cohort study to review and evaluate visits to a tertiary care freestanding pediatric emergency department. Patients were included if they were 60 days to 36 months old and discharged with a diagnosis of UTI or ‘rule-out UTI’ between July 2015 and July 2020. Primary outcome measure was proportion of visits seen by Nurse Practitioners (NP) which were associated with national guideline compliance in the diagnosis and treatment of suspected UTI. We performed descriptive statistics and comparative analyses to determine differences in practice patterns between NPs, and physicians. Results: A total of 636 charts were reviewed, of which 402 patients met inclusion criteria. 17 patients were treated by NPs, 385 were treated by either Pediatric Emergency Medicine physicians (PEM) or non-PEM physicians. Overall, the proportion of infants receiving guideline-compliant care was 25.9% (21.8-30.4%). Of those who were prescribed antibiotics, 79.6% (74.7-83.8%) received first line guideline recommended therapy and 58.9% (53.8-63.8%) received fully compliant therapy with respect to age, dose, duration, and frequency. In patients treated by NPs, 16/17 (94%(95% CI:73.0-99.0)) required antibiotics, 15/16 (93%(95% CI: 71.7-98.9)) were treated with first line agent (cephalexin), 8/16 (50%(95% CI:28-72)) were guideline compliant of dose and duration. 5/8 (63%(95% CI:30.6-86.3)) were noncompliant for dose being too high. There was no difference in receiving guideline compliant empiric antibiotic therapy between physicians and nurse practitioners (OR: 0.837 CI: 0.302-2.69). Conclusion: In this post-hoc analysis, guideline noncompliance by nurse practitioners is common in children tested and treated for UTIs in a pediatric emergency department. Care by a Nurse Practitioner was not associated with greater rate of noncompliance than care by a Pediatric Emergency Medicine physician. Future appropriately powered studies may focus on confirming these results.

Keywords: antibiotic stewardship, infectious disease, nurse practitioner, urinary tract infection

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Authors: Waad Al Saleemi, Badriya Al Adawi, Zaaima Al Jabri, Sahim Al Ghafri, Jalila Al Hadhramia

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Objectives: Using standard lab methods, a positive blood culture requires a minimum of two days (two occasions of overnight incubation) to obtain a final identification (ID) and antimicrobial susceptibility results (AST) report. In this study, we aimed to evaluate the accuracy and precision of identification and antimicrobial susceptibility testing of an alternative method (direct method) that will reduce the turnaround time by 24 hours. This method involves the direct inoculation of positive blood culture broths into the Phoenix system using serum separation tubes (SST). Method: This prospective study included monomicrobial-positive blood cultures obtained from January 2022 to May 2023 in SQUH. Blood cultures containing a mixture of organisms, fungi, or anaerobic organisms were excluded from this study. The result of the new “direct method” under study was compared with the current “standard method” used in the lab. The accuracy and precision were evaluated for the ID and AST using Clinical and Laboratory Standards Institute (CLSI) recommendations. The categorical agreement, essential agreement, and the rates of very major errors (VME), major errors (ME), and minor errors (MIE) for both gram-negative and gram-positive bacteria were calculated. Passing criteria were set according to CLSI. Result: The results of ID and AST were available for a total of 158 isolates. Of 77 isolates of gram-negative bacteria, 71 (92%) were correctly identified at the species level. Of 70 isolates of gram-positive bacteria, 47(67%) isolates were correctly identified. For gram-negative bacteria, the essential agreement of the direct method was ≥92% when compared to the standard method, while the categorical agreement was ≥91% for all tested antibiotics. The precision of ID and AST were noted to be 100% for all tested isolates. For gram-positive bacteria, the essential agreement was >93%, while the categorical agreement was >92% for all tested antibiotics except moxifloxacin. Many antibiotics were noted to have an unacceptable higher rate of very major errors including penicillin, cotrimoxazole, clindamycin, ciprofloxacin, and moxifloxacin. However, no error was observed in the results of vancomycin, linezolid, and daptomycin. Conclusion: The direct method of ID and AST for positive blood cultures using SST is reliable for gram negative bacteria. It will significantly decrease the turnaround time and will facilitate antimicrobial stewardship.

Keywords: bloodstream infection, oman, direct ast, blood culture, rapid identification, antimicrobial susceptibility, phoenix, direct inoculation

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Authors: T. Elrazaz

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This paper examines accrual and real earnings management by publicly listed targets around mergers and acquisitions. Prior literature shows that earnings management around mergers and acquisitions can have a significant economic impact because of the associated wealth transfers among stakeholders. More importantly, acting on behalf of their shareholders or pursuing their self-interests, managers of both targets and acquirers may be equally motivated to manipulate earnings prior to an acquisition to generate higher gains for their shareholders or themselves. Building on the grounds of information asymmetry, agency conflicts, stewardship theory, and the revelation principle, this study addresses the question of whether takeover targets employ accrual and real earnings management in the periods prior to the announcement of Mergers and Acquisitions (M&A). Additionally, this study examines whether acquirers are able to detect targets’ earnings management, and in response, adjust the acquisition premium paid in order not to face the risk of overpayment. This study uses an aggregate accruals approach in estimating accrual earnings management as proxied by estimated abnormal accruals. Additionally, real earnings management is proxied for by employing widely used models in accounting and finance literature. The results of this study indicate that takeover targets manipulate their earnings using accruals in the second year with an earnings release prior to the announcement of the M&A. Moreover, in partitioning the sample of targets according to the method of payment used in the deal, the results are restricted only to targets of stock-financed deals. These results are consistent with the argument that targets of cash-only or mixed-payment deals do not have the same strong motivations to manage their earnings as their stock-financed deals counterparts do additionally supporting the findings of prior studies that the method of payment in takeovers is value relevant. The findings of this study also indicate that takeover targets manipulate earnings upwards through cutting discretionary expenses the year prior to the acquisition while they do not do so by manipulating sales or production costs. Moreover, in partitioning the sample of targets according to the method of payment used in the deal, the results are restricted only to targets of stock-financed deals, providing further robustness to the results derived under the accrual-based models. Finally, this study finds evidence suggesting that acquirers are fully aware of the accrual-based techniques employed by takeover targets and can unveil such manipulation practices. These results are robust to alternative accrual and real earnings management proxies, as well as controlling for the method of payment in the deal.

Keywords: accrual earnings management, acquisition premium, real earnings management, takeover targets

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Authors: S. Mamoucha, N.Tsafantakis, T. Ioannidis, S. Chatzipanagiotou, C. Nikolaou, L. Skaltsounis, N. Fokialakis, N. Christodoulakis

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Introduction: Pistacia lentiscus L. (well known as Mastic tree) is an evergreen sclerophyllous shrub that extensively thrives in the eastern Mediterranean area yet only the trees cultivated in the southern region of the Greek island Chios produces mastic resin. Different parts of P. lentiscus L. var. chia have been used in folk medicine for various purposes, such as tonic, aphrodisiac, antiseptic, antihypertensive and management of dental, gastrointestinal, liver, urinary, and respiratory tract disorders. Several studies have focused on the antibacterial activity of its resin (gum) and its essential oil. However, there is no study combining anatomy of the plant organs, phytochemical profile, and antibacterial screening of the plant. In our attempt to discover novel bioactive metabolites from the mastic tree, we screened its antibacterial activity not only against ATCC strains but also against clinical, resistant strains. Materials-methods: Leaves were investigated using Transmission (ΤΕΜ) and Scanning Εlectron Microscopy (SEM). Histochemical tests were performed on fresh and fixed tissue. Extracts prepared from dried, powdered leaves using 3 different solvents (DCM, MeOH and H2O) the waste water obtained after a hydrodistillation process for essential oil production were screened for their phytochemical content and antibacterial activity. Μetabolite profiling of polar and non-polar extracts was recorded by GC-MS and LC-HRMS techniques and analyzed using in-house and commercial libraries. The antibacterial screening was performed against Staphylococcus aureus ATCC25923, Escherichia coli ATCC25922, Pseudomonas aeruginosa ATCC27853 and against clinical, resistant strains Methicillin-resistant S. aureus (MRSA), Carbapenem-Resistant Metallo-β-Lactamase (carbapenemase) P. aeruginosa (VIM), Klebsiella pneumoniae carbapenemases (KPCs) and Acinetobacter baumanii resistant strains. The antibacterial activity was tested by the Kirby Bauer and the Agar Well Diffusion method. The zone of inhibition (ZI) of each extract was measured and compared with those of common antibiotics. Results: Leaf is compact with inosclereids and numerous idioblasts containing a globular, spiny crystal. The major nerves of the leaf contain a resin duct. Mesophyll cells showed accumulation of osmiophillic metabolites. Histochemical treatments defined secondary metabolites in subcellular localization. The phytochemical investigation revealed the presence of a large number of secondary metabolites, belonging to different chemical groups, such as terpenoids, phenolic compounds (mainly myricetin, kaempferol and quercetin glycosides), phenolic, and fatty acids. Among the extracts, the hydrostillation wastewater achieved the best results against most of the bacteria tested. MRSA, VIM and A. baumanii were inhibited. Conclusion: Extracts from plants have recently been of great interest with respect to their antimicrobial activity. Their use emerged from a growing tendency to replace synthetic antimicrobial agents with natural ones. Leaves of P. lentiscus L. var. chia showed a high antimicrobial activity even against drug - resistant bacteria. Future prospects concern the better understanding of mode of action of the antibacterial activity, the isolation of the most bioactive constituents and the clarification if the activity is related to a single compound or to the synergistic effect of several ones.

Keywords: antibacterial screening, leaf anatomy, phytochemical profile, Pistacia lentiscus var. chia

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Authors: M. S. Raza, A. Kapil, Sonu Tyagi, H. Gautam, S. Mohapatra, R. Chaudhry, S. Sood, V. Goyal, R. Lodha, V. Sreenivas, B. K. Das

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Background: Acute bacterial meningitis remains the major cause of mortality and morbidity. More than half of the survivors develop the significant lifelong neurological abnormalities. Diagnosis of the hospital acquired acute bacterial meningitis (HAABM) is challenging as it appears either in the post operative patients or patients acquire the organisms from the hospital environment. In both the situations, pathogens are exposed to high dose of antibiotics. Chances of getting multidrug resistance organism are very high. We have performed this experiment to find out the etiological agents of HAABM and its antibiotics susceptibility pattern. Methodology: A perspective study was conducted at the Department of Microbiology, All India Institute of Medical Sciences, New Delhi. From March 2015 to April 2018 total 400 Cerebro spinal fluid samples were collected aseptically. Samples were processed for cell count, Gram staining, and culture. Culture plates were incubated at 37°C for 18-24 hours. Organism grown on blood and MacConkey agar were identified by MALDI-TOF Vitek MS (BioMerieux, France) and antibiotic susceptibility tests were performed by Kirby Bauer disc diffusion method as per CLSI 2015 guideline. Results: Of the 400 CSF samples processed, 43 (10.75%) were culture positive for different bacteria. Out of 43 isolates, the most prevalent Gram-positive organisms were S. aureus 4 (9.30%) followed by E. faecium 3 (6.97%) & CONS 2 (4.65%). Similarly, E. coli 13 (30.23%) was the commonest Gram-negative isolates followed by A. baumannii 12 (27.90%), K. pneumonia 5 (11.62%) and P. aeruginosa 4(9.30%). Most of the antibiotics tested against the Gram-negative isolates were resistance to them. Colistin was most effective followed by Meropenem and Imepenim for all Gram-negative HAABM isolates. Similarly, most of antibiotics tested were susceptible to S. aureus and CONS. However, E. faecium (100%) were only susceptible to vancomycin and teicoplanin. Conclusion: Hospital acquired acute bacterial meningitis (HAABM) is becoming the emerging challenge as most of isolates are showing resistance to commonly used antibiotics. Gram-negative organisms are emerging as the major player of HAABM. Great care needs to be taken especially in tertiary care hospitals. Similarly, antibiotic stewardship should be followed and antibiotic susceptibility test (AST) should be performed regularly to update the antibiotic patter and to prevent from the emergence of resistance. Updated information of the AST will be helpful for the better management of the meningitis patient.

Keywords: CSF, MALDI-TOF, hospital acquired acute bacterial meningitis, AST

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Authors: Ken Zakreski

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Regulating Canadian Facebook Groups, of a size and type, when they reach a threshold of audio video content. Consider the evolution of the Streaming Act, Parl GC Bill C-11 (44-1) and the regulations that will certainly follow. The Canadian Heritage Minister's office stipulates, "the Broadcasting Act only applies to audio and audiovisual content, not written journalism.” Governance— After 10 years, a community radio station for Gabriola Island, BC – Canadian Radio-television and Telecommunications Commission (“CRTC”) was approved but never started – became a Facebook Group “Community Bulletin Board - Life on Gabriola“ referred to as CBBlog. After CBBlog started and began to gather real traction, a member of the Group cloned the membership and ran their competing Facebook group under the banner of "free speech”. Here we see an inflection point [change of cultural stewardship] with two different mathematical results [engagement and membership growth]. Canada's telecommunication history of “portability” and “interoperability” made that Facebook Group CBBlog the better option, over broadcast FM radio for a community pandemic information sharing service for Gabriola Island, BC. A culture of ignorance flourishes in social media. Often people do not understand their own experience, or the experience of others because they do not have the concepts needed for understanding. It is thus important they are not denied concepts required for their full understanding. For example, Legislators need to know something about gay culture before they can make any decisions about it. Community Media policies and CRTC regulations are known and regulators can use that history to forge forward with regulations for internet platforms of a size and content type that reach a threshold of audio / video content. Mostly volunteer run media services, provide order of magnitude lower costs over commercial media. (Treating) Facebook Groups as new media.? Cathy Edwards, executive director of the Canadian Association of Community Television Users and Stations (“CACTUS”), calls it new media in that the distribution platform is not the issue. What does make community groups community media? Cathy responded, "... it's bylaws, articles of incorporation that state they are community media, they have accessibility, commitments to skills training, any member of the community can be a member, and there is accountability to a board of directors". Eligibility for funding through CACTUS requires these same commitments. It is risky for a community to invest into a platform as ownership has not been litigated. Is a FaceBook Group an asset of a not for profit society? The memo, from law student, Jared Hubbard summarizes, “Rights and interests in a Facebook group could, in theory, be transferred as property... This theory is currently unconfirmed by Canadian courts. “

Keywords: social media, governance, community media, Canadian radio

Procedia PDF Downloads 39

Authors: Sofia Papadimitriou

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INTRODUCTION: The differential diagnosis between acute viral and bacterial infections is an important cost-effectiveness parameter at the stage of the treatment process in order to achieve the maximum benefits in therapeutic intervention by combining the minimum cost to ensure the proper use of antibiotics.The discovery of sensitive and robust molecular diagnostic tests in response to the role of the host in infections has enhanced the accurate diagnosis and differentiation of infections. METHOD: The study used a sample of six independent blood samples (total=756) which are associated with human proteins-proteins, each of which at the transcription stage expresses a different response in the host network between viral and bacterial infections.Τhe individual blood samples are subjected to a sequence of computer filters that identify a gene panel corresponding to an autonomous diagnostic score. The data set and the correspondence of the gene panel to the diagnostic patents a new Bangalore -Viral Bacterial (BL-VB). FINDING: We use a biomarker based on the blood of 10 genes(Panel-VB) that are an important prognostic value for the detection of viruses from bacterial infections with a weighted average AUROC of 0.97(95% CL:0.96-0.99) in eleven independent samples (sets n=898). We discovered a base with a patient score (VB 10 ) according to the table, which is a significant diagnostic value with a weighted average of AUROC 0.94(95% CL: 0.91-0.98) in 2996 patient samples from 56 public sets of data from 19 different countries. We also studied VB 10 in a new cohort of South India (BL-VB,n=56) and found 97% accuracy in confirmed cases of viral and bacterial infections. We found that VB 10 (a)accurately identifies the type of infection even in unspecified cases negative to the culture (b) shows its clinical condition recovery and (c) applies to all age groups, covering a wide range of acute bacterial and viral infectious, including non-specific pathogens. We applied our VB 10 rating to publicly available COVID 19 data and found that our rating diagnosed viral infection in patient samples. RESULTS: Τhe results of the study showed the diagnostic power of the biomarker VB 10 as a diagnostic test for the accurate diagnosis of acute infections in recovery conditions. We look forward to helping you make clinical decisions about prescribing antibiotics and integrating them into your policies management of antibiotic stewardship efforts. CONCLUSIONS: Overall, we are developing a new property of the RNA-based biomarker and a new blood test to differentiate between viral and bacterial infections to assist a physician in designing the optimal treatment regimen to contribute to the proper use of antibiotics and reduce the burden on antimicrobial resistance, AMR.

Keywords: acute infections, antimicrobial resistance, biomarker, blood transcriptome, systems biology, classifier diagnostic score

Procedia PDF Downloads 128

Authors: Lana Whiskeyjack, Kyle Napier

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The Spirit of the language embodies the motivation for indigenous people to connect with the indigenous language of their lineage. While the concept of the spirit of the language is often woven into the discussion by indigenous language revitalizationists, particularly those who are indigenous, there are few tangible terms in academic research conceptually actualizing the term. Through collaborative work with indigenous language speakers, elders, and learners, this research sets out to identify the spirit of the language, the catalysts of disconnection from the spirit of the language, and the sources of reconnection to the spirit of the language. This work fundamentally addresses the terms of engagement around collaboration with indigenous communities, itself inviting a decolonial approach to community outreach and individual relationships. As indigenous researchers, this means beginning, maintain, and closing this work in the ceremony while being transparent with community members in this work and related publishing throughout the project’s duration. Decolonizing this approach also requires maintaining explicit ongoing consent by the elders, knowledge keepers, and community members when handling their ancestral and indigenous knowledge. The handling of this knowledge is regarded in this work as stewardship, both in the handling of digital materials and the handling of ancestral Indigenous knowledge. This work observes recorded conversations in both nêhiyawêwin and English, resulting from 10 semi-structured interviews with fluent nêhiyawêwin speakers as well as three structured dialogue circles with fluent and emerging speakers. The words were transcribed by a speaker fluent in both nêhiyawêwin and English. The results of those interviews were categorized thematically to conceptually actualize the spirit of the language, catalysts of disconnection to thespirit of the language, and community voices methods of reconnection to the spirit of the language. Results of these interviews vastly determine that the spirit of the language is drawn from the land. Although nêhiyawêwin is the focus of this work, Indigenous languages are by nature inherently related to the land. This is further reaffirmed by the Indigenous language learners and speakers who expressed having ancestries and lineages from multiple Indigenous communities. Several other key differences embody this spirit of the language, which include ceremony and spirituality, as well as the semantic worldviews tied to polysynthetic verb-oriented morphophonemics most often found in indigenous languages — and of focus, nêhiyawêwin. The catalysts of disconnection to the spirit of the language are those whose histories have severed connections between Indigenous Peoples and the spirit of their languages or those that have affected relationships with the land, ceremony, and ways of thinking. Results of this research and its literature review have determined the three most ubiquitously damaging interdependent factors, which are catalysts of disconnection from the spirit of the language as colonization, capitalism, and Christianity. As voiced by the Indigenous language learners, this work necessitates addressing means to reconnect to the spirit of the language. Interviewees mentioned that the process of reconnection involves a whole relationship with the land, the practice of reciprocal-relational methodologies for language learning, and indigenous-protected and -governed learning. This work concludes in support of those reconnection methodologies.

Keywords: indigenous language acquisition, indigenous language reclamation, indigenous language revitalization, nêhiyawêwin, spirit of the language

Procedia PDF Downloads 121

Authors: Austin P. Hopkins, R. Daren Harmel, Jim A Ippolito, P. J. A. Kleinman, D. Sahoo

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Field-scale runoff and water quality data are critical to understanding the fate and transport of nutrients applied to agricultural lands and minimizing their off-site transport because it is at that scale that agricultural management decisions are typically made based on hydrologic, soil, and land use factors. However, regional influences such as precipitation, temperature, and prevailing cropping systems and land use patterns also impact nutrient runoff. In the present study, the recently-updated MANAGE (Measured Annual Nutrient loads from Agricultural Environments) database was used to conduct an ecoregion-level analysis of nitrogen and phosphorus runoff from agricultural lands in the North America. Specifically, annual N and P runoff loads for cropland and grasslands in North American Level II EPA ecoregions were presented, and the impact of factors such as land use, tillage, and fertilizer timing and placement on N and P runoff were analyzed. Specifically we compiled annual N and P runoff load data (i.e., dissolved, particulate, and total N and P, kg/ha/yr) for each Level 2 EPA ecoregion and for various agricultural management practices (i.e., land use, tillage, fertilizer timing, fertilizer placement) within each ecoregion to showcase the analyses possible with the data in MANAGE. Potential differences in N and P runoff loads were evaluated between and within ecoregions with statistical and graphical approaches. Non-parametric analyses, mainly Mann-Whitney tests were conducted on median values weighted by the site years of data utilizing R because the data were not normally distributed, and we used Dunn tests and box and whisker plots to visually and statistically evaluate significant differences. Out of the 50 total North American Ecoregions, 11 were found that had significant data and site years to be utilized in the analysis. When examining ecoregions alone, it was observed that ER 9.2 temperate prairies had a significantly higher total N at 11.7 kg/ha/yr than ER 9.4 South Central Semi Arid Prairies with a total N of 2.4. When examining total P it was observed that ER 8.5 Mississippi Alluvial and Southeast USA Coastal Plains had a higher load at 3.0 kg/ha/yr than ER 8.2 Southeastern USA Plains with a load of 0.25 kg/ha/yr. Tillage and Land Use had severe impacts on nutrient loads. In ER 9.2 Temperate Prairies, conventional tillage had a total N load of 36.0 kg/ha/yr while conservation tillage had a total N load of 4.8 kg/ha/yr. In all relevant ecoregions, when corn was the predominant land use, total N levels significantly increased compared to grassland or other grains. In ER 8.4 Ozark-Ouachita, Corn had a total N of 22.1 kg/ha/yr while grazed grassland had a total N of 2.9 kg/ha/yr. There are further intricacies of the interactions that agricultural management practices have on one another combined with ecological conditions and their impacts on the continental aquatic nutrient loads that still need to be explored. This research provides a stepping stone to further understanding of land and resource stewardship and best management practices.

Keywords: water quality, ecoregions, nitrogen, phosphorus, agriculture, best management practices, land use

Procedia PDF Downloads 54

Authors: A. F. G. Van Woezik, L. M. A. Braakman-Jansen, O. A. Kulyk, J. E. W. C. Van Gemert-Pijnen

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Background: Zoonoses pose a serious threat to public health and economies worldwide, especially as antimicrobial resistance grows and newly emerging zoonoses can cause unpredictable outbreaks. In order to prevent and control emerging and re-emerging zoonoses, collaboration between veterinary, human health and public health domains is essential. In reality however, there is a lack of cooperation between these three disciplines and uncertainties exist about their tasks and responsibilities. The objective of this ongoing research project (ZonMw funded, 2014-2018) is to develop an online education and communication One Health platform, “eZoon”, for the general public and professionals working in veterinary, human health and public health domains to support the risk communication of non-alimentary zoonoses in the Netherlands. The main focus is on education and communication in times of outbreak as well as in daily non-outbreak situations. Methods: A participatory development approach was used in which stakeholders from veterinary, human health and public health domains participated. Key stakeholders were identified using business modeling techniques previously used for the design and implementation of antibiotic stewardship interventions and consisted of a literature scan, expert recommendations, and snowball sampling. We used a stakeholder salience approach to rank stakeholders according to their power, legitimacy, and urgency. Semi-structured interviews were conducted with stakeholders (N=20) from all three disciplines to identify current problems in risk communication and stakeholder values for the One Health platform. Interviews were transcribed verbatim and coded inductively by two researchers. Results: The following key values were identified (but were not limited to): (a) need for improved awareness of veterinary and human health of each other’s fields, (b) information exchange between veterinary and human health, in particularly at a regional level; (c) legal regulations need to match with daily practice; (d) professionals and general public need to be addressed separately using tailored language and information; (e) information needs to be of value to professionals (relevant, important, accurate, and have financial or other important consequences if ignored) in order to be picked up; and (f) need for accurate information from trustworthy, centrally organised sources to inform the general public. Conclusion: By applying a participatory development approach, we gained insights from multiple perspectives into the main problems of current risk communication strategies in the Netherlands and stakeholder values. Next, we will continue the iterative development of the One Health platform by presenting key values to stakeholders for validation and ranking, which will guide further development. We will develop a communication platform with a serious game in which professionals at the regional level will be trained in shared decision making in time-critical outbreak situations, a smart Question & Answer (Q&A) system for the general public tailored towards different user profiles, and social media to inform the general public adequately during outbreaks.

Keywords: ehealth, one health, risk communication, stakeholder, zoonosis

Procedia PDF Downloads 255

Authors: Michael Rahme

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Over the past decade, there is an overwhelming consensus spanning across academia, government commissions, and civil societies that concede that individuals with disabilities (IWDs), particularly those with intellectual differences, are a demographic most ‘vulnerable’ to experiences of sexual violence. From this global accord, numerous policies have sprouted in the protection of this ‘pregnable’ sector of society, primarily framed around liberal obligations of stewardship over the ‘defenceless.’ As such, these initiatives mainly target post-incident or victim-based factors of sexual violence, which is apparent in proposals for more inclusive sexual education and accessible contact lines for IWDs. Yet despite the necessity of these initiatives, sexual incidents among this demographic persist and, in nations such as Australia, continue to rise. Culture of Violence theory reveals that such discrepancies in theory and practice stem from societal structures that frame individuals as ‘vulnerable’, ‘impregnable’, or ‘defenceless’ because of their disability, thus propagating their own likelihood of abuse. These structures, as embodied by the Australian experience, allow these sexual violences to endure through cultural ideologies that place the IWDs ‘failures’ at fault while sidelining the institutions that permit this abuse. Such is representative of the initiatives of preventative organizations like People with Disabilities Australia, which have singularly strengthened victim protection networks, despite abuse continuing to rise dramatically among individuals with intellectual disabilities alone. Yet regardless of this rise, screenings of families and workers remain inadequate and practically untouched, a reflection of a tremendous societal warp in understanding surrounding the lived experiences of IWDs. This theory is also representative of broader literature, where the study of the perpetrators of disability rights, particularly sexual rights, is almost unapparent in a field that is already seldom studied. Therefore, placing power on the abuser via stripping that of the victims. As such, the Culture of Violence theory (CVT) sheds light on the institutions that allow these perpetrators to prosper. This paper, taking a CVT approach, aims to dissipate this discrepancy in the Australian experience by way of a qualitative analysis of all available court proceedings and tribunals between 2020-2022. Through an analysis of the perpetrator, their relation to the IWD, and the motives for their actions granted by court and tribunal transcripts and the psychological, and behavioural reports, among other material, that have been presented and consulted during these proceedings. All of which would be made available under the 1982 Freedom of Information Act. The findings from this study, through the incorporation of CVT, determine the institutions in which these abusers function and the ideologies which motivate such behaviour; while being conscious of the issue of re-traumatization and language barriers of the abusees. Henceforth, this study aims to be a potential policy guide on strengthening support institutions that provide IWDs with their basic rights. In turn, undermining sexual violence among individuals with intellectual disabilities at its roots.

Keywords: criminal profiling, intellectual disabilities, prevention, sexual violence

Procedia PDF Downloads 63

Authors: Burmansyah Muhammad, Supriyoto Supriyoto

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Crop yield, quality and food safety are three important components that all estate and food crops must put into consideration to lifting the economic value. These measurements should be evaluated because marketplace demand is simultaneously changing and farmers must adapt quickly to remain competitive. The increase in economic value could be done by producing high quality product that aligns with harvest collector preferences. The purpose of this study is to examine the causal effects of value added farming in agriculture economic aspects towards crop yield, quality and food security. This research is using descriptive survey research by employing data from small-scale cocoa farmers listed to off-taker company, located on Sulawesi area of Indonesia. The questionnaire was obtained from 650 cocoa farmers, selected randomly. Major findings of the study indicate that 78% of respondents agree that agriculture inputs have positive effect on crop yield, quality and food safety. The study recommended that cocoa stakeholders should ensure access to agriculture inputs in first priority and then followed by ensuring access to cocoa supply chain trader and micro-financing. Value Added Farming refers to lifting the economic value of a commodity through particular intervention. Regarding access to agriculture inputs, one of significant intervention is fertilization and plant nutrition management, both organic and inorganic fertilizer. Small-scale cocoa farmers can get access to fertilizer intervention through establishment of demo farm. Ordinary demo farm needs large area, selective requirements, lots of field resources and centralization impact. On the contrary, satellite demo farm is developing to wide-spread the impact of agriculture economic aspects and also the involvement in number of farmers. In Sulawesi Project, we develop leveling strata of small-scale demo farm with group of farmers and local cooperative. With this methodology, all of listed small-scale farmers can get access to agriculture input, micro-financing and how to deliver quality output. PT Pupuk Kaltim is member firm of holding company PT Pupuk Indonesia, private company belongs to the government of Indonesia. The company listed as Indonesia's largest producer of urea fertilizers, besides ammonia, Compound Fertilizer (NPK) and biological fertilizers. To achieve strategic objectives, the company has distinguished award such as SNI Platinum, SGS Award IFA Protect and Sustain Stewardship and Gold Rank of Environment Friendly Company. This achievement has become the strategic foundation for our company to energize value added farming in sustaining food security program. Moreover, to ensure cocoa sustainability farming the company has developed partnership with international companies and Non-Government Organization (NGO).

Keywords: fertilizer and plant nutrition management, good agriculture practices, agriculture economic aspects, value-added farming

Procedia PDF Downloads 73

Authors: Lauren Beth Birney

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BOP-CCERS is a consortium of scientists, K-16 New York City students, faculty, academicians, teachers, stakeholders, STEM Industry professionals, CBO’s, NPO’s, citizen scientists, and local businesses working in partnership to restore New York Harbor’s oyster populations while at the same time providing clean water in New York Harbor. BOP-CCERS gives students an opportunity to learn hands-on about environmental stewardship as well as environmental law and policy by giving students real responsibility. The purpose of this REU will allow for the BOP CCERS Project to further broaden its parameters into the focus of environmental law and policy where further change can be affected. Creating opportunities for undergraduates to work collaboratively with graduate students in law and policy and envision themselves in STEM careers in the field of law continues to be of importance in this project. More importantly, creating opportunities for underrepresented students to pursue careers in STEM Education has been a goal of the project over the last ten years. By raising the level of student interest in community-based citizen science integrated into environmental law and policy, a more diversified workforce will be fostered through the momentum of this dynamic program. The continuing climate crisis facing our planet calls for 21st-century skill development that includes learning and innovation skills derived from critical thinking, which will help REU students address the issues of climate change facing our planet. The demand for a climate-friendly workforce will continue to be met through this community-based citizen science effort. Environmental laws and policies play a crucial role in protecting humans, animals, resources, and habitats. Without these laws, there would be no regulations concerning pollution or contamination of our waterways. Environmental law serves as a mechanism to protect the land, air, water, and soil of our planet. To protect the environment, it is crucial that future policymakers and legal experts both understand and value the importance of environmental protection. The Environmental Law and Policy REU provides students with the opportunity to learn, through hands-on work, the skills, and knowledge needed to help foster a legal workforce centered around environmental protection while participating alongside the BOP CCERS researchers in order to gain research experience. Broadening this area to law and policy will further increase these opportunities and permit students to ultimately affect and influence larger-scale change on a global level while further diversifying the STEM workforce. Students’ findings will be shared at the annual STEM Institute at Pace University in August 2022. Basic research methodologies include qualitative and quantitative analysis performed by the research team. Early findings indicate that providing students with an opportunity to experience, explore and participate in environmental science programs such as these enhances their interests in pursuing STEM careers in Law and Policy, with the focus being on providing opportunities for underserved, marginalized, and underrepresented populations.

Keywords: environmental restoration science, citizen science, environmental law and policy, STEM education

Procedia PDF Downloads 78

Authors: I. N. Nwafia, U. C. Ozumba, M. E. Ohanu, S. O. Ebede

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Antibiotic resistance is increasing globally and has become a major health challenge. Extended-spectrum beta-lactamase is clinically important because the ESBL gene are mostly plasmid encoded and these plasmids frequently carry genes encoding resistance to other classes of antimicrobials thereby limiting antibiotic options in the treatment of infections caused by these organisms. The specific objectives of this study were to determine the prevalence of ESBLs production in Escherichia coli, to determine the antibiotic susceptibility pattern of ESBLs producing Escherichia coli, to detect TEM, SHV and CTX-M genes and the risk factors to acquisition of ESBL producing Escherichia coli. The protocol of the study was approved by Health Research and Ethics committee of the University of Nigeria Teaching Hospital (UNTH), Enugu. It was a descriptive cross-sectional study that involved all hospitalized patients in UNTH from whose specimens Escherichia coli was isolated during the period of the study. The samples analysed were urine, wound swabs, blood and cerebrospinal fluid. These samples were cultured in 5% sheep Blood agar and MacConkey agar (Oxoid Laboratories, Cambridge UK) and incubated at 35-370C for 24 hours. Escherichia coli was identified with standard biochemical tests and confirmed using API 20E auxanogram (bioMerieux, Marcy 1'Etoile, France). The antibiotic susceptibility testing was done by disc diffusion method and interpreted according to the Clinical and Laboratory Standard Institute guideline. ESBL production was confirmed using ESBL Epsilometer test strips (Liofilchem srl, Italy). The ESBL bla genes were detected with polymerase chain reaction, after extraction of DNA with plasmid mini-prep kit (Jena Bioscience, Jena, Germany). Data analysis was with appropriate descriptive and inferential statistics. One hundred and six isolates (53.00%) out of the 200 were from urine, followed by isolates from different swabs specimens 53(26.50%) and the least number of the isolates 4(2.00) were from blood (P value = 0.096). Seventy (35.00%) out of the 200 isolates, were confirmed positive for ESBL production. Forty-two (60.00%) of the isolates were from female patients while 28(40.00%) were from male patients (P value = 0.13). Sixty-eight (97.14%) of the isolates were susceptible to imipenem while all of the isolates were resistant to ampicillin, chloramphenicol and tetracycline. From the 70 positive isolates the ESBL genes detected with polymerase chain reaction were blaCTX-M (n=26; 37.14%), blaTEM (n=7; 10.00%), blaSHV (n=2; 2.86%), blaCTX-M/TEM (n=7; 10.0%), blaCTX-M/SHV (n=14; 20.0%) and blaCTX-M/TEM/SHV (n=10; 14.29%). There was no gene detected in 4(5.71%) of the isolates. The most associated risk factors to infections caused by ESBL producing Escherichia coli was previous antibiotics use for the past 3 months followed by admission in the intensive care unit, recent surgery, and urinary catheterization. In conclusion, ESBLs was detected in 4 of every 10 Escherichia coli with the predominant gene detected being CTX-M. This knowledge will enable appropriate measures towards improvement of patient health care, antibiotic stewardship, research and infection control in the hospital.

Keywords: antimicrobial, Escherichia coli, extended spectrum beta lactamase, resistance

Procedia PDF Downloads 267

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

Procedia PDF Downloads 96

Authors: Kelly S. Parkinson, Katherine Y. Teh-White

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Futureye has a bespoke social licence to operate methodology which has successfully secured community approval and commercial return for fisheries which have faced regulatory and financial risk. This unique approach to fisheries management focuses on delivering improved social and environmental outcomes to support the fishing industry make steps towards achieving the United Nations SDGs. An SLO is the community’s implicit consent for a business or project to exist. An SLO must be earned and maintained alongside regulatory licences. In current and new operations, it helps you to anticipate and measure community concerns around your operations – leading to more predictable and sensible policy outcomes that will not jeopardise your commercial returns. Rising societal expectations and increasing activist sophistication mean the international fishing industry needs to resolve community concerns at each stage their supply chain. Futureye applied our tested social licence to operate (SLO) methodology to help Austral Fisheries who was being attacked by activists concerned about the sustainability of Patagonian Toothfish. Austral was Marine Stewardship Council certified, but pirates were making the overall catch unsustainable. Austral wanted to be carbon neutral. SLO provides a lens on the risk that helps industries and companies act before regulatory and political risk escalates. To do this assessment, we have a methodology that assesses the risk that we can then translate into a process to create a strategy. 1) Audience: we understand the drivers of change and the transmission of those drivers across all audience segments. 2) Expectation: we understand the level of social norming of changing expectations. 3) Outrage: we understand the technical and perceptual aspects of risk and the opportunities to mitigate these. 4) Inter-relationships: we understand the political, regulatory, and reputation system so that we can understand the levers of change. 5) Strategy: we understand whether the strategy will achieve a social licence through bringing the internal and external stakeholders on the journey. Futureye’s SLO methodologies helped Austral to understand risks and opportunities to enhance its resilience. Futureye reviewed the issues, assessed outrage and materiality and mapped SLO threats to the company. Austral was introduced to a new way that it could manage activism, climate action, and responsible consumption. As a result of Futureye’s work, Austral worked closely with Sea Shepherd who was campaigning against pirates illegally fishing Patagonian Toothfish as well as international governments. In 2016 Austral launched the world’s first carbon neutral fish which won Austral a thirteen percent premium for tender on the open market. In 2017, Austral received the prestigious Banksia Foundation Sustainability Leadership Award for seafood that is sustainable, healthy and carbon neutral. Austral’s position as a leader in sustainable development has opened doors for retailers all over the world. Futureye’s SLO methodology can identify the societal, political and regulatory risks facing fisheries and position them to proactively address the issues and become an industry leader in sustainability.

Keywords: carbon neutral, fisheries management, risk communication, social licence to operate, sustainable development

Procedia PDF Downloads 100

Authors: Ok-Kyun Im, Kyoung Hee Kim

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We live in an era that faces global challenges of climate changes and resource depletion. With the rapid urbanization and growing energy consumption in the built environment, building facades become ever more important in architectural practice and environmental stewardship. Furthermore, building facade undergoes complex dynamics of social, cultural, environmental and technological changes. Kinetic facades have drawn attention of architects, designers, and engineers in the field of adaptable, responsive and interactive architecture since 1980’s. Materials and building technologies have gradually evolved to address the technical implications of kinetic facades. The kinetic façade is becoming an independent system of the building, transforming the design methodology to sustainable building solutions. Accordingly, there is a need for a new design methodology to guide the design of a kinetic façade and evaluate its sustainable performance. The research objectives are two-fold: First, to establish a new design methodology for kinetic facades and second, to develop a micro-oculi façade system and assess its performance using the established design method. The design approach to the micro-oculi facade is comprised of 1) façade geometry optimization and 2) dynamic building energy simulation. The façade geometry optimization utilizes multi-objective optimization process, aiming to balance the quantitative and qualitative performances to address the sustainability of the built environment. The dynamic building energy simulation was carried out using EnergyPlus and Radiance simulation engines with scripted interfaces. The micro-oculi office was compared with an office tower with a glass façade in accordance with ASHRAE 90.1 2013 to understand its energy efficiency. The micro-oculi facade is constructed with an array of circular frames attached to a pair of micro-shades called a micro-oculus. The micro-oculi are encapsulated between two glass panes to protect kinetic mechanisms with longevity. The micro-oculus incorporates rotating gears that transmit the power to adjacent micro-oculi to minimize the number of mechanical parts. The micro-oculus rotates around its center axis with a step size of 15deg depending on the sun’s position while maximizing daylighting potentials and view-outs. A 2 ft by 2ft prototyping was undertaken to identify operational challenges and material implications of the micro-oculi facade. In this research, a systematic design methodology was proposed, that integrates multi-objectives of kinetic façade design criteria and whole building energy performance simulation within a holistic design process. This design methodology is expected to encourage multidisciplinary collaborations between designers and engineers to collaborate issues of the energy efficiency, daylighting performance and user experience during design phases. The preliminary energy simulation indicated that compared to a glass façade, the micro-oculi façade showed energy savings due to its improved thermal properties, daylighting attributes, and dynamic solar performance across the day and seasons. It is expected that the micro oculi façade provides a cost-effective, environmentally-friendly, sustainable, and aesthetically pleasing alternative to glass facades. Recommendations for future studies include lab testing to validate the simulated data of energy and optical properties of the micro-oculi façade. A 1:1 performance mock-up of the micro-oculi façade can suggest in-depth understanding of long-term operability and new development opportunities applicable for urban façade applications.

Keywords: energy efficiency, kinetic facades, sustainable architecture, urban facades

Procedia PDF Downloads 228

Authors: A. Kolendo

Abstract:

Pacific Islands are one of the most vulnerable areas to climate change. Sea level rise and accelerating storm surge continuously threaten the communities' habitats on low-lying atolls. With scientific predictions of encroaching tides on their land, the Islanders have been informed about the need for future relocation planning. However, some communities oppose such retreat strategies through the reasoning that comprehends current climatic changes through the lenses of the biblical ark of Noah. This parable states God's promise never to flood the Earth again and never deprive people of their land and habitats. Several interpretations of this parable emerged in Oceania, prompting either climate action or denial. Resistance to relocation planning expressed through Christian thoughts led religion to be perceived as a barrier to dialogue between the Islanders and scientists. Since climate change concerns natural processes, the attitudes towards environmental stewardship prompt the communities' responses to it; some Christian teachings indicate humanity's responsibility over the environment, whereas others ascertain the people's dominion, which prompts resistance and sometimes denial. With church denominations and their various environmental standpoints, competing responses to climate change emerged in Oceania. Before miss-ionization, traditional knowledge had guided the environmental sphere, influencing current Christian teachings. Each atoll characterizes a distinctive manner of traditional knowledge; however, the unique relationship with nature unites all islands. The interconnectedness between the land, sea and people indicates the integrity between the communities and their environments. Such a factor influences the comprehension of Noah's story in the context of climate change that threatens their habitats. Pacific Islanders experience climate change through the slow disappearance of their homelands. However, the Western world perceives it as a global issue that will affect the population in the long-term perspective. Therefore, the Islanders seek to comprehend this global phenomenon in a local context that reads climate change as the Great Deluge. Accordingly, the safety measures that this parable promotes compensate for the danger of climate change. The rainbow covenant gives hope in God's promise never to flood the Earth again. At the same time, Noah's survival relates to the Islanders' current situation. Since these communities have the lowest carbon emissions rate, their contribution to anthropogenic climate change is scarce. Therefore, the lack of environmental sin would contextualize them as contemporary Noah with the ultimate survival of sea level rise. This study aims to defy religion constituting a barrier through secondary data analysis from a risk compensation perspective. Instead, religion is portrayed as a source of knowledge that enables comprehension of the communities' situation. By demonstrating that the Pacific Islanders utilize Noah's story as a vessel for coping with the danger of climate change, the study argues that religion provides safety measures that compensate for the future projections of land's disappearance. The purpose is to build a bridge between religious communities and scientific bodies and ultimately bring an understanding of two diverse perspectives. By addressing the practical challenges of interdisciplinary research with faith-based systems, this study uplifts the voices of communities and portrays their experiences expressed through Christian thoughts.

Keywords: Christianity, climate change, existential threat, Pacific Islands, story of Noah

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Authors: Amarasinghe Shashikala, Pramudika Hansini, Fernando Tajan, Rathnayake Piyumi

Abstract:

This study investigates the prominence of the social entrepreneurship (SE) model over the sustainable entrepreneurship model among Sri Lankan exporters in the small and medium enterprise (SME) sector. The primary objective of this study is to explore how the unique socio-economic contextual nuances of the country influence this behavior. The study employs a multiple-case study approach, collecting data from thirteen SEs in the SME sector. The findings reveal a significant alignment between SE and the lifestyle of the people in Sri Lanka, attributed largely to its deep-rooted religious setting and cultural norms. A crucial factor driving the prominence of SE is the predominantly labor-intensive nature of production processes within the exporters of the SME sector. These processes inherently lend themselves to SE, providing employment opportunities and fostering community engagement. Further, SE initiatives substantially resonate with community-centric practices, making them more appealing and accessible to the local populace. In contrast, the findings highlight a dilemma between cost-effectiveness and sustainable entrepreneurship. Transitioning to sustainable export products and production processes is demanded by foreign buyers and acknowledged as essential for environmental stewardship, which often requires capital-intensive makeovers. This investment inevitably raises the overall cost of the export product, making it less competitive in the global market. Interestingly, the study notes a disparity between international demand for sustainable products and the willingness of buyers to pay a premium for them. Despite the growing global preference for eco-friendly options, the findings suggest that the additional costs associated with sustainable entrepreneurship are not adequately reflected in the purchasing behavior of international buyers. The abundance of natural resources coupled with a minimal occurrence of natural catastrophes renders exporters less environmentally sensitive. The absence of robust policy support for environmental preservation exacerbates this inclination. Consequently, exporters exhibit a diminished motivation to incorporate environmental sustainability into their business decisions. Instead, attention is redirected towards factors such as the local population's minimum standards of living, prevalent social issues, governmental corruption and inefficiency, and rural poverty. These elements impel exporters to prioritize social well-being when making business decisions. Notably, the emphasis on social impact, rather than environmental impact, appears to be a generational trend, perpetuating a focus on societal aspects in the realm of business. In conclusion, the manifestation of entrepreneurial behavior within developing nations is notably contingent upon contextual nuances. This investigation contributes to a deeper understanding of the dynamics shaping the prevalence of SE over sustainable entrepreneurship among Sri Lankan exporters in the SME sector. The insights generated have implications for policymakers, industry stakeholders, and academics seeking to navigate the delicate balance between socio-cultural values, economic feasibility, and environmental sustainability in the pursuit of responsible business practices within the export sector.

Keywords: small and medium enterprises, social entrepreneurship, Sri Lanka, sustainable entrepreneurship

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Authors: Bryan Jenkins

Abstract:

Introduction: The expansion of irrigation in the Canterbury region has led to the sustainability limits being reached for water availability and the cumulative effects of land use intensification. The institutional framework under New Zealand’s Resource Management Act was found to be an inadequate basis for managing water at sustainability limits. An alternative paradigm for water management was developed based on collaborative governance and nested adaptive systems. This led to the formulation and implementation of the Canterbury Water Management Strategy. Methods: The nested adaptive system approach was adopted. Sustainability issues were identified at multiple spatial and time scales and defined potential failure pathways for the water resource system. These included biophysical and socio-economic issues such as water availability, cumulative effects on water quality due to land use intensification, projected changes in climate, public health, institutional arrangements, economic outcomes and externalities, and, social effects of changing technology. This led to the derivation of sustainability strategies to address these failure pathways. The collaborative governance approach involved stakeholder participation and community engagement to decide on a regional strategy; regional and zone committees of community and rūnanga (Māori groups) members to develop implementation programmes for the strategy; and, farmer collectives for operational management. Findings: The strategy identified improvements in the efficiency of use of water already allocated was more effective in improving water availability than a reliance on increased storage alone. New forms of storage with less adverse impacts were introduced, such as managed aquifer recharge and off-river storage. Reductions of nutrients from land use intensification by improving management practices has been a priority. Solutions packages for addressing the degradation of vulnerable lakes and rivers have been prepared. Biodiversity enhancement projects have been initiated. Greater involvement of Māori has led to the incorporation of kaitiakitanga (resource stewardship) into implementation programmes. Emerging issues are the need for improved integration of surface water and groundwater interactions, increased use of modelling of water and financial outcomes to guide decision making, and, equity in allocation among existing users as well as between existing and future users. Conclusions: However, sustainability analysis indicates that the proposed levels of management interventions are not sufficient to achieve community targets for water management. There is a need for more proactive recovery and rehabilitation measures. Managing to environmental limits is not sufficient, rather managing adaptive cycles is needed. Better measurement and management of water use efficiency is required. Proposed implementation packages are not sufficient to deliver desired water quality outcomes. Greater attention to targets important to environmental and recreational interests is needed to maintain trust in the collaborative process. Implementation programmes don’t adequately address climate change adaptations and greenhouse gas mitigation. Affordability is a constraint on adaptive capacity of farmers and communities. More funding mechanisms are required to implement proactive measures. The legislative and institutional framework needs to be changed to incorporate water framework legislation, regional sustainability strategies and water infrastructure coordination.

Keywords: collaborative governance, irrigation management, nested adaptive systems, sustainable water management

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