The appropriate carbapenem use is a critical concern for patient safety, public health, and a national priority. We investigated the nationwide status of carbapenem prescription in patients within their last 14 days of life to guide judicious-use protocols from the previous study comprising of 1,350 decedents. Carbapenem use was universally restricted by computerised authorisation at all centres during the study period. Carbapenem prescribing patterns and their optimality were evaluated. A total of 1201 patients received antimicrobial agents within the last 2 weeks of their lives, of whom 533 (44.4%) received at least one carbapenem. The median carbapenem treatment duration was 7 days. Of the 533 patients receiving carbapenems, 510 (95.7%) patients had microbiological samples drawn and 196 (36.8%) yielded carbapenem-resistant pathogens. A total of 200 (37.5%) were referred to infectious disease (ID) specialists. Of the 333 patients (62.5%) without ID consults, 194 (58.2%) were assessed as “not optimal”: 79 (23.7%) required escalation, 100 (30.0%) required de-escalation, and 15 (4.5%) discontinued. Notwithstanding the existing antibiotic restriction program system, carbapenems are commonly prescribed to patients within their last days of life, a majority of whom do not require it.

Poliomyelitis, commonly known as “polio” is a paralytic and perilous disease caused by the poliovirus. Due to its highly contagious nature, the virus was a challenge to the world in the late 1980s. . Since 1988 the collective work of the Global Polio Eradication Initiative (GPEI), Centre for Disease Control and Prevention (CDC), and World Health Organization (WHO) through immunizations, communication awareness, and monitoring have helped the world exonerate polio. The mission of polio-free Pakistan was herculean and had confronted enormous challenges in different ways but came out with positive results. In 2019, with only two remaining polio-endemic countries, Pakistan and Afghanistan, GPEI launched an “Endgame strategy 2019-2023” which aims to eradicate polio globally, with a targeted focus, especially on polio-endemic countries, the plan emphasizes the early detection of polio cases for complete eradication and to restrict the spread of polio. Pakistan has achieved a milestone in combating polio despite having a web of factors that have thwarted Pakistan’s polio eradication efforts, but this is not the end, the struggle continues until we really get an internationally verified certification of Polio free nation, for this WHO has designed a multidisciplinary strategy 2022-2026 to really end this polio for once and for all.

An effective behavior changes program is the first-line of prevention for youth obesity. However, effectiveness in prevention of adolescent obesity requires several approaches, with special attention paid to disordered eating behaviors and psychological support among other environmental factors. The aim of this systematic review was to compare the impact of two types of obesity prevention programs, inclusive of behavior change components on weight outcomes. Energy-balance studies were aimed at reducing calories from high-energy sources and increasing PA levels, while “shared risk factors for obesity and eating disorders” focused on reducing disordered eating behaviors to promote a positive relationship with food and eating. A systematic search of ProQuest, PubMed, PsycInfo, SciELO, and Web of Science identified 8825 articles. Twenty were considered “energy-balance” and fifteen “shared-risk factors for obesity and eating disorders”. Overall, energy-balance studies were unable to support a maintenance weight status, diet, and PA over time. Shared risk factors programs also did not result in significant differences in weight status over time. However, the majority of shared risk factors studies demonstrated reduced body dissatisfaction, dieting, and weight-control behaviors. More research is needed to examine how a shared risk factor approach can address both obesity and eating disorder.

The purpose of this study was to assess if self-regulation of intensity based on rating of perceived exertion (RPE) is a reliable method to control the intensity of metabolic conditioning of functional-fitness session. In addition, the relationship between RPE and changes in heart rate and lactate responses was also analyzed. Eight male participants (age 28.1 ± 5.4 years; body mass 77.2 ± 4.4kg; VO₂max: 52.6 ± 4.6 mL·(kg·min)⁻¹) completed three randomly sessions (5 to 7 days apart) under different conditions: (1) all-out (ALL); (2) self-regulation of intensity based on a RPE of 6 (hard) on the Borg CR-10 scale (RPE6); and (3) a control session. Rate of perceived exertion, LAC and HR response were measured pre, during and immediately after the sessions. The RPE and LAC during the ALL-OUT sessions were higher (p ≤ 0.05) than the RPE6 and control sessions for all the analyzed time points during the sessions. Regarding HR, the 22 min area under the curve of HR during ALL-OUT and RPE6 sessions were significantly higher (p ≤ 0.05) than the control session. The average number of repetitions was lower (p ≤ 0.05) for the RPE6 session (190.5 ± 12.5 repetitions) when compared to the ALL session (214.4 ± 18.6 repetitions). There was a significant correlation between RPE and LAC (p = 0.001; r = 0.76; very large) and number of repetitions during the session (p = 0.026; r = 0.55; large). No correlation was observed between RPE and HR (p = 0.147; r = 0.380). These results indicate that self-regulation of intensity of effort based on RPE may be a useful tool to control exercise intensity during a metabolic conditioning session of functional-fitness.

(1) Introduction: Every two hours, a Romanian woman is diagnosed with cervical cancer [1] as the country ranks second in Europe in terms of mortality and incidence rate [2]. This paper aims to identify the main reasons that have led to this situation, focusing on the measures taken by the Romanian Ministry of Health for the prevention of this type of cancer national - programs for cervical cancer screening and HPV vaccination. (2) Materials and methods: We performed a study based on available secondary data from the National Statistics Institute, World Health Organization and Bucharest Institute of Oncology in order to assess the burden associated with cervical cancer and placing it in the context of known global and European incidence and mortality rates, thus evaluating the importance of this health issue in Romania. The second component of our study was a cross-sectional study, using a 14 questions questionnaire, applied to the women participating in the National Screening Program for Cervical Cancer, aimed to evaluate the women’s level of knowledge about screening and HPV vaccination and their access cervical cancer specific health-care services. (3) Results: The results of the research shows that a high percentage of women postpone the routine checks due to lack of time and financial resources and indicate that low level of knowledge about the disease and the specific preventive methods determines low participation screening and HPV vaccination programs implemented in Romania contributing to the country’s situation of cervical cancer. (4) Conclusions: The national programs have complicated procedures, are underfunded, and do not motivate enough health care workers. This combined with the lack of information adds up to an extremely low number of women screened and vaccinated. Our conclusion is that the Romanian Ministry of Health must take immediate action by conducting major awareness campaigns, implementing measures to make the programs functional and ensuring coherent funding.

Macrophytes and seagrasses play a crucial role with a variety of the functions in the marine ecosystem and respond synchronized-promptly to the changing climate, followed by ecological status. Monitoring of the seagrasses was one of the paramount topics at the marine environment. One of the fast monitoring techniques is the vegetation acoustics with the advantages compared to the other remote sensing techniques. The acoustic method alone is ambitious to sea-truth identities of the backscatterers at the sea. Therefore, a package of computer programs was developed to identify, estimate leaf biometrics (leaf length and biomass) of one of the common seagrasses, Posidonia oceanica. Some troubleshooting in the acoustical data were fixed and then solved to reach the estimates regarding to the matters encountered for the vegetation as well as fisheries and plankton acoustics. One of the trouble was the “Lost” bottom which occurred during the data collection and post-processing due to occurrence of the acoustical noises, reverberations, interferences and intense scatterers suchlike fish schools. Another problem to remove was the occurrence as studying the near-bottom echoes belonging to submerged vegetations such as seagrasses, followed by spurious echoes. Last one was recognition of the seagrass to estimate leaf length and biomass calibrating the sheaths/vertical rhizome of the seagrass and establishing relationships between acoustical units and biometrics, respectively. As a consequence, an autonomous package of the code written in language MatLab was developed to perform all processes, and the name of the package was abbreviated as POSIBIOM, POSIdonia BIOMass. This study presented the algorithms, methodology, acoustics-biometrics relation, and mapping of the biometrics for the first time, and discussed advantages and disadvantages of the package compared to the software purposed for the bottom types, habitat and vegetation acoustic. The future studies were recommended to improve the package.

Teachers of English as a foreign language in Taiwan are challenged to organize multi-dimensional language activities for foreign students coming from ASEAN countries, including Japan, the Philippines, South Korea, and Vietnam. With different cultural backgrounds, these students have different prior knowledge of Taiwanese culture, and, because of the similarities and differences between Taiwan and these countries, it is meaningful to explore the development of globalization with the students, who are learning both English and Chinese. The different historical backgrounds, various cultural and religious differences, and social conditions, such as gender relationships in working places, are significant topics for class discussions. When teachers serve as discussion facilitators, they encourage students to express their own multi-identities and expectations for the exchange program. Most interesting of all is to find out about their own short-term and long-term career goals. 32 foreign students from the Philippines and Vietnam were recruited for research. Questionnaires were used to assess their foreign language learning motivation and strategies, as well as to discover the learning environment they prefer and their globalization prospects. It was found that multi-lingual language policies for promoting globalization in higher education are very likely to influence the success of foreign student study in Taiwan.

Intercultural education can be seen as a cornerstone in the sustainability of the current culturally diverse society. In addition, through the establishment of policies and strategies to reverse situations of discrimination and exclusion, there is a consensus on the importance of the social inclusion of groups at risk of exclusion. In this context, actions are suggested to reverse high dropout rates and school failure within the Roma population. The aim of this systematic review in the educational context is to analyze investigations of programs and interventions that have been made to promote the educational inclusion of Roma students. Three databases are used, Scopus, Web of Science, and Eric, to examine 419 articles, which after a selection, based on an inclusion criterion which follows the guidelines given by the Declaration PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyzes), 17 articles were chosen for the analysis. The main findings shed light on data for programs and interventions developed mostly within the school setting and for students of elementary and secondary education. These programs provide answers for the molding of intercultural education and the policies for educational inclusion of Roma people.

Aim: Child-to-parent offenders (CPOs) are commonly specialist offenders and with high rates of recidivism. Thus, a field study was designed to estimate the prevalence in the reference measures of recidivism i.e., dangerousness, risk factors and psychopathy, and compare CPOs with non-child-to-parent juvenile offenders. Method: 136 juvenile offenders (76.5% boys), 76 CPOs and 60 non-CPOs juvenile offenders, aged from 14 to 18 years old, were measured in dangerousness, risk of factors and psychopathic traits. Results: The results showed in CPOs a more than common prevalence (> .50), 75.0%, 95% CI [.653, .847], of dangerousness (caseness); a significant prevalence (> .05) of diagnostic of psychopathy, 25.0%, 95% CI [.150, .350]; and a common prevalence (= .50), 55.3%, 95% CI [.441, .665] of classification as high and very high risk by risk factors. Comparatively, no significant differences were observed between CPOs and non-CPOS juvenile offenders in mental health problems (dangerousness), meanwhile that CPOs exhibited significant more interpersonal and affective psychopathic traits and significant more risk in family circumstances, and personality and behaviour risk factors. Conclusions: The implications for prevention and intervention programs with CPOs are discussed

This study aimed to evaluate the impact of the COVID-19 pandemic on routine immunization (RI) programs in six Northern Nigerian states: Bauchi, Borno, Kaduna, Kano, Sokoto, and Yobe. This study compared the programmatic data of 2019 and 2020, as well as survey data collected during the pandemic. RI program variables included service delivery, leadership and governance, monitoring and evaluation/supportive supervision, community engagement, vaccine supply chain and logistics, and finance and financial management. Data were analyzed using SPSS (version 23, IBM), student t-test, and structural equation modelling. The results showed that RI programs were affected by the pandemic in terms of reduced meetings and low completion rates of action points in certain states. However, routine immunization support services increased owing to improved monitoring techniques and consistent vaccine deliveries, with fewer reports of stock-outs. The most significant impact of the pandemic was observed on activities coordinated at the healthcare facility level, whereas those at the state level were less impacted. The major challenges encountered during the pandemic included insufficient supplies and consumables, movement restrictions, shortage of human resources, and fear of infection.

Tidal swamp rice has long been cultivated by the local people of the South Kalimantan, Indonesia. This germplasm possess some important traits for adapted to a wide range of abiotic and biotic stresses. In this study, a total of sixteen cultivars of this germplasm, consisting of fifteen of the South Kalimantan Province and one of Sumatera Island, Indonesia (an outgroup) were analyzed, phylogenetically based on the chloroplast trnL-F and nuclear intergenic spacer region (IGS). The results showed that this germplasm has a relatively more extraordinary genetic diversity than other local rice germplasm. In a nucleotide level, this germplasm showed a genetic diversity of 0.61 for nuclear IGS and 0.58 for trnL-F. The phylogenetic reconstruction also exhibited that this germplasm has the unique illustration of phylogenetic trees, particularly for the combined sequence datasets. Thus, the results of our study would provide useful information for further understanding of evolutionary relationships of this germplasm and facilitate the efficient utilization of valuable genes for genetic improvement, particularly in the tidal swamp areas.

Urban settings are increasingly faced with challenges across natural and engineered environmental systems, threatening the sustainability of urban centers where >50% of the world's population resides. The pressures of aging infrastructure, water and air pollution, and environmental justice exemplify the growing need for urban professionals to employ complex scientific reasoning across disciplines where they can effectively address the multi-faceted issues of urban sustainability. Here we present an innovative model for preparing the next generation of public, private, and academic leaders to address complex problems in urban sustainability. Specifically, we outline the design and implementation of an integrated, adaptable graduate training program, with the goals of science leadership, curriculum relevancy, community impact, broader applicability, recruitment into science, technology, engineering and mathematics (STEM) programs and careers, and program sustainability. This program addresses human-ecosystem challenges using a transdisciplinary approach to produce scientific products in partnership with local communities, businesses, industries, scientists, and policy makers, while providing a mechanism to understand and overcome contemporary societal challenges. Students receive rigorous training in their home disciplines, coupled with training across disciplinary lines and developmental experiences, to prepare them to communicate, collaborate, and innovate in a variety of contexts. Training success is evaluated across measurable competency domains including problem definition, research methods, communication, collaboration, and problem-solving. After three years the program expanded relationships across fields and professions, successfully established 18 internship opportunities with community partners, created a new dual-title PhD program open to students in 5 academic departments, and facilitated the co-production of knowledge with external partners. This model bridges the gaps between research, education, and application, providing an integrated, rigorous graduate training program that fosters collaborative problem-solving between STEM graduate students and the broader community of professionals conducting sustainability work in a post-industrial urban setting.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) of Minnesota, “Sage”, provides breast cancer screening to uninsured women. We introduce a novel mapping technique, spatially adaptive filters (SAFs), to estimate utilization of Sage screening in Minnesota. Sage screenings (N = 74,712) were geocoded. The eligible population was modeled with the RTI synthetic population dataset. Between 2011 and 2015, 36,979 women a year were Sage eligible. Utilization was highly variable across Minnesota (M = 37.2%, range 0% - 131%, SD = 18.7%). This replicable approach modeled utilization rates to the neighborhood-level, allowing Sage to prioritize locations and engage communities.

We argue for reconsidering leadership development based on systems design principles. A primary advantage of systems thinking is that it encourages holistic approaches to development and avoids episodic program-based training and piecemeal thinking. The latter approaches are both limited and limiting yet tend to be the preferred approach to leadership development in organizations. Systems approaches to development offer numerous advantages both conceptually and pragmatically, especially through the incorporation of ongoing feedback cycles. Core practices that define a leadership development system are presented and implications are discussed.

The research presented in this paper examines a new proposed approach for identifying safety improvement sites on rural highways. Unlike conventional approaches, the proposed approach does not require crash history, but rather utilizes classified variables for traffic volume, geometric features, and roadside characteristics that do not require access to exact data or extensive technical expertise. The research validates the performance of the proposed approach using field data from a large sample of rural two-lane highway segments in the state of Oregon including traffic, roadway, and crash data. Using observed crash history as a reference, the performance of the proposed ap-proach was compared to two of the well-established methods in practice, namely: the Empirical Bayes (EB) and the Potential for Safety Improvement (PSI) methods. The study results suggest that, using crash density for highway segments, the performance of the proposed method was lower than that of the EB and PSI methods. This is despite the high R-square value of the predictive model used in the proposed method. However, when using crash frequencies for highway segments, the per-formance of the proposed method was found comparable to the well-established EB and PSI methods.

eHealth applications are an essential component in achieving Universal Health Coverage. (1) Background: The lack of skilled healthcare personnel has hindered successful integration and use, especially in developing and low and middle-income countries. (2) Methods: A descriptive study was conducted using an online survey to collect quantitative data from 37 organizations to address this issue. (3) Results: The findings showed that there are limited training opportunities available for policymakers and eHealth specialists. Additionally, obstacles such as insufficient funds, inadequate infrastructure, poor leadership, and governance were identified and found to be context specific. To mitigate these challenges, the study proposed continuous in-service training, the implementation of computer-based systems, and the integration of academic modules. The importance of strong eHealth policies and committed leaders was also emphasized. (4) Conclusions: The results of this study support previous research and emphasize the importance of implementing practical and uncomplicated solutions to overcome eHealth barriers to capacity building in low- and middle-income countries. It is essential to recognize that the data collected for this study only pertains to BETTEReHEALTH.

Objectives: This paper presents a statistical review of modelling simulations for frequency and sensitivity of COVID-19 testing paradigms. Methods: We performed a review of preprints and published articles on PubMed from January 1, 2020 – March 1, 2021 using the search terms “COVID screening testing”, “COVID testing frequency”, “COVID testing frequency screening” and “SARS-CoV-2 testing frequency”.Results: Several authors’ conclusions support the claim that test frequency and test sensitivity both play a role in reducing SARS-CoV-2 transmission. We highlight the interplay between frequency of testing, test sensitivity and the speed at which test results are available in our review. Conclusions: Evidence suggests that sensitivity and frequency of testing both play a part in decreasing transmission of disease. We conclude that, overall, test sensitivity plays less of a role in reducing disease transmission in a population compared to the frequency of testing and how quickly test results are available.

The number of entrepreneurship education programs (EEP) has increased exponentially over the past two decades. However, a systematic review has not yet been carried out to confirm the effectiveness of EEPs and their presence in the current global world. The main objective of this study was to provide a systematic synthesis of EEP, exploring their characteristics and effectiveness. The search was carried out in the following databases: Scopus, Web of Science, ProQuest and ERIC. Twenty-nine articles were included, with programs developed mainly in European (n=15), Asian (n=6) and American (n=5) countries. The programs were mainly aimed at higher education students (n=17), addressing the development of business plans and entrepreneurial skills. However, greater attention is paid to the entrepreneurial skills in both basic and secondary education. The development of the programs under analysis varied between one week and two years. The results of the studies showed the effectiveness of most of these programs in promoting entrepreneurial skills at all levels of education. In turn, there was not a verified increase in the intention to start a business, since this intention is determined by predisposition, namely socio-cultural and family aspects. This systematic review of the EEP points to the need for this type of program to be preferentially developed since the early school years, since it is at that time that predispositions are created for the development of entrepreneurial skills and intentions. This condition is corroborated by the global geography of the EEP, which demonstrates that, where there is currently an entrepreneurial culture, countries have made a long educational journey, with strategic options from the perspective of educational policies defending entrepreneurship among the younger generations.

The school food environment is a suitable place to promote healthy habits, as it is a space for learning and constant social interaction, where children spend at least a third of their day, and have one to two meals. This study aimed to analyze the sale of food in the canteens of private schools in a capital in the Northeast of Brazil and verify the influence of it on students’ eating behavior. A cross-sectional, quantitative, multicenter study was carried out, taking place simultaneously in twenty capitals in Brazil. A checklist with 87 questions was applied to those responsible for the canteens in a representative sample of schools in each city. Frequencies and associations were performed using Pearson's Chi-Square test. The analysis of the foods sold, was based on the NOVA food classification from the Dietary Guidelines for the Brazilian Population, regarding the degree and extent of processing. Latent Class Analysis was carried out to group the canteens into similar response patterns, modeled with covariates, and the association was calculated with the Kruskal-Wallis and Duun tests or Fisher's Exact test. The results showed that students were very frequently offered ultra-processed, sugar-rich foods with low nutritional value; 88.7% of such foods had been chosen by managers as part of the menu because they are “students’ food preferences”. There is an average of 2.3 fresh foods in canteens compared to 7.5 varieties of ultra-processed foods. There must be stricter control over what is sold, to minimize student’s exposure to unhealthy foods.

In recent years, there has been a surge of proposals for innovative approaches to public planning. It has become apparent that the traditional emphasis on "economic development" as the predominant objective of public policy is no longer adequate to promote a thriving society. Common Agricultural Policy in Europe faces challenges to adopt and implement the dynamic of culture. However, culture as a pillar of sustainable development is not a new topic. This concept has been incorporated into economic studies with increasing tension. The present study aims to measure scientific interest through published scientific studies and papers related to the contribution of culture in the context of European development programs and strategies. A total of (n=902) published documents during the period 1990-2023 from the Scopus database were explored to identify (n=27) appropriate publications for research analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach and flow diagram. Bibliometric analyses using Vos Viewer (Center for Science and Technology Studies, Leiden University, Leiden, The Netherlands) and constructed term co-occurrence network plots based on bibliometric evidence were performed. The results show that there was no scientific interest. The systematic review and bibliometric analysis of the present paper could provide a valuable and seminal reference for the researchers of rural development and the relevant policymakers.

Cervical cancer is the fourth most common malignancy in women worldwide, although it is preventable with prophylactic HPV vaccination. HPV transmission-dynamic models can predict the potential for global elimination of cervical cancer. The random network model is a new approach that allows individuals to be followed, and to implement a given vaccination policy according to their clinical records. We developed an HPV transmission dynamics model on a lifetime sexual partners network based on individual contacts, also accounting for the sexual behavior of men who have sex with men (MSM). We analyzed the decline in the prevalence of HPV infection in a scenario of 75% and 90% coverage for both sexes. An important herd immunity effect for men and women was observed in the heterosexual network, even with 75% coverage. However, HPV in-fections are persistent in the MSM population, with sustained circulation of the virus among un-vaccinated individuals. Coverage around 75% of both sexes would be necessary to eradicate HPV-related conditions in women within five decades. Nevertheless, the variation in the decline in infection in the long term between vaccination coverage of 75% and 90% is relatively small, suggesting that reaching coverage of around 70-75% in the heterosexual network may be enough to confer high protection. Nevertheless, HPV eradication maybe achieved if men’s coverage is strictly controlled. This accurate representation of HPV transmission demonstrates the need to maintain high HPV vaccination coverage, especially in men, for whom the cost-effectiveness of vaccination is questioned.

In the U.S. 44% of low-income households struggle to pay their utility bills, affecting their ability to afford necessities such as food and health expenses. Several government and utility funded energy efficiency programs exist to assist those experiencing energy insecurity. In Salt Lake City, Utah, there is a high demand for, but low availability of, energy efficiency services in underserved neighborhoods creating an opportunity for creative community-based programs to fill this inherent gap. This pilot project, involving the exchanging of LED bulbs in Salt Lake City, highlights the development of a community-based energy efficiency program that aims to bring energy savings to a uniquely targeted portion of the city and determines its feasibility in addressing energy insecurity at a larger scale. Through the 8-month project duration, 1,432 bulbs were exchanged at 23 events reaching 181 households in low-income areas. Through a year of use, these bulbs are estimated to save residents approximately 18,219 USD in electricity bills and reduce CO2 emissions from power plants by 122.23 metric tons, in addition to a savings of 4,400 USD in social cost of carbon as defined by the U.S. Environmental Protection Agency. Since this pilot reached less than 1% of households, we extrapolated a reach of 2%, 5%, and 7.5% and found substantial potential decreases in power plant emissions and financial savings. As this project is ongoing and being expanded, we discuss relevant findings that will help shape future community-based models so that they are appropriately deployed and more effective in alleviating local energy insecurity.

This paper assesses whether there is intrinsic positive educational value in travelling animal presentations and exhibits, referred to here as Mobile Live Animal Programs (MLAPs). Given that educational claims serve as the basis for allowing MLAPs to operate in many jurisdictions throughout Canada and the United States, it is essential to examine whether these purported claims are valid. This study takes a twofold approach of examining first, what constitutes an MLAP and how such programs are situated within the larger context of animal observation and tourism, and second, what constitutes both positive and negative education, and how such learning can empirically be measured in these settings. This approach provokes the ethical question of whether or not MLAPs should be allowed to operate given the high price paid not only by the individual animals used, but also to our psychological, emotional, and intellectual relationship with other species when we use non-human animals for our own knowledge, pleasure or comfort. The paper concludes that we must consider that the pervasive problem of negative education, that using displaced captive wild animals as learning tools that highlights human control over them, their objectification and their exploitation, is not justified by the purported positive educational claims of MLAPs.

Abstract: Colistin is a last-resort antimicrobial for treating multidrug-resistant Gram-negative bacteria. Phe-notypic colistin resistance is highly associated with plasmid-mediated mobile colistin resistance (mcr) genes. mcr-bearing Enterobacteriaceae have been detected in many countries, with the emergence of colistin-resistant pathogens a global concern. This study assessed the distribution of mcr-1, mcr-2, mcr-3, mcr-4, and mcr-5 genes with the phenotypic colistin resistance in isolates from diarrheal infants and children in Bangladesh. Bacteria were identified using the API-20E biochemical panel and 16s rDNA gene sequencing. Polymerase chain reac-tions detected mcr gene variants in the isolates. Their susceptibilities to colistin were determined by agar dilu-tion and E-test by minimal inhibitory concentration (MIC) measurements. Over 30.0% (69/225) of isolates showed colistin resistance by agar dilution assessment (MIC> 2.0 μg/mL). Overall, 15.5% of isolates carried mcr genes (7, mcr-1; 17, mcr-2; 13, mcr-3; and co-occurrence occurred in 2 isolates). Clinical breakout MIC val-ues (≥ 4 μg/mL) were associated with 91.3% of mcr-positive isolates. The mcr-positive pathogens include twenty Escherichia spp., five Shigella flexneri, five Citrobacter spp., two Klebsiella pneumoniae, and three Pseudo-monas parafulva. mcr-genes appeared to be significantly associated with phenotypic colistin resistance phe-nomena (p=0.000), with 100% colistin-resistant isolates showing MDR phenomena. Age and sex of patients showed no significant association with detected mcr variants. Overall, mcr-associated colistin-resistant bacte-ria have emerged in Bangladesh, which warrants further research to determine their spread and instigate ac-tivities to reduce resistance.

This paper presents an original method of additive manufacturing of cylindrical parts with variable circumference thickness, which allows the control of the deposition of molten material using an algorithm for decomposing the part geometry into volumetric elements with known dimensional configuration. In the absence of a post-processor capable of controlling additive manufacturing on a 5-axis numerical control machine, control of the deposition of molten material is done using parameterized programs, which can control both the feed speeds of the machine tool axes and the specific functions of the printing equipment. Additive manufacturing can make a positive contribution to sustainable development compared to traditional manufacturing technologies, thus making a positive contribution for a sustainable future. The aim of the work is to make it possible to 3D print parts with variable wall thickness using a CNC machining centre. To obtain the variable thickness layer we have implemented an original method of deposition with molten material (FDM), the coordination of the system composed of physical elements respectively programmable elements, is realized through control functions materialized in parameterized part programs, the generated outputs being the variable speed of the machine axes on a circular trajectory, the angular positioning, the filament advance.

The process of senescence (aging) is largely determined by the action of wild-type genes. For most organisms, this does not reflect any adaptive function of senescence, but rather evolutionary effects of declining selection against genes with deleterious effects later in life. To understand aging requires an account of how evolutionary mechanisms give rise to pathogenic gene action and late-life disease, that integrates evolutionary (ultimate) and mechanistic (proximate) causes into a single explanation. A well-supported evolutionary explanation by G.C. Williams argues that senescence can evolve due to pleiotropic effects of alleles with antagonistic effects on fitness and late-life health (antagonistic pleiotropy, AP). What has remained unclear is how gene action gives rise to late-life disease pathophysiology. One ultimate-proximate account is T.B.L. Kirkwood’s disposable soma theory. Based on the hypothesis that stochastic molecular damage causes senescence, this reasons that aging is coupled to reproductive fitness due to preferential investment of resources into reproduction, rather than somatic maintenance. An alternative and more recent ultimate-proximate theory argues that aging is largely caused by programmatic, developmental-type mechanisms. Here ideas about AP and programmatic aging are reviewed, particularly those of M.V. Blagosklonny (the hyperfunction theory) and J.P. de Magalhães (the developmental theory), and their capacity to make sense of diverse experimental findings is described.

Since the beginning of the 21st century, Romanian migrants have become one of the most significant national groups doing agricultural work in Spain, initially coming via a temporary migration program and later under several different modalities. However, despite their critical importance for the functioning of Europe’s largest agro-industry, the study of this long-term circular mobility is still underdeveloped in migration and agriculture literature. Thanks to extensive fieldwork carried out in the provinces of Huelva and Lleida in Spain and in the counties of Teleorman and Buzău in Romania, this paper has two main objectives: first, to identify some of the most common forms of mobility of these migrants and second, to discuss whether this industrial agriculture, hugely dependent on migrant work, is socially sustainable. The case of Romanian migrants in Spanish agriculture will serve to show how a critical sector for the EU and for the 2030 Agenda for Sustainable Development of the United Nations, operates on an unsustainable model based on precariousness and exploitation.

One of the IRDiRC goals for 2017-2027 is to achieve definitive diagnosis for rare undiagnosed diseases within one year, as diagnosis delay remains one of the pending issues in the rare diseases field. The Spanish Undiagnosed Rare Diseases Program (SpainUDP) was created in response to this challenging scenario to cover patients’ needs and after seeing the success of the UDP in USA. SpainUDP offers a multidisciplinary approach to those patients who have long sought a diagnosis without any success. During a first phase of the protocol, undiagnosed cases are sent to SpainUDP by individual patients, patient organizations or hospitals. After a carefully analysis of phenotype, data from sequencing experiments (WES) is processed with a standard pipeline and a detailed standardized phenotypic information (mapped to HPO) is connected to genetic data. In addition, the participation of SpainUDP in international initiatives such as the European projects RD-Connect and Solve RD, the Undiagnosed Diseases Network International (UDNI), and the MatchMaker Exchange platform, allows the establishment of a global data sharing strategy across multiple projects submitting data to these international initiatives. From the official beginning of the program (at the end of 2015) until early 2018, 147 cases were accepted in SpainUDP. During this time, 37 cases (25 %) dropped out the program due to several reasons. The remaining 110 cases are distributed as follows: phenotypic and genotypic (WES) characterization was finished in 30 cases, of which 20 (67 %) were diagnosed; 21 cases are pending on variants validation by Sanger; in 25 cases, WES is ongoing and 34 cases are in a deep phenotypic characterization. As a conclusion, SpainUDP aims to achieve a diagnosis following two recommendations of the IRDiRC: the patients’ diagnosis in a period of time as short as possible and the promotion of data sharing (especially genomic) at the international level.

(1) Background: Factors reported in literature associated with inappropriate prescribing of antimicrobials, such as physicians with less experience, uncertain diagnosis, and patient caregiver influences on physicians' decisions. Monitoring antimicrobial resistance is critical for identifying emerging resistance patterns, developing, and assessing the effectiveness of mitigation strategies. Improvement in prescribing `antimicrobials would minimize the risk of resistance and, consequently, improve patients' clinical and health outcomes. The purpose of the study is to delineate factors associated with antimicrobial resistance, describe the factors influencing prescriber’s choice during prescribing of antimicrobial, and examine factors related to consequences of inappropriate prescribing of antimicrobial. (2) Methods: Cross-sectional study conducted among healthcare providers (190) in six tertiary hospitals in the Eastern province of Saudi Arabia. The research panel has developed validated and piloted survey specific with closed-ended questions. A value of P <0.05 was considered for statistical significance. All data analysis was performed using Statistical Package for Social Sciences (IBM SPSS version 23.0). (3) Results: 72.7% of the respondents have agreed that poor skills and knowledge are key factors that contribute to the inappropriate prescribing of antimicrobials. All the respondents acknowledged effectiveness and previous experience with the antimicrobial, and reading scientific materials (such as books, articles, and the internet) were key factors influencing physicians’ choice during antimicrobial prescribing. (4) Conclusion: The current study has identified comprehensive education and training needs for healthcare providers about antimicrobial resistance. Using antimicrobials unnecessarily, insufficient duration of antimicrobial use, and using broad spectrum antimicrobials, were reported to be common practices. Further, poor skills and knowledge were a key factor that contributed to the inappropriate use and overuse of antimicrobials and using antimicrobials without physician prescription (self-medication) were the key factors which contribute to AMR from participants’ perspectives. Furthermore, internal policy and guidelines are needed to ensure that the antimicrobials are prescribed in accordance with standard protocols and clinical guidelines.

Accurate and reliable project cost estimates are fundamental to achieve successful municipal capital improvement (CIP) programs. Engineering cost estimates typically represent critical information for key decision makers to authorize and efficiently allocate the necessary funds for construction, budgeting, to generate a request for proposals, contract negotiations, scheduling, etc. for these reasons, cost estimators are using different estimating methods and approaches that allow for required levels of accuracy. As the project’s scope becomes more detailed and the potential risks are identified and/or the project design stage progresses these cost estimates are revised and updated. In this paper, the most common project cost estimation methods and approaches were collected and categorized into two main groups of (1) probabilistic and (2) deterministic methods. Under these groups overall ten different methods were identified and discussed addressing their requirements, advantages, and shortcomings, including the potential risk that can positively or negatively affect the project’s cost outcome. This paper will be a good resource for professionals who are in budget development and/or are seeking to a better understanding of different methods in determining an appropriate base cost margin and produce a meaningful and reliable project cost estimate.

Background: Evaluation of nutrition programs is essential to guarantee the effectiveness of community-based management of acute malnutrition (CMAM). Methods: The Rainbow Project Supplementary Feeding Programs (SFPs) in Zambia were evaluated between years 2015-17, following implementation of new recommendations based on previous evaluations (years 2012-14). Outcomes of the program were compared with International Standards and with those of 2012-14. Cox proportional risk regression analysis was performed to identify predictors of mortality and defaulting. Results: Data for 900 under age 5 years malnourished children (48.8% male; mean age 19.7months ±9.9) were analyzed. Rainbow 2015-17 program outcomes met International Standards, for general malnutrition or stratified moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). When comparing with 2012-14 outcomes, better performance was noted: mortality rates were reduced by half (5.6% vs 3.1%, p = 0.01; for SAM: 12.4% vs 6.7%, p = 0.006), with significant improvement in average weight gain and mean length of stay (p<0.001), and increased awareness of HIV status (+30%; p < 0.001). HIV infection (5.5; 1.9–15.9), WAZ < −3 at baseline (4.6; 1.3–16.1) and kwashiorkor (3.5; 1.2–9.5) remained the major predictors of mortality. Conclusion: The effectiveness of the Rainbow SFPs for child malnutrition treatment and prevention in Zambia has significantly improved after evaluation and implementation activities, with impressive outcomes which resulted in a 50% reduction in mortality.

To handle the challenges and uncertainties of the actual labor market, the concept of employability becomes increasingly relevant, especially for graduates facing the transition from university to work. Graduate employability is a complex concept comprising different dimensions that may trigger effective job search and career management. This study introduces a new multifaceted tool, labeled the Orientamentis Questionnaire, to assess graduate employability from an agentic perspective, testing its psychometric properties. The Orientamentis questionnaire measures 14 dimensions merged into four 4 areas, namely graduate psychological capital, graduate agentic capabilities, graduate career perspective, and graduate proactive strategies. The tool was administered to a sample of 1238 graduate students (66% females) examining its factorial structure and reliability. To test its criterion validity, associations with three occupational outcomes collected one year later were explored on a subsample of 273 participants (66% females). Results attested the factorial structure of the Orientamentis questionnaire and the reliability of all dimensions. Moreover, the four areas and most of the dimensions were differently related to at least one subsequent occupational outcome. The Orientamentis Questionnaire represents a sound and reliable tool providing a multifaceted profile of graduate employability strengths and weaknesses, that could be used in academic placement programs to foster graduates’ self-awareness and proactive job search.

Carbapenem antibiotics are the drug of choice for treating multidrug-resistant bacterial infections. Metallo-beta-lactamases (MBLs) are carbapenemase capable of hydrolyzing nearly all therapeutically available beta-lactam antibiotics. Consequently, a need to assess the frequency and phenotypic resistance phenomena of two MBL genes in diarrheal and urinary tract infections (UTIs). Samples were collected through a cross-sectional study, with MBLs genes detected via PCR. Two hundred twenty eight diarrheal bacteria were isolated from 240 samples. The most predominant pathogens were Escherichia coli (32%) and Klebsiella spp. (7%). Phenotypic resistance to amoxicillin-clavulanic acid, aztreonam, cefuroxime, cefixime, cefepime, imipenem, meropenem, gentamicin, netilmicin, and amikacin was 50.4%, 65.6%, 66.8%, 80.5%, 54.4%, 41.6%, 25.7%, 41.2%, 37.2%, and 42.9%, respectively.  Total 142 UTI pathogens were obtained from 150 urine samples, with Klebsiella spp. (39%) and Escherichia coli (24%) are the major pathogens. Phenotypic resistance to amoxycillin-clavulanic acid, aztreonam, cefuroxime, cefixime, cefepime, imipenem, meropenem, gentamicin, netilmicin, and amikacin was 93.7%, 75.0%, 91.5%, 93.7%, 88.0%, 72.5%, 13.6%, 44.4%, 71.1%, and 43%, respectively.  Twenty four diarrheal isolates carried either blaNDM-1 or blaVIM genes; the overall MBL gene prevalence was 10.5%. Thirty six UTI pathogens carried either blaNDM-1 or blaVIM genes (25.4%). Seven isolates carried both blaNDM-1 and blaVIM genes.  MBL genes exhibited a strong association with phenotypic carbapenem and other beta-lactam antibiotic resistance. Resistance to carbapenems requires active surveillance and stewardship.

Semi-supervised consensus clustering is a promising strategy to compensate for the subjectivity of clustering and its sensitivity to design factors, with various techniques being recently proposed to integrate domain knowledge and multiple clustering partitions. In this article we present a new approach that makes double use of domain knowledge, namely to build the initial partitions as well as to combine them. In particular, we show how to model and integrate must-link and cannot-link constraints into the objective function of a generic consensus clustering (??) framework that maximizes the similarity between the consensus partition and the input partitions, which have, in turn, been enriched with the same constraints. In addition, borrowing from the theory of functional dependencies, the integrated framework exploits the notions of deductive closure and minimal cover to take full advantage of the logical implication between constraints. Using standard UCI benchmarks, we found that the resulting algorithm, termed ??? (double-Constrained Consensus Clustering), was more effective than plain ?? at combining base constrained partitions. We then argue that ??? is especially well-suited to profiling counterfeit e-commerce websites, because constraints can be acquired by leveraging specific domain features, and demonstrate its potential for detecting affiliate marketing programs. Taken together, our experiments suggest that ??? makes the process of clustering more robust and able to withstand changes in clustering algorithms, datasets, and features, with a remarkable improvement of average performance.