Access Categories Research Articles

Application of appropriate technology for feed supplements in Sukanagalih Village, Tasikmalaya Regency

Feed supplement is useful as a growth promoter, increasing efficiency and feed consumption, helping digestion and metabolism, and improving the quality of livestock products. The aim of this community service is to apply appropriate technology to utilize mangosteen peel and turmeric as feed supplement for poultry in Sukanagalih Village, Tasikmalaya Regency, as well as produce quality feed supplement and improve the skills of farmers in processing the supplement feed. This community service activity is one of the Kosabangsa programs between the Universitas Perjuangan Tasikmalaya as the implementation team and the IPB University as the accompanying team. This activity started from September to December 2023 in Sukanagalih Village, Rajapolah District, Tasikmalaya Regency. The method for implementing this activity consists of counseling, training, and assistance to livestock groups. The target partners for this activity were Kelompok Megar Bebek Cihateup and the Berdikari Village-Owned Enterprise (Bumdes Berdikari) with a total of 20 participants each, so the total participants are 40 people. The level of community empowerment increased to 80 – 85% in the knowledge, skills, accessibility, and income categories. The results of this activity are very beneficial for the community, where the application of appropriate technology for processing mangosteen peel and turmeric as feed supplements can increase the added value and selling value of agro-industrial waste products in Tasikmalaya Regency. The application of appropriate technology for the use of supplement feed is able to increase the knowledge and skills of the community in Sukanagalih Village, Tasikmalaya Regency in processing feed supplements.

Evaluation of antibiotic prescription patterns using WHO AWaRe classification.

Antimicrobial resistance is a rising problem worldwide and it poses a serious risk to public health. In Pakistan, about 70.0% of the Acinetobacter group of bacteria were resistant to all antibiotics and were responsible for high mortality among neonates within the first week of life. To evaluate the pattern of antibiotic prescription in the Ear, Nose and Throat (ENT) Department of Shalamar Hospital, Lahore, Pakistan, using the WHO AWaRe 2021 classification. We collected prescription data from the ENT outpatient department of Shalamar Hospital from October to December 2021. We compared the quantitative analysis of antibiotics with the WHO AWaRe classification. We analysed the data using SPSS version 26 and discussed the results with the ENT Department for possible improvements. Some 862 (12.1%) of the total 7126 entries were assessed. Others were excluded because they had some missing data or had no antibiotic prescription. Of all the antibiotics prescribed, around 54.9% belonged to the access category. The WHO 13th General Programme of Work 2019-2023 recommends a country-level target of at least 60% of the total antibiotic consumption in the access group antibiotics. The outpatient department of the ENT did not prescribe any reserve or not recommended antibiotics. The use of watch antibiotics was higher than recommended by the WHO AWaRe classification. More efforts should be made to increase prescriptions from the AWaRe access group to achieve the 60% minimum target recommended by WHO for the country.

Social determinants of health and health inequities in breast cancer screening: a scoping review.

This scoping review aims to highlight key social determinants of health associated with breast cancer screening behavior in United States women aged ≥40 years old, identify public and private databases with SDOH data at city, state, and national levels, and share lessons learned from United States based observational studies in addressing SDOH in underserved women influencing breast cancer screening behaviors. The Arksey and O'Malley York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. The 72 included studies were published between 2013 and 2023. Among the various SDOH identified, those related to socioeconomic status (n = 96) exhibited the highest frequency. The Health Care Access and Quality category was reported in the highest number of studies (n = 44; 61%), showing its statistical significance in relation to access to mammography. Insurance status was the most reported sub-categorical factor of Health Care Access and Quality. Results may inform future evidence-based interventions aiming to address the underlying factors contributing to low screening rates for breast cancer in the United States.

A six years trend analysis of systemic antibiotic consumption in Northwest Ethiopia.

Consumption of antibiotics, a major global threat to public health, is perhaps the key driver of antibiotic resistance. Monitoring antibiotic consumption is crucial to tackling antimicrobial resistance. This study assessed antibiotic consumption trends during the last six years in the Bahir Dar branch of the Ethiopian pharmaceutical supply agency (EPSA), Northwest Ethiopia, in 2022. Retrospective data were collected in August 2022 based on antibiotic distribution data from the Bahir Dar Brach of EPSA from July 2016 to June 2022. Data were analyzed according to the Anatomic Therapeutic Classification (ATC) developed by the World Health Organization (WHO). We measured antibiotic consumption using a defined daily dose per 1000 inhabitants per day (DIDs) based on the Agency's catchment population. Descriptive statistics and trend analyses were conducted. About 30.34 DIDs of antibiotics were consumed during the six years. The consumption of antibiotics decreased by 87.4%, from 6.9 DIDs in 2016/17 to 0.9 DIDs in 2021/22. Based on the WHO AWaRe classification, 23.39 DIDs (77.1%) of the consumed antibiotics were from the Access category. Consumption of Access category antibiotics was decreased by 72.7% (from 5 to 0.5 DIDs) but Watch antibiotics decreased by 54.3% (from 1.8 to 0.4 DIDs). Oral antibiotics accounted for 29.19 DIDs (96.2%) of all consumed systemic antibiotics. The average cost expenditure per DDD for all antibiotics was 54.1 birr/DDD (0.4-482.3 birr/DDD). Only seven antibiotics accounted for DU90% and the cost expenditure per DDD for the DU90% antibiotics ranged from 0.4/DDD for Doxycycline to 232.8 birr/DDD for Piperacillin/tazobactam. Overall, during the last six years, the most commonly used antibiotic was Amoxicillin (10.1 DIDs), followed by Doxycycline (5.3 DIDs) and Ciprofloxacin (3.4 DIDs). In this study, we found that antibiotic usage was low and continuously declining over time. Minimizing unnecessary antibiotic usage is one possible approach to reduced AMR. However, a shortage of access to important medicines can compromise the quality of treatment and patient outcomes. A prospective study is needed to evaluate the balance of patient outcomes and reduce AMR by optimizing the community consumption of systemic antibiotics.

Influence of age, socioeconomic status, and location on the infant gut resistome across populations

ABSTRACT Antibiotic resistance is a growing global concern, with many ecological niches showing a high abundance of antibiotic resistance genes (ARGs), including the human gut. With increasing indications of ARGs in infants, this study aims to investigate the gut resistome profile during early life at a wider geographic level. To achieve this objective, we utilized stool samples data from 26 studies involving subjects aged up to 3 years from different geographical locations. The 32,277 Metagenome Assembled Genomes (MAGs) previously generated from shotgun sequencing reads from these studies were used for resistome analysis using RGI with the CARD database. This analysis showed that the distribution of ARGs across the countries in our study differed in alpha diversity and compositionally. In particular, the abundance of ARGs was found to vary by socioeconomic status and healthcare access and quality (HAQ) index. Surprisingly, countries having lower socioeconomic status and HAQ indices showed lower ARG abundance, which was contradictory to previous reports. Gram-negative genera, including Escherichia, Enterobacter, Citrobacter, and Klebsiella harbored a particularly rich set of ARGs, which included antibiotics that belong to the Reserve, Access or Watch category, such as glycopeptides, fluoroquinolones, sulfonamides, macrolides, and tetracyclines. We showed that ARG abundance exponentially decreased with time during the first 3 years of life. Many highly ARG-abundant species including Escherichia, Klebsiella, Citrobacter species that we observed are well-known pathobionts found in the infant gut in early life. High abundance of these species and a diverse range of ARGs in their genomes point toward the infant gut, acting as an ARG reservoir. This is a concern and further studies are needed to examine the causal effect and its consequences on long-term health.

The Ground Floor Approach to Video Game Accessibility: Identifying Design Features Prioritized by Accessibility Reviews

This article describes the priorities for accessibility found in video game accessibility reviews. Through an analysis of 20 articles published by the accessibility review websites DAGERSystem.com and CanIPlayThat.com, this study categorizes the accessibility features in those articles in order to discover which accessibility features are the most important to reviewers, gauged by how many words are dedicated to addressing each feature. The study discovers 15 primary categories of accessibility most prominently features in these reviews. Word counts for each category provide a prioritized list of which accessibility features are the most central to video game accessibility. This article concludes by introducing the ground floor approach to video game accessibility, which calls for subtitles, difficulty settings, control options, and visual clarity as essential features in modern game design.

A comparison between antibiotic utilisation in public and private community healthcare in Malaysia

BackgroundThere are two parallel systems in Malaysian primary healthcare services: government funded public primary care and privately-owned practices. While there have been several studies evaluating antibiotic utilisation in Malaysian public healthcare, there is a lack of literature on the use of antibiotics in the private sector. There is a dire need to evaluate the more recent performance of public vs. private community healthcare in Malaysia. As such, this study aimed at measuring and comparing the utilisation of antibiotics in the public and private community healthcare sectors of Malaysia in 2018–2021.MethodsThis study was a retrospective analysis of antibiotic utilisation in Malaysian primary care for the period of 1 January 2018 until 31 December 2021 using the nationwide pharmaceutical procurement and sales data from public and private health sectors. Rates of antibiotic utilisation were reported as Defined Daily Doses per 1000 inhabitants per day (DID) and stratified by antibiotic classes. The secondary analysis included proportions of AWaRe antibiotic category use for each sector and proportion of antibiotic utilisation for both sectors.ResultsThe overall national antibiotic utilisation for 2018 was 6.14 DID, increasing slightly to 6.56 DID in 2019, before decreasing to 4.54 DID in 2020 and 4.17 DID in 2021. Private primary care antibiotic utilisation was almost ten times higher than in public primary care in 2021. The public sector had fewer (four) antibiotic molecules constituting 90% of the total antibiotic utilisation as compared to the private sector (eight). Use of Access antibiotics in the public sector was consistently above 90%, while use of Access category antibiotics by the private sector ranged from 64.2 to 68.3%. Although use of Watch antibiotics in the private sector decreased over the years, the use of Reserve and ‘Not Recommended’ antibiotics increased slightly over the years.ConclusionAntibiotic consumption in the private community healthcare sector in Malaysia is much higher than in the public sector. These findings highlight the need for more rigorous interventions targeting both private prescribers and the public with improvement strategies focusing on reducing inappropriate and unnecessary prescribing.

Evaluation of antibiotics in pediatrics using the defined daily doses method and the World Health Organization (WHO) access, watch, and reserve classification (AWaRe 2021): a cross-sectional study.

irrational antibiotic use can result in antibiotic resistance, which, in turn, can lead to increased morbidity and mortality, as well as high treatment costs. This phenomenon is more common in children because they are a population that often receives antibiotics. This study aimed to evaluate antibiotic use in pediatric patients in Indonesia using the Defined Daily Doses (DDD) method and the WHO Access, Watch, and Reserve Classification (AWaRe 2021). this is an observational study that uses a quantitative approach to calculate the quantity of antibiotic use in pediatric patients in two hospitals in Central Java, Indonesia. A cross-sectional study was conducted at two referral hospitals in Central Java Province, Indonesia, from January to December 2020. The DDD approach was used to examine antibiotic use. Antibiotic use was also classified into three groups based on the World Health Organization´s "AWaRe" categorization: "Access," "Watch," and "Reserve." a total of 505 pediatric encounters were assessed. The most frequently prescribed antibiotics in pediatric inpatients were cefotaxime accounting for 42.72%, ceftriaxone 22.91% and ampicillin 12.11%. Cephalosporins 69.89% were the most commonly prescribed antibiotic class. The number of antibiotics consumed was 11.08 DDD/100 patient days. Cefotaxime, with a DDD/100 patient days value of 2.95, was the most frequently prescribed antibiotic (47.72%). Evaluation of antibiotics uses based on WHO AWaRe 2021 showed that 31.6% and 68.4% of prescribed antibiotics were in the Access category and watch category, respectively. antibiotic use was high in the research setting. Over half of the antibiotic use was in the "Watch" group, according to the usage control criteria. Ceftazidime, cefixime, cefotaxime, and ceftriaxone had the highest levels of antibiotic consumption.

Unveiling Spatial Disparities: Exploring High-Risk Diarrhea Among Children Under Five Using Geographically Weighted Quantile Regression

We investigate the impact of the percentage of clean water access, the percentage of handwashing habits, and the toilet category factors on the upper quantile of toddlers’ diarrhea risks in Bandung City, Indonesia, using the Geographically Weighted Quantile Regression model on the 75th percentile. The breusch-Pagan test was used to detect spatial heterogeneity. The results show that the significance, strength, and direction of the relationship between diarrhea and its risk factors depend on the location. At the upper quantile, the Panyileukan district is predicted to have the highest diarrhea risk. In this district, all three predictors significantly affect the toddlers’ diarrhea risk, with the variable of the percentage of houses practicing hand washing habits observed to reduce diarrhea risk the most. In conclusion, clean water access, handwashing habits, and toilet category are the potential risk factors for high-risk childhood diarrhea. This method is powerful as it would allow the decision maker to handle the diarrhea problem aptly based on which predictor has a substantial effect at a specific district of interest. And it can be used to investigate the effect of various intervention strategies and effectively allocate the limited available resources according to the most important locations.

Disparities in preconception health indicators in U.S. women: a cross-sectional analysis of the behavioral risk factor surveillance system 2019.

Optimized preconception care improves birth outcomes and women's health. Yet, little research exists identifying inequities impacting preconception health. This study identifies age, race/ethnicity, education, urbanicity, and income inequities in preconception health. We performed a cross-sectional analysis of the Center for Disease Control and Prevention's (CDC) 2019 Behavioral Risk Factor Surveillance System (BRFSS). This study included women aged 18-49 years who (1) reported they were not using any type of contraceptive measure during their last sexual encounter (usage of condoms, birth control, etc.) and (2) reported wanting to become pregnant from the BRFSS Family Planning module. Sociodemographic variables included age, race/ethnicity, education, urbanicity, and annual household income. Preconception health indicators were subdivided into three categories of Physical/Mental Health, Healthcare Access, and Behavioral Health. Chi-squared statistical analysis was utilized to identify sociodemographic inequities in preconception health indicators. Within the Physical/Mental Health category, we found statistically significant differences among depressive disorder, obesity, high blood pressure, and diabetes. In the Healthcare Access category, we found statistically significant differences in health insurance status, having a primary care doctor, and being able to afford a medical visit. Within the Behavioral Health category, we found statistically significant differences in smoking tobacco, consuming alcohol, exercising in the past 30 days, and fruit and vegetable consumption. Maternal mortality and poor maternal health outcomes are influenced by many factors. Further research efforts to identify contributing factors will improve the implementation of targeted preventative measures in directly affected populations to alleviate the current maternal health crisis.

Ground level utility of Access, Watch, Reserve classification: Insights from a tertiary care center in North India.

The overuse and misuse of antimicrobials contribute significantly to antimicrobial resistance (AMR), which is a global public health concern. India has particularly high rates of AMR, posing a threat to effective treatment. The World Health Organization (WHO) Access, Watch, Reserve (AWaRe) classification system was introduced to address this issue and guide appropriate antibiotic prescribing. However, there is a lack of studies examining the prescribing patterns of antimicrobials using the AWaRe classification, especially in North India. Therefore, this study aimed to assess the prescribing patterns of antimicrobials using the WHO AWaRe classification in a tertiary care centre in North India. To study the prescribing patterns of antimicrobials using WHO AWaRe classification through a cross-sectional study in All India Institute of Medical Sciences Rishikesh. A descriptive, cross-sectional study was conducted from July 2022 to August 2022 at a tertiary care hospital. Prescriptions containing at least one antimicrobial were included in the study. Data on prescriptions, including patient demographics, departments, types of antimicrobials prescribed, and duration of treatment, were collected. A questionnaire-based survey was also conducted to assess the knowledge and practices of prescribing doctors regarding the utility of AWaRe classification. The study involved a total of 123 patients, each of whom received at least one antimicrobial prescription. Most prescriptions were for inpatients, evenly distributed between Medicine (Internal medicine, Pediatrics, Dermatology) and Surgical departments (General surgery and specialties, Otorhinolaryngology, Ophthalmology, Obstetrics and Gynecology). Metronidazole and ceftriaxone were the most prescribed antibiotics. According to the AWaRe classification, 57.61% of antibiotics fell under the Access category, 38.27% in Watch, and 4.11% in Reserve. Most Access antibiotics were prescribed within the Medicine department, and the same department also exhibited a higher frequency of Watch antibiotics prescriptions. The questionnaire survey showed that only a third of participants were aware of the AWaRe classification, and there was a lack of knowledge regarding AMR and the potential impact of AWaRe usage. This study highlights the need for better antimicrobial prescribing practices and increased awareness of the WHO AWaRe classification and AMR among healthcare professionals. The findings indicate a high proportion of prescriptions falling under the Access category, suggesting appropriate antibiotic selection. However, there is a significant difference between the WHO Defined Daily Dose and the prescribed daily dose in the analysed prescriptions suggesting overuse and underuse of antibiotics. There is room for improvement and educational interventions and antimicrobial stewardship programs should be implemented to enhance knowledge and adherence to guidelines, ultimately contributing to the containment of AMR.

National health insurance scheme improves access and optimization of antimicrobial use in the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.

Nigeria instituted the National Health Insurance Scheme (NHIS) for universal health coverage. This study compared the NHIS and out-of-pocket (OOP) antibiotic prescribing with the World Health Organization (WHO) optimal values. A total of 2190 prescription forms from the NHIS and OOP were included in this study conducted at Obafemi Awolowo University Teaching Hospitals Complex, Nigeria from January 2021 to December 2022 and analysed using WHO drug prescribing guidelines. The average number of drugs per encounter was higher in the NHIS prescribing (χ2=58.956, p=0.00) than in OOP prescribing. The percentage of encounters with an antibiotic prescribed is higher in NHIS prescribing (χ2=46.034, p=0.000) than in OOP prescribing. The percentage of parenteral antibiotic prescribing is higher in OOP prescribing (χ2=25.413, p=0.000) than in NHIS prescribing. The percentage of antibiotic prescribed from the National Essential Medicine List is higher in NHIS prescribing (χ2=8.227, p=0.000) as well as the antibiotics prescribed from the Access category of the WHO Access, Watch and Reserve (AWaRe) Classification of antibiotics (χ2=23.946, p=0.000) when compared with OOP prescribing. Prescribing indicators show better performances with NHIS antibiotic prescribing and are closer to the WHO-recommended optimal values than in OPP prescribing. Hence NHIS prescribing can be an easy target for hospital antibiotic stewardship intervention for optimal antibiotic prescribing.

A Sistematic Literature Review : Implementasi Asesmen Diagnostik pada Kurikulum Merdeka

This research aims to examine scientific articles that are relevant and related to the implementation of diagnostic assessments. The research method used in writing this article is a literature review. The literature review was obtained from articles published in the last 5 years, namely from 2019 to 2023. The literature search was focused on the keyword "Diagnostic Assessment" so that a total of 29 articles were obtained, for research at the secondary school level, which were accessed via the Publish or Peerish application. However, after going through the screening stage there were 17 articles in the open access category and relevant to the topic of discussion. Based on the results of the literature review analysis, there are doubts from teachers to carry out diagnostic assessments because teachers have not received a lack of socialization regarding the Implementation of the Independent Curriculum (IKM), so that training and guidance for teachers needs to be carried out. Apart from that, in the implementation of diagnostic assessments, it was found that (1) diagnostic assessments can be implemented in the independent curriculum at primary and secondary school levels, (2) implementation of diagnostic assessments can also help students overcome learning problems with various learning styles. (3) Diagnostic assessments can evaluate students' strengths and weaknesses (4) while from the educator/teacher side they can be used to plan learning strategies. Apart from that, there are also diagnostic assessment tools that teachers can use, such as the Fout-tier Test Diagnostic and Google Form.

A Point Prevalence Survey of Antimicrobial Use at Geita Regional Referral Hospital in North-Western Tanzania.

We conducted a point prevalence survey (PPS) to determine the prevalence of antibiotic use at Geita Regional Referral Hospital (GRRH) located along the shores of Lake Victoria in north-western Tanzania. This has led to the identification of gaps for improvement. This PPS study was conducted on 9-10 March 2023. Patient-related information, including sociodemographic and clinical data, was collected from medical records. STATA software version 15.0 was used to perform descriptive data analysis. About 94.8% (55/58) patients were on antibiotics with a mean (±SD) prescription of 2 (±0.5) antibiotic agents ranging from 1 to 4 different agents. The commonest indications of the antibiotic prescription were medical prophylaxis 47.3% (26/55) followed by empiric treatment 41.8% (23/55). In total, 110 prescriptions were made, of which metronidazole (25.5%; n = 28), ceftriaxone (23.6%; n = 26), and ampicillin-cloxacillin (23.6%; n = 26) were frequently observed. Only 67.3% (n = 74) of prescriptions complied with Tanzania Standard Treatment Guidelines. Moreover, according to the WHO-AWaRe classification, 50.9%, 23.6%, and 25.5% were under the Access category, Watch category, and Not Recommended category, respectively. The prevalence of antibiotic use among patients admitted to GRRH was high, whereby medical prophylaxis and empiric treatment were the commonest indications for antibiotic prescription. To support rational therapy and antimicrobial stewardship initiatives, we recommend that laboratories in regional hospitals be equipped to conduct sustained routine culture and antimicrobial susceptibility testing.

Analysis of IEEE 802.11p-Based Intra-Platoon Message Broadcast Delay in a Platoon of Vehicles

For platooning applications, vehicles in a platoon require timely and reliable delivery of road-safety information in order to maintain the stable operation of the platoon. Intra-platoon message broadcast delay (InPB-delay) is a critical metric that is used to measure the message delivery performance in a platoon of vehicles, where a V2V multi-hop broadcast mode is used for message delivery. In this paper, we study the modeling and analyses of the InPB-delay for a platoon of connected and automated vehicles (CAVs), which employs an IEEE 802.11p EDCA mechanism for channel access. A 2-D Markov chain model is first built to describe a backoff procedure of a platoon broadcasting node, which takes into account the four access categories of different priorities in the EDCA mechanism. Based on the Markov model, a theoretical performance model is further derived to investigate the impacts of major system parameters on the InPB-delay, taking into account the effects of both platoon vehicles and non-platoon vehicles. The derived performance model is validated through simulation results and the impacts of major system parameters are investigated through numerical results. The InPB-delay model can be used to provide reference values for system parameter settings in order to ensure the stable operation of a platoon.

Application of K-Means Algorithm in Clustering Model for Learning Management System Usage Evaluation

The use of a learning management system (LMS) is one of the media that can be used to disseminate lecturer materials to students. Materials that can be uploaded on the LMS can be in the form of lecture materials in the form of files, videos, or questions. The effectiveness of LMS can be evaluated by looking at activities in using LMS. The effectiveness of using LMS can be seen from the log. Log results from LMS can be evaluated in various ways and one way is to use data mining clustering models. The clustering model can be used to create student groupings and the clustering results can be labeled in the form of categories, such as very good, good, and bad categories. This labeling depends on the clustering results that will be processed in the modeling. The research method uses CRISP DM which consists of business understanding, data understanding, data preparation, modeling, evaluation, and deployment. The beginning of the research process is carried out by taking log data in the Moodle LMS. The clustering model in this research will use the K-Means algorithm and the evaluation of clustering results will be evaluated for performance using the Davies-Bouldin method. Implementation of data mining processing using Rapid Miner application. The datasheet used is a datasheet taken from the LMS log of the Computer Programming course in the Mechanical Engineering study program - AKPRIND Institute of Science & Technology Yogyakarta odd semester of the 2021/2022 and 2022/2023 academic years. The results of the study resulted in the best clustering based on the Davies Bouldin method of 2. The clustering results, cluster 0 consists of 28 data named the category of frequent access to LMS and cluster 1 consists of 54 with the category of not frequent access to LMS.

Fibrantly generated weak factorization systems

We prove that, assuming Vopěnka’s principle, every small projectivity class in an accessible category is accessible. This conclusion is not provable in ZFC alone, and in fact carries large cardinal strength.

Stop antibiotic resistance - A roller coaster ride through "antibiotic stewardship," "prescription auditing" and "AWaRe" assessment tool.

The emergence of superbugs and highly resistant organisms like methicillin-resistant staphylococci, vancomycin-resistant enterococci, carbapenem-resistant enterobacteriaceae demands the monitoring of antibiotic prescription and usage in various domains. The impact of antibiotic resistance is huge that it increases mortality, morbidity, and economic costs. The issue has to be addressed at various levels and that is why regulatory bodies implement antibiotic stewardship programs. These programs give a list of guidelines like infection control, tracking antibiotic use, prescription auditing, and involvement of health professionals like pharmacists, nurses, etc., A comparison of the list of guidelines given by the Centre for Disease Control and Prevention and Indian Council of Medical Research gives an idea about the measures to be taken at various levels to reduce the burden of antibiotic resistance. Prescription auditing is one of the major components of antibiotic stewardship. The auditing can be done either prospectively or retrospectively using WHO core prescribing indicators and antibiotic-specific indicators. An AWaRe assessment tool was also used to evaluate antibiotic consumption in countries and hospitals. The antibiotics are classified into access, watch and reserve categories. The aim of implementing the AWaRe tool is to increase the rational use of access antibiotic and reduce the consumption of watch and reserve antibiotics. This review focuses on the importance of prescription auditing, AWaRe tool and antibiotic stewardship in decreasing the threat of antibiotic resistance.

Powder‐Based Additive Manufacturing: A Critical Review of Materials, Methods, Opportunities, and Challenges

As a 0D material, powder particles can be used to create almost any complicated engineering component by utilizing the high‐performance manufacturing capabilities of additive manufacturing (AM). Although powder‐based AM methods provide an outstanding practical value and development for modern manufacturing world, they continue to face challenges such as a lack of accessible categories, temperature restrictions, and poor performance of molded components. Therefore, researching for new AM materials and procedures has become an extremely necessary endeavor. For this purpose, a firm grasp of the current state of the art of powder‐based AM technologies is imperative. Hence, herein, a comprehensive review is presented on the most widely used powder‐based AM methods, and the materials used by these methods. For each method, the development and current state, operating principles, limitations, and future prospects are summarized. In contrast, for materials, their classifications, properties, and preparation methods are explored in great detail, while also commenting on the specific compatibilities between powder materials and powder methods. Industrial and commercialized applications of powder‐based AM are also presented in this work. Finally, the limitations of the current powder‐based technologies are highlighted, with comments regarding the future of this field.

The impact of smart destination implementations in Malaga

PurposeThis study assesses the impact of smart destination implementations in Malaga. Thus, this study aims to guide the transformation of destinations into smart destinations as well as the introduction of smart destination concept in the literature.Design/methodology/approachMalaga was selected because it was one of the two winners of 2020 European Capital of Smart Tourism competition as well as the winner in the accessibility category of the 2019. The research population lives in Malaga and has been professionally involved in smart destination implementations. Data were collected through a semi-structured interview of 14 smart-tourism experts in different career fields. Content analysis was applied to the findings.FindingsMalaga has become a successful smart destination while it has had a great success in improving its attractiveness and competitiveness due to the developments in the past 20 years. Now, its citizens and tourists are very satisfied and have a higher and more attractive quality of life. Moreover, Malaga has become a leading destination, especially in accessibility and mobility.Originality/valueAlthough smart destination is becoming popular topic day by day, almost all the studies are created to introduce the approach with secondary data. There are still only limited research studies conducted by primary data on a real smart destination case. Furthermore, Malaga is a quite good example to understand the importance of smart destination approach since the city has achieved to become an attractive and popular destination for both tourists and local residents.