Access Categories Research Articles

P-1770. Antimicrobial Stewardship: Usage of AWaRe Classification for justification of antibiotic therapy in a tertiary care hospital in South India

Abstract Background Antibiotic resistance, a consequence of the overuse and inappropriate use of antibiotics, poses a significant global health threat, endangering our ability to effectively treat bacterial infection. Utilizing the WHO,s categorization of antibiotics into Access, Watch, and Reserve (AWaRe) for justification provides a structured approach for assessing antimicrobial use, thereby facilitating the identification of areas for improvement and the implementation of effective antimicrobial stewardship programs (AMS). Methods This Prospective Observational study was conducted in a Tertiary care hospital in South India in the month of APRIL 2024 using a tool containing patient’s demographic data, drug chart , indications, culture reports and justification column. Results Out of 1046 patients 246 patient were receiving antibiotics in which the study revealed that a majority of antibiotics fell into the WATCH (63.4%), followed by ACCESS (33.3%) and RESERVE (3.25%) categories. Among the antibiotics prescribed, Ceftriaxone (28.1%), Cefuroxime (24.8%) and Piperacillin-Tazobactam (22.4%) were most frequently used. Conversely, Fosfomycin, Tigecycline, and Linezolid were prescribed less frequently, each constituting less than 1% of prescriptions. Analysis showed that 164 patients (66.6%) received antibiotics without justification, while 84 patients (33.4%) received justified therapy. Regarding patient referral, 26.3% were referred with an ID reference, while the majority (74.6%) were not. Indications for antibiotic use varied, with empirical treatment being the most common (30.5%), followed by prophylaxis (48.9%), and definitive treatment (16.3%). A smaller percentage of cases transitioned from empirical to definitive treatment (6.2%). Conclusion In summary, the majority of prescriptions fell under the WATCH category (63.4%), with common antibiotics like Ceftriaxone and Cefuroxime being frequently prescribed. A significant portion (66.6%) of prescriptions lacked justification, highlighting the need for improved antimicrobial stewardship. The low rate of infectious disease referrals suggests potential gaps in consultation. Targeted interventions are necessary to rationalize prescribing practices and address the threat of antimicrobial resistance. Disclosures All Authors: No reported disclosures

StegoEDCA: An Efficient Covert Channel for Smart Grids Based on IEEE 802.11e Standard

Smart grids are continuously evolving, incorporating modern technologies such as Wi-Fi, Zigbee, LoRaWAN or BLE. Wi-Fi are commonly used to transmit data from measurement systems, distribution control and monitoring systems, as well as network protection systems. However, since Wi-Fi networks primarily operate on unlicensed frequency bands, this introduces significant security risks for sensitive data transmission. In this paper, we propose a novel and highly efficient covert channels that utilize IEEE 802.11 Enhanced Distributed Channel Access (EDCA) for data transmission. It is also the first ever covert channel that employ three or four independent covert mechanisms to enhance operational efficiency. The proposed mechanism is also the first to exploit the Transmission Opportunity (TXOP) period and the access categories of the EDCA function. The protocol was developed and tested using the ns-3 simulator, achieving excellent performance results. Its efficiency remains consistent even under heavy network load with additional background traffic. These covert channels provide an innovative solution for securely transmitting large volumes of data within the smart grid.

Analysis of antibacterial agents consumption in a Brazilian southeastern hospital complex from 2018 to 2021

Abstract Healthcare during the COVID-19 pandemic may have led to the inappropriate use of antimicrobial agents and contributed to elevated multidrug resistance. The aim of this study was to analyze the consumption of antibacterial agents at a hospital complex from 2018 to 2021. Drug utilization study using antibacterial agents consumption data. The groups of antibacterial agents most consumed in the hospital complex were carbapenems, penicillins + beta-lactamase inhibitors, beta-lactamase-resistant penicillins, glycopeptides, and fluoroquinolones. The drugs with a compound annual growth rate that increased by more than 20% from 2018 to 2021 were amikacin (50.12%), benzylpenicillin (24.33%), oral clarithromycin (51.06%), daptomycin (34.38%), polymyxin B (20.85%), and tigecycline (41.49%). According to the AWaRE classification, the antibacterial agents from the Watch group subjected to AWaRE exhibited increased consumption in all years of the study. On the other hand, there was a reduction in the access category. In turn, the consumption of antibacterial agents in the reserve category also increased. The pattern of antimicrobial consumption in the hospital complex showed increased consumption in medical clinics and intensive care units, with a predominance of carbapenems, penicillins + beta-lactamase inhibitors, beta-lactamase-resistant penicillins, glycopeptides, fluoroquinolones, and polymyxin B, reflecting the care profile and influence of the COVID-19 pandemic.

Evaluating Antibiotic Utilization in Intensive Care Units Using WHO Defined Daily Dose and Drug Utilization 90% Methods

It is essential to assess the drug utilization evaluation patterns of antimicrobials in the ICU to safeguard rational use of antibiotics. We aimed to evaluate the drug utilization patterns of antibiotics using World Health Organization (WHO) methodologies, namely Defined Daily Dose (DDD)/100 patient days and DU 90% in the ICU. We conducted a drug utilization evaluation study in three medicine intensive care units on a sample of 397 patients. We used World Health Organization- Anatomic Therapeutic Classification (ATC)/Defined Daily Dose (DDD) and Drug Utilization 90% methods to measure drug utilization. We classified the commonly used antibiotics into Access, Watch, and Reserve (AWaRe) category proposed by WHO. The average number of antibiotics per prescription was 2.14±1.28 and average duration of treatment with an antibiotic was 6.25 ± 3.37. The DDD/100 patient days for cefoperazone + sulbactam was 2.64. The drugs included in the DU90% segment, indicating the most often used antibiotics, were cefoperazone + sulbactam, ceftriaxone, cefpodoxime, azithromycin, piperacillin + tazobactam, amikacin, metronidazole, levofloxacin, meropenem, and cefixime. Seventy-two percent of antibiotics in DU90% segment fell into the ‘Watch’ category. Culture sensitivity tests were often not performed, and there was a heavy reliance on the use of antibiotics from the Watch group.

PDCF-DRL: a contention window backoff scheme based on deep reinforcement learning for differentiating access categories

AbstractIn wireless networks, the Contention Window (CW) is a crucial parameter for wireless channel sharing among numerous stations, directly influencing overall network performance. With the rapid growth and increasing diversity of traffic in wireless networks, differentiating and serving various types of traffic to enhance network performance has become a pressing issue that needs to be addressed. Deep Reinforcement Learning (DRL) optimizes decision-making through the interaction between an agent and its environment, enabling it to handle complex state spaces and high-dimensional data, making it particularly suitable for dynamically adjusting the contention window and adapting to environmental changes in real time. Access Category (AC) is used to differentiate various types of traffic to support different quality of service (QoS) requirements. Therefore, this paper proposes the integration of DRL techniques into the EDCA mechanism, utilizing AC to differentiate network traffic, while the DRL technology adjusts the contention window to adequately ensure QoS for different types of traffic and enhance overall network performance. This paper proposes a CW back off scheme based on DRL for differentiating ACs. The scheme uses DRL technology to observe the channel collision rate and sense the current network conditions, thereby adaptively adjusting the CW size for ACs. In addition, it dynamically adjusts the back off strategy according to the perceived current network conditions to optimize the data transmission process. In the range of 20–120 stations, the scheme was tested in both single AC and multiple AC traffic scenarios, demonstrating excellent performance. The collision rate consistently remained below 18%, while the normalized throughput was maintained above 76%. Additionally, there is a significant improvement compared to existing deep reinforcement learning-based optimization schemes. Experimental results show that this scheme effectively discriminates between different ACs, resulting in lower latency and higher throughput for high-priority traffic. Furthermore, adaptively adjusting the CW size and improving the back off strategy maintains a low collision rate and stable throughput even under heavy load conditions, significantly improving the overall network performance.

Exploring Antibacterial Usage and Pathogen Surveillance over Five Years in a Tertiary Referral Teaching Hospital Adult General Intensive Care Unit (ICU).

Antimicrobial resistance is a globally recognised health emergency. Intensive care is an area with significant antimicrobial consumption, particularly increased utilisation of broad-spectrum antibacterials, making stewardship programmes essential. We aimed to explore antibacterial consumption, partnered with pathogen surveillance, over a five-year period (2018 to 2023) in a tertiary referral adult general intensive care unit (ICU). The mean number of admissions was 1645 per annum. A comparison between the ICU populations admitted before and after the COVID-19 pandemic peak (2020/21) identified several notable differences with increased average daily unit bed occupancy (21.6 vs. 25.2, respectively) and a higher proportion of admissions with sepsis (28.4% vs. 32.5%, respectively) in the post-pandemic period. Over the entire five years, the overall proportion of antibacterial use by the WHO AWaRe classification was 42.6% access, 54.7% watch and 2.6% reserve. One hundred and forty-seven positive blood culture isolates were reported, with the most concerning antibacterial resistance identified in 7.5% (9 Escherichia coli and 2 Klebsiella pneumoniae isolates). The COVID-19 pandemic peak year was associated with increased ICU bed occupancy, as well as a greater number of positive blood cultures but lower antibacterial consumption. Despite an increasingly complex workload, a large proportion of overall antibacterial consumption remained within the access category. However, the mortality rate and the incidence of most concerning antimicrobial resistance with respect to pathogens remained satisfyingly consistent, suggesting the positive consequences of real-world antibiotic stewardship in an intensive care setting.

Appropriateness of Empirical Antibiotic Use and Concordence with the WHO Aware Classification in Hospitalized Patients

Background: Antibiotic prescription trends analysis is essential for monitoring the sensitivity and resistance patterns of microorganisms discovered, regularly generating and updating antibiograms, and providing the context for antibiotic usage and prevalence. Specifically, consistent prescription patterns and antibiotic therapy practices with the WHO AWaRe (Access, Watch, and Reserve) classification of antibiotics and the national or WHO essential medicine list would enhance the prudent use of antibiotics, prevent the emergence and spread of antimicrobial resistance, and preserve antibiotic efficacy for future requirements. Objective: This study aimed to analyze selection of antibiotics for empirical use and definitive therapy and to evaluate rational use of antibiotics according to the WHO-AWaRe (Access, Watch, and Reserve) categories in hospitalized patients. Methodology: An observational and cross-sectional study was conducted in a 300 bedded multispecialty tertiary care hospital from October 2022 to March 2023 for a period of six months. Evaluation of demographic data based on antimicrobial susceptibility reports, pathogen characteristics, and infection site; evaluation of antibiotics administered before and after AST reports; and classification of antibiotics using WHO AWaRe metrics from the WHO essential medicines list. Descriptive statistics were applied for the data collected using Microsoft Excel. Results are expressed as total count, frequency, and percentages. Results: Antimicrobial susceptibility results from 162 patients were gathered from the laboratory. Of these 138 (85.18%) patients had positive results for Gram-negative bacteria and 24 (14.81%) for Gram-positive bacteria. The mean (SD) age of patients was 55 ± 28 years; predominantly male patients 92 (56.79%). 107 (66%) patients were hospitalized for 1-5 days. Monotherapy was given in 17 (10.5%) patients, Most of the patients were admitted into the general medicine 94 (58.02%), Bacteria were mainly isolated from urine (65 isolates, 40.1%), and a total of 36 organisms were isolated. The proportions of appropriate empirical therapy use were 84.05% for Gram-negative bacteria. A total of 706 antibiotics were prescribed out of which 334 are prescribed before AST and 372 are prescribed after AST. More prescribed empirical antibiotics were from the ‘Watch’ group (55.69%), followed by the ‘Access’ group (25.75%). ‘Reserve’ category (8.38%) and ‘not-recommended’ category (10.18%) antibiotics were also prescribed. A greater number of prescribed definitive antibiotics were from the ‘Watch’ group (48.11%). ‘Access’ group antibiotics should be preferable to the ‘Watch’ group. ‘Reserve’ antibiotics are always used as the last option when “Access” and “Watch” group antibiotics don’t work. Conclusion: The high use of empirical antibiotics especially from the ‘Watch’ category is a disturbing trend as observed in our study. . Increasing the use of ‘Access' antibiotics while limiting the use of ‘Watch' and ‘Reserve' antibiotics at the same time is the highest priority for preserving effectiveness of important antibiotics and minimizing the danger of AMR. Conducting such studies and analysis of such data periodically would pave the way for promotion of rational use of antimicrobials and help restrict the emergence of resistant strains of bacteria.

Analyzing Antibiotic Resistance: A Comparative Study of E. coli Isolates from Wastewater and Clinical UTI Samples at a University Community in Grenada, West Indies

Abstract Introduction/Objective The rise of antibiotic resistance poses a significant global health threat, needing a robust monitoring system to track its emergence and spread. However, most developing countries lack the infrastructure to monitor such resistance effectively. Wastewater-based epidemiology (WBE) has been proven effective in surveilling various outbreaks and offers a promising method for monitoring antibiotic resistance at the community level. This study aims to assess and compare the antibiotic resistance of Escherichia coli isolated from raw wastewater with those isolated from clinical urinary tract infection (UTI) samples from the same community. Methods/Case Report Conducted from January 2022 to October 2023, this study analyzed antibiogram data from eighty-six Escherichia coli isolates sourced from wastewater and thirty-four isolates derived from clinical urinary tract infections (UTIs). The clinical samples were obtained and processed at the Clinical Microbiology Laboratory of a university campus. The isolates were evaluated against the eleven most prescribed antibiotics for UTIs in the University Clinic including: Amoxicillin/Clavulanic Acid, Ampicillin, Cefazolin, Cefoxitin, Ceftriaxone, Cefuroxime, Ciprofloxacin, Gentamicin, Nalidixic Acid, Nitrofurantoin, and Sulfamethoxazole-trimethoprim. Results (if a Case Study enter NA) Explaining the observed trends in both wastewater and clinical samples from the perspective of AWaRE-WHO classification (Access, Watch, Reserve), we see similar trends of resistance in both data sets. A) The antibiotics used in the Access category (Empiric first or second choice for treatment of most common infections) demonstrates similar resistance patterns for both wastewater and clinical isolates except for Nitrofurantoin. B) The antibiotics used in the Watch category (Antibiotics that have higher toxicity issues and higher potential to negatively impact AMR) resistance pattern shows negligible risk in the university community evaluated. Conclusion It is recommended that the university clinic prescribe Nitrofurantoin as the last antibiotic from the Access list to the university community to treat UTI patients. Furthermore, WBE is a useful tool to determine patterns of resistance under the studied settings.

Flat comodules and contramodules as directed colimits, and cotorsion periodicity

This paper is a follow-up to Positselski and Št’ovíček (Flat quasi-coherent sheaves as directed colimits, and quasi-coherent cotorsion periodicity. Electronic preprint arXiv:2212.09639 [math.AG]). We consider two algebraic settings of comodules over a coring and contramodules over a topological ring with a countable base of two-sided ideals. These correspond to two (noncommutative) algebraic geometry settings of certain kind of stacks and ind-affine ind-schemes. In the context of a coring C\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathcal {C}}$$\\end{document} over a noncommutative ring A, we show that all A-flat C\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathcal {C}}$$\\end{document}-comodules are ℵ1\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\aleph _1$$\\end{document}-directed colimits of A-countably presentable A-flat C\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathcal {C}}$$\\end{document}-comodules. In the context of a complete, separated topological ring R\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathfrak {R}}$$\\end{document} with a countable base of neighborhoods of zero consisting of two-sided ideals, we prove that all flat R\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathfrak {R}}$$\\end{document}-contramodules are ℵ1\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\aleph _1$$\\end{document}-directed colimits of countably presentable flat R\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathfrak {R}}$$\\end{document}-contramodules. We also describe arbitrary complexes, short exact sequences, and pure acyclic complexes of A-flat C\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathcal {C}}$$\\end{document}-comodules and flat R\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathfrak {R}}$$\\end{document}-contramodules as ℵ1\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\aleph _1$$\\end{document}-directed colimits of similar complexes of countably presentable objects. The arguments are based on a very general category-theoretic technique going back to an unpublished 1977 preprint of Ulmer and rediscovered in Positselski (Notes on limits of accessible categories. Electronic preprint arXiv:2310.16773 [math.CT]). Applications to cotorsion periodicity and coderived categories of flat objects in the respective settings are discussed. In particular, in any acyclic complex of cotorsion R\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\mathfrak {R}}$$\\end{document}-contramodules, all the contramodules of cocycles are cotorsion.

Increasing trends of antibiotic resistance in Uganda: analysis of the national antimicrobial resistance surveillance data, 2018–2021

BackgroundContinuous monitoring of antimicrobial resistance (AMR) in Uganda involves testing bacterial isolates from clinical samples at national and regional hospitals. Although the National Microbiology Reference Laboratory (NMRL) analyzes these isolates for official AMR surveillance data, there's limited integration into public health planning. To enhance the utilization of NMRL data to better inform drug selection and public health strategies in combating antibiotic resistance, we evaluated the trends and spatial distribution of AMR to common antibiotics used in Uganda.MethodsWe analyzed data from pathogenic bacterial isolates from blood, cerebrospinal, peritoneal, and pleural fluid from AMR surveillance data for 2018–2021. We calculated the proportions of isolates that were resistant to common antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR resistance over the study period.ResultsOut of 537 isolates with 15 pathogenic bacteria, 478 (89%) were from blood, 34 (6.3%) were from pleural fluid, 21 (4%) were from cerebrospinal fluid, and 4 (0.7%) were from peritoneal fluid. The most common pathogen was Staphylococcus aureus (20.1%), followed by Salmonella species (18.8%). The overall change in resistance over the four years was 63–84% for sulfonamides, fluoroquinolones macrolides (46–76%), phenicols (48–71%), penicillins (42–97%), β-lactamase inhibitors (20–92%), aminoglycosides (17–53%), cephalosporins (8.3–90%), carbapenems (5.3–26%), and glycopeptides (0–20%). There was a fluctuation in resistance of Staphylococcus aureus to methicillin (60%-45%) (using cefoxitin resistance as a surrogate for oxacillin resistance) Among gram-negative organisms, there were increases in resistance to tetracycline (29–78% p < 0.001), ciprofloxacin (17–43%, p = 0.004), ceftriaxone (8–72%, p = 0.003), imipenem (6–26%, p = 0.004), and meropenem (7–18%, p = 0.03).ConclusionThe study highlights a concerning increase in antibiotic resistance rates over four years, with significant increase in resistance observed across different classes of antibiotics for both gram-positive and gram-negative organisms. This increased antibiotic resistance, particularly to commonly used antibiotics like ceftriaxone and ciprofloxacin, makes adhering to the WHO's Access, Watch, and Reserve (AWaRe) category even more critical. It also emphasizes how important it is to guard against the growing threat of antibiotic resistance by appropriately using medicines, especially those that are marked for "Watch" or "Reserve."

Reflexive Activation of Monoracial Categories During Multiracial Categorization.

Previous research has examined the real-time cognitive processes underlying perceivers' ability to resolve racial ambiguity into monoracial categorizations, but such processes for multiracial categorizations are less clear. Using a novel, three-choice mouse-tracking paradigm, we found that when perceivers categorized faces as multiracial their hand movements revealed an initial attraction to a monoracial category (study 1). Moreover, exposure to multiracial individuals moderated these effects. When measured (Study 2) or manipulated (Study 3), multiracial exposure reduced monoracial category activation and activation occurred for both morphed and real multiracial faces (Study 4). Together, the findings suggest that multiracial categorizations emerge from dynamic competition between relatively more accessible monoracial categories and a less-accessible multiracial category, which is attenuated through greater exposure to multiracial targets. This research is the first to chart out the real-time dynamics underlying multiracial categorizations and offers a new theoretical account of this increasingly common form of social categorization.

Antibiotic prescribing practices and antibiotic use quality indicators in Luang Prabang, Lao PDR: a point prevalence survey in a tertiary care hospital

ContextThe increase and global dissemination of antibiotic resistance limit the use of antibiotics to prevent and treat infections. Implementing antibiotic stewardship programs guided by local data on prescription profiles is a useful strategy to reduce the burden of antibiotic resistance. The aim was to determine the prevalence of antibiotic use and guideline compliance at Luang Prabang provincial hospital, Lao PDR.MethodsA point prevalence survey of antibiotics was conducted among hospitalized patients admitted to Luang Prabang hospital (204 beds) in Lao PDR on May 25, 2023. All patients presenting at 8:00 AM were eligible. Sociodemographic data, indications for antibiotic use, and antibiotic prescriptions were collected from medical records using a paper-based questionnaire and entered into an electronic platform following WHO methodology. The prevalence of antibiotic use was determined.ResultsOut of the 102 patients included, 60(58.8%) were undergoing antibiotic treatment, of which 33(55.0%) received combination therapy, and 7(10.5%) had two indications for antibiotic use. The highest prevalence was in the surgical ward (14/15, 93%) followed by general paediatrics (18/27, 67%). Out of the 100 antibiotic prescriptions, 47(47%) were for community-acquired infections, 26(26%) for surgical prophylaxis, 13(13%) for hospital-acquired infections and 5(5%) for medical prophylaxis. Twenty(20%) antibiotics were prescribed for obstetrics and gynaecology prophylaxis, 17(17%) for intra-abdominal infections, and 10(10.0%) for pneumonia treatment as well as bone, and joint infections. The main antibiotics prescribed were ceftriaxone 36(34.6%), metronidazole 18(17.3%), ampicillin 8(7.7%), and gentamicin 8(7.7%). Only 2(3%) samples were sent to the laboratory, one of which showed a positive culture for Escherichia coli Extended Spectrum β-Lactamase. According to the WHO Access Watch and Reserve classification, 55(52.9%) molecules belonged to the Access category, 47(49.1%) to the Watch category, and none to the Reserve category. Only 14.9% of antibiotic prescriptions were fully compliant with current guidelines.ConclusionThis study indicated a significant prevalence of antibiotic use and a very low compliance with guidelines at Luang Prabang provincial hospital, Lao PDR. This highlights an urgent need for comprehensive strategies at all levels to optimize antibiotic use in hospitals, emphasizing diagnostic improvements, and continued research to address the factors driving this excessive antibiotic usage and improve adherence to guidelines.

Locally Coherent Exact Categories

A locally coherent exact category is a finitely accessible additive category endowed with an exact structure in which the admissible short exact sequences are the directed colimits of admissible short exact sequences of finitely presentable objects. We show that any exact structure on a small idempotent-complete additive category extends uniquely to a locally coherent exact structure on the category of ind-objects; in particular, any finitely accessible category has the unique maximal and the unique minimal locally coherent exact category structures. All locally coherent exact categories are of Grothendieck type in the sense of Št’ovíček. We also discuss the canonical embedding of a small exact category into the abelian category of additive sheaves in connection with the locally coherent exact structure on the ind-objects, and deduce two periodicity theorems as applications.

Retractions in academic publishing: insights from highly ranked global universities

Purpose The study aims to profile the scientific retractions in the top five global universities and provide descriptive statistics on specific subjects. Design/methodology/approach The data for reasons behind retractions is manually extracted from the Retraction Watch Database. The top five global universities according to the Times Higher Education global ranking of 2024 are selected for this study. Findings The study found that Stanford University emerged with the highest number of retractions in the assessment across institutions in the field of basic life sciences and health sciences. Notably, the predominant reasons for these retractions were identified, with “unreliable results” being the most prevalent, accounting for 53 retractions. Following closely was the category of “errors in results and/or conclusions”, contributing to 51 retractions. MIT has the longest time between publication and retraction of any subject group, with an average of 1,701 days. Research limitations/implications This study has some limitations, as it only analysed the retractions of the top five global universities. Originality/value The study provides a comprehensive analysis of retractions in academic publishing, focusing on reasons, time gaps, article types and accessibility categories across prestigious universities. The paper underscores the critical role of retractions in maintaining the integrity of scientific literature, emphasizing the importance of transparent correction and responsible peer review to ensure the reliability and trustworthiness of published research. Results show that common reasons for retractions include duplication, fake peer review and plagiarism, underlining the need for ethical research standards.

Bibliometric analysis on Deep Brain StimulationProcedures Conducted Between 2000-2023

Objective: Deep brain stimulation (DBS) is a treatment method that uses electrodes to stimulate the brain, affecting brain activity and potentially causing medical conditions. It is commonly used to treat Parkinson's disease, essential tremor, dystonia, epilepsy, Tourette syndrome, and obsessive-compulsive disorder. This bibliometric study examines advanced bibliometric parameters in articles published since 2000, focusing on trends in publishing organizations, countries, funding sources, international collaborations, and trend keywords. Materials and Methods: We have searched the Web of Science database to find articles on DBS which published since 2000. The search was performed by using the MESH keywords releated to "Deep brain stimulation". Results: This study presents a comprehensive analysis of 4,601 articles on Deep Brain Stimulation (DBS) from 2000 to 2023, focusing on publication trends, properties, funding, country contributions, and international collaborations. Noteworthy findings include a peak of 413 publications in 2020 and 14,992 citations in 2021. The overall trajectory demonstrates a significant increase in scientific output, with an average of 31.9 citations per article. Publication properties reveal diverse access categories, including 66 Early Access and 2,136 Open Access articles. The majority of records are in the Science Citation Index Expanded (93.980%). Clinical Neurology dominates research topics with 63.464% representation. Funding sources highlight major contributions from the USA, Germany, and China. The USA leads in research output, while the University of Toronto tops institutions. Major journals include "Stereotactic and Functional Neurosurgery" and "Movement Disorders." Keyword analysis emphasizes common themes like "deep brain stimulation" and "Parkinson's disease." International collaborations involve researchers from 75 countries, with the USA leading in total link strength. This study contributes valuable insights into the global landscape of DBS research. Conclusion: This analysis highlights the dynamic nature of Deep Brain Stimulation research, highlighting global collaboration and diverse topics, emphasizing the crucial role of key countries, institutions, and journals.

Supporting VoIP communication in IEEE 802.11ax networks: A new admission control and scheduling resource allocation scheme

The current IEEE 802.11ax standard enhances Wi-Fi networks with a series of new features, such as multi-user (MU) transmission, an Orthogonal Frequency Division Multiple Access (OFDMA) scheme and the ability to multiplex traffic from different access categories (ACs). These features can be utilized to enhance the QoS support for VoIP traffic and optimize the usage of IEEE 802.11ax network resources. This work proposes a new scheme to multiplex VoIP calls in IEEE 802.11ax MU frames and a new scheduler and resource allocation algorithm specifically designed for VoIP data traffic. Our scheduler allocates VoIP packets requiring longer transmission times into the same frame(s), minimizing the channel air-time assigned to VoIP transmission. In addition, unused radio resources in the MU frame are leveraged to transmit best-effort packets along with VoIP packets. For completeness, we also define a call admission control (CAC) algorithm that anticipates channel saturation conditions to ensure VoIP users can maintain a guaranteed level of QoS. Based on simulation results, our scheme is more efficient in reducing channel utilization than other schedulers such as multi-user round-robin (RR) (implemented by ns-3) or single-user FIFO. For example, for 30 VoIP stations using the G.711 codec under mixed channel conditions, our scheme reduces by 30% the air-time required to transmit VoIP packets. When coupled with the ability to also send best-effort packets along with VoIP packets, this translates into a higher throughput (i.e. 10 Mbit/s vs 4 Mbit/s) and more simultaneous VoIP users with guaranteed QoS (up to 46 VoIP users vs 26 and 28 users for the multi-user RR and single-user FIFO scheduling algorithms, respectively).

Unmet health-care needs among Jordanian Roma with chronic diseases

PurposeThis study aims to identify the reasons for unmet health-care needs and related barriers among the Roma population with chronic diseases in Jordan.Design/methodology/approachA descriptive survey with a cross-sectional design was conducted, involving a sample of 347 Jordanian Roma participants. Data collection was performed using a structured questionnaire based on the Canadian Community Health Survey.FindingsThe analysis revealed that within the three categories of reasons for unmet health-care needs (accessibility, availability and acceptability), “Transportation issues” under the accessibility category constitute the most reported reasons: (mean = 90.4%, SD = 22.6%), followed by “Cost” (mean = 89.0%, SD = 26.2%) and “Care not available in the area” (mean = 85.8%, SD = 23.6%). Predictors of unmet health-care needs were being married, having health insurance and self-perception of mental health (OR = 0.215, p = 0.044), (OR = 0.391, p = 0.008) and (OR = 0.302, p = 0.002) respectively.Originality/valueUnmet health-care needs are highly prevalent among Jordanian Roma, rendering them a vulnerable group susceptible to other diseases. To address this pressing issue, concerted and comprehensive efforts should be made to improve the utilization and accessibility of health-care services within this community. Furthermore, efforts should be made to elevate their social standing and status. facilitate their integration into the broader community.

Universal integration of photothermal particles onto g-C3N4 towards improved photocatalysis

The photothermal effect has been recognized as a universal promoter in various photocatalytic reactions. However, in many promising nanocomposite systems, the integration of heterogeneous photothermal materials with photocatalysts remains a significant technical challenge. Focusing on the emerging graphitic carbon nitride (g-C3N4) based photocatalyst, we identified that the segregation of the introduced photothermal particles results from the dynamic instability of the original solid-solid dispersion system, which essentially origins from a sluggish two-step solid-liquid-solid phase transformation of urea towards g-C3N4. By taking advantages of the photothermal particles to be loaded, we developed a photothermal-polymerization strategy to create a rapid heating to overcome their undesired segregation during g-C3N4 formation. The strategy enables a one-step loading of various photothermal particles on the g-C3N4, presenting a versatile methodology. This sustainable technique enhances the synthesis yield of g-C3N4 by 352 % with reduced energy consumption. The derived photothermal particles-dispersed g-C3N4 shows 290 % improvement in photocatalytic CO2 reduction compared to the separated system, which is obtained from the traditional heating synthesis. Beyond enriching the accessible categories of composite catalysts, this study may deepen physiochemical insights into the dynamic transformation of the novel dispersion system.

Hybrid Clustering Approach (SG-MFOA) using Multipath Cross-Layer Design in MANET Network

Mobile Ad-hoc Networks (MANETs) are used in a wide range of applications because of their unique capabilities. The routing in MANET is regarded as a main challenge on account of its permanent movement and nodes' randomness that can cause a continual change of network topology, thus finding correct paths among the nodes is the fundamental task of routing protocols. There is a rise in protocols that depend on cross-layer communication across several layers to increase the MANET performance. In this manuscript, a Hybrid Clustering Approach (SG-MFOA) using a Multipath Cross-Layer Design in a MANET Network is proposed. Here, multiple routes are selected for data packet transmission with the help of hybrid routing. Furthermore, a cross-layer metric is acquired depending upon Expected Transmission Time (ETT), Residual Energy and Load Balancing Factor. It is necessary to select a Cluster Head (CH) depending on this trade for proficient routing. So, the cluster head is optimally chosen to utilize SG-MFOA. Thus, the multipath route selection is performed by the multi-objective functions containing bandwidth, congestion delay, transmission delay and to ensure the prolonging of network lifetime, queue delay at each connection Access Category from the available routes to a destination. When compared with the existing methods, like a proficient self-attention-based conditional variational auto-encoder generative adversarial networks-based multipath cross-layer design routing paradigm for MANET (SCVAGAN-MCDR-MANET), Energy Aware Cross Layer Routing Protocol to Increase Route Reliability in MANETs (EACLRP-RR-MANET), Cross-layer Adaptive Fuzzy-based Ad hoc On-Demand Distance Vector Routing Protocol for MANET (CLAF-DVRP-MANET), respectively.

Antibiotic prescribing practice using WHO Access, Watch and Reserve classification and its determinants among outpatient prescriptions dispensed to elderly population in six community chain pharmacies in Asmara, Eritrea: a cross-sectional study

ObjectiveTo assess antibiotic prescribing practice and its determinants among outpatient prescriptions dispensed to the elderly population.DesignA prescription-based, cross-sectional study.SettingSix community chain pharmacies in Asmara, Eritrea.ParticipantsAll outpatient prescriptions dispensed to the...