Global Priority Research Articles

Phenotypic and Genotypic Characterization of Pan-Drug-Resistant Klebsiella pneumoniae Isolated in Qatar.

In secondary healthcare, carbapenem-resistant Enterobacterales (CREs), such as those observed in Klebsiella pneumoniae, are a global public health priority with significant clinical outcomes. In this study, we described the clinical, phenotypic, and genotypic characteristics of three pan-drug-resistant (PDR) isolates that demonstrated extended resistance to conventional and novel antimicrobials. All patients had risk factors for the acquisition of multidrug-resistant organisms, while microbiological susceptibility testing showed resistance to all conventional antimicrobials. Advanced susceptibility testing demonstrated resistance to broad agents, such as ceftazidime-avibactam, ceftolozane-tazobactam, and meropenem-vaborbactam. Nevertheless, all isolates were susceptible to cefiderocol, suggested as one of the novel antimicrobials that demonstrated potent in vitro activity against resistant Gram-negative bacteria, including CREs, pointing toward its potential therapeutic role for PDR pathogens. Expanded genomic studies revealed multiple antimicrobial-resistant genes (ARGs), including blaNMD-5 and blaOXA derivative types, as well as a mutated outer membrane porin protein (OmpK37).

Effectiveness of Postnatal Maternal or Caregiver Interventions on Outcomes among Infants under Six Months with Growth Faltering: A Systematic Review.

The care of infants at risk of poor growth and development is a global priority. To inform new WHO guidelines update on prevention and management of growth faltering among infants under six months, we examined the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants between 0 and 6 months. We searched nine electronic databases from January 2000 to August 2021, included interventional studies, evaluated the quality of evidence for seven outcome domains (anthropometric recovery, child development, anthropometric outcomes, mortality, readmission, relapse, and non-response) and followed the GRADE approach for certainty of evidence. We identified thirteen studies with preterm and/or low birth weight infants assessing effects of breastfeeding counselling or education (n = 8), maternal nutrition supplementation (n = 2), mental health (n = 1), relaxation therapy (n = 1), and cash transfer (n = 1) interventions. The evidence from these studies had serious indirectness and high risk of bias. Evidence suggests breastfeeding counselling or education compared to standard care may increase infant weight at one month, weight at two months and length at one month; however, the evidence is very uncertain (very low quality). Maternal nutrition supplementation compared to standard care may not increase infant weight at 36 weeks postmenstrual age and may not reduce infant mortality by 36 weeks post-menstrual age (low quality). Evidence on the effectiveness of postnatal maternal or caregiver interventions on outcomes among infants under six months with growth faltering is limited and of 'low' to 'very low' quality. This emphasizes the urgent need for future research. The protocol was registered with PROSPERO (CRD42022309001).

Food insecurity: Discrepancy within Australian couple households

AbstractFood security remains a global public health priority but there may be bias in the prevalence of household food insecurity, depending upon who answers the questions. Using a cross‐section from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, we analysed components of food insecurity reported separately by both partners in 718 households, allowing examination of discrepancies among couples. We modelled discrepancy in reports of food insecurity on 8 items using binary logit models for each question and a binomial regression for the number of questions on which there was discrepancy. Among couples who differed on an item, (conditional) discrepancy rates ranged from 71.75% to 85.86%. Females were more likely than males to report food insecurity on most items. Key characteristics associated with discrepancy were female's and male's age, female's education, being born in Australia, renting and male's employment. Male's age and birthplace were associated with discrepancy on more items while male's higher education and being a homeowner were associated with discrepancy on fewer items. Among couples who differed in responses, females were more likely to report food insecurity if they were older or had a disability, if their male partner was younger or had no disability, or if either person had more education than high school. The prevalence of food insecurity among couple households may be underestimated by 7.4 percentage points due to discrepancies in reporting. Discrepancies can reduce the accuracy of measures of food insecurity, impeding the targeting of responses, and lead to a less efficient allocation of resources to combat food insecurity.

A biogeographical appraisal of the threatened South East Africa Montane Archipelago ecoregion

Recent biological surveys of ancient inselbergs in southern Malawi and northern Mozambique have led to the discovery and description of many species new to science, and overlapping centres of endemism across multiple taxa. Combining these endemic taxa with data on geology and climate, we propose the ‘South East Africa Montane Archipelago’ (SEAMA) as a distinct ecoregion of global biological importance. The ecoregion encompasses 30 granitic inselbergs reaching > 1000 m above sea level, hosting the largest (Mt Mabu) and smallest (Mt Lico) mid-elevation rainforests in southern Africa, as well as biologically unique montane grasslands. Endemic taxa include 127 plants, 45 vertebrates (amphibians, reptiles, birds, mammals) and 45 invertebrate species (butterflies, freshwater crabs), and two endemic genera of plants and reptiles. Existing dated phylogenies of endemic animal lineages suggests this endemism arose from divergence events coinciding with repeated isolation of these mountains from the pan-African forests, together with the mountains’ great age and relative climatic stability. Since 2000, the SEAMA has lost 18% of its primary humid forest cover (up to 43% in some sites)—one of the highest deforestation rates in Africa. Urgently rectifying this situation, while addressing the resource needs of local communities, is a global priority for biodiversity conservation.

Characterizing Family Planning Utilization in Adult Women and Adolescents in Pohnpei, Federerated States of Micronesia

IntroductionIncreasing family planning xutilization in low-income countries to improve health outcomes of women and children is a global priority. The Federated States of Micronesia (FSM) has poor maternal child health outcomes; therefore, this study aimed to examine family planning utilization in Pohnpei State, FSM.MethodsThis cross-sectional study sought to characterize family planning utilization in adult women of reproductive age and high school age adolescents in Pohnpei using representative survey data collected in 2019 (N = 570 and N = 1726, respectively). Chi-square tests were used to determine significant factors associated with family planning utilization.ResultsAmong adult women of reproductive age (18–49 years old) not trying to get pregnant, 31.6% reported using contraception during last intercourse. Contraceptive use was significantly lower among younger women (18–24 years old) (21.7%, p = 0.021), unmarried women (18.6%, p < 0.001), those without health insurance (28.7%, p = 0.030), those who have never had a pap smear (20.5%, p < 0.001), and those who have never been pregnant (14.5%, p < 0.002). Among adolescents who reported being sexually active, 28.5% reported using any contraception at last intercourse and 22.6% reported using a condom at last intercourse. Condom use among sexually active adolescents was lowest among 12th graders (13.5%, p < 0.001) and girls (16.8%, p = 0.004).ConclusionsOur findings suggest that young, unmarried, never pregnant women face an unmet need for family planning. Additionally, women with lower access to and use of healthcare services have lower use of family planning.

Food Waste Initiatives Across Tertiary Sectors in the Pacific Region

Preventing food waste is becoming a global priority, with approximately 1.3 billion tonnes of food wasted annually contributing to 10% of the world’s carbon emissions. The United Nations has established the Sustainable Development Goal (SDG) target 12.3, aiming to halve food waste by 2050. Pacific nations are at risk of becoming food insecure, due in part to their hot climate and limited resources to store food properly. This research paper investigates food waste initiatives at universities across the Pacific region. The aim of this project was to identify current proactive measures addressing food waste, assess the effectiveness of existing initiatives, and pinpoint actions that could enhance sustainable food consumption. This project involved both primary and secondary data collection, to investigate the practices of 34 universities from 17 islands in the Pacific Region.&#x0D; Supervised by: Miranda Mirosa&#x0D; Scholarship Project Funded by: Riddet Summer

Impact of respiratory viral infections on nasopharyngeal pneumococcal colonization dynamics in children.

Prevention of acute respiratory illnesses (ARI) in children is a global health priority, as these remain a leading cause of pediatric morbidity and mortality throughout the world. As new products and strategies to prevent respiratory infections caused by important pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza, respiratory syncytial virus and pneumococcus are advancing, increasing evidence suggests that these and other respiratory viruses and pneumococci may exhibit interactions that are associated with altered colonization and disease dynamics. We aim to review recent data evaluating interactions between respiratory viruses and pneumococci in the upper respiratory tract and their potential impact on pneumococcal colonization patterns and disease outcomes. While interactions between influenza infection and subsequent increased susceptibility and transmissibility of colonizing pneumococci have been widely reported in the literature, emerging evidence suggests that human rhinovirus, SARS-CoV-2, and other viruses may also exhibit interactions with pneumococci and alter pneumococcal colonization patterns. Additionally, colonizing pneumococci may play a role in modifying outcomes associated with respiratory viral infections. Recent evidence suggests that vaccination with pneumococcal conjugate vaccines, and prevention of colonization with pneumococcal serotypes included in these vaccines, may be associated with reducing the risk of subsequent viral infection and the severity of the associated illnesses. Understanding the direction and dynamics of viral-pneumococcal interactions may elucidate the potential effects of existing and emerging viral and bacterial vaccines and other preventive strategies on the health impact of these important respiratory pathogens.

Tackling physical inactivity and inequalities: implementing a whole systems approach to transform community provision for disabled people and people with long-term health conditions

BackgroundPhysical inactivity is a global public health priority. There are known health and well-being consequences of being inactive, and the benefits of being physically active are well established. However, there are persistent inequalities when it comes to how physically active people are, with disabled people, people living with long-term health conditions, and people residing in areas of socio-economic deprivation being particularly affected. Methods such as whole system approaches (WSAs), which are dynamic, multifaceted, and engage all relevant stakeholders, have gained momentum as an approach to address such complex public health problems. However, evidence relating to the implementation of WSAs to address physical inactivity is lacking. The aim of the Prevention and Enablement Model (PEM) was to take a whole system approach in Essex to encourage and support disabled people and/or individuals living with long-term health conditions to be more active, happier, and to live more independently.MethodsThe aim of this study was to explore the enablers, challenges, and reflections associated with the process of designing and implementing the PEM. Semi-structured interviews (n = 12) were used to collect data from people involved in the PEM’s design, implementation and/or delivery. Data was analysed using Braun and Clarke’s reflexive thematic analysis.ResultsFour themes were identified: (1) Working collaboratively: Specific enablers of time and space were identified as important in the planning and implementation of a WSA (2) Leadership and planning: Distributed and flexible leadership was identified as central to successful implementation (3) Re-orientating practice: Highlighted the transformative potential of a whole system approach and how it contrasts with conventional work practices, and (4) Reflection and learning: Informing ongoing refinements and further implementation of successful system change.ConclusionsThese findings highlight the challenge and complexity of implementing a WSA that involves diverse stakeholders from across adult social care, the NHS, and the third sector. Several important enablers are identified, such as leadership and planning, and the challenges and discomfort that can arise whilst changing systems. Ongoing efforts are required to ensure that different elements of the system collaborate effectively to address inequalities in physical activity participation, through the implementation of a WSA.

Hydrogenation of CO2 into Value-added Chemicals Using Solid-Supported Catalysts.

Reducing CO2 emissions is an urgent global priority. In this context, several mitigation strategies, including CO2 tax and stringent legislation, have been adopted to halt the deterioration of the natural environment. Also, carbon recycling procedures undoubtedly help reduce net emissions into the atmosphere, enhancing sustainability. Utilizing Earth's abundant CO2 to produce high-potential green chemicals and light fuels opens new avenues for the chemical industry. In this context, many attempts have been devoted to converting CO2 as a feedstock into various value-added chemicals, such as CH4, lower methanol, light olefins, gasoline, and higher hydrocarbons, for numerous applications involving various catalytic reactions. Although several CO2-conversion methods have been used, including electrochemical, photochemical, and biological approaches, the hydrogenation method allows the reaction to be tuned to produce the targeted compound without significantly altering infrastructure. This review discusses the numerous hydrogenation routes and their challenges, such as catalyst design, operation, and the combined art of structure-activity relationships for the various product formations.

Robust and sensitive amplicon-based whole-genome sequencing assay of respiratory syncytial virus subtype A and B.

In this paper, we report an improved high-throughput respiratory syncytial virus (RSV) whole-genome sequencing (WGS) assay performed directly on clinical samples, using a 4-primer-pool, short-amplicon PCR-tiling approach that is suitable for short-read sequencing platforms. The RSV WGS approach described in this study has increased sensitivity compared to previous approaches and can be applied to clinical specimens without the requirement for enrichment. The updated approach produces sequences of high quality consistently and cost-effectively, suitable for implementation to underpin national and global programs for the surveillance of RSV genomic variation. The quality of sequence produced is essential for preparedness for new interventions in monitoring antigenic escape, where a single point mutation might lead to a reduction in antibody binding effectiveness and neutralizing activity, or indeed in the monitoring of retaining susceptibility to neutralization by existing and new interventions.

High efficacy fluconazole loaded ZnO‐poly (vinyl alcohol) nanocomposite: Interpretive breakpoints for biological applications

AbstractNanotechnology, a versatile field, holds promise in diverse applications, such as advanced pharmaceutical techniques and innovative chemical compound fabrication. Recently, the World Health Organization (WHO) has identified sepsis as a global health priority, attributing most sepsis‐related deaths to the underlying infection. Sepsis is a complex disease that manifests in various ways, depending on factors, such as pathogen involved, mode of transmission, and the patient's immune competence. This study focuses on synthesizing zinc oxide (ZnO) through an in‐situ precipitation method and employing a solution‐based technique to coat the inorganic ZnO nanomaterial with the antimicrobial drug fluconazole (FLZ), resulting in a FLZ‐ZnO composite. Further enhancement is achieved by modifying the composite with poly(vinyl alcohol) (PVA) to improve mechanical strength, physicochemical characteristics, and the interfacial network between ZnO and FLZ. Characterization through X‐ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), field emission scanning electron microscopy (FESEM), particle size distribution (PSD), and thermo gravimetric analysis (TGA) confirms the synthesized compounds are stoichiometric in nature. The FLZ‐ZnO‐PVA nanocomposite demonstrates significant antifungal activity against C. albicans and A. niger, as well as enhanced antibacterial activity against E. coli and S. aureus evaluated through well diffusion technique. In vitro cellular compatibility assessment using the MTT assay with NIH‐3T3 cells reveals exceptional viability (above 75%) and negligible cytotoxicity at a concentration of 1.56 μg/mL, indicating high biosafety. The FLZ‐ZnO‐PVA nanocomposite exhibits outstanding biological performance, making it a promising candidate for clinical applications in preventing sepsis and prospective infections.Highlights Developments and preparation of FLZ‐ZnO‐PVA nanocomposite. FLZ‐ZnO‐PVA nanocomposite shows optimum antimicrobial activity. FLZ‐ZnO‐PVA shows cytotoxicity against the mouse embryonic fibroblast cell line. FLZ‐ZnO‐PVA could be used as a suitable material for treatment of sepsis.

Transformative Horizons in Education: Navigating Challenges, Embracing Innovations, and Shaping Global Landscapes

The global education landscape stands at a crossroads, grappling with multifaceted challenges that demand transformative solutions. The inertia within traditional educational systems, financial constraints, stakeholder resistance, reliance on standardized testing, digital inequalities, and a gap between education and needs of the workforce collectively hinder the necessary evolution. Bringing change in education requires a concerted, collaborative effort to embrace disruptive innovations. Reshaping curricular frameworks, bridging digital divides, and fostering a culture that values adaptability and inclusivity are priority. As we navigate this transformative journey, the solutions to educational challenges can be achieved by recognizing the interconnected nature of these challenges and addressing them collectively. That will also ensure that the pursuit of innovation in education becomes a global priority. Through sustained commitment, collaboration, and strategic planning we can equip learners to be ready to face the complexities of the 21st century. In closing, we welcome the readers of the 'International Journal of Change in Education.' The journal envisions itself as a catalyst for positive change, providing a space for cutting-edge research and innovative ideas that address the critical issues facing education globally. By fostering a community of scholars, educators, and policymakers, this journal aspires to generate insights and solutions that will shape the future of education. As contributors and readers, your support is pivotal. We encourage you to share your expertise, experiences, and groundbreaking studies that delve into the heart of educational transformation. Thank you for joining us on this transformative journey.

Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study

Background Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored. Objectives This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China. Methods Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders. Results Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308–0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275–0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276–0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051–4.825). Conclusion Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.

Women's sexual health improvement: sexual quality of life and pelvic floor muscle assessment in asymptomatic women.

Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern and evaluate the usefulness of tools, such as patient-reported outcomes (PROs) and pelvic floor examination, to improve women's sexual wellbeing and to identify predictors of poor quality of sexual life during the well-woman annual visit. A cross-sectional study was designed to examine 300 healthy women to determine whether the sexual quality of life (SQOL) questionnaire (on electronic devices) and pelvic floor muscle assessment (the vulva, anus, muscles, and periurethral (VAMP) protocol) of asymptomatic women during the annual bimanual examination (BME) help differentiate patients who would benefit from discussing sexual problems with a gynecologist. Dyspareunia was an exclusion criterion. The majority of subjects experienced high sexual wellbeing (82.0% with SQOL score of ≥84), with a mean of 85.7 points. SQOL scores were lower for psychiatric disorders or symptoms (37.0% of subjects), although they did not correlate with age, BMI, parity, contraception use, history of vulvovaginal symptoms, neurosurgical/orthopedic problems, and rectal, bowel, or bladder symptoms. Patients with dyspareunia (16.0% of participants, although they denied it during the face-to-face consultation) had a 3.6 times higher prevalence of low or moderate quality of sexual life. The VAMP protocol score was low in asymptomatic women, 33.0% met positive criteria (VAMP+, NRS ≥3) for pelvic floor dysfunction (overactivity), although at borderline levels. VAMP+ was positively correlated with chronic pain and genitourinary symptoms, but neither with dyspareunia nor incontinence, and was unrelated to the SQOL score (p = 0.151). Women's sexual health is a global health priority. Finding a way to start a discussion with an asymptomatic patient is crucial to increasing patients' interest in disclosing a sexual health problem to be resolved. PROs or simple questions about sexual wellbeing direct the discussion mainly toward the at-risk group for sexual deterioration: those with mental health problems and women with dyspareunia. Dyspareunia is considered a predictor of decreased quality of sexual life, a major sexual disorder that should not be overlooked. Gynecological consultation should resolve concerns, identify the problem, and refer for professional sexual care if still needed.

The master’s degree in development practice: a case study of twelve university programs

Sustainable development is a global priority. However, a lack of research exists on the programs designed to train sustainable development practitioners. This multi-case case study, possibly the first to describe the programs that trains development practitioners, utilized case study theory and semi-structured interviews with program administrators to describe sustainable development programs offered by 12 higher education institutions in eight countries with membership in the Global Association of Masters in Development Practice. The results revealed five themes or key drivers, nine advantages, and four deficiencies. Two drivers were enrollment-focused (admission of students with prior work experience in development and financial support), two were curriculum-focused (incorporation of field work and integration of specific knowledge aspects and skills training in the curricula), and one was institutional attitude (adoption of a culture of flexibility). The most common challenges were impacts from the COVID-19 pandemic. These results provide insights for continuous improvement efforts of program administrators for students in sustainable development. The practical methodology developed can be replicated and adapted for investigation of similar programs and other disciplines in higher education.

The relationship between sense of coherence and emotional intelligence as individual health assets for mental health promotion in students and healthcare professionals: a scoping review.

Workplace Mental health promotion in healthcare sector, is a global priority due to the stress associated with caregiving environments and the increase of mental health problems among health professionals and students. The role of emotional intelligence (EI) and sense of coherence (SOC) have been identified as critical health protectors. However, the relationship between them as well as the underlying mechanisms of these relationships on health benefits in this population is still unclear. To synthetize the existing literature on the relationship between emotional intelligence and sense of coherence, as well as their mutual impact on healthcare workers' and student's well-being. A scoping review was conducted following the Joanna Briggs Institute guidelines. A systematic search was conducted in PsyCINFO, CINHAL, SCOPUS and PUBMED databases, using key-terms such as students, health professionals, emotional intelligence, and sense of coherence. A total of 11 articles were included, with a range of years from 2014 to 2022. Evidence was found to support the positive relationship between sense of coherence and emotional intelligence. The use of EI as a training pathway to improve SOC and health promoting behaviors is suggested. The benefits of intervening on these factors contribute to improved health professionals' and students' general well-being and motivation for a better performance, either in their studies or clinical work. The positive relationship between emotional intelligence and a sense of coherence has direct and indirect benefits on students' and healthcare professionals' well-being. Future studies should address longitudinal and experimental analysis to confirm these findings.

Artificial intelligence in neurology: opportunities, challenges, and policy implications.

Neurological conditions are the leading cause of disability and mortality combined, demanding innovative, scalable, and sustainable solutions. Brain health has become a global priority with adoption of the World Health Organization's Intersectoral Global Action Plan in 2022. Simultaneously, rapid advancements in artificial intelligence (AI) are revolutionizing neurological research and practice. This scoping review of 66 original articles explores the value of AI in neurology and brain health, systematizing the landscape for emergent clinical opportunities and future trends across the care trajectory: prevention, risk stratification, early detection, diagnosis, management, and rehabilitation. AI's potential to advance personalized precision neurology and global brain health directives hinges on resolving core challenges across four pillars-models, data, feasibility/equity, and regulation/innovation-through concerted pursuit of targeted recommendations. Paramount actions include swift, ethical, equity-focused integration of novel technologies into clinical workflows, mitigating data-related issues, counteracting digital inequity gaps, and establishing robust governance frameworks balancing safety and innovation.

Optimising diagnosis and management of kidney disease: an implementation trial of a clinical decision support system future health today

BackgroundChronic kidney disease affects more than 10% of the world’s population and is a non-communicable disease of global concern and priority. There is a significant implementation gap between best practice guideline recommendations and current kidney disease management. Previous research has shown the need to partner with primary care to improve education, collaboration, and kidney disease awareness. This implementation trial will explore use of an innovative clinical decision support software, Future Health Today, to improve screening, diagnosis, and management of kidney disease in primary care. The program will be supported by tertiary care outreach services. The primary aim is to test the hypothesis that the Future Health Today implementation program will improve screening, diagnosis, and management of kidney disease. Secondary aims are to evaluate primary care satisfaction and broader health service impacts.MethodsThis pre-post implementation trial using an interrupted time series design will evaluate the clinical and service outcomes of Future Health Today, using a mixed methods study in twenty general practices with an estimated population size of 150,000. Deidentified patient data will be extracted from participating practices to examine the primary aims of the study. Surveys and semi-structured interviews with general practice will inform secondary hypotheses. Data linkage between primary care and tertiary care data will examine the broader health service impacts.DiscussionThis investigator driven trial will assess the impact of Future Health Today software coupled with education and clinical outreach support. Investigators hypothesise that there will be improvement in appropriate screening, diagnosis, and management of kidney disease. This program has the potential to be scaled more broadly.Trial RegistrationAustralian New Zealand Clinical Trial Registry: ACTRN12623001096640.

BENEFITS OF MANAGING FOOD LOSS AND WASTE FOR SUSTAINABLE RURAL DEVELOPMENT IN INDONESIA

The reduction of food loss and waste (FLW) has become a global priority under the Sustainable Development Goals (SDG). Reports from the United Nations and FAO reveal alarming statistics, with 13.3 percent of the world’s food lost post-harvest and 17 percent wasted at the consumer level. FLW is a problem found in both industrialized nations like the EU and emerging countries like Indonesia. While EU nations have committed to reducing per capita food waste by 2030, Indonesia has only begun addressing FLW. This paper explores the awareness and management of FLW in Indonesia, focusing on food recovery and redistribution strategies and their potential impact on rural sustainability development. It addresses FLW management through literature review with the aim of raising awareness to the urgency of FLW management and to support the circular economy in Indonesia. FLW is closely associated with consumer behaviour, and lessons from the EU suggests that supporting local farmers and improving the supply chain can help reduce FLW. The role of food recovery and redistribution in reducing FLW in Indonesia highlights the successful practices, emphasizing the transformation of „ugly food“ and the redistribution of excess edibles to combat FLW. Non-profit organizations in Indonesia have emerged to combat FLW by redistributing edible leftovers to those in need. Additionally, FLW recovery practices extend to agriculture, involving the reprocessing of unharvested agricultural products onto animal feed or organic fertilizers. These initiatives not only reduce waste, but also contribute to food security and poverty alleviation, especially in rural areas. The study concludes that addressing FLW in Indonesia can lead to increased food availability and sustainability. It recommends the development of national policies, programs, and partnerships to promote FLW management and the well-being of Indonesian communities. Further research is needed to identify specific challenges and opportunities for implementing food recovery and redistribution initiatives effectively. By taking concrete steps to reduce FLW, Indonesia can enhance food security and simultaneously align itself with the global sustainability agenda. Keywords: Food loss and waste (FLW), food recovery, redistribution, sustainable rural development JEL: O31, Q53, R11

Transporting and implementing a caregiver-mediated intervention for toddlers with autism in Goa, India: evidence from the social ABCs.

Autism is a global health priority with an urgent need for evidence-based, resource-efficient, scalable supports that are feasible for implementation in low- and middle-income countries (LMICs). Initiating supports in the toddler years has potential to significantly impact child and family outcomes. The current paper describes the feasibility and outcomes associated with a Canadian-developed caregiver-mediated intervention for toddlers (the Social ABCs), delivered through a clinical service in Goa, India. Clinical staff at the Sethu Centre for Child Development and Family Guidance in Goa, India, were trained by the Canadian program development team and delivered the program to families seen through their clinic. Using a retrospective chart review, we gathered information about participating families and used a pre-post design to examine change over time. Sixty-four families were enrolled (toddler mean age = 28.5 months; range: 19-35), of whom 55 (85.94%) completed the program. Video-coded data revealed that parents learned the strategies (implementation fidelity increased from M = 45.42% to 76.77%, p < .001, with over 90% of caregivers attaining at least 70% fidelity). Toddler responsivity to their caregivers (M = 7.00% vs. 46.58%) and initiations per minute (M = 1.16 vs. 3.49) increased significantly, p's < .001. Parents also reported significant improvements in child behaviour/skills (p < .001), and a non-significant trend toward reduced parenting stress (p = .056). Findings corroborate the emerging evidence supporting the use of caregiver-mediated models in LMICs, adding evidence that such supports can be provided in the very early years (i.e., under three years of age) when learning may be optimized.