National Action Research Articles

Environmental Antimicrobial Resistance: Implications for Food Safety and Public Health

Antimicrobial resistance (AMR) is a serious global health issue, aggravated by antibiotic overuse and misuse in human medicine, animal care, and agriculture. This study looks at the different mechanisms that drive AMR, such as environmental contamination, horizontal gene transfer, and selective pressure, as well as the severe implications of AMR for human and animal health. This study demonstrates the need for concerted efforts across the scientific, healthcare, agricultural, and policy sectors to control the emergence of AMR. Some crucial strategies discussed include developing antimicrobial stewardship (AMS) programs, encouraging targeted narrow-spectrum antibiotic use, and emphasizing the significance of strict regulatory frameworks and surveillance systems, like the Global Antimicrobial Resistance and Use Surveillance System (GLASS) and the Access, Watch, and Reserve (AWaRe) classification. This study also emphasizes the need for national and international action plans in combating AMR and promotes the One Health strategy, which unifies environmental, animal, and human health. This study concludes that preventing the spread of AMR and maintaining the effectiveness of antibiotics for future generations requires a comprehensive, multidisciplinary, and internationally coordinated strategy.

The Influence of COVID-19 on Antimicrobial-Resistance in Gram-Positive Bacteria at a Private Saudi Hospital: A Five-Year Evaluation

Due to the emergence of antimicrobial-resistance (AR) as a public health threat, the Saudi National Action Plan (SNAP) was implemented in 2017, incorporating various strategies to combat AR. To evaluate the effectiveness of SNAP and the impact of COVID-19, the study analyzed pre- and post-pandemic rates of AR, methicillin-resistant Staphylococcus aureus (MRSA), and multidrug resistance (MDR) among Gram-positive bacteria at a private medical center in Saudi Arabia. This study reviewed the cases of all patients who had been diagnosed with Gram-positive bacterial infection between January 2017 and December 2021. Bacterial strain identification was conducted using VITEK-2 ID-GP cards, while AR, MRSA, and MDR were defined using AST-GP 67 and AST-ST02 cards, all adhering to the manufacturer’s recommended protocols. The five-year study from 2017 to 2021 yielded 6,271 Gram-positive bacteria isolates from patients in a Saudi private hospital. Though the rate of AR initially declined between 2017 and 2019, it spiked significantly from 2020 to 2021. Similarly, the MRSA rate exhibited a substantial decrease (p < 0.05) from 2017 to 2019, followed by a significant rise (p < 0.05) between 2020 and 2021. Out of the isolated pathogens, 1,031 (16.44%) exhibited MDR, with all isolates showing a marked increase (p < 0.05) in MDR from 2020 to 2021. The study highlights the aggravating impact of the COVID-19 pandemic on AR, underscoring the need for the SNAP to intensify its efforts in combating AR.

Is Greener Better? Quantifying the Impact of a Nature Walk on Stress Reduction Using HRV and Saliva Cortisol Biomarkers

The physiological impact of walking in nature was quantified via continuous heart rate variability (HRV), pre- and post-walk saliva cortisol measures, and self-reported mood and mindfulness scores for N = 17 participants who walked “The Green Road” at Walter Reed National Military Medical Center in Bethesda, Maryland. For N = 15 of the participants, HRV analysis revealed two main groups: group one individuals had a 104% increase (mean) in the root mean square standard deviation (RMSSD) and a 47% increase (mean) in the standard deviation of NN values (SDNN), indicating an overall reduction in physiological stress from walking the Green Road, and group two individuals had a decrease (mean) of 42% and 31% in these respective HRV metrics, signaling an increase in physiological stresses. Post-walk self-reported scores for vigor and mood disturbance were more robust for the Green Road than for a comparable urban road corridor and showed that a higher HRV during the walk was associated with improved overall mood. Saliva cortisol was lower after taking a walk for all participants, and it showed that walking the Green Road elicited a significantly larger reduction in cortisol of 53%, on average, when compared with 37% of walking along an urban road. It was also observed that the order in which individuals walked the Green Road and urban road also impacted their cortisol responses, with those walking the urban road before the Green Road showing a substantial reduction in cortisol, suggesting a possible attenuation effect of walking the Green Road first. These findings provide quantitative data demonstrating the stress-reducing effects of being in nature, thus supporting the health benefit value of providing access to nature more broadly in many settings.

Exploring pharmacists’ understanding and use of antifungals at a tertiary hospital in England - an interview study

Abstract Introduction Antimicrobial resistance (AMR) is an emerging crisis worldwide. If continued, it is estimated AMR could cause over 10 million deaths annually by 20501. Antifungals are critical in the treatment and prophylaxis of fungal infections, especially invasive fungal infections which can be life-threatening. The national and international antimicrobial stewardship action plan focus primarily on the use of antibacterials. Antifungals have not yet been a focus for stewardship programmes. The appropriate use and understanding surrounding antifungals remain a challenge among healthcare professionals, including pharmacists but there is scarce empirical evidence to demonstrate this problem. Aim To explore pharmacists’ understanding and use of antifungals at a tertiary hospital in England. Methods A qualitative study utilising a constructivist approach involving one-to-one online semi-structured interview based on the Critical Incident Technique2 was conducted. Pharmacists working in the tertiary hospital were purposively sampled and recruited to participate in the study. Following informed consent, participants took part in a semi-structured interview via Microsoft Teams with a researcher. Interviews explored 1) the general purpose of using antifungals and 2) system factors and decisions taken when managing a routine and unusual or challenging case using antifungals. The interviews were audio-recorded and then transcribed verbatim. Transcripts were analysed using reflexive thematic analysis3. The study was registered with the tertiary hospital where participants were recruited from. This study was registered with Oxford University Hospitals NHS Foundation Trust (ref no. 8482) and received ethical approval from the University of Reading School of Chemistry, Food and Nutritional Sciences and Pharmacy internal ethics review committee (study no: 46/2023). Results Nine participants took part in the study. Interviews took an average of 29 minutes (range 15-55 minutes). Participants worked in different specialties including oncology, haematology, paediatrics, and respiratory care. Three themes were generated through the analysis. Theme 1: Diagnosing and managing fungal infections is complex. Limited and/or lack of reliable and timely diagnostic testing makes diagnosing fungal infections difficult. Consequently, patients were sometimes prescribed empiric antifungals to avoid treatment delay. Treatment was then reviewed once test results were available. Patient-related issues such as comorbidities and drug-drug interactions contribute to complex treatment plans. Theme 2: Antifungal stewardship involved a multidisciplinary approach. Pooling together expertise amongst healthcare professionals was imperative in decision-making. Pharmacists were often key antifungal stewards and medication experts despite working with uncertainty. Theme 3: Expressed need to upskill on antifungal stewardship. Participants were aware of gaps in their experience and knowledge when managing complex fungal infections. They want to be more confident in their role. Discussion/conclusions To our knowledge, this is the first study investigating hospital pharmacists’ understanding and use of antifungals in England. Our study showed that pharmacists navigate uncertainties when using antifungals. Pharmacists were viewed as antifungal stewards and medication experts in a multidisciplinary team but pharmacists were themselves aware that they need more exposure to a wider range of scenarios to enhance their confidence. Our findings suggest a need for reliable diagnostic-driven approaches and education and training initiatives for pharmacists to steward antifungals. Our participants worked in one tertiary hospital representing the culture and work practice specific to the hospital. It would be interesting to explore experiences of pharmacists working in other hospitals.

Healthcare workers' views on antibiotic prescribing and stewardship during the COVID-19 pandemic at an NHS Foundation Trust in England: a cross-sectional survey

Abstract Introduction Antimicrobial resistance (AMR) is a rapidly escalating global health challenge, projected to cause 10 million deaths annually by 2050.1 In response, the UK Government developed a five-year national action plan, 'Confronting Antimicrobial Resistance 2024 to 2029,' aimed at optimising antimicrobial use and implementing antimicrobial stewardship.2 The COVID-19 pandemic has significantly impacted the healthcare system, jeopardising public health and causing millions of deaths worldwide. The pandemic has exacerbated AMR due to increased antimicrobial therapy and misuse.3 Aim This study explores healthcare workers’ (HCWs) views towards antibiotic prescribing, AMS and AMR during the COVID-19 pandemic in a UK secondary care setting. Methods This cross-sectional study employed an online questionnaire survey conducted at an NHS Foundation Trust in the East of England, targeting doctors, nurses, and pharmacists. The total eligible participants comprised 5,636 doctors, 2,140 nurses, and 206 pharmacists. Data collection was carried out using Qualtrics XM from 12 June to 13 September 2023. Inclusion criteria required healthcare workers (HCWs) to be adults aged 25 or older, registered with relevant professional bodies, and employed during the pandemic. Data analysis involved both descriptive statistics and qualitative methods to interpret participants’ open-ended responses to the question, “What lessons have been learnt during the COVID-19 pandemic?” This study was registered under ISRCTN number 14825813 and received ethical approval from the University of Hertfordshire Ethics and Health Research Authority (HRA) (REC reference number 22/EM/0161). The Citizens Senate reviewed the study protocol to ensure public and patient involvement. Results A total of 23 HCWs completed the survey, including 12 pharmacists, nine doctors, and two nurses. The survey included an open-text section where respondents shared lessons learned during the COVID-19 pandemic. Among pharmacists, 75% (9 out of 12) identified inappropriate antibiotic use without clinical justification as a significant issue, and 67% (8 out of 12) reported an increase in healthcare-associated infections (HCAIs). Additionally, 83% (10 out of 12) noted the positive impact of technology platforms and antibiotic reviews on implementing effective and sustainable AMS. Among doctors, 89% (8 out of 9) emphasised the need for reliable information dissemination, observing that social media often overshadowed evidence-based guidelines. Additionally, 78% (7 out of 9) stressed the importance of staying informed about resistance patterns and antibiotic prescribing trends. All nurses highlighted the significance of AMR awareness and reported that mental fatigue affected decision-making during the pandemic. Discussion/Conclusion This study highlights the essential role of technology platforms in enhancing antimicrobial stewardship practices and the necessity of disseminating reliable information to counter misinformation. The pandemic highlighted the need for clear guidelines and robust communication strategies to support clinical practices. However, this study has limitations, including a small sample size of 23 participants, which may affect the generalisability of the findings. Future research should include larger, more diverse samples to validate these findings and assess specific AMS interventions. The study also revealed the importance of resilient AMS implementation to optimise antibiotic use and improve patient outcomes. Achieving this requires ongoing AMS education, interdisciplinary collaboration, and adaptive strategies to effectively mitigate antimicrobial resistance.

Antibiotic prescribing in health and justice settings (HJS)-surveillance and opportunities for quality improvement

Abstract Introduction Improving surveillance of antibiotic prescribing and reducing health inequalities in antimicrobial resistance (AMR) are priorities in the new 5 year AMR national action plan (2024-2029)1. People in contact with the justice system are one of the inclusion groups in the CORE20plus5, a national NHE England approach to support reduction of health inequalities.2 Aim This project aimed to collate and analyse all antibiotic prescribing data from English prisons in order to identify opportunities for quality improvement. Method This project analysed antibiotic prescribing data from September 2022 to current date for the first time in HJS from the IT system used in all prisons in England. No ethical approval is required as surveillance is of anonymised data only. Data was broken down by age band (18 and under, 19-49, 50 and over), category of prison, region, ICB, individual prison and antibiotic type. The dashboard allows benchmarking across sites and comparison with primary care, as prisoners in HJS are considered to have similar infections to primary care patients. Results The majority of prescribing is in male prisoners, reflecting the male/female population split. The most frequently prescribed antibiotics are those used for: skin and soft tissue (including acne), respiratory tract, dental and urinary tract infections. A number of focus areas for quality improvement have been identified, including: Broad spectrum antibiotics (Cephalosporins, Co-amoxiclav and Quinolones), target of <10% total antibiotic prescribing in primary care, in HJS, currently 11%. Appropriate quinolone prescribing is a target in all settings due to recent MHRA alert3. Acne prescribing represents a significant proportion of antibiotic prescribing in HJS. Lymecycline 12%, whereas in primary care <3%. Duration of Antibiotic Courses: In primary care there is a medicines optimisation opportunity ambition to achieve 75% prescribing amoxicillin 500mg as 5 day duration. In HJS only 27% is for 5 days. When prescribing 100mg doxycycline for respiratory infections, NICE guidance recommends a 5 day course, but in HJS only 3% is prescribed as a 5 day course. For UTI in female prisons, nitrofurantoin 100mg MR is most commonly prescribed, NICE guidance for UTI in women is for 3 days; 47% in HJS are for 3 days, but 35% are 7 day courses. Discussion and Conclusion This dashboard provides insight into antibiotic prescribing data allowing opportunities for quality improvement opportunities to be identified and antimicrobial stewardship interventions to be evaluated. This work will progress to tackle the focus areas identified. Next steps are to work with antibiotic champions from HJS to co-produce intervention plans, share patient safety messages, trial available resources, rollout interventions and monitor impact via the dashboard. Limitations Indications are not available from the data but extrapolated from the antibiotic prescribed. The dashboard is currently an excel spreadsheet in NHSE. It will be moved to a platform that enables access by individual prisons.

The political economy of gender mainstreaming in energy access in Sierra Leone

Abstract In 2017, the Economic Community of West African States launched its Policy for Gender Mainstreaming in Energy Access with each member state tasked to create a National Action Plan (NAP). This study explores the case of Sierra Leone, to understand how stakeholders have influenced the NAP process, and what that might mean for implementation. Using the Actor-Objective-Context framework with interview data from key gender and energy actors. We find elements that make Sierra Leone’s NAP unique; such as addressing systematic barriers, explicitly promoting solar energy and heavily relying on civil society. The study finds that a policy focus on gender reflects both a push from international donor organisations and the national efforts of civil society. Sierra Leone’s NAP reflects the tension between the high priority of gender politics at the national and international level and more immediate interest from the Ministry of Energy and government actors on economic development. It affirms the uneasy co-existence of the liberal and liberating view of women in international development with some evidence that the liberal view prevails. Still, despite the government focus on economic development, poor engagement with the private sector and cultural barriers are likely to hamper the inclusion of women into the energy industry.

Experience of Health System Personnel in the Implementation of Mass Distribution Campaigns for the Control of Lymphatic Filariasis in Rural Guinea in 2022

This study documents the experiences of health system personnel in the implementation of mass distribution campaigns for the control of lymphatic filariasis in rural Guinea. This was an exploratory qualitative study using data collected from implementing actors of mass distribution campaigns in the Boké health district. The results showed four main facilitators of mass distribution campaign rollout in the Boké health district: (i) support to the district teams in the organization of the campaigns; (ii) involvement of community-based associations in social mobilization; (iii) strong adherence of the communities to the different mass distribution campaigns, facilitated through the involvement of community relays, who are members of these communities, in the distribution of drugs; and (iv) transparency in the allocation of incentives to drug dispensers and supervisors. However, the frequent shortages of medicines, the difficulty of access to rural areas, and the lack of logistical means for the supervision of activities were the main obstacles to the success of the various mass distribution campaigns in Boké. The provision of buffer stocks for special areas such as Boké by national programme actors and partners, joint planning of campaign activities with local managers of health systems and services, and improvement of existing mechanisms for motivating health workers, including community health workers, during future campaigns should help to achieve national objectives in the fight against NTDs in Guinea.

Inertia in transformed times: Work health and safety amid climate change

Climate change will impact work health and safety conditions at an unprecedented scale, and the effects are already being felt. The most significant consequences are for workers labouring in higher temperatures and heatwaves. Other dangers include increased air pollution, vector-borne diseases and solar ultraviolet radiation. The International Labour Organisation (ILO) says climate change and WHS ‘needs to top our list of global priorities’, requiring national planning and action to ensure successful workplace adaptation to limit injuries and deaths. If this is correct, why is so little happening in Australia to plan for these current and emerging issues? This article considers the findings of key ILO and Australian Government reports and initiatives in 2023 and 2024 to assess what action experts argue is needed and how Australia stacks up.

A "silent storm": uncovering the escalating crisis in mental healthcare for children and adolescents in Slovenia during and after the COVID-19 pandemic.

Our aim was to assess the burden of children and adolescents' mental health problems on the Slovenian outpatient healthcare system before, during and after the pandemic. In a retrospective analysis of healthcare indicators from 2008 to 2023, we analysed data from the National Institute of Public Health. Key domains included initial visits for mental and behavioural disorders (MBDs) to primary care for the population aged 0-19; the number of referrals to an initial assessment with a child and adolescent psychiatrist (CAP) at the secondary level for the population aged 0-17 along with the corresponding waiting times; and the number of urgent referrals for the population aged 0-17 to emergency mental health centres at the tertiary level. The calculations included rates per 1000 people. Descriptive statistics and diagrams were used to compare the data. Segmented linear regression analysis (SLR) was conducted on the primary healthcare data to identify the distinct temporal point indicating an increase. Comparing the average rates of the 2020-2022 period to those of the 2018-2019 period, there was a 20% increase in initial visits to primary care, a 23% increase in the referral rate to a CAP at the secondary level, and a 41% increase to the tertiary level of care. In secondary care, a four- to sevenfold increase in waiting times for the initial CAP assessment was observed between 2019 and 2023. The incidence of initial visits to primary healthcare services for MBD increased from 2008 to 2019 (average annual growth rate of 4.5%). The average annual growth rate for the 2020-2022 period tripled to 13.9%. The SLR showed that the trend of accelerating growth could have begun in 2017 for the 0-5 age group and possibly for the 15-19 age group as well. After the initial decline in 2020, all levels of the Slovenian healthcare system faced an increased burden of MBD in children and adolescents from 2021 to 2022 compared to pre-pandemic levels. Nevertheless, a portion of this increase aligns with longitudinal growing trends from 2008 onwards. Tackling the crisis requires urgent national action, significant improvement in organization, and investments in mental health.

POST-CONFLICT RECONSTRUCTION AND INSTITUTION BUILDING IN CAMEROON

Cameroon has been embroiled in prolonged conflicts, including the Anglophone Crisis and the Boko Haram insurgency, both of which have deeply impacted the nation's socio-political fabric. The central problem is the breakdown of institutions, displacement of populations, and socio-economic instability, necessitating urgent post-conflict reconstruction. This study aims to explore the key challenges and barriers to reconstruction, assess the roles of national and international actors, and analyze strategies to build institutions for sustainable peace and stability. The research draws on hybrid peace and conflict transformation theories and adopts a qualitative research design, relying on secondary data sources. Through an in-depth analysis of official documents, scholarly articles, and reports from international organizations, this study provides a comparative examination of similar post-conflict settings, such as Rwanda and Sierra Leone. Data were systematically analyzed to identify key themes related to governance, security, and institutional reform. Findings reveal that political instability, lack of decentralization, and limited financial resources significantly hinder effective reconstruction efforts. Governance challenges, including corruption and centralization of power, impede institution-building, while socio- economic issues, such as ethnic and linguistic divisions, further complicate peacebuilding efforts. International actors and NGOs play a vital role but often lack coordination, limiting the effectiveness of their interventions. The study concludes that Cameroon’s post-conflict reconstruction requires comprehensive reforms. Decentralization, inclusive governance, and accountability must be prioritized. International efforts should align with local needs, emphasizing long-term development over short-term aid. Effective security sector reform, alongside strategies for institutional capacity-building, will be essential to fostering peace and preventing future conflict.

Using a policy learning lens to understand health financing policy outcomes: the case of translating strategic health purchasing into policy and practice in Burkina Faso

IntroductionAchieving universal health coverage (UHC) through an effective health financing system is a challenge for many low-income countries. Learning is key to success due to many uncertainties and unknowns. Using the case of translating strategic health purchasing into policy and practice in Burkina Faso, our study seeks to understand how policy learning can shape policy processes and outcomes.MethodsWe used a qualitative case study design and Dunlop and Radaelli’s conceptualisation of policy learning to identify which modes of learning did or did not occur, what helped or hindered them and the resulting policy outcomes. Dunlop and Radaelli frame policy learning as epistemic, reflexive, negotiative or hierarchical. We collected data through documentary review and in-depth individual interviews with 21 key informants. We analysed the data manually using pattern-matching techniques.ResultsThe introduction of strategic health purchasing in Burkina Faso was initially seen as an opportunity to reduce the fragmentation of the health financing system by coupling a performance-based financing scheme and a user fee exemption policy. However, this has faltered, and our findings suggest that an inability to harness all modes of learning has led to blockages. Indeed, while reflective learning was present, epistemic, hierarchical and learning through bargaining were absent, preventing national policy actors from defending their own policy or scheme from reaching compromises. But thanks to facilitating processes led by a well-resourced organisation and contextual elements that encouraged the emergence of more pluralistic modes of learning, some progress was achieved in operationalising strategic health purchasing.ConclusionsSome modes of learning seem to be overlooked in countries’ efforts to achieve UHC. Facilitation techniques and initiatives that encourage the use of all modes of learning, while supporting countries to take full ownership and responsibility for consolidating their own learning health systems, should be promoted.

Dupilumab use in patients with hypereosinophilic syndromes: a multicenter case series and review of the literature

BackgroundHypereosinophilic syndromes (HES) are defined as hypereosinophilia with eosinophil-related clinical manifestations, some of which overlap in presentation with asthma, atopic dermatitis, eosinophilic esophagitis, and/or chronic rhinosinusitis with nasal polyps (CRSwNP). Dupilumab is approved to treat these conditions but can induce a transient rise in the absolute eosinophil count (AEC) and rare eosinophil-related complications. ObjectiveTo determine whether eosinophil-related complications of dupilumab are increased in HES. MethodsRetrospective chart review of patients with HES treated with dupilumab enrolled on an IRB-approved research protocol at the National Institutes of Health (NCT00001406) or receiving care at Walter Reed National Military Medical Center. Clinical response and treatment-emergent adverse events were recorded. Serum mediators were assessed in a subset of patients before and after dupilumab using stored samples. ResultsAmong the 28 patients (15 male, 13 female; median age 41.5), the most common prescribing indication for dupilumab was CRSwNP (n=11). Twenty-three patients (82%) showed significant clinical improvement on dupilumab. Hypereosinophilia (AEC >1.5x109/L) recurred or worsened in 9/20 patients on dupilumab monotherapy. Moreover, 4/20 (20%) patients developed an eosinophil-related complication with dupilumab discontinuation and/or addition of eosinophil-lowering therapy. None of the 8 patients who received dupilumab while in hematologic remission on an eosinophil-lowering biologic developed hypereosinophilia or an eosinophil-related complication. Serum IgE and eotaxin levels decreased on dupilumab therapy. ConclusionThese data suggest that dupilumab is effective in treating residual symptoms in HES patients but that the incidence of eosinophil-related complications is increased. Concomitant eosinophil-lowering therapy may reduce the risk of eosinophil-related complications during dupilumab therapy in patients with HES.

SYNERGY IN SECURITY: EVALUATING THE EFFICACY OF COLLABORATIVE STRATEGIES EMPLOYED BY THE ARMED FORCES OF NIGERIA IN COUNTERING VIOLENT EXTREMISM

In the face of evolving security threats, the Armed Forces of Nigeria (AFN) stand at a critical juncture, where the echoes of gunfire meet the whispers of diplomacy. This study delves into the heart of Nigeria's counter-extremism efforts, examining the AFN's journey from traditional military approaches to a symphony of collaborative strategies. Through an extensive literature review, the study unravels the tapestry of stakeholder engagement woven by the AFN in their quest to combat violent extremism. This research navigates the complex terrain of Nigeria's security landscape, exploring how the AFN has transformed from a lone sentinel to a conductor of a diverse orchestra of stakeholders. It analyses key initiatives such as the National Security Strategy and the National Action Plan for Preventing and Countering Violent Extremism, viewing them as scores that guide this intricate performance of national security. The study reveals a narrative of progress punctuated by persistent challenges. It found that while the AFN has successfully harmonized efforts with civil society, religious leaders, and international partners, discordant notes of mistrust and resource constraints continue to resonate. The analysis uncovers the delicate balance the AFN must maintain – striking a chord between military might and community engagement, between national sovereignty and international collaboration. Emerging from our review is a portrait of an armed force in transition, learning to wield soft power alongside hard power. The study identifies innovative practices where the AFN has successfully bridged divides, creating unexpected alliances in the fight against extremism. However, we also highlight the unfinished symphony – areas where the collaboration falls short of its potential. This study contributes to the growing body of literature on military transformation in the face of asymmetric threats. By examining the AFN's collaborative strategies, it provides insights applicable not only to Nigeria but to armed forces globally grappling with similar security challenges. As the AFN continues to compose its response to violent extremism, this research offers both a reflection on its current performance and a prelude to future harmonies in national security efforts.

An Analysis of Real Estate Market Responses towards Climate Resilient Policies in Malaysia and Indonesia

As global warming increases climate-related disasters, countries must address its impact on real estate. Malaysia’s National Policy on Climate Change, Green Building Index, and National Urbanisation Policy, along with Indonesia’s National Action Plan on Climate Change, Climate Resilience and Adaptation Strategy, and Disaster Management Law, highlight climate resilience in real estate. This study examines these policies and their effects on the real estate markets in Malaysia and Indonesia using qualitative methods. The findings reveal that property values in both countries have increased due to a growing emphasis on sustainability and durability in the market.

An antimicrobial resistance gene situationer in the backyard swine industry of a Philippine City

Antimicrobial resistance (AMR) as a result of antimicrobial overuse and misuse in agriculture is a growing concern, especially in the predominant but poorly regulated backyard or smallholder swine farms of the Philippines. A city-scale surveillance of antimicrobial resistance genes (ARGs) was conducted through selected backyard swine farms to obtain a comprehensive understanding of the AMR situation in the backyard sector of Davao City, Philippines. The ARGs encoding resistance to four antimicrobial classes (β-lactams: blaCTX−M, blaOXA, blaSHV, blaTEM, mecA; quinolones: qnrS and qnr-A2; macrolides: ermA and ermB; tetracycline: tetM) were quantified in swine feces via real-time PCR, and point maps were generated to visualize the ARG geographic distribution. The ARGs bla-TEM, ermB, qnrS, and tetM were detected in all farms at relatively intermediate to high levels, consistently representing the four most used antimicrobial classes in Philippine farms. All the investigated ARGs were present in some local barangay units, indicating potential emergence of AMR hotspots. A 0.5 quantile regression analysis identified specific backyard farm attributes associated with ARG occurrence and diversity, which may influence the ecological spread of the ARGs. These findings provide support for evidence-based guidelines to reinforce a One Health framework for the Philippine National Action Plan to Combat AMR.

Preparation and Mechanical Properties Analysis of Rare Earth Filling Ethylene‐Allene Monomer Rubber Composite

AbstractEthylene propylene diene monomer (EPDM) rubber is used in critical sectors such as national defense, military, and aerospace. However, it has performance limitations under high temperatures, affecting its dynamic mechanical properties, creep, and stress relaxation. To overcome these limitations, rare earth cerium oxide (CeO2) was incorporated as a filler into EPDM in this study, which enhances its properties and makes it suitable for the demanding applications. It could be seen that the CeO2‐enriched EPDM has significantly improved mechanical characteristics at elevated temperatures. The Young's modulus of CeO2‐enriched EPDM increased by about 100 %, while the energy storage modulus reaches a maximum increase of around 140 % at 165 °C. The addition of CeO2 improves its damping properties, provides better creep and stress relaxation resistance, and results in greater residual strain recovery. At room temperature, the impact on the stress relaxation rate at 50 % strain is minimal for the material EPDM, and it is almost negligible for the material EPDM/CeO2.These findings demonstrate that CeO2‐enriched EPDM has enhanced performance under high‐temperature conditions. Under elevated temperature conditions, EPDM enriched with CeO2 exhibits enhanced mechanical properties, superior creep resistance, and stable stress relaxation behavior, rendering it more adept at withstanding the rigorous conditions encountered in aerospace applications.

Multi-level governance and modal thinking: Tensions in electric mobility transitions in European cities

Innovations around electric vehicle (EV) technology are viewed as a promising pathway to rapidly decarbonise transport systems in transition studies. However, the mobility histories and path dependencies that shape these transitions are spatially uneven both horizontally across different geographies and vertically between different scales of authority and responsibility. As such, they are rooted in the assumptions and power relations that underlay the policy processes of city and metropolitan governance. This study takes the novel approach of comparing these processes both horizontally between cities and vertically between levels of government. The analysis is based on 50 expert interviews with local and national actors involved in delivering policy related to electric mobility in four European cities: Bristol, United Kingdom; Oslo, Norway; Poznań, Poland, and Utrecht, Netherlands. In all four cities, national, inter- and supra-national pressures generate a perception among some interviewees that the transition to electric mobility, and particularly the electrification of private cars, is inevitable. Yet because modal thinking permeates urban transport policymaking, the majority of our experts define sustainable and just urban mobility as that involving modes other than the private car. A key contribution of this study is revealing this tension between national EV priorities and urban aims to reduce car traffic, which subconsciously influences local policymakers’ perceptions of the transition to electric mobility. The study also offers new insights into how city and metropolitan policymakers can be more inclusive, innovative, and locally-responsive in shaping policies for accommodating both EVs and new modes like e-scooters.

How Can Land Use Management in Traditional Cultural Landscapes Become a Policy Instrument for Soil Organic Carbon Sequestration and Climate Change Mitigation? A Transylvanian Case Study

Changes in land use from high-nature-value grasslands to arable fields reduce the organic carbon stock in soil, increasing atmospheric carbon concentrations. Maintaining grasslands through traditional agricultural techniques can mitigate climate change by transferring atmospheric carbon to the soil. Benefits of soil organic carbon sequestration include improved soil properties and enhanced ecosystem services and biodiversity. With Romania’s ratification of the Paris Agreement, it is crucial to review climate-related agricultural policies and incentivize carbon sequestration practices in organic soils. This paper presents a soil carbon study in Transylvania’s Târnava Mare region, Romania, known for its preserved cultural landscapes. Soil samples were taken at a depth of 60 cm to assess organic carbon pools under grassland and arable land management across three soil classes: Cernisoils, Hidrisoils, and Luvisoils. Several statistical tests were applied to evaluate the most significant drivers of soil organic carbon sequestration including land use, soil class, and soil depth. The results indicate that land management has the largest impact, with grasslands storing 45% more carbon than arable land on average. This finding should be integrated into national climate action plans, prioritizing the preservation of grasslands and sustainable agricultural practices to support soil organic carbon sequestration.

A guide for policy and decision makers on health literacy policies

Abstract Supported by supranational organizations such as the WHO or the European Union, governments across the world have begun to work systematically on developing and implementing action plans, strategies and policies to improve the health literacy of their citizens and the health literacy friendliness/responsiveness of health organizations. In 2023, a first project on evidence-based policies and practices was initiated by the WHO Action Network on Measuring Population and Organizational Health Literacy (M-POHL) and financially supported by the Swiss Ministry of Health. In this project a guide on how health literacy policies can be developed and implemented was developed by an international working group. This guide brings together insights from existing literature on national health literacy strategies, action plans and interventions, including an expert snowball search within the M-POHL network and among other partners, experiences and case examples collected from M-POHL members and other countries. Feedback on the guide was collected in interactive webinars with policy representatives and decision-makers and addressed. The structure of the guide follows an adapted version of the Public Health Action Cycle model, assisting step-by-step action on health literacy policy development: situation analysis; agenda setting; developing policies, strategies and interventions; implementation; evaluation and monitoring. Each phase is described, and best practices and recommendations provided. The guide closes with a checklist for self-assessment which follows the structure of this document. It supports reflection on the state of policies in a country. This innovative guide contributes to supporting evidence-informed policies and practice. This can be of interest to experts and practitioners who have data on challenges relating to the health literacy levels of population groups and who wish to develop or adjust their policies, services and communications accordingly.