Systematic Program Research Articles

Dual mediating effects of anxiety to use and acceptance attitude of artificial intelligence technology on the relationship between nursing students’ perception of and intention to use them: a descriptive study

BackgroundArtificial intelligence (AI)-based healthcare technologies are changing nurses’ roles and enhancing patient care. However, nursing students may not be aware of the benefits, may not be trained to use AI-based technologies in their practice, and could have ethical concerns about using them. This study was conducted to identify the dual mediating effects of anxiety to use and acceptance attitude toward AI on the relationship between perception of and intentions to use AI among nursing students in South Korea.MethodsThe research model followed the PROCESS Macro model 6 proposed by Hayes. The participants were 180 nursing students in Gyeonggi-do. Data were collected from January 5–16, 2023, using self-reported questionnaires. Data were analyzed using the SPSS/WIN 25.0 program, with independent t-tests, one-way analysis of variance, Pearson’s correlations, and Hayes’s PROCESS macro method for mediation.ResultsAI perception positively correlated with acceptance attitude (r =.44, p <.001), intention to use AI (r =.38, p <.001) and negatively correlated with anxiety (r = −.27, p <.001). Anxiety about AI negatively correlated with an acceptance attitude toward AI (r = −.36, p <.001) and intentions to use AI (r = −.28, p <.001). Acceptance attitude toward AI positively correlated with intentions to use AI (r =.43, p <.001). Anxiety about AI and acceptance attitude toward AI had a dual mediating effect on the relationship between AI perception and intentions to use AI.ConclusionsIt is necessary to develop systematic educational programs to improve the perception of AI. Thus, the competency and professionalism of nursing students regarding the use of AI in healthcare can be improved.

Raising Adaptive Capacity to Climate Change in the Energy and Food Sectors of Egypt

Climate change will likely impact food security globally, regionally, and locally. Climate change can disrupt food availability, reduce access to food, and affect food quality. Accordingly, the impacts of climate change on the agricultural sector reflect food security and pose a serious threat to sustainable development. Furthermore, the total energy demand of Egypt is marked by an exponential growth of electricity demand, at a pace much faster than that of GDP, primary energy consumption, and population mainly due to a doubling up of the consumption of Egypt. The expected development of the industrial sector, the accelerated access to electricity, and the improvement of standards of living (directly connected with the consumption of the residential sector) are the reasons for these consumption upsurges. The different components of climatic change such as projected increases in temperatures, changes in precipitation patterns, changes in extreme weather events, and reductions in water availability may all result in reduced agricultural productivity and may cause energy consumption upsurges. The main problem with climatic change and climatic variability in all parts of the Mediterranean Basin is that systematic climate observation programs are, at present, inadequate to permit reliable assessment, quantification, and prediction of climatic conditions and their impacts. More accurate assessments of regional climate variability and change and their related environmental and socio-economic impacts are highly needed.

Supervisi dalam Pendidikan Islam: Menyempurnakan Proses Pembelajaran Menuju Kualitas Pendidikan yang Unggul

This article aims to compare classical supervision with modern supervision. The research method used is content analysis by collecting data from scientific articles, books, and other sources. The findings of this paper are as follows: Supervision is carried out for no other reason than to foster educational actors in an organization to improve the quality of learning. In the ancient, ent sense, supervision,n is the inspection and examination process. With this ancient understanding, the supervisor becomes afraid, thus making himself not open to the problems that are afflicting him. In the current era, supervision comes in a humanist form, namely as a process of coaching, directing, assisting, serving, and providing assistance, and carried out on an ongoing basis with a directed and systematic program for teachers in improving their competencies. It is necessary to reflect on several things that are the basis of supervision in the world of education so that the purpose and principle of supervision will be realized in the world of education.

영유아교사의 전문성 인식, 놀이신념, 놀이교수효능감이 놀이지원역량에 미치는 영향

Objectives In this study, the relationship between early childhood teachers' professional perception, play belief, play teaching efficacy, and play support capabilities was identified, and the effect of early childhood teachers' professional perception, play belief, and play teaching efficacy on play support capabilities was analyzed.&#x0D; Methods Data on the scale of professionalism perception, play belief, play teaching efficacy, and play support capability were collected from 166 infant teachers working at daycare centers located in A and S cities in Chungcheongnam-do. The collected data were subjected to frequency analysis, descriptive statistics, reliability tests, correlation analysis, and hierarchical regression analysis using the SPSS ver. 22.0 program.&#x0D; Results First, there was a significant positive correlation between early childhood teachers' professional perception, play belief, play teaching efficacy, and play support competency. Second, when examining the influence of early childhood teachers' professional perception, play belief, and play teaching efficacy on play support competency, it was found that play belief and play teaching efficacy had a significant effect on play support competency, but professional awareness did not significantly affect play support competency.&#x0D; Conclusions The results of this study suggest the necessity of developing a systematic educational program to develop professionalism awareness, play beliefs, and play teaching efficacy in order to develop the play support capabilities of early childhood teachers.&#x0D;

Stroke without cerebral arteriopathy in sickle cell disease children: causes and treatment.

Cerebral arteriopathy (CA) in children with sickle cell disease (SCD) is classically described as chronic stenosis of arteries in the anterior brain circulation, leading to ischemic stroke. Some studies have, however, reported strokes in children with SCD but without CA. In order to better understand the etiology and risk factors of these strokes, we retrospectively analyzed ischemic strokes occurring in a large cohort of children over a 13-year period. Between 2007 and 2020, 25 of 1,500 children with SCD had an ischemic stroke in our center. Among them, 13 (52%) had CA, described as anatomical arterial stenosis, while 12 (48%) did not. Patients with stroke without CA were older than patients with stroke attributed to SCD-CA (9.0 years old vs. 3.6 years old; P=0.008), and more frequently had SC genotype (25% vs. 0%, respectively). Their strokes more frequently involved the posterior circulation, with cerebellar involvement in 42%. Retained stroke etiologies in patients without typical SCD-related CA were reversible cerebral vasoconstriction syndrome, cerebral fat embolism, arterial thrombosis or thromboembolism, hyperviscosity, vasculitis in a context of infectious meningo-encephalitis, and severe hemodynamic failure. No recurrence was observed in the 24 months following stroke, even though 67% of the patients in this group were no longer receiving exchange transfusions. In conclusion, in a cohort of pediatric SCD patients with an efficient stroke screening strategy, half of the ischemic strokes that occurred were related to causes other than CA. They affected a different population of SCD children and systematic long-term transfusion programs may not be necessary in these cases.

‘First, do no harm’: systematic program evaluation of an equine veterinary service-learning initiative with Indigenous communities in Canada

BackgroundVeterinary students have historically lacked meaningful experiential learning opportunities in equine medicine. At the same time, there are barriers to accessing veterinary care in Indigenous communities stemming from colonial injustices. In 2018–2019, a partnership was initiated where University of Calgary students began to provide equine veterinary services to Indigenous communities. As the first-documented equine veterinary service-learning initiative in Indigenous communities embedded in a veterinary curriculum, the purpose of the study is to systematically evaluate the program for its potential impact as part of a formative process for improvement.MethodsMultiple parties in the program were engaged in a convergent, parallel, mixed-methods systematic program evaluation to explore the main program outcomes: (1) equine veterinary care; (2) clinical experiential student education; (3) cultural training of veterinary professionals and students; and (4) education of community members. The hypothesis was that ethical development using the “first, do no harm principle” would lead to benefits including a healthy horse population, a technically and culturally competent veterinary community, and an educated horse clientele.ResultsThe program had a positive impact on accessibility to veterinary care and self-reported improvement in veterinary and cultural competency. In addition to the hypothesized program outcomes, additional program outcomes and effects were identified, including reciprocal learning and relationship building with the Indigenous community, leading to trust and equity-building. The students learned from both the in-community programming as well as the Indigenous community members they worked with.ConclusionProgram evaluation of an equine service-learning initiative in Indigenous communities reveals multiple and profound impacts including improved patient health status, wider scope of veterinary and cultural learning, strengthened relationships, and reciprocal learning with partnering Indigenous communities.

Dendroarchaeology in Greece – From humble beginnings to promising future

It was back in the early 1960s when Bryant Bannister recognized the potential of dendrochronological research on wooden cultural heritage in Greece. More than two decades later, in the late 1980s, P.I. Kuniholm and C.L. Striker started collecting and analyzing tree-ring series from several historical buildings, forests, and archeological sites in Greece and the surrounding Aegean region. Despite highly promising results, especially from the northern and western parts of the country, dendroarchaeology did not attract much attention in the subsequent decades. It was only near the end of the 2000s that dendroarchaeology was reintroduced: first in Crete through the Cretan Dendrochronology Project, and then by another independent project concerning the restoration of a historical building on the island of Euboea. These isolated case studies inspired a five-year systematic research program called the “Balkan-Aegean Dendrochronology Project: Tree-Ring Research for the Study of Southeast-European and East Mediterranean Civilizations” (BAD Project). Dendroarchaeological surveys of historical buildings and archaeological sites were conducted throughout Greece with an emphasis on regions that had been previously ignored, such as the southern part of the country and the Aegean islands. Priority was given to buildings under restoration since in such cases original timbers were usually accessible and the architects, structural engineers, and archaeologists in charge were willing to collaborate. Our goals were not only to date timbers or provide information about the species used or the possible origin of the wood, but also to document the date, evolution, interventions and even the construction phases of historical buildings, as well as to help all those interested parties (academics, non-academics, researchers, professionals, local communities, etc.,) see the value of such information and how dendroarchaeology can contribute to the reconstruction of local history and the protection of cultural heritage. Tree-ring analysis led to the development of 18 chronologies from historical timbers and forests for six different species and different parts of the country from remote mountainous areas to small islands across the Aegean. The current dataset covers more than a thousand (1000) years and demonstrates the further potential of dendroarchaeology in the region.

Introduction of a penicillin allergy de-labelling program with direct oral challenge and its effects on utilization of beta-lactam antimicrobials: a multicenter retrospective parallel cohort study

BackgroundSelf-reported penicillin allergy labels are common and often inaccurate after assessment. These labels can lead to reduced use of first-line beta-lactam antibiotics and worse outcomes. We measured the impact of a previously performed inpatient proactive systematic penicillin allergy de-labelling program on subsequent antibiotic use. This prior program included assessment, risk-stratification, and low risk direct oral amoxicillin challenge.MethodsWe performed a retrospective comparison of parallel cohorts from two separate tertiary care hospital campuses in Ottawa, Canada across two penicillin de-labelling intervention periods across April 15th to April 30th, 2021, and February 15th to March 8th, 2022. Outcomes, including penicillin allergy labelling and antibiotic use, were collected for the index admission and the subsequent 6-month period. Descriptive statistics and multivariate regression analyses were performed.ResultsA total of 368 patients with penicillin allergy label were included across two campuses and study periods. 24 (13.8%) patients in the intervention groups had sustained penicillin allergy label removal at 30 days from admission vs. 3 (1.5%) in the non-intervention group (p < 0.001). In the 6-months following admission, beta-lactams were prescribed more frequently in the intervention groups vs. the non-intervention groups for all patients (28 [16.1%] vs.15 [7.7%], p = 0.04) and were prescribed more frequently amongst those who received at least one antibiotic (28/46 [60.9%] vs.15/40 [37.5%], p = 0.097). In a multivariate regression analysis, the intervention groups were found to be associated with an increased odds of beta-lactam prescribing in all patients (OR 2.49, 95%CI 1.29–5.02) and in those prescribed at least one antibiotic (OR 2.44, 95%CI 1.00–6.15). No drug-related adverse events were reported.ConclusionsProactive penicillin allergy de-labelling for inpatients was associated with a reduction in penicillin allergy labels and increased utilization of beta-lactams in the subsequent 6-months.

Studies of Second-Language Writing in Canada

Canada’s social and educational policies have always involved immigrant settlement and English-French bilingualism. Research on writing in second languages emerged in the 1980s from graduate programs of education and applied linguistics at major universities in Toronto, Montreal, Ottawa, and Vancouver, particularly scholars investigating cognitive and learning processes and rhetorical characteristics of writing in English as a mother tongue. In the 1990s several Canadian scholars established systematic programs of research focused on L2 composing processes, writing for academic purposes, assessment, and innovative educational programs— spawning, in turn, in the 2000s a third generation of L2 writing researchers who have now established themselves across Canada and around the world.

Early chest tube removal on the 1st postoperative day protocol of an enhanced recovery after cardiac surgery programme is safe.

The aim of this study was to assess the safety of early chest tube removal (CTR) protocol on the 1st postoperative day (POD1) of our Enhanced Recovery After Surgery (ERAS) programme by comparing the risk of postoperative pneumothorax, pleural and pericardial effusion requiring intervention and hospital mortality. All consecutive patients undergoing elective coronary revascularization and/or valve surgery between 2015 and 2021 were assessed in terms of their perioperative management pathways: conventional standard of care (control group) versus standardized systematic perioperative ERAS programme including an early CTR on POD1 (ERAS group). A propensity score matching was applied. The primary end-point was a composite of postoperative pneumothorax, pleural and pericardial effusion requiring intervention and hospital mortality. A total of 3153 patients were included. Propensity score analysis resulted in 2 groups well-matched pairs of 1026 patients. CTR on POD1 was significantly increased from 29.5% in the control group to 70.3% in the ERAS group (P < 0.001). The incidence of the primary end-point was 6.4% in the control group and 6.9% in the ERAS group (P = 0.658). Patients in the ERAS group, as compared with control group, had significant lower incidence of bronchopneumonia (9.0% vs 13.5%; P = 0.001) and higher incidence of mechanical ventilation ≤6 h (84.6% vs 65.2%; P < 0.001), length of intensive care unit ≤1 day (61.2% vs 50.8%; P < 0.001) and hospital ≤6 days (67.3% vs.43.2%; P < 0.001). CTR on POD1 protocol can be safely incorporated into a standardized systematic ERAS programme, enabling early mobilization, and contributing to the improvement of postoperative outcomes. Ethics committee of the French Society of Thoracic and Cardio-Vascular Surgery (CERC-SFCTCV-2022-09-13_23140).

Vitality structures in 'addictive' game design.

For decades, research on technology use and mental health has been based on the assumption that identifiable structures of 'design' are psychologically relevant for their users. This has been central especially for the nosological emergence of 'behavioural addictions', which currently include two formal diagnoses on technology use: problems related to playing gambling games (gambling disorder) and videogames (gaming disorder). Alas, the research on identifying 'addictive' design structures has suffered from major construct validity issues. To make progress over those issues, I draw from the history of 'vitality affects' in psychiatry and introduce vitality structures as a design-phenomenological framework that can help researchers conceptualise psychologically relevant 'bonds' between entities of game design and corresponding player phenomenology. Vitality structures are not natural kinds to be discovered but pragmatic constructs to be used-and useful as long as they communicate what is both identifiable and empirically prevalent. As a demonstration of practice, I propose working conceptualisations of three vitality structures, which surface in videogames played by gaming treatment-seekers. Systematic research programs for identifying relevant vitality structures can lead to construct-valid and replicable design effects.

What happens post-pilot testing? A model for revising a disability awareness and competency training program

Disability awareness and competency trainings are an important component of addressing ableism and health equity in the health promotion context. This commentary describes our process of developing, implementing, and refining a disability competency training, the Inclusive Community Exercise Training, for community-based group exercise instructors. The training originated from a partnership between academic researchers, community organizations, and individuals with disabilities. After initial pilot testing, we used feedback from participants to enhance the training. To optimize successful dissemination of this training, we utilized the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, which is widely used in public health. The revision process focused on generalizing content to suit a wider audience, utilizing an eLearning platform for dissemination, and optimizing interactivity to improve learning effectiveness. The commentary emphasizes the lessons learned and the significance of systematic program revision, considering diverse expertise, content tailoring, and the benefits of accessible eLearning platforms.

Design and Implementation of a Career Planning Program at Chonnam National University Medical School

Chonnam National University Medical School has designed and implemented two career planning programs: a three-phase curriculum-based program and a longitudinal non-curricular program over the course of 6 academic years. The three phases of the curriculum-based career planning program are self-assessment, career exploration, and field experience. The non-curricular career counseling program operates through a faculty advisor system, with each faculty member guiding a group of students from each academic year, and students in each year forming a mentor-mentee relationship. The non-curricular career exploration program consists of a student research support program, an international practice program in basic and clinical medicine, and a specialty exploration fair. A survey conducted among 38 graduates (54.3%) working as interns at Chonnam National University Hospital revealed that graduates preferred autonomous elective subjects within the curriculum-based program. They also responded positively to the faculty advisor system, through which they maintained close relationships. A focus group interview with three interns indicated that subjects providing direct experience in fields of interest and courses that students could choose freely were helpful in career decisions. Through follow-up research, it is necessary to design and operate a systematic career planning program based on an analysis of the needs of graduates taking part in a residency training program after selecting a medical specialty.

Career Guidance to Help Medical School Students Choose a Specialty after Graduation

The author recommends the creation of a nationwide career guidance program at the national level through the establishment of a long-term cohort, involving collaboration among medical schools nationwide. This cohort would be constructed for the purpose of analyzing correlations from admission to medical school to post-graduate education, facilitating the development of a career guidance program. This will aid in career development through students' self-analysis and competency building. Each medical school should operate a systematic career guidance program. Career guidance for post-graduate major selection should be included in the regular curriculum. Schools are advised to operate student counseling rooms for various career guidance services. For example, medical schools can operate 1:1 career counseling, academic counseling, career guidance surveys, psychological tests, and counseling. It is advisable to establish a mentor-professor system, connect mentor professors, and build a network of experts related to majors to provide immediate support according to students' needs. Professional mentor training should be provided to mentor professors. To provide opportunities for students to experience their career paths in advance, early clinical exposure, long-term integrated clinical practice, community-based clinical practice, participation in student research programs, career fairs, and student internship programs are recommended. In South Korea, it is necessary to systematically operate the internship system and make improvements to facilitate optical career choices. Additionally, considering the significant influence of social factors on students' career choices in South Korea, efforts should be made to identify and address the issues related to these social factors.

Influences of communication ability, organizational intimacy, and trust among colleagues on job satisfaction of nurses in comprehensive nursing care service units.

Communication abilities, organizational intimacy, trust among colleagues, and job satisfaction of nurses in comprehensive nursing care service units are emphasized more than any other ward, and research on this is necessary. The study was to examine the influences of communication ability, organizational intimacy, and trust among colleagues on the job satisfaction of nurses in the comprehensive nursing care service units. This study used a cross-sectional descriptive design. The participants were 155 nurses caring for patients in the comprehensive nursing care service units in Seoul. Measures included the general characteristics of study participants, communication ability, organizational intimacy, trust among colleagues, and job satisfaction. The data were analyzed using the SPSS/WIN version 27.0 program. The data collection period was from August to September 2022. Factors influencing the job satisfaction of nurses at the comprehensive nursing care service units were organizational intimacy (β = 0.36), communication abilities (β = 0.26), trust among colleagues (β = 0.22), and the average number of patients assigned to a nurse (β = -0.19), which explained 67% of the variance. Organizational intimacy was the greatest factor influencing the job satisfaction of nurses in the comprehensive nursing care service units. To increase the job satisfaction of ward nurses working in the comprehensive nursing care service, securing manpower is required, and it is necessary to provide effective nursing care with an average number of patients of 5 or less. In particular, a systematic job training program is needed to increase organizational intimacy among team nurses.

Community-based monitoring reveals low anthropogenic pressure on a game vertebrate population in a sustainable-use Amazonian protected area

SummaryBiodiversity systematic monitoring programmes have been expanding across the globe, especially in protected areas (PAs). Amongst sustainable-use PAs, medium- to large-sized mammals and birds comprise crucial groups to monitor, given their importance to forest functionality and subsistence for local residents. Here, we used 6 years of community-based monitoring data from a sustainable-use PA in the Brazilian Amazonia (Tapajós–Arapiuns Extractive Reserve) to examine the influence of anthropogenic stressors and time on the density and biomass of forest mammal and bird game species. We further assessed trends in population density of target groups over the period. A total of 1915 km of line-transect surveys were completed by trained local monitors along eight established transects, providing data from 12 medium-sized and five large-sized game genera. Generalized linear mixed models of all medium-sized species, all large species and four individual taxa (Tinamidae, Dasyproctidae, primates and Cervidae) showed that some species (e.g., Dasyprocta croconota) exhibited great density, whereas others (e.g., Tapirus terrestris and Tayassu pecari) were rarely detected. Anthropogenic variables did not affect the density and biomass of the overall medium-sized and large vertebrates. Dasyproctidae, Tinamidae and primates were the only taxa influenced by anthropogenic stressors, with negative influence occurring only for Tinamidae. Moreover, density of groups and taxa remained stable throughout the period in the Reserve, although the frequency of some species may indicate past population losses. Continuation of this monitoring programme is required to improve understanding of population fluctuations, but over the 6 years studied, game population density and biomass were not linked to anthropogenic stressors.

Raising Adaptive Capacity to Climate Change in Energy and Food Sectors of Egypt

It's highly probable that climate change will impact food security on a global, regional, and local scale. Climate change can disrupt food availability, reduce access to food, and affect food quality. Accordingly, climate change’s impacts on both the agricultural sector reflected on food security and pose a serious threat to sustainable development. Furthermore, the total energy demand of Egypt is marked by an exponential growth of demand on electricity, at a pace much faster than that of GDP, of primary energy consumption and of population mainly due to a doubling up of the consumptions of Egypt. The expected development of the industrial sector, the accelerated access to electricity, and the improvement of standards of living (directly connected with the consumption of the residential sector) are the reasons for these consumption upsurges. The different components of climatic change such as projected increases in temperatures, changes in precipitation patterns, changes in extreme weather events, and reductions in water availability may all result in reduced agricultural productivity and may cause energy consumption upsurges. The main problem pertaining to climatic change and climatic variability in Egypt and even in some parts of the Mediterranean Basin is that systematic climate observation programs are, at present, inadequate to permit reliable assessment, quantification and prediction of climatic conditions and their impacts. A more accurate assessments of regional climate variability and change and their related environmental and socio-economic impacts are highly needed.

Developing indicators for a new principal induction program in Taiwan using the fuzzy delphi method

ABSTRACT Quality induction initiatives can mitigate burnout, turnover, and shortage challenges in global education systems. Increasing the relevance of induction programs for new principals is imperative. However, systematic program evaluations lack comprehensive tools. This study aims to construct assessment indicators for the Taipei Induction Program for New Principals (IPNP) using mixed methods. Six capacity-building dimensions and 52 indicators were developed through qualitative interviews, expert consensus, and the Fuzzy Delphi Method. Survey results showed positive perceptions of program effectiveness, particularly regarding communication, learning, and execution capacities. However, dimensions related to professionalism and accountability require further refinement. This study’s contribution lies in providing a comprehensive assessment tool for program providers and enhancing novice principal induction programs. By addressing a critical gap in systematic evaluation, this research contributes to the enhancement of principal development programs. Future research could prioritize indicators and delve into real-life experiences, further refining the design and implementation of effective induction programs.

Enterobacterales carrying chromosomal AmpC β-lactamases in Europe (EuESCPM): Epidemiology and antimicrobial resistance burden from a cohort of 27 hospitals, 2020–2022

IntroductionThe ESCPM group (Enterobacter species including Klebsiella aerogenes - formerly Enterobacter aerogenes, Serratia species, Citrobacter freundii complex, Providencia species and Morganella morganii) has not yet been incorporated into systematic surveillance programs. MethodsWe conducted a multicentre retrospective observational study analysing all ESCPM strains isolated from blood cultures in 27 European hospitals over a 3-year period (2020–2022). Diagnostic approach, epidemiology, and antimicrobial susceptibility were investigated. ResultsOur study comprised 6,774 ESCPM isolates. MALDI-TOF coupled to mass spectrometry was the predominant technique for bacterial identification. Susceptibility to new β-lactam/β-lactamase inhibitor combinations and confirmation of AmpC overproduction were routinely tested in 33.3% and 29.6% of the centres, respectively. The most prevalent species were E. cloacae complex (44.8%) and S. marcescens (22.7%). Overall, third-generation cephalosporins (3GC), combined third- and fourth-generation cephalosporins (3GC + 4GC) and carbapenems resistance phenotypes were observed in 15.7%, 4.6%, and 9.5% of the isolates, respectively. AmpC overproduction was the most prevalent resistance mechanism detected (15.8%). Among carbapenemase-producers, carbapenemase type was provided in 44.4% of the isolates, VIM- (22.9%) and OXA-48-enzyme (16%) being the most frequently detected. E. cloacae complex, K. aerogenes and Providencia species exhibited the most notable cumulative antimicrobial resistance profiles, with the former displaying 3GC, combined 3GC + 4GC and carbapenems resistance phenotypes in 15.2%, 7.4%, and 12.8% of the isolates, respectively. K. aerogenes showed the highest rate of both 3GC resistant phenotype (29.8%) and AmpC overproduction (32.1%), while Providencia species those of both carbapenems resistance phenotype (42.7%) and carbapenemase production (29.4%). ESCPM isolates exhibiting both 3GC and combined 3GC + 4GC resistance phenotypes displayed high susceptibility to ceftazidime/avibactam (98.2% and 95.7%, respectively) and colistin (90.3% and 90.7%, respectively). Colistin emerged as the most active drug against ESCPM species (except those intrinsically resistant) displaying both carbapenems resistance phenotype (85.8%) and carbapenemase production (97.8%). ConclusionsThis study presented a current analysis of ESCPM species epidemiology in Europe, providing insights to inform current antibiotic treatments and guide strategies for antimicrobial stewardship and diagnostics.

New Approaches to the Bipolar Flaking Technique: Qualitative, Quantitative, and Kinematic Perspectives

The bipolar technique is a flaking strategy that has been identified from 3.3 Ma until the twentieth century, with no geographical or chronological homogeneous distribution. It is represented by the intentional contact of an active percussive element against a core rested on an anvil. This tool composite has been described by some researchers as a sign of low-skill of hominins, unable to perform successfully free-hand flaking or for flaking low-quality raw materials. Based on this premise, our research focused on the following question: Are there any quantitative and qualitative differences in terms of both kinematic parameters and technical skills between knappers with different levels of expertise when flaking using the bipolar technique? To get an answer, we developed a systematic experimental program with 12 volunteer participants with different levels of expertise. Then, to assess potential quantifiable differences and to understand the mechanics of bipolar technology, we did a video motion analysis based on kinematic parameters (including position, velocity, acceleration, and kinetic energy of the hammerstone). In addition, we performed a technological analysis of the experimental lithic assemblages to assess the technological differences between knappers based on their levels of expertise. In kinematic parameters, both statistical analysis and observations from the experiment clearly show that there are differences between the levels of expertise in this technique. Intermediate knappers have been observed to apply more velocity and kinetic energy than experts and novices. Also, differences were observed in the flaking strategies. Expert knappers show a longer reduction sequence, while intermediates show shorter one. Moreover, some of the novice knappers did not even obtain a single flake. The results of our experiment stress the complexity of bipolar flaking and that previous assumptions about it might be reconsidered, especially in terms of reconsidering the negative connotations attributed to this flaking technique.