Search Results (208)

Background: Antimicrobial resistance (AMR) is a major global health threat, and Cyprus reports one of the highest levels of community antibiotic consumption in the EU. Despite their central role in antibiotic access and counselling, the stewardship practices and perspectives of community pharmacists in this regulated setting are not well documented. Methods: We conducted semi-structured qualitative interviews with 20 community pharmacists to explore their perspectives on antibiotic use and AMR. Results: We analysed the data using reflexive thematic analysis, revealing five key themes: regulation and control of dispensing; pharmacist–patient interaction and misuse; antimicrobial stewardship and public education; safety and professional responsibility; and systemic barriers. Pharmacists reported strict adherence to prescription-only rules, and described regulation and e-prescribing as a practical ‘shield’ that legitimised refusals and redirected some misuse from overt non-prescription requests towards attempts to reuse, extend, or ‘top up’ prior prescriptions and household leftovers. They described managing frequent patient demands for antibiotics for self-limiting conditions and using brief counselling scripts, written aids, and symptomatic alternatives to promote appropriate use. Participants emphasised the risks of antibiotic-related harms, including AMR and other health consequences, while also highlighting workload, access constraints, and communication difficulties as barriers to effective counselling. Overall, the findings indicate that community pharmacists in Cyprus function as front-line antimicrobial stewards. Conclusions: These accounts position community pharmacists in Cyprus as front-line antimicrobial stewards. Policy should consider supporting this function by providing enhanced communication tools, improving access pathways for timely prescriber review (including outside routine hours), and strengthening links between community pharmacy and national AMR action plans. Full article

Eco-anxiety—emotional distress arising from awareness of environmental collapse—has become a critical dimension of social sustainability, linking mental well-being, professional functioning, institutional trust, and climate governance. This study investigates how higher education professionals (HEPs) experience and interpret eco-anxiety within their professional contexts, situating it as a lens on institutional legitimacy from the perspective of those who produce, teach, and steward climate knowledge. A cross-sectional mixed-methods survey of 556 HEPs was conducted across a month in 2023, combining an adapted climate anxiety scale with open-ended narratives. Quantitative analyses identified perceived governmental inadequacy as the strongest correlate of climate worry (β = 0.48, p < 0.001), accounting for 26% of the variance, whereas institutional inadequacy had a weaker effect. Qualitative findings revealed pervasive emotions of moral injury, solastalgia, and exhaustion when sustainability rhetoric outpaced genuine action, with many respondents describing governmental and institutional “betrayal.” Integrating Cognitive Appraisal Theory with concepts of moral legitimacy, the study conceptualises eco-anxiety as a relational and ethically grounded emotion reflecting the perceived misalignment between knowledge and governance. Addressing it requires transparent climate leadership, participatory governance, and organisational care infrastructures to sustain motivation and trust within universities. Eco-anxiety thus may function not only as a personal pathology but also as a psychosocial response that can illuminate HEPs’ perceptions of institutional misalignment with sustainability commitments, with implications for higher education’s contribution to the Sustainable Development Goals. Full article

Beach nourishment is a widely used strategy to mitigate coastal erosion, yet its long-term geological impacts remain poorly understood. This study provides a multi-decadal synthesis of shoreline change and sedimentological evolution on the nourished beaches of Cape May and Wildwood, New Jersey, USA. Using shoreline positions from 1991 to 2024, we identify contrasting trajectories: Wildwood exhibits ‘persistent transition’ with severe northern erosion (EPR: −10.0 m/yr) feeding southwards accretion, while Cape May demonstrates a ‘managed equilibrium’ with widespread accretion (mean EPR: +1.15 m/yr). Wave energy correlations account for less than 15% of shoreline variability, indicating natural drivers have been superseded by human sediment inputs. Direct sediment comparison shows substantial textural transformation, with median grain sizes increasing from 153 to 435 μm to 467–982 μm and sorting degrading from very well to moderately well sorted, reflecting sustained disequilibrium. These findings are synthesized into a conceptual model where nourishment initiates feedback cycles that create human-dependent morphodynamic trajectories. This study concludes that the long-term resilience of developed coasts will depend on a strategic evolution from managing ‘sand as volume’ toward stewarding ‘sediment as a system,’ where textural compatibility is a primary determinant of success. Full article

Background: Antimicrobial resistance (AMR) is one of the most significant global health threats of the 21st century, endangering healthcare systems worldwide as a silent pandemic. Despite the globally recognized role of pharmacists as antimicrobial stewards, their involvement remains limited in antimicrobial stewardship (AMS) endeavors in Pakistan. Methods: By utilizing the Straussian grounded theory methodology, this study aimed to develop a pharmacist-centered novel AMS approach for healthcare in Pakistan in order to enhance the engagement of pharmacists in AMS and reduce the burden of AMR in Pakistan. Through 13 semi-structured in-depth interviews with pharmacists and AMS experts, this study explored the facilitators and obstacles faced by pharmacists in Pakistan pertaining to their participation in AMS. Results: The findings highlighted the underutilization of pharmacists in AMS owing to persistent policy, institutional, and resource-level barriers. Several facilitators were also identified, including institutional ownership and pharmacist-prescriber-patient (3P) communication. The evidence generated informed the development of the pharmacist-centered novel AMS approach, which recommends extending AMS policy support to pharmacists, improving One Health interdisciplinary collaborations, promoting pharmacist-led behavior change campaigns, granting prescribing rights to pharmacists for minor ailments, and advancing AMS trainings and education. Conclusions: Formally integrating pharmacists into AMS efforts is the need of the hour to contain the consequences of AMR in Pakistan. Full article

This study examines Apostle Paul’s missionary work through the lens of modern behavioral and organizational scholarship. Paul was highly intentional in both his words and actions. What would we learn if we used the conceptual frameworks from the social sciences to analyze his actions and decisions? In this study, we use entrepreneurial and identity theories to re-examine Paul’s life. Paul was an extraordinary entrepreneur who possessed all the core features of an entrepreneur, but with a distinct motivation and mindset grounded in his stewardship identity. We introduce the term “entrepreneurial steward” to characterize his unique identity, which combines the two paradoxical qualities of entrepreneurship and stewardship. Full article

As an emerging sports tourism event, Guizhou’s “Village Super League” injects new vitality into the optimization of human–land relationships and the development of household livelihoods in traditional villages of ethnic mountainous regions. Studying five affected traditional tourism villages from an “event–actor–capital” perspective using mixed methods, this research finds the following: (1) The composite average score of household livelihood capital is 0.3177, indicating a medium–low level, which suggests that households’ livelihood structure still requires significant enhancement despite the tourism boost from the “Village Super League”. (2) There is an imbalance in development among the villages. The livelihoods of households under the influence of the “Village Super League” exhibit distinct characteristics, being “driven by external flows, led by social capital, supported by the material foundation, and coordinated with other forms of capital.” (3) The evolution of household livelihoods follows a pathway of “event-driven supplementation, endogenous renewal of actors, capital integration and synergy.” By constructing shared event memory markers, the livelihoods of villages at different stages of tourism development demonstrate differentiated dynamic mechanisms. The findings deepen the theoretical understanding of livelihoods in traditional villages under event-driven development. Consequently, this study recommends that policymakers and community stewards channel transient social capital and external flows into durable physical and financial assets to ensure livelihood sustainability beyond the initial event boom. Full article

Background/Objectives: The right diagnostic tests, for the right patient, at the right time, are key to optimising antimicrobial use (AMU) and preventing antimicrobial resistance (AMR). This study evaluated diagnostic stewardship trends and AMR patterns in Zambian surveillance sentinel sites from 2020 to 2024. Methods: This descriptive, retrospective study analysed routine laboratory data from January 2020 to December 2024 at seven designated AMR surveillance sentinel sites across Zambia. Data on clinical specimens submitted for antimicrobial susceptibility testing were extracted from WHONET and analysed by year, specimen type, and antimicrobial susceptibility profile. Results: A total of 184,788 bacteriology specimens were processed over five years. Urine was the most frequently collected specimen, peaking above 20,000 in 2024. Escherichia coli was the most commonly isolated organism among 15 priority pathogens, comprising 25.9% of the 30,013 isolates. Though a statistically significant increasing trend in total organism isolations was observed annually, only Shigella sp. demonstrated a substantial increase in non-susceptibility to azithromycin (p = 0.027). High resistance was observed with doxycycline, azithromycin, clindamycin, trimethoprim/sulfamethoxazole, ciprofloxacin, and rifampicin, exhibiting resistance ranging from 50% to 80%. Critical AMR alerts included 65% for Vancomycin-Resistant Enterococcus (VRE), 72% for linezolid, and 44% for carbapenems, and possible ESBL-producing Enterobacterales showing the highest overall resistance at 35%, across sentinel sites. Conclusions: Zambia faces a concerning and significant increase in AMR, with high resistance prevalence across commonly used antibiotics. Critical resistance alerts for VRE, linezolid, carbapenems, and possible ESBL-producing Enterobacterales underscore an urgent need for robust antimicrobial stewardship and continuous diagnostic surveillance. Full article

Background/Objectives: Antimicrobial Resistance (AMR) remains a growing public health threat, underscoring the need for robust surveillance of Antimicrobial Consumption (AMC) and Antimicrobial Use (AMU). This study analysed AMC and AMU trends in Zambia’s human and animal health sectors, identifying priority areas for antimicrobial stewardship (AMS) under a One Health framework. Methods: A retrospective study was conducted in February 2025, utilising data from 2018 to 2023. Sources of data included the Zambia Medicines Regulatory Authority (ZAMRA) and the WOAH Animal Antimicrobial Use (ANIMUSE) Global Database platform. AMC was analysed using the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) methodology. Antimicrobials were classified using the WHO Anatomical Therapeutic Chemical (ATC) system, and consumption was measured in Defined Daily Doses (DDDs) per 1000 inhabitants per day (DID). Antibiotics were further categorised using the WHO Access, Watch, and Reserve (AwaRe) classification. Data analysis was performed using IBM SPPS version 25.0. Results: In the human health sector, oral antibiotics accounted for 88% of total consumption. Penicillins (33%), cephalosporins (19.2%), and macrolides (12.4%) were the most consumed classes. In 2023, 98,651,882.42 DDDs per 1000 inhabitants/day were recorded, with amoxicillin, ceftriaxone, and sulfamethoxazole/trimethoprim leading as the most consumed antibiotics. According to the consumption of antibiotics by the WHO AwaRe classification, 47% were Access, 40% Watch, and 3% Reserve group antibiotics. In animal health, tetracyclines dominated (63%), followed by sulphonamides (26%) and penicillins (11%). AMU in animal health peaked in 2023. Conclusions: This study found high AMC and AMU, especially Watch-group antibiotics and tetracyclines, highlighting the need for strengthened antimicrobial stewardship, regulatory oversight, and integrated One Health surveillance to mitigate AMR risks in Zambia. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a critical global health threat, with sub-Saharan Africa disproportionately affected. Antimicrobial stewardship (AMS) programs are essential in combating AMR; however, data on their implementation in resource-limited settings like Zambia remain scarce. This study assessed the post-implementation status of World Health Organization (WHO) AMS core elements in selected public hospitals in Zambia. Methods: A cross-sectional pre- and post-intervention survey was conducted in 11 public hospitals across Zambia’s 10 provinces. Baseline (pre-implementation) and 12-month follow-up (post-implementation) assessments were carried out using the WHO-adapted Periodic National and Healthcare Facility Assessment Tool. The six AMS core elements evaluated included leadership, accountability, AMS actions, education, monitoring, and feedback. Results: The average AMS program score increased from 59% at pre-implementation to 81% at post-implementation. Significant improvements were observed in education and training (+36%) and accountability (+31%). While leadership and monitoring also showed positive trends, gaps persisted in AMS actions (63%) and feedback/reporting mechanisms (68%). Drug and Therapeutics Committee (DTC) functionality improved by 23%, with 90% of facilities now holding regular DTC meetings. Implementation of AMS actions, such as ward rounds, rose from 0% to 73%. Challenges remained in clinical audit feedback, resource mobilization, and prescribing optimization. Variability across facilities highlighted differences in leadership, resources, and technical capacity. Conclusions: AMS implementation in Zambia improved substantially across key domains. However, sustained leadership, adequate financing, and continuous capacity-building are needed to address persistent gaps and ensure long-term success in mitigating AMR. Full article

Background/Objectives: Antimicrobial resistance (AMR) is a major global health threat that undermines treatment in humans and animals. In Zambia, where livestock production underpins food security and livelihoods, AMR challenges are aggravated by limited surveillance, weak diagnostics, and poor regulatory enforcement, facilitating the spread of resistant pathogens across the human–animal–environment interface. This study aims to analyse AMR patterns of bacterial isolates collected from Zambia’s animal health sector between 2020 and 2024, to generate evidence that informs national AMR surveillance, supports antimicrobial stewardship (AMS) interventions, and strengthens One Health strategies to mitigate the spread of resistant pathogens. Methods: We conducted a retrospective descriptive analysis of previously collected routine laboratory data from five well-established animal health AMR surveillance sentinel sites between January 2020 and December 2024. Data were analysed by year, sample type, and antimicrobial susceptibility testing (AST) profiles using WHONET. Results: A total of 1688 samples were processed, with faecal samples accounting for 87.6%. Animal environmental samples (feed, manure, litter, abattoir/meat processing floor, wall, and equipment surface swabs) (collected from abattoirs, water, and farms) increased significantly over time (p = 0.027). Overall, Escherichia coli (E. coli) (50.4%) and Enterococcus spp. (30%) were the most frequently isolated bacteria. E. coli exhibited high resistance to tetracycline (74%) and ampicillin (72%) but remained susceptible to aztreonam (98%), nitrofurantoin (95%), and imipenem (93%). Enterococcus spp. were susceptible to penicillin (84%) and ampicillin (89%) but showed borderline resistance to vancomycin (53%) and linezolid (50%). Klebsiella spp. demonstrated resistance to ciprofloxacin (52%) and gentamicin (40%), whereas Salmonella spp. remained highly susceptible. Notably, resistance to amoxicillin/clavulanic acid rose sharply from 22.2% to 81.8% (p = 0.027). Across 1416 isolates, high levels of multidrug resistance (MDR) were observed, particularly in E. coli (48.4%) and K. pneumoniae (18.6%), with notable proportions progressing toward possible Extensively Drug-Resistant (XDR) and Pan-Drug-Resistant (PDR) states. Conclusions: The findings of this study reveal rising resistance to commonly used antibiotics in the animal health sector. Despite the lack of molecular analysis, our findings underscore the urgent need for AMS programs and integrated AMR surveillance under Zambia’s One Health strategy. Full article

Background/Objectives: Antimicrobial stewardship programs (ASPs) play a vital role in combating antimicrobial resistance (AMR). However, their implementation in Zambia remains variable despite some notable progress. This study assessed healthcare professionals’ awareness of the Multisectoral National Action Plan (NAP) on AMR, alongside their perceptions, barriers, and implementation practices related to ASPs. Methods: A cross-sectional survey conducted between August and December 2024 included 364 healthcare professionals (HCPs) in 58 randomly selected public healthcare facilities in Zambia. Data were analysed using IBM SPSS 25.0. Results: Findings revealed that while 75.3% of respondents were aware of the Zambian NAP on AMS, only 68.1% of the respondents reported that their hospitals had established AMS committees. Conversely only 41.2% of the respondents stated that their hospitals possessed hospital-specific treatment guidelines. Encouragingly, 97.5% believed ASPs could enhance clinical outcomes and reduce AMR. Key barriers included limited funding (75.9%), inadequate IT infrastructure (64.1%), limited access to essential data (64%), and healthcare workforce shortages (53.8%). Conclusions: Whilst HCPs in Zambia demonstrated high awareness of the NAP and supported ASP implementation, systemic challenges hindered their consistent execution across health facilities. Gaps in treatment guideline development, AMR data usage, and the integration of antimicrobial susceptibility recording systems into clinical activities must be addressed to strengthen ASP efforts nationwide. Full article

Background: Zambia, like many low- and middle-income countries, faces a growing burden of antimicrobial resistance (AMR), driven by the misuse of antimicrobials in both human and animal health, a limited diagnostic capacity, and weak regulatory enforcement. To address this challenge, Standard Treatment Guidelines (STGs) were developed for the veterinary sector, which represents a major milestone in the country’s AMR containment strategy. STGs are evidence-based protocols that guide veterinary professionals in consistently and appropriately diagnosing and treating animal diseases. They promote the rational use of veterinary medicines, and can mitigate AMR and improve animal health outcomes. By translating the best evidence into best practices, STGs also provide a practical foundation for antimicrobial stewardship (AMS) programs. Until 2023, Zambia lacked nationally adopted STGs for the veterinary sector. The introduction and standardization of these guidelines are expected to promote prudent antimicrobial use and raise the standard of care delivered to animal patients across the country. Objective: The aim of this paper is to provide a practical reference for future revisions of STGs and outline the successful methodology used to create STGs in the Zambian animal sector. Methods: A situational analysis was conducted to identify priority animal health conditions and existing treatment gaps within the veterinary sector. A multidisciplinary expert committee was then formed, comprising veterinarians, veterinary paraprofessionals, academics, regulatory authorities, and private sector stakeholders, to lead the development of the STGs. The process was guided by the WHO methodology for developing treatment guidelines, including a comprehensive review of the clinical evidence, local disease patterns, antimicrobial resistance data, and existing treatment practices. Draft STGs were developed with clearly defined, species-specific treatment protocols tailored to the Zambian context. For the validation process, the AGREE II instrument was used to assess the quality, clarity, and applicability of the guidelines. Structured stakeholder consultations with practitioners, policy-makers, and technical experts were held to ensure that the guidelines were practical, evidence-based, and aligned with national priorities. The validated drafts were then disseminated and piloted in selected districts. Conclusions: The development of the species-specific STGs represents an essential turning point in the country’s efforts to promote responsible veterinary care and contain AMR. STGs have become a prominent key support in the delivery of quality animal care. Further, the guidelines will assist in the optimization of antimicrobial use in animal health in Zambia. Full article

Architectural education has increasingly engaged with the Circular Economy (CE); however, integration remains largely material-centric, emphasising life-cycle accounting, efficiency, and design for disassembly, while social, cultural, and governance dimensions are underrepresented. This study introduces the Circular Commons Framework, which repositions circularity as a collective, participatory, and socio-spatial practice. Using a qualitative comparative case study methodology, five international cases were analysed through eight dimensions spanning technical CE strategies and pedagogical approaches. Cross-case synthesis reveals convergent patterns around multi-scalar systems thinking, transdisciplinary collaboration, and stakeholder engagement. Nonetheless, persistent gaps emerged across cases, including those related to elective-based delivery, weak assessment infrastructure, and underdeveloped social equity dimensions. The Circular Commons Framework comprises four empirically grounded components: Circular Design Practices, Local Knowledge and Cultural Practices, Collaborative Governance, and Circular Synergy Workshops. Operationalisation guidance addresses curricular design, pedagogical methods, assessment mechanisms, and institutional enablers. Mainstreaming the framework requires systemic institutional support, including accreditation reform, supportive policy environments, and effective resource allocation, which are currently constraining even well-designed pedagogical initiatives. The framework positions architects as equity-minded stewards facilitating socially just and culturally resonant circular transitions. Limitations, including scalability tensions, indicate that the framework requires validation through longitudinal research and deeper engagement with non-Western knowledge systems. Full article

Indigenous Peoples have developed and stewarded complex knowledge systems that have contributed to thriving societies. With continued threats to Indigenous lifeways, there is increasing need to further protect traditional ecological knowledges (TEK). We carried out a qualitative study to explore Indigenous community perspectives on stewarding and protecting TEK while identifying gaps in community-level protections of TEK. We conducted ten semi-structured interviews in December 2024 and one focus group in January 2025 with Indigenous Peoples in the southwestern United States. Reflexive thematic analysis through open coding was carried out using qualitative software. Six overarching themes were characterized in the interviews, which overlapped with findings from the focus group, including the following: (1) Historical and current barriers impact the sharing of TEK; (2) Preserving our language is necessary for intergenerational transmission of our TEK; (3) Our TEK reveals changes to our Lands; (4) Protecting our Lands and medicines is vital to our health; (5) We must take the time to learn our TEK for future generations; and (6) We need to protect our TEK. Our research highlights the importance of supporting Indigenous communities’ capacities to protect their TEK for personal, community, and environmental well-being. Full article

Lithium-ion battery (LIB) wireless charging using inductive power transfer (IPT) represents a transformative pathway for transportation electrification. While applications in railway systems remain limited, early studies highlight significant promises for implementation. This paper presents a hybrid energy-supply framework integrating LIB, inductive battery charging (BC) charging, and battery swapping (BS) to support a 20 km heritage trolley excursion between Belmont and Gastonia, NC. A kinematic simulation was developed to estimate traction energy demand, yielding 56 kWh per trip, or 112 kWh for two daily round trips. Finite element analysis (FEA) was conducted to design an LCL-s compensated 3 kW IPT system. Two transmitter configurations were evaluated: W–I ferrite cores (peak coupling ~0.22) and magnetic concrete slabs (~0.20). Although ferrite offers higher efficiency, magnetic concrete demonstrates superior durability and integration potential. Simulation results indicate that wireless charging alone, whether static or dynamic, is insufficient; similarly, a single daily BS strategy provides only 96 kWh. Seven BC-BS hybridization scenarios were evaluated, showing that mid-day swaps combined with either static or dynamic IPT produce a 12–16 kWh surplus. The most practical approach is a one-pack swap supplemented by uniformly distributed static pads, providing energy neutrality. This hybrid pathway ensures operational sufficiency, structural resilience, and compatibility with heritage rail preservation. Full article