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Perspectives of health care professionals and policymakers on antimicrobial stewardship and implementation challenges in low- and middle-income country hospital settings: a qualitative systematic review protocol
Full text linkObjective:
The objective of this review is to synthesize qualitative evidence on the perceptions of health care professionals and policymakers regarding barriers and facilitators to implementing antimicrobial stewardship (AMS) programs in hospital settings, particularly in low- and middle-income countries.
Introduction:
AMS programs are widely recognized as critical interventions to combat antimicrobial resistance and optimize the use of antibiotics. While quantitative studies have demonstrated the effectiveness of AMS programs in reducing inappropriate antibiotic use, less is known about the experiences, perceptions, and contextual factors that influence their implementation and sustainability.
Eligibility criteria:
This review will include qualitative studies exploring the experiences, perceptions, attitudes, and contextual factors influencing implementation of AMS programs among health care professionals and policymakers. Studies conducted in any health care setting and involving any population relevant to AMS programs will be considered.
Methods:
The key information sources to be searched for this review include PubMed, CINAHL (EBSCOhost), PsycINFO (Ovid), Scopus, Embase (Elsevier), and Web of Science. The search will include studies published in any language from 2015 onwards. Study selection will be conducted independently by 2 reviewers, with any disagreements resolved through discussion or consultation with a third reviewer. All included studies will be critically appraised for methodological quality, and only those meeting a predefined threshold will proceed to synthesis. Data relevant to the review objectives will be extracted, followed by an aggregative data synthesis approach. Confidence in the findings will be assessed using a structured grading process based on credibility and dependability.
Review registration:
PROSPERO CRD420251044164Full Tex
Intensive flooding enhances methane but reduces carbon dioxide and nitrous oxide emissions in reservoir drawdown areas
No full textRiparian ecosystems, vital interfaces for soil-atmosphere greenhouse gases (GHG) exchange, are increasingly subject to perturbations from extreme flooding events and artificial hydrological alterations. The resultant effects on soil microbiomes and GHG emissions, particularly under varying flooding regimes, remain poorly elucidated. Here, we conducted an in-situ flooding manipulation experiment across three elevation gradients in a reservoir drawdown area, applying continuous flooding (Extreme), 3-day flooding alternating with 3-day drainage (Moderate), and no flooding (Control) to evaluate responses of CH4, CO2, and N2O emissions and associated microbiomes. Flooding exerted stronger control than elevation on GHG fluxes. CH4 emissions increased dramatically under both extreme and moderate flooding (24-fold and 25-fold, respectively), whereas CO2 and N2O emissions decreased: extreme flooding reducing CO2 by 51 % and N2O by 108 %, and moderate flooding reducing N2O by 67 % with minimal effect on CO2 emissions. CH4 emissions increased primarily due to elevated water tables and enhanced soil anaerobic conditions, stimulating methanogenic activity via methylotrophic pathways (up-regulated mtaC gene) and greater availability of labile plant litter. CO2 emissions declined as flooding reduced aboveground plant biomass, thereby lowering plant respiration. N2O emissions decreased because higher soil moisture promoted complete denitrification, converting N2O to N2. Using co-occurrence network analysis, the bacterial order Xanthomonadales emerged as keystone taxa, showing strong associations with microbial functional groups involved in GHG-related metabolic pathways. Overall, our findings indicate that riparian ecosystems may become CH4 emission hotspots under future climatic extremes and highlight the critical role of hydrological dynamics–microbiome interactions in shaping riparian carbon and nitrogen cycles.No Full Tex
Impact of environmental policies, oil market dynamics, and R&D on renewable energy generation, consumption, and transition
No full textThe transition to renewable energy is a global imperative for achieving sustainable development and mitigating climate change. However, the pace of this transition is often challenged by the complex interplay of environmental policies, volatile oil market dynamics, and research and development (R&D). Utilizing a panel dataset from 1990 to 2020, we employ a fully modified ordinary least squares (FMOLS) technique to examine how these factors affect renewable energy generation, consumption, and comprehensive energy transition in G10 countries. The study’s major findings reveal that global climate policy uncertainties increase renewable energy consumption and accelerate the energy transition but hinder renewable energy generation. Domestic stringent environmental policies promote renewable energy consumption and transition, and are associated with a decline in generation. Higher oil supply negatively impacts energy consumption, generation, and transition, while oil price fluctuations positively affect renewable energy consumption but negatively affect its generation. Rising aggregate demand is found to reduce both renewable energy consumption and the pace of energy transition. R&D supports energy consumption, generation, and transition. The study concludes that a balanced approach, combining stringent adaptable environmental policies, economic stability, and innovation-driven R&D, is critical for a successful energy transition. Policymakers should focus on creating a supportive framework that includes incentives for R&D, demand-side subsidies, and flexible environmental standards to strengthen the renewable energy transition.No Full Tex
Love at first sight? Segmenting tourists’ attitudes toward autonomous boats in Kaohsiung’s Love River
No full textIntegrating autonomous technology for waterborne vessels is gaining momentum with several services launched in recent years. However, compared to other autonomous public transportation modes, passenger intentions, key influencing factors, and variations across different user segments remain underexplored. Our work addresses the research gap by focusing specifically on tourists, contrasting with the prevailing literature emphasis on economic aspects of cargo vessels. This study investigates intentions to adopt autonomous boats at Kaohsiung’s Love River in Taiwan through a pre-trial on-site survey of 491 domestic visitors. The findings reveal that perceptions of performance effectiveness, ease of use, and enjoyment significantly drive adoption intentions, while concerns related to unfamiliarity and anxiety about new technologies inhibit acceptance. Utilizing an extended Unified Theory of Acceptance and Use of Technology (UTAUT2) model, structural equation modeling, and response-based segmentation (REBUS), three distinct user segments were identified: Pleasure Seekers, Cautious Enthusiasts, and Skeptics, each characterized by varying levels of enthusiasm and apprehension. This research contributes to transport and tourism literature by providing deeper insights into tourists’ acceptance of autonomous boats, emphasizing the roles of performance expectancy, hedonic motivation, and psychological barriers. Conceptually, we extend the UTAUT2 model with Technology Interest, Anxiety, and Trust. We apply REBUS-PLS to analyze heterogeneity, providing new methodological directions. The practical implications offer valuable insights for policymakers and operators to develop targeted marketing strategies and policies, foster user acceptance, enhance safety and emotional assurance, and effectively promote the distinctive experiences provided by autonomous maritime tourism.Full Tex
Paleo-proteomic analysis of Iron Age dental calculus provides direct evidence of Scythian reliance on ruminant dairy
Full text linkThe Scythians, often described as mounted horse-back warriors of the Iron Age steppe with lavish burial goods, have attracted increasing scientific interest over the past years. Recent genetic and multi-isotopic studies have uncovered that the 'Scythians' were neither a homogenous political nor a cultural group, but rather diverse populations of heterogeneous origins with intricate socio-political systems. Although populational differences in agro-pastoral subsistence regimes of Northern Black Sea Region groups have previously been identified through stable isotope analysis, it remains unclear which animal products were consumed. Here we investigate the dietary systems of two Scythian-era populations in present-day Ukraine using protein analysis of ancient dental calculus. Various dietary proteins and their taxonomic origin were identified revealing the consumption of milk from ruminant and equine species. This study supplements previous findings that Scythians engaged in complex, agro-pastoralist subsistence strategies in forest-steppe and steppe environments.Full Tex
Rubber plantation management affects soil nitrogen availability and tree growth in smallholder farms: Evidence from a survey in Agusan del Sur, southern Philippines
Full text linkNatural rubber (NR) is a critical industrial commodity, and its production in Southeast Asia is dominated by smallholder farmers. In the Philippines, rubber farming is a major source of income for rural communities. However, the link between field management, soil properties and rubber tree growth in the region remains poorly understood, particularly in the key production areas such as the Province of Agusan del Sur, southern Philippines. This study investigated the rubber tree growth and soil properties – including soil type, ammonium, nitrate, soil pH/EC, soil organic carbon (SOC) and total nitrogen (TN) – and evaluated how these variables are associated with two common field management systems in Agusan del Sur: rubber monoculture (RM) vs. rubber-based intercropping (RI). We collected data from 36 smallholder rubber farms growing 9–10-year-old trees. The results showed field management significantly affected rubber tree growth and soil properties. Trees under monoculture system had a larger girth (57.3 ± 11.9 (SD) cm) but with lower soil pH (pH 5.38 ± 0.67), compared to those under intercropping (51.4 ± 8.8 cm; pH 5.81 ± 0.73). Results showed that the monoculture systems were associated with higher tree girth, due to the higher TN and NH4⁺ availability in the soil, and enhanced leaf N uptake. These findings highlight that improving ammonium availability while managing soil acidification may be critical to optimizing productivity and sustainability in smallholder rubber farming systems.Full Tex
Intrusive Parenting and Adolescent Internalizing and Externalizing Symptoms: Three-level Meta-analytic Reviews Considering Parenting Concepts and Methodology
Full text linkMultilevel random effects meta-analyses were performed to produce a summary effect size from 231 studies (2000 to 2025) that contributed 482 effect estimates for intrusive parenting and youth’s (age 13–25) internalizing (N = 152,280) and 232 effect estimates for intrusive parenting and externalizing symptoms (N = 85,711). Intrusive parenting subtype (psychological control, overprotective, helicopter, autonomy support-reversed), youth symptom subtype, parent gender, respondent, child age, and study region were examined as moderators. Intrusive parenting was associated with higher symptoms, with a pooled effect size of r = 0.24 for parenting-internalizing and r = 0.22 for parenting-externalizing. I2 values indicated that a large proportion of variation in the effects across studies was not explained by chance (internalizing I2 = 89.3%; externalizing I2 = 91.8%). Subtypes of intrusive parenting, parent gender, and respondent moderated the parenting-internalizing effect size, accounting for a small portion of this heterogeneity; studies of psychological control produced a stronger effect than studies of helicopter parenting and autonomy support-reverse. Parent gender revealed a smaller effect for fathers than mixed gender (mothers in-between), and there was a larger effect for studies using child report than multiple reporters. For the parenting-externalizing relationship, studies of delinquency and antisocial behavior produced smaller effects than aggression and externalizing, and the parenting-externalizing association was weaker among youth aged 19 + and stronger for child report. Region of the world was not a significant moderator. Even after considering all moderators, large proportions of effect size heterogeneity were not accounted for by chance. When working with parents and youth, intrusive parenting should be considered as one partial indicator of elevated symptoms among youth.Full Tex
Facilitators to the implementation of exercise into cancer care: a systematic review
Full text linkPurpose: Although governing bodies urge the importance of integrating exercise into routine cancer care, facilitators to implementation have not been systematically identified and collated. This review aimed to summarise facilitators to implement exercise services within real-world settings. Methods: A systematic review of qualitative, quantitative, and mixed-method studies was conducted (three databases, 13th September 2024). Reports were included if they documented the implementation of co-located exercise services (delivered onsite within cancer centres) or referral pathways to external exercise services from cancer centres. The updated Consolidated Framework for Implementation Research (CFIR 2.0) was used to code and synthesise facilitators. Results: Of 8544 search results, 28 reports (full-text articles) describing 29 implementation efforts (structured initiatives to integrate an exercise service within a cancer hospital or centre) were included. One hundred and sixty-four facilitators were identified across all CFIR 2.0 domains. Facilitators existed within all CFIR 2.0 domains; inner setting (30%), implementation process (27%), innovation (21%), individuals (15%), and outer setting (7%). The most frequent CFIR 2.0 constructs identified were (i) access to knowledge and information, (ii) engaging recipients and deliverers, (iii) individual motivation, (iv) innovation adaptability, (v) reflecting and evaluating on the innovation and implementation. Conclusions: The implementation of exercise services within cancer settings is influenced by an interconnected network of facilitators, with an organisation’s resources and willingness playing a central role. This review provides a generalised blueprint of facilitators and considerations to guide stakeholders in their own exercise oncology contexts. Implications for Cancer Survivors: This map of facilitators provides potential opportunities for clinicians, policy makers, and researchers, to advance efforts to embed exercise in routine cancer care, so that all people living with or beyond cancer have the opportunity to benefit from it.Full Tex
Anthocyanin Supplementation and Inflammation: A Systematic Review and Meta-Analysis of IL-8, IL-10, IL-18, IFN-γ, and Resistin in Healthy, Overweight, and Obese Populations
Full text linkPrevious research has demonstrated the anti-inflammatory effects of anthocyanin supplementation, as evidenced by reduced levels of inflammatory adipokines in obese populations. However, the relationship between anthocyanin intake and obesity-related adipokines remains unclear in existing research. To investigate this, we hypothesised that anthocyanin supplementation would significantly reduce plasma concentrations of interleukin-8 (IL-8), IL-18, interferon-gamma (IFN-γ) and resistin, and significantly increase plasma concentrations of IL-10 in a healthy, overweight, and obese population. A systematic search of PubMed and Scopus was conducted between September 2024 and November 2024, resulting in 22 eligible studies for inclusion. The standardised mean difference was used to establish the effect size, and I-squared was used to determine heterogeneity. The risk of bias was assessed using Cochrane's risk of bias assessment tool. An Egger's test and funnel plot were utilised to determine any publication bias. The meta-analysis data showed that the inclusion of anthocyanins resulted in significant reductions in IL-8 (p = 0.004) and IFN-γ (p = 0.02). However, we observed that IL-10 (p = 0.97), IL-18 (p = 0.28) and resistin (p = 0.42) did not show a significant effect after anthocyanin consumption. The findings indicate that anthocyanin supplementation can significantly decrease circulating plasma levels of IL-8 and IFN-γ in healthy, overweight, and obese populations, but not IL-10, IL-18 or resistin levels.Full Tex
Between frameworks and frontlines: Youth leadership for peacebuilding and climate justice in Southeast Asia and Latin America and the Caribbean
Full text linkThis report discusses the strategies used and challenges faced by youth activists working in peacebuilding and environmental justice in Southeast Asia (SEA) and Latin America and the Caribbean (LAC). Considering the lack of attention to both regions in global agendas such as the Youth, Peace and Security (YPS) and Climate, Peace and Security (CPS), this report aims to provide key insights from youth peacebuilders and climate activists where commonalities and particularities are perceived at the intersection of both agendas. These insights emerge from a pilot project, which included an online South-South Knowledge Exchange facilitated by the research team in January 2026, where youth involved in peacebuilding and environmental justice from both regions shared their advocacy experiences and reflections. Based on this workshop and a desk review, this report presents six recommendations based on the challenges experienced by youth activists in SEA and LAC in their work on youth, climate, peace and security.Full Tex