Knowledge, attitude and practices of residences toward antimicrobial usage and resistance in Gondar, Northwest Ethiopia

Background Antimicrobials are essential for human and animal health. Drug resistance to an antimicrobial agent follows the introduction of a new antimicrobial agent. Evidence suggests that the public plays an important role in the risk, increase, and spread of antimicrobial resistance. The purpose of this study was to assess the knowledge, attitudes, and practices of the Gondar city residences regarding antimicrobial use and resistance. Methods A cross-sectional study was conducted from April to July 2021 on 400 randomly selected Gondar city residents using a pretested semi-structured questionnaire. The descriptive and Chi-square tests were used to analyse the data. Results The response rate was one hundred percent. Approximately 75% of respondents were men, with 32% having completed secondary school. Nearly 74% and 35% of participants were married and worked in various government jobs, respectively. Furthermore, 48%, 54%, and 50% of respondents, respectively, had moderate knowledge, a positive attitude, and good practice concerning antimicrobial use and resistance. The chi-square analysis revealed a significant (p < 0.05) disparity between knowledge and educational level, marital status, and position in the house. The respondents' attitude level was also significantly associated (p < 0.05) with their educational level, marital status, occupation, and position in the house. Respondents' practice level was also significantly associated (p 0.05) with their educational level and occupation. The study also found a significant relationship between respondents' knowledge and attitude (χ2 = 215.23, p ≤ 0.001), knowledge and practice (χ2 = 147.2, p ≤ 0.001), and attitude and practice (χ2 = 116.03, p ≤ 0.001). Conclusion This study found that study participants had some misconceptions about antimicrobial use and resistance. As a result, enforcing antimicrobial regulation and educating people about antimicrobial use are both recommended.

Thromboembolic events during neoadjuvant chemotherapy in muscle invasive bladder cancer – any correlation to the central venous access? A clinical practice article

Patients with muscle invasive bladder cancer have a generally known 5-year overall survival of approximately 58% with neoadjuvant chemotherapy (NAC). During the last decades, addition of Cisplatinum-based NAC in fit patients prior to radical cystectomy (RC), has significantly improved OS, compared to RC only. However, some published studies following NAC addition, describe an intermediate risk increase of thromboembolic events (TEEs). Placement of central venous access (CVA) before NAC has also been suggested as being a potential risk factor for thrombosis. We present a combination of images and cases from the Northern Swedish health region where three patients developed venous TEE after CVA placement for NAC-administration and found that the time until curable RC was prolonged circa one month each, with an addition of one RC cancelled. These are serious events and to our knowledge, there are no current guidelines on prevention of TEE before RC. The aim with this report was to provide examples of these events and conclude that further prospective trials are warranted on prevention and future guidelines regarding venous anticoagulant treatment for TEE that occur pre-RC in NAC-patients.

Time course of serum uric acid accumulation and the risk of diabetes mellitus

Background The impact of long-term serum uric acid (SUA) exposure and time course of SUA accumulation on diabetes mellitus (DM) is unknown. This study aimed to evaluate the association of cumulative SUA (cumSUA) exposure and its accumulation time course with risk of DM. Methods This prospective study included 46,434 participants without DM and underwent three examinations at 2006, 2008, and 2010. CumSUA from 2006 to 2010 was calculated, multiplying mean values between consecutive examinations by time intervals between visits. Time course of SUA accumulation was categorized as the slope of SUA versus time from 2006 to 2010, or by splitting the overall accumulation into an early (cumSUA06-08) and late accumulation (cumSUA08-10). Results During 6.99 years of follow-up, we identified 2971 incident DM cases. In the fully adjusted model, a higher risk of DM was observed in participants with the highest quartile of cumSUA (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.17–1.46), cumulative burden >0 (HR, 1.23; 95% CI, 1.08–1.40), and with 6 year of hyperuricemia exposure duration (HR, 1.25; 95% CI, 1.01–1.55). When considering the time course of SUA accumulation, participants with a negative slope (HR, 1.05; 95% CI, 1.01–1.12), or combined with cumSUA ≥ median and a negative slope had elevated risk of DM (HR, 1.58; 95% CI, 1.18–2.11). Conclusions Incident DM risk depends on cumulative exposure of SUA and time course of SUA accumulation. Early SUA accumulation resulted in a greater risk increase compared with later accumulation, emphasizing the importance of optimal SUA control early in life.

Analyzing the Application of X-Band Radar for Improving Rainfall Observation and Flood Forecasting in Yeongdong, South Korea

The mountainous Yeongdong region of South Korea contains mountains over 1 km. Owing to this topographic blockage, the region has a low-density rain-gauge network, and there is a low-altitude (~1.5 km) observation gap with the nearest large S-band radar. The Korean government installed an X-band dual-polarization radar in 2019 to improve rainfall observations and to prevent hydrological disasters in the Yeongdong region. The present study analyzed rainfall estimates using the newly installed X-band radar to evaluate its hydrological applicability. The rainfall was estimated using a distributed specific differential phase-based technique for a high-resolution 75 m grid. Comparison of the rainfall estimates of the X-band radar and the existing rainfall information showed that the X-band radar was less likely to underestimate rainfall compared to the S-band radar. The accuracy was particularly high within a 10 km observation radius. To evaluate the hydrological applicability of X-band radar rainfall estimates, this study developed a rain-based flood forecasting method—the flow nomograph—for the Samcheok-osib stream, which is vulnerable to heavy rain and resultant floods. This graph represents the flood risk level determined by hydrological–hydraulic modeling with various rainfall scenarios. Rainfall information (X-band radar, S-band radar, ground rain gauge) was applied as input to the flow nomograph to predict the flood level of the stream. Only the X-band radar could accurately predict the actual high-risk increase in the water level for all studied rainfall events.

The effects of efficiency on banks’ market risk: Empirical evidence from China

This article investigates the effect of efficiencies on market risk using a sample of Chinese commercial banks from 2000 to 2015 using different measures of market risk; the Value at Risk (VaR) and Expected Shortfall (ES). The cost and profit efficiencies are estimated by the Stochastic Frontier Analysis (SFA) on the 12 biggest banks listed on the Shanghai Stock Exchange. In testing the effect between efficiency and market risk, this study applied four different models to uncover the relationship between VaR and ES as measures of market risk on cost and profit efficiencies. Utilising a panel data analysis, the results show that different banks efficiencies affect market risk measures differently. While bank cost efficiency reduces market risk, increase in profit efficiency increase market risk. The analysis in this study helps explain the unconvincing evidence of an inefficiencies-risk connection in the bank sector. Bank regulators and managers may need to focus on the cost and profit efficiencies-related initiatives to better manage the market risk. These findings provide bank managers with more understanding of bank risk and serve as an underpinning for bank supervision efforts aimed at strengthening the joint risk management of efficiency market risks.

Gradual, but Not Sudden, Dose-Dependent Increase of ONJ Risk With Bisphosphonate Exposure: A Nationwide Cohort Study in Women With Osteoporosis

BackgroundA causal relationship of bisphosphonate (BP) exposure with osteonecrosis of the jaw (ONJ) has been reported; however, a definite dose-dependent risk remains to be elucidated beyond current vague recommendations of 4-year oral BP for ONJ risk increase.ObjectiveTo identify the effect of bisphosphonate cumulative dose on ONJ development in women with osteoporosis.MethodsA retrospective cohort study was designed using the National Health Insurance Service—National Health Screening database of Korea. Females over the age of 50 were diagnosed with osteoporosis based on the International Classification of Diseases 10th revision (ICD-10) codes (M80, M81, and M82) with bisphosphonate prescriptions. The cumulative dose of bisphosphonate was calculated using defined daily doses (DDD) to provide an accurate BP cumulative effect on ONJ occurrence. Osteonecrosis of the jaw was identified using both ICD-10 codes and related procedure codes. The incidence rates of ONJ and hazard ratios were estimated according to the bisphosphonate cumulative dose.ResultsAmong 74,491 included subjects, 190 cases of ONJ were identified. The incidence rate substantially increased after BP cumulative dose over 1 year (25.75 for DDD &lt; 365, which increased to 53.43 for 365 ≤ DDD &lt; 730). Compared to subjects with a cumulative dose of DDD &lt; 365, subjects with a cumulative dose of 365 ≤ DDD &lt; 730 had 2.36-fold hazard for developing ONJ (p &lt; 0.001).ConclusionA bisphosphonate cumulative dose of more than 1 year had an increased risk of ONJ development. A gradual, but not sudden, dose-dependent increase in ONJ risk with BP exposure needs to be considered in providing the optimal BP treatment duration.

Confirmation Bias and Auditor Risk Assessments: Archival Evidence

Judgment and decision making research suggests that auditors’ judgments are negatively affected by the use of heuristics. However, there is little research investigating whether such biases survive the quality control processes that regulators and audit firms implement to mitigate them. We investigate this by identifying a setting where one such bias – confirmation bias – is likely to manifest. Consistent with confirmation bias influencing observable audit outcomes, we find that auditors with previous experience auditing a client with a history of low risk followed by an increase in risk do not adequately respond to the higher level of risk. This effect is mitigated when the risk increase is likely large enough to violate auditors’ reasonableness constraint and when the client is highly visible or has strong external monitors. Our study complements prior experimental research by providing archival evidence that auditors’ use of heuristics has a significant effect on auditor judgments.

Central bank digital currency, loan supply, and bank failure risk: a microeconomic approach

Central bank digital currencies (CBDCs), which are legal tenders in digital form, are expected to reduce currency issuance and circulation costs and broaden the scope of monetary policy. In addition, these currencies may also reduce consumers’ need for conventional demand deposits, which, in turn, increases banks’ loan provision costs because deposits require higher rates of return. We use a microeconomic banking model to investigate the effects of introducing an economy-wide, account-type CBDC on a bank’s loan supply and its failure risk. Given that a CBDC is expected to lower the cost of liquidity circulation and become a strong substitute for demand deposits, both the loan supply and the bank failure risk increase. These increases are countered by subsequent increases in the rates of return on term deposits and loans, which, in turn, reduce the loan supply and thus bank failure risk. These offsetting forces lead to no significant change in banking, as long as the rate of return on loans is below a certain threshold. However, once the rate is above the threshold, bank failure risk increases, thereby undermining banking stability. The problem is more pronounced when the degree of pass-through of funding costs to the loan rate is high and the profitability of a successful project is low. Our results imply that central banks wishing to introduce an economy-wide, account-type CBDC should first monitor yields on bank loans and consider policy measures that induce banks to maintain adequate liquidity reserve levels.

Towards a Resilient Riverine Community: A Case Study in Sadong Jaya, Sarawak, Malaysia

This study highlights the vulnerabilities faced by a resource-deprived riverine community in Borneo (the Sadong Jaya community), particularly in dealing with different types of socio-ecological risks enhanced by the impacts of climate change. The sustainable development goals (SDGs) promote resilience and Disaster Risk Reduction (DRR) as cornerstones of sustainable development. It is in this light that this chapter studies how a local community can sustain their livelihoods while coping with environmental and economic stresses and shocks. Comparisons and reflections are then made by referring to the findings of past studies carried out among other riverine communities to highlight the similarities and, more importantly, the uniqueness of adaptation mechanisms. Findings presented in the chapter are derived from content analysis based on the data collected from four Focus Group Discussions (FGD) and in-depth interviews with the key informants. Despite the fact that Borneo is a resource-rich region where most areas are blessed with an abundance of resources, there are also regions that have limited natural and economic or capital assets, or limited access to them. This situation raises the question of how a community that is located in a disadvantaged region, resource-wise, can adapt and strive to become more resilient. These findings illustrate the need for a comprehensive community strategy to reduce risk, increase resilience and support long-term survival.