Antibiotic Access and Use in the Community and the Feasibility to Implement Pharmacy Targeted Interventions

Over-consumption of antibiotics is a major concern globally and has been linked to the spread of antimicrobial resistance (AMR), which poses a challenge for healthcare systems across the world. However, despite international efforts to regulate antibiotic use, the global consumption of antibiotics has continued to increase over time, especially in low- and middle-income countries (LMICs) that are experiencing economic growth such as Vietnam. These countries are AMR hotspots and have experienced excessive consumption of antibiotics at different levels of the healthcare system. Antibiotic consumption in community settings dominates. Among these settings, community pharmacies, although not considered a formal provider for primary-care examination and treatment services, are known as a major contact for non-prescription supply of antibiotics, and a driver of their over-consumption. My PhD was conducted with two main goals. The first goal was to obtain a comprehensive understanding of antibiotic use patterns in different types of healthcare settings at community-level in Vietnam. The second goal was to assess the feasibility of implementing pharmacy-targeted interventions to enhance rational antibiotic access and use in the community. My PhD thesis includes six chapters: - The first chapter provides an overview about antibiotics, antibiotic access and use at the community-level in LMICs and links to the spread of antimicrobial resistance. This chapter also summarizes antibiotic stewardship interventions that have been implemented at community-level, with a special focus on interventions targeting pharmacies and using point-of-care diagnostic tests. - The second chapter provides the first look on antibiotic dispensing in the community. This chapter was based on a study using data from 1342 customer exit interviews at 20 community antibiotic suppliers in Ba Vi District, Hanoi in 2017 and 2018. - The third chapter investigates antibiotic prescribing for acute respiratory infection (ARI) in primary healthcare settings. I retrospectively reviewed 193,010 health records of outpatients with ARI visiting one of 112 commune health centres in 6 rural districts of Nam Dinh province during 2019. - The fourth and fifth chapters assess the feasibility of implementing an intervention aimed at reducing over-the-counter supply of antibiotics in pharmacies. The intervention was an out-of-pocket C-reactive-protein point-of-care testing (CRP-POCT) service to guide antibiotic treatment at private pharmacies for patients with minor ARI symptoms, the most common cause of healthcare seeking in the community. The fourth chapter was a quantitative study with participation of 520 pharmacy customers. This study investigated acceptability, willingness to pay for CRP-POCT, and the relevant determinants. The fifth chapter included a qualitative study to investigate different stakeholders’ perspectives. The participants were comprised of pharmacists, primary care doctors and medical specialists, health regulatory officials and device suppliers. - The final (sixth) chapter of my thesis provides a comprehensive discussion of findings from the above chapters, their implications, limitations and recommendations in future studies

THE STATUS OF PARTICIPATION IN EXTRACURRICULAR SPORT TRAINING OF STUDENTS IN SOC TRANG PROVINCE, VIETNAM

The method of sociological investigation is used in the article to survey students' opinions at colleges in Soc Trang province and provided information on the status of participation in extracurricular sports of students at colleges in Soc Trang province by gender, ethnicity and purpose.  Article visualizations

Inverse kinematic and dynamic analysis of redundant measuring manipulator BKHN-MCX-04

This paper deals with the problem of inverse kinematics and dynamics of a measuring manipulator with kinematic redundancy which was designed and manufactured at Hanoi University of Technology for measuring the geometric tolerance of surfaces of machining components. A comparison between the calculation result and the experimental measurement is also presented

Identification of non plastidic adp-glucose pyrophosphorylase unconventional partners in Arabidopsis thaliana

ADP-glucose pyrophosphorylase (ATP: alpha-glucose-1-phosphate adenylyl transferase, ADGase) previously has been studied as a key regulatory enzyme in the starch biosynthetic pathway in plant. Surprisingly, ADP-glucose pyrophosphorylase small subunit APS1 (ADG1) was found not only in chloroplast but also in non plastidic region, especially, small proportion in nucleus. To elucidate the novel mechanisms underlying non plastidic ADG1 actions, yeast two-hybrid screening method was used to identify proteins associated with ADG1. Yeast two hybrid assay and co-immunoprecipitation (Co-IP) assay were used to confirm the interaction between ADG1 and interacting candidates. Furthermore, localization of interacting proteins was analyzed using Green Fluorescent Protein (GFP) fusion proteins under laser scanning microscopy. Two protein RPC4 (RNA polymerase III subunit) and LSU3 (Response to low Sulfur 3) were confirmed as strong candidates which interact with ADG1. Therefore, we hypothesized that non plastidic localized-ADG1 might have additional function which mediate plant cellular metabolism status and intracellular signaling to regulate proper plant growth and development

THE CURRENT CONDITIONS OF PROMOTING THE PHYSICAL EDUCATION AND SPORTS ACTIVITIES FOR STUDENTS AT VIETNAM NATIONAL UNIVERSITY, HO CHI MINH CITY

The purpose of the study was to have a comprehensive understanding of the existing conditions assured to give physical education (PE) programs to students at Vietnam National University, Ho Chi Minh City (VNUHCM). Through document synthesis, interviews, and statistical processing, the article gained a general evaluation of the current PE conditions according to the following aspects: facilities, administration, and curriculums. In terms of facilities, the total space for sports activities at VNUHCM is measured at 25,454m2, besides, the ratio of sports field area per student is 0.44m2/student. This indicates that VNUHCM’s students do not have enough space for their sports practice as standard. In terms of faculty, teachers at VNUHCM Sports Center are comprised 67.6% male, 88.2% at the age of thirty to fifty, and 100% holding postgraduate qualifications. In addition, 79.4% of the staff at the VNUHCM Sports Center graduated with PE specialized degrees, and 64.7% of them have less than five years of seniority. However, 68.8% of those who are currently delivering PE courses at this Center are visiting teachers. The statistic number reveals that the ratio of students per teacher at VNUHCM is 814.75 students/teacher, which reveals that the number of PE lecturers has not met the standard, and they have been in charge of a large teaching volume. In terms of curriculums, PE programs are conducted with 06 credits in total (90 periods), divided into 02 modules with 3 credits per each (45 periods). Students are allowed to choose their favorite PE content among 10 sports courses including football, volleyball, basketball, table tennis, tennis, badminton, martial arts, aerobics, swimming, and chess. The results indicate that VNUHCM’s students actively participate in sports training and competitions to advance their physical fitness.  Article visualizations

Sensor clustering using a K-means algorithm in combination with optimized unmanned aerial vehicle trajectory in wireless sensor networks

We examine a general wireless sensor network (WSN) model which incorporates a large number of sensors distributed over a large and complex geographical area. The study proposes solutions for a flexible deployment, low cost and high reliability in a wireless sensor network. To achieve these aims, we propose the application of an unmanned aerial vehicle (UAV) as a flying relay to receive and forward signals that employ nonorthogonal multiple access (NOMA) for a high spectral sharing efficiency. To obtain an optimal number of subclusters and optimal UAV positioning, we apply a sensor clustering method based on K-means unsupervised machine learning in combination with the gap statistic method. The study proposes an algorithm to optimize the trajectory of the UAV, i.e., the centroid-to-next-nearest-centroid (CNNC) path. Because a subcluster containing multiple sensors produces cochannel interference which affects the signal decoding performance at the UAV, we propose a diagonal matrix as a phase-shift framework at the UAV to separate and decode the messages received from the sensors. The study examines the outage probability performance of an individual WSN and provides results based on Monte Carlo simulations and analyses. The investigated results verified the benefits of the K-means algorithm in deploying the WSN.Web of Science234art. no. 234

Feasibility of Tomotherapy-Based Image-Guided Radiotherapy to Reduce Aspiration Risk in Patients with Non-Laryngeal and Non-Pharyngeal Head and Neck Cancer

Purpose: The study aims to assess the feasibility of Tomotherapy-based image-guided radiotherapy (IGRT) to reduce the aspiration risk in patients with non-laryngeal and non-hypopharyngeal cancer. A retrospective review of 48 patients undergoing radiation for non-laryngeal and non-hypopharyngeal head and neck cancers was conducted. All patients had a modified barium swallow (MBS) prior to treatment, which was repeated one month following radiotherapy. Mean middle and inferior pharyngeal dose was recorded and correlated with the MBS results to determine aspiration risk

The results of deep magnetotelluric sounding for studying the Nha Trang - Tanh Linh fault

The profile of deep magnetotelluric sounding (MT) from Duc Trong - Tuy Phong has been carried out in Lam Dong and Binh Thuan  provinces. The length of the Duc Trong - Tuy Phong profile is about 80 km with 15 stations and the distance between the stations measures about 5 km. Two-dimensional MT inversion was used to find a resistivity model that fits the data. The 2D resistivity model allows determining position and development formation of the Nha Trang - Tanh Linh  fault. This is the deep fault, which is showed by the boundaries of remarkable change of resistivity. In the near surface of the Earth (from ground to the depth of 6 km), the angle of inclination of this fault is about 60o; in the next part, the direction of the Nha Trang - Tanh Linh  faut is vertical. Geoelectrical section of the Nha Trang - Tanh Linh  profile shows that the resistivity of mid-crust is higher than that of lower-crust and of upper-crust

Overcoming Fear of Developing Country: A Case Report of Retroperitoneal Laparoscopic Partial Nephrectomy for T3a Renal Cell Carcinoma

INTRODUCTION: Renal cell carcinoma poses significant challenges in kidney diseases, particularly in the context of the T3 stage, where treatment strategies remain controversial. The utilization of laparoscopic partial nephrectomy, particularly in developing countries, has been restricted for such patients, primarily due to limited infrastructure and concerns about recurrence risk and long-term pathologic outcomes. PRESENTATION OF CASE: In this report, we present a case of a 64-year-old male diagnosed with T3aN0M0 renal cell carcinoma (RCC). Abdominal computed tomography revealed a 5.2 × 5.2 × 5.1 cm mass on the right upper part of the kidney with a possible thrombus in the superior renal polar vein. The patient underwent successful treatment with retroperitoneal laparoscopic partial nephrectomy (LPN), leading to the preservation of kidney function with/min/1.73 m2 GFR reduced after one year postoperative (estimated GFR from 85 mL/min/1.73 m2 to 81.79 mL/min/1.73 m2). The patient was discharged after three days; no recurrence was observed during the follow-up. DISCUSSION: For stage T3a RCC, studies show that LPN induces comparable long-term outcomes to radical nephrectomy, with advantages such as preserved kidney function, reduced operative time, blood loss, and shorter hospital stays. However, due to infrastructure constraints and limited access to robotic-assisted surgery in our country, coupled with concerns about tumor recurrence, laparoscopic radical nephrectomy is predominantly employed for similar patients. Our case represents one of the very first cases in which we successfully treated a patient diagnosed with T3a RCC using retroperitoneal laparoscopic partial nephrectomy. CONCLUSION: Laparoscopic partial nephrectomy is a reliable choice for T3aN0M0 RCC with good long-term outcomes and preserved renal function, especially by the hands of an experienced laparoscopic surgeon

AMRomics: a scalable workflow to analyze large microbial genome collections

Whole genome analysis for microbial genomics is critical to studying and monitoring antimicrobial resistance strains. The exponential growth of microbial sequencing data necessitates a fast and scalable computational pipeline to generate the desired outputs in a timely and cost-effective manner. Recent methods have been implemented to integrate individual genomes into large collections of specific bacterial populations and are widely employed for systematic genomic surveillance. However, they do not scale well when the population expands and turnaround time remains the main issue for this type of analysis. Here, we introduce AMRomics, an optimized microbial genomics pipeline that can work efficiently with big datasets. We use different bacterial data collections to compare AMRomics against competitive tools and show that our pipeline can generate similar results of interest but with better performance. The software is open source and is publicly available at https://github.com/amromics/amromics under an MIT license