A major driver of antimicrobial resistance (AMR) is the inappropriate use of antimicrobials. At the community level, people are often engaged in behaviors that drive AMR within human, animal, and environmental (One Health) impacts. This scoping review consolidates research to determine (a) the community\'s knowledge, attitudes, and practices around AMR; (b) existing community-based interventions; and (c) barriers and enablers to addressing AMR in Nepal.
This scoping review follows the Joanna Briggs Institute scoping review methodology. Literature indexed in PubMed, Scopus, CINAHL, Global Index Medicus, HINARI-SUMMON, Embase (Ovid), Global Health (Ovid), CAB Abstracts (Ovid), Web of Science, and Google Scholar between January 2000 and January 2023 were reviewed for inclusion. Articles were included in the review if they considered the issues of AMR at the community level in Nepal; this excluded clinical and laboratory-based studies. A total of 47 studies met these criteria, were extracted, and analyzed to consolidate the key themes.
A total of 31 (66%) articles exclusively included human health; five (11%) concentrated only on animal health; no studies solely focused on environmental aspects of AMR; and the remaining studies jointly presented human, animal, and environmental aspects. Findings revealed inadequate knowledge accompanied by inappropriate practice in both the human and animal health sectors. Four community interventions improved knowledge and practices on the appropriate use of antimicrobials among community people. However, various social and economic factors were found as barriers to the appropriate use of antimicrobials in the community.
Community engagement and One Health approaches could be key tools to improve awareness of AMR and promote behavioral change related to AM use in communities, as current studies have revealed inadequate knowledge alongside inappropriate practices shared in both human and animal health sectors.
DOI: 10.17605/OSF.IO/FV326.

Nutrient management is one of the critical challenges for developing sustainable circular economies in cities. Nutrients such as nitrogen and phosphorus from our food end up in our wastewater and pose an environmental threat when they are released in waterways. Yet, these nutrients are essential for crop production and food security. Hince human excreta contains the bulk of nutrients going through the urban ecosystem. Source separation of excreta from the rest of urban wastewater flows can enable safe and efficient nutrient recovery. Yet, source-separating wastewater systems are not yet common in urban areas. The aim of this study is to assess the legitimacy of source-separating wastewater systems from the perspective of wastewater professionals in Sweden. The study uses interviews and a survey to explore the pragmatic, normative, cognitive and regulatory dimensions of legitimacy and how these aspects can vary between different municipalities. Finally, it looks into possible knowledge-based activities to increase legitimacy. The results from this study show variations in legitimacy levels in urban areas in Sweden. Overall opinion appears to be neutral to the concept rather than negative. Although many see multiple barriers to implementation. Normative legitimacy (moral motivation) was relatively high, while cognitive legitimacy (knowledge & experiences) was lowest. Respondents from organizations where source-separation is being implemented, or they believe that it will be implemented within 10 years, generally saw more drivers and fewer barriers. These innovators were also more interested in knowledge-based activities. Overall recommendations to increase cognitive knowledge regarding source-separating systems among multiple stakeholders seems the most promising path forward to increase legitimacy in the Swedish wastewater sector.

Over the past 2 years, the COVID-19 pandemic has placed enormous pressure on the health care industry. There has been an increase in demand and, at the same time, a shortage of supplies. This has shown that supply chain management in the health care industry cannot be taken for granted. Furthermore, the health care industry is also facing other major challenges, such as the current labor market shortage. In the literature, the Internet of Things (IoT) is highlighted as an effective tool to build a more resilient and efficient supply chain that can manage these challenges. Although using IoT in supply chain management has been extensively examined in other types of supply chains, its use in the health care supply chain has largely been overlooked. Given that the health care supply chain, compared to others, is more complex and is under growing pressure, a more in-depth understanding of the opportunities brought by IoT is necessary.
This study aims to address this research gap by identifying and ranking the drivers of and barriers to implementing IoT in the health care supply chain.
We conducted a 2-stage study. In the first, exploratory stage, a total of 12 semistructured interviews were conducted to identify drivers and barriers. In the second, confirmatory stage, a total of 26 health care supply chain professionals were asked in a survey to rank the drivers and barriers.
The results show that there are multiple financial, operational, strategy-related, and supply chain-related drivers for implementing IoT. Similarly, there are various financial, strategy-related, supply chain-related, technology-related, and user-related barriers. The findings also show that supply chain-related drivers (eg, increased transparency, traceability, and collaboration with suppliers) are the strongest drivers, while financial barriers (eg, high implementation costs and difficulties in building a business case) are the biggest barriers to overcome.
The findings of this study add to the limited literature regarding IoT in the health care supply chain by empirically identifying the most important drivers and barriers to IoT implementation. The ranking of drivers and barriers provides guidance for practitioners and health care provider leaders intending to implement IoT in the health care supply chain.

Advances in digital electronics delivered small and portable gadgets, changing human interface with technology. Demand for new small devices of Information and Telecommunication Technology (small-IT) that have a short lifespan, like smartphones and laptops, creates flows and accumulation of electronic resources. These include precious metals that show potential for Urban Mining and Circular Economy. To find out the extent of setting up an improved recycling, reuse and repair system, data collection was conducted through surveys, bin observations and social experiments. These methods enabled us to analyse stocks and flows, identify behavioural practices and map collection infrastructure. About 80% of domestic small-IT stocks are hibernated, meaning they could be directly reused or easily repaired. Results show four barriers that keep citizens from handing in their unused small-IT: Devices are kept as back-up, they contain sentimental value, citizens are suspicious of post-collection data confidentiality issues and there is a perceived high effort to recycle. Drivers to enhance circularity are: improving e-waste infrastructure, introducing economic incentives and raising awareness on environmental impacts of hibernated stocks. A more trustworthy and legitimate management system is expected to deliver safety and confidentiality of personal data and provide the quality that fits the expectations of citizens of a proper place to dispose of their valuable items.

As antimicrobial resistance (AMR) represents a substantial threat to the efficacy of available antimicrobial options, it is important to understand how to implement effective and practical mitigation efforts, including antimicrobial stewardship (AMS), across human, animal, and environmental sectors.
A mixed-methods questionnaire was distributed virtually to attendees of the virtual One Health Antimicrobial Stewardship Conference (March 10-12, 2021) and their professional networks. Respondents (n = 81) were largely from the veterinary (75%) or human (19%) health sectors. Qualitative data were analyzed in NVivo using template analysis whereas quantitative data were analyzed in STATA using Kruskall-Wallis tests. The questionnaire asked respondents about their perceptions of AMS, as well as the perceived barriers and drivers of AMS efforts.
Perceptions of what AMS meant to the respondents personally and their profession as a whole were grouped into 3 main themes: 1) AMS strategies or considerations in antimicrobial prescribing and use; 2) responsibility to maintain health and preserve antimicrobial effectiveness; and 3) reducing antimicrobial use (AMU) as a goal of AMS efforts. Identified AMS barriers had 3 main themes: 1) lack of various prescribing and AMU support mechanisms; 2) shift in prescriber attitudes to drive change; and 3) stronger economic considerations to support shifting prescribing practices. Drivers of AMS had the following themes: 1) leadership to guide change; 2) education to support optimizing AMU; and 3) research to identify best practices and opportunities for action. Across all questions, 2 cross-cutting themes emerged: 1) a One Health understanding of AMS; and 2) blame placed on others for a lack of AMS success.
Overall, sector-specific, but particularly cross-sectoral AMS drivers and barriers were identified, highlighting the importance of a One Health approach in AMR research and mitigation.

The purpose of this research is to synthesize the fragmented extant knowledge on flexible and green supply chain management (FGSCM) in the context of emerging economies and to unearth research gaps to motivate future research. We adopted a novel structured systematic literature review by triangulating a systematic literature review, text mining, and network analysis. Institutional theory and contingency theory were employed to analyze the results of the review. The results show that, firstly, research on FGSCM in emerging economies, despite its importance, is immature compared to general FGSCM literature. Second, the specificities of strategies and practices that distinguish this topic in emerging economies are discussed and the drivers and barriers are identified with respect to sources of institutional pressure. Third, a research framework for FGSCM in emerging economies is developed and 12 gaps for future research are identified. This study has exclusively developed a research framework for FGSCM in an emerging economy which has received the least consideration in the literature and practice. The framework was developed to synthesize the existing literature and to identify the research gaps to inspire future research.

UNASSIGNED: HIV self-testing could add a new approach to scaling up HIV testing with potential of being high impact, low cost, confidential, and empowering for users.
UNASSIGNED: Pregnant women attending antenatal clinics (ANC) and their male partners were recruited in 14 clinics in the eastern and central regions of Kenya and randomly allocated to intervention or control arms at a ratio of 1:1:1. Arm 1 received the standard of care, which involved invitation of the male partner to the clinic through word of mouth, arm 2 received an improved invitation letter, and arm 3 received the same improved letter and, two self-testing kits. Analysis was done using adjusted odds ratios (aOR) at 95% confidence intervals (CI) to calculate and determine effects of HIV self-testing in increasing uptake of male partner testing.
UNASSIGNED: A total of 1410 women and 1033 men were recruited; 86% (1217) women and 79% (1107) couples were followed up. In arm 3, over 80% (327) of male partners took HIV test, compared to only 37% (133) in arm 2 and 28% (106) in arm one. There was a statistical significance between arm one and two (p-value=0.01) while arm three was statistically significant compared to arm two (p-value<0.001). Men in arm three were twelve times more likely to test compared to arm one (aOR 12.45 (95% CI 7.35, 21.08)).
UNASSIGNED: Giving ANC mothers test kits and improved male invitation letter increased the likelihood of male partner testing by twelve times. These results demonstrate that HIV self-test kits could complement routine HIV testing methods in the general population.

Inclusion of alternative methods that replace, reduce, or refine (3R) animal testing within regulatory safety evaluations of chemicals generally faces many hurdles. The goal of the current work is to i) collect responses from key stakeholders involved in food safety evaluations on what they consider the most relevant factors that influence the acceptance and use of 3R methods and to ii) use these responses to formulate activities needed to increase the acceptance and use of 3R methods, particularly for kinetics. The stakeholders were contacted by e-mail for their opinions, asking the respondents to write down three barriers and/or drivers and scoring these by distributing 5 points over the three factors. The main barriers that obtained the highest aggregated scores were i) uncertain predictability 3R methods/lack of validation, ii) insufficient guidance regulators/industry and iii) insufficient harmonization of legislation. The major driver identified was the possibility of 3R methods to provide more mechanistic information. Based on the results, recommendations are given to enhance the acceptance and application of 3R toxicokinetic methods in food safety evaluations. These include steering of regulatory data requirements as well as creating (funding) opportunities for development and validation of alternative methods for kinetics and development of guidances.

In April 2013 the mouse antibody serum neutralization test (SNT) was formally incorporated into European Pharmacopoeia monograph 0451 for potency testing of inactivated veterinary rabies vaccines. The SNT is designed to replace the highly variable and pain and distress causing NIH mouse rabies challenge assay. The adoption of the SNT meets the European ambition (i.e., EC and CoE) to replace, reduce and/or refine laboratory animal testing. However, regulatory acceptance and use of 3R models, such as the SNT, remains challenging. This paper aims at clarifying the process of acceptance and use of the SNT. For this purpose it reconstructs the process and reveals barriers and drivers that have been observed by involved stakeholders to have played a role. In addition it extracts lessons to stimulate regulatory acceptance in similar future processes. The incorporation of the SNT into the monographs went relatively quick due to a thorough test development and pre-validation phase, commitment and cooperation of relevant stakeholders and a strong project coordination of the international validation study. The test was developed by the Paul Ehrlich Institut; a leading European OMCLs. This facilitated its European regulatory use. The use by industry is in a critical phase. At this stage product specific validation and the question whether the SNT will be accepted outside Europe are important influencing factors.

Pharmaceuticals and chemicals are subjected to regulatory safety testing accounting for approximately 25% of laboratory animal use in Europe. This testing meets various objections and has led to the development of a range of 3R models to Replace, Reduce or Refine the animal models. However, these models must overcome many barriers before being accepted for regulatory risk management purposes. This paper describes the barriers and drivers and options to optimize this acceptance process as identified by two expert panels, one on pharmaceuticals and one on chemicals. To untangle the complex acceptance process, the multilevel perspective on technology transitions is applied. This perspective defines influences at the micro-, meso- and macro level which need alignment to induce regulatory acceptance of a 3R model. This paper displays that there are many similar mechanisms within both sectors that prevent 3R models from becoming accepted for regulatory risk assessment and management. Shared barriers include the uncertainty about the value of the new 3R models (micro level), the lack of harmonization of regulatory requirements and acceptance criteria (meso level) and the high levels of risk aversion (macro level). In optimizing the process commitment, communication, cooperation and coordination are identified as critical drivers.