EKN Trackside: 2023 Challenge of the Americas – Phoenix – Saturday Report
Gulick and Hodgson win big on first day of racing at Phoenix Kart Racing Association
The halfway point has been reached for the 2023 Challenge of the Americas championship following the Saturday action at the Phoenix Kart Racing Association. Round Three was put into the books at the Glendale, Arizona facility with perfect racing weather greeting the roughly 120 entries in the seven categories. GFC Karting’s Jacob Gulick secured his third career victory in the ROK Shifter division while CompKart pilot Oliver Hodgson defended his new home with third straight win at PKRA in Senior 100cc.
The ROK Shifter class presented by Swedetech Racing Engines was swept on the day by Jacob Gulick (GFC Karting). The Round One winner cleared the field in qualifying by nearly a half second and dominated the Prefinal, winning by over 11 seconds. Issues surrounding the LeVanto tires has been an issue, and Challenge promoter Andy Seesemann brought the competitors together and provided them with new rear tires to utilize for the main event. At the green flag, Round Two winner Macy Williams (CB / Gillard) grabbed the holeshot and led the opening four circuits until Gulick was able to take back the top spot. From there, he drove away to a 4-second advantage for his second victory on the season. Keawn Tandon (GFC Karting) was runner-up in his 2023 debut while Ethan Booher made it an all GFC podium with a move for third late in the race ahead of Williams. Henry Barton (RWR / CRG) capped off the top-five.
Oliver Hodgson (CompKart) made it three wins in a row at PKRA in the Senior 100cc presented by Forward Direction Motorsports. Championship leader Liam Letzsch (GFC Karting) was able to grab fast time in the qualifying session, however Hodgson took over at the start of the Prefinal to never relinquish the top spot through those 14 laps and the 20 of the main event. The wire-to-wire sessions gave Hodgson his first win on the season in his 2023 debut. Jesus Vasquez Jr. (Nash / EOS) made his first start of the year in the class, running second the entire distance of the main event. Behind him was the battle for the final podium position including Letzsch, Senior rookie Cooper O’Clair (CompKart) and Josh Campbell (RPM / Tony Kart), who missed Friday practice to play in the Arizona state championship for his high school basketball team – winning the state title. Letzsch held onto the spot for much of the race but in the end, lap traffic played a role and Campbell was able to take advantage to claim the position ahead of O’Clair and Letzsch.
The Nash Motorsportz Junior 100cc class welcomed a two-time winner in Nixx Eggleston (Ruthless / Exprit). Max Altman (Speedsense / Exprit) was the driver to beat as the day began, securing fast time in qualifying and winning the Prefinal. In the Final, Eggleston put in a solid opening lap to grab the lead and from there led all 20 laps to secure his second victory on the season, his first career Challenge win at his home track. Keagan Kaminski (FW / GFC) ran second for much of the race until point leader Alexander Gonzalez (Nash / EOS) worked by for position late in the race. Altman would go on to finish the race in fourth, however, was disqualified on the day for physical actions done by his mechanic. That person was suspended from the series for a full season by series officials, and unfortunately Altman lost all his finished on the day. That promoted Payton Westcott (Nash / EOS) to fourth and Ryan Giannetta (FW / GFC) to fifth.
The finish went down to the wire in the Ruthless Karting Master 100cc division, however, the end result was the same for the as the two main events in Tucson. Christopher Mann (Ruthless / Exprit) set the tone with fast time in qualifying and leading all 14 laps in the Prefinal. He got out to a healthy lead on the opening lap of the main event as Stepanova Nekeel (Ruthless / LN Racing Kart) – subbing for the injured Derek Wang – was able to push past two-time race winner and defending champion Ian Koentges (FDM / CompKart) at the start. Koentges worked by Nekeel and began to reel in Mann. By the halfway point, Koentges took over the lead and the two ran nose to tail the remainder of the distance. Mann was unable to make a charge, keeping the pressure on, but came up short as Koentges won his eighth straight in the class dating back to last year’s season opener. Nekeel pulled off early, and Preston Newberry (FDM / CompKart) retired on the opening lap with a broken chain, allowing Daniel Jones (RWR / CRG) and Luke Tracy (VemmeKart) to fight for third. Jones was able to secure the position in the end as Jeff Tompkins (Tony Kart) completed the top-five.
The Ron White Racing ROK Shifter Master class nearly welcomed a first time winner on the day. Bud Grossenbacher (Racelab / TB Kart) continued his pace from Friday Pre-Qualifying to set quick time in qualifying and win the Prefinal. He jumped out to the lead at the start of the 20-lap Final, and led the opening five laps until pulling off with a flat tire. That handed the lead over to two-time winner Jonathan Vitolo (GFC Karting), who led the remainder of the race to claim his third straight victory on the season. Nick George (Aluminos) and defending series champion Kevin Woods (RWR / CRG) kept it close, finishing second and third. Pat Beckley (GFC Karting) and Bill Pyles (CRG) were fourth and fifth.
Blake Nash (Nash / EOS) became the first two-time winner in the new OK-N category presented by P1 Engines. Alex Keyes (AKR / Charles Leclerc) was the driver to beat as the day began, setting fast time in qualifying and went on to win the Prefinal. Nash was second, trying to work past Keyes on the final circuit of the Prefinal but came up short. In the Final, Nash nearly was shuffled back after Chase Jones (MPG / Kart Republic) got a great start to move into second through the opening laps. Nash made a bold move into turn one – fourth turn after the start – to reclaim second and from there began to run down Keyes who pulled out to a sizable lead. It took Nash 13 laps to catch and pass Keyes for the top spot, and from there drove away to a 1.7 second advantage with fast lap of the race. Keyes settled for second, his first podium in the category while Round One winner Jesus Vasquez Jr. (Nash / EOS) stood on the podium for his second time, placing third. Jones won the battle on track for fourth, however, was penalized 10 seconds for passing after the commitment cone prior to the start, dropping him to seventh and moving Dustin Salaverria (TKC / Sodikart) to fourth and Chris Martin (TKC / Sodikart) to fifth. All driver in the category were competing with the TM engine.
It was a busy day on and off the track surrounding the Mini ROK class presented by Alex Keyes Racing. Braydon Wagner (GFC Karting) set fast time in qualifying however he and two others – Matt Guidera (RWR / CRG) and Luca Popescu (Nash / EOS) were found to violate the rear width rule and were put at the back of the 11-driver field. That put Conner Lypka (CompKart) on the pole position for the Prefinal. Round Two winner Gabriel Balog (Racelab / JV Kart) started second and grabbed the lead early, going on to the race win by holding off a charging Guidera at the end by 29 thousandths at the line. Guidera used the front row starting spot to jump out to good lead at the start of the Final. He would eventually be run down by Popescu and Wagner. The three drivers swapped positions in the second half of the race with Popescu coming away with the top position, and becoming the third different first-time winner on the season. Wagner was a close second, earning fast lap of the race, while Guidera came across the line in third. However, he was removed from the results after tech for a clutch issue. That promoted Balog to the third spot with Lucas Tarango (Ruthless / Nitro Kart) into fourth and Paxton Romero (FDM / CompKart) in fifth.
All the drivers will be back in action on Sunday for Round Four of the series. Tune into the live audio commentary, beginning at 9:30 am, on the EKN Radio Network app or on www.ekartingnews.com/live


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The growing garden is a work in progress. The journey began in April 2019 when the Eco Squad, the newly formed Gardening Club and many other children from across the school helped make the garden a space to grow veg once more. Children gave up some of their lunch playtime to dig, sieve and replace the soil in the raised beds ready for planting. It was hard work preparing the garden but it was worth it! Because in May, the first seeds were planted and over the summer they grew and grew and produced their fruits (and veg). As autumn progressed, the crops were harvested: carrot soup for the gardeners and year three tasted the sweetcorn with a resounding thumbs up! The pumpkins were harvested just in time for Hallowe'en and the competition was a real hit, raising valuable funds for the garden.
2020 threw up a few challenges, but throughout lockdown the keyworker children kept the garden going. This summer, peas, beans and courgettes were grown and harvested, picked and podded, along with a few juicystrawberries. Spring onions too, and also four sacks of potatoes were grown which tasted amazing too!
Watch this space to see how our growing garden develops - and what we do with our produce too!
Guess the weight of the pumpkin competition!
The pumpkin weighed 4kg753g. A huge well done goes to Zach in year 5 who guessed 4kg760g and won the pumpkin and the voucher. Well done Zach.
Also a huge thank you goes to everyone who joined in and had a guess. We raised the fantastic total of £47.60 🥳
Autumn Term 2019
Harvest time is upon us and it’s time for the growing garden to start winding down for winter.
Summer Term 2019
Wanting something fairly easy to grow, that the children would like, we settled on carrots, pumpkins and sweetcorn. Pumpkins and corn are traditional companion plants (according to Native Americans). Some bargain tomato plants found their way to us and also a raspberry tree that we hope with a bit of nurture will treat us.

domain: agronomy


text:
Happiness at Work: Be resilient, motivated, and successful - no matter what
Srikumar S Rao
The Happiness Equation: The surprising economics of our most valuable asset
Icon Books £14.99
Happiness at Work offers 35 brisk reflections on what matters in life. It covers themes from coping with fear to cultivating friends and repeatedly returns to a central piece of advice: notice what's happening to you and, by noticing, become less attached.
It's a broadly Buddhist agenda, part of the phenomenon in which eastern religious ideas are incorporated into western secular contexts such as the workplace, with the aim of raising spiritual questions amid the humdrum concerns of our otherwise consumer-shaped lives. It's spiritual release without religious dogma.
Perhaps it's an approach that can offer businesspeople some comfort as they wait in the departure lounge for their delayed flight. If you took the advice seriously and began to constantly observe yourself - as if on an internalised Candid Camera - would that not nurture a profound self-obsession?
Our problem is that we live in a narcissistic age - the problem with narcissism, of course, not being that we love ourselves but that we can't love ourselves and so become caught up in repeated cycles of trying to do so. To my mind, the kind of exercises that Rao recommends might well exacerbate the problem.
His book also amply demonstrates the risks run by writers of self-help books. For example, Rao promises that with his method: 'Your relationships will improve. Your career will take off. Toxic people will leave your life.' To read this gospel of gain, you also have to negotiate uncomfortable phrases such as 'botherations'. And you have to be prepared to swallow substantial contradictions too. Consider this: following the promise to improve your career, Rao asks you to contemplate nothing less than the annihilation of the planet, as if the sun had gone supernova. Your daily concerns won't matter much then, which seems to imply that your career doesn't much matter either. Why, then, even want it to 'take off'?
The Happiness Equation is more serious and draws on the so-called 'science of happiness', which has reported a growing number of insights to do with human felicity: saying thank-you increases wellbeing; earning more money does not necessarily make you more happy; relationships are worth a small fortune (a good marriage, roughly ú200,000 a year, according to Powdthavee).
I can't help but feel that the new science is of most value to economists, and books like this one are really documents in which economists convince themselves that human beings are not wholly rational creatures after all.
In fact, happiness researchers might save themselves time by turning to the philosophical tradition on the subject. Powdthavee does this in part, citing Jeremy Bentham, the British philosopher who championed utilitarianism. Bentham went so far as to develop a 'felicific calculus'. It has been heavily criticised: how can you compare the pleasure of eating an apple to that of eating a pear, let alone the pleasure of good friendship to that of eating a bar of good chocolate? And Powdthavee is aware of the problems, though he believes modern psychology overcomes them.
What he's apparently not aware of is the deeper critique developed by Bentham's pupil and godson, John Stuart Mill. Mill was raised a good utilitarian and had a massive mental breakdown as a result. That led him to question the pursuit of happiness and he concluded: 'Ask yourself whether you are happy, and you cease to be so.' He'd realised that happiness is the byproduct of a life and can't be pursued head-on.
Mill's approach could be summed up as 'forget happiness' and return to traditional questions about the good life - what's just, what's compassionate, what's good. So, here's a prediction. In about a decade or so, there will be a new fashion among economists: there'll be a splurge of books with titles like The Happiness Error.
- Mark Vernon is the author of Wellbeing (Acumen), in which he pursues Mill's line of thought. See www.markvernon.com

domain: literature


text:
Subject: [Stop-traffic] News/US: Teacher In Child Sex Sting Sentenced
From: Melanie Orhant (firstname.lastname@example.org)
Date: Tue Aug 15 2000 - 11:14:11 EDT
Teacher In Child Sex Sting Sentenced
By Joe Garner
Denver Rocky Mountain News, July 22, 2000
A veteran North High School math teacher accused of importing Mexican boys
to Denver for sex will serve 27 months behind bars, followed by three
years' supervised parole and registration as a sex offender.
Michael Charles Smith, 51, who pleaded guilty May 5 to four federal
felonies, was sentenced Friday to the miniumum under federal guidelines.
Smith pleaded guilty in May to three counts of harboring an illegal alien
and one child-pornography charge, which involved 16 pictures of boys
transmitted over computers. As part of Smith's plea agreement to admit
guilt, Denver U.S. District Judge Edward Nottingham also dismissed an
original charge of smuggling a Mexican boy into the United States for sex.
At Friday's sentencing, Smith portrayed himself as a member of a respected
family of teachers who is "as opposed to child pornography as anyone in
"I'm amazed to find myself here," the tall, graying Smith told the judge in
a controlled voice.
He accepted responsibility for his crimes, but he did not apologize for
abusing the boys.
He described the anguishing loss of reputation, health and income he has
Admitting he has damaged himself, his elderly parents and other family
members, "I guess, at this time, I'm asking for the mercy of the court,"
Prosecutor Michele Horn described Smith as a person "who has led two lives
for a long time. His remarks today indicate he is still in denial."
Smith was identified in a federal investigation of child sex and
pornography rings in the United States and Mexico. The ring maintained a
vacation house in the Mexican beach resort of Acapulco, where pedophiles
engaged in sex with boys who lived at a nearby orphanage or on the streets,
Defense attorney Craig Truman described Smith "as a dedicated public
servant who has been tormented by his sexual orientation for most of his
life. The judge also ordered a $6,000 fine and restricted Smith from
unsupervised access to computers.
U.S. Attorney Tom Strickland said Smith's sentence was appropriate, both as
punishment and as a warning to others tempted to abuse children sexually.
"The exploitation of children is a scourge on the community," Strickland said.
Please contact me off-list for any questions about the list at
Women's Reproductive Health Initiative
Program for Appropriate Technology in Health
Stop-traffic is facilitated, international electronic list
funded by the Women's Reproductive Health Initiative
of the Program for Appropriate Technology in Health (PATH)
dealing with human rights abuses associated with trafficking
in persons, with an emphasis on public health and trafficking
in persons for forced labor, including forced prostitution,
sweatshop labor, domestic service and some coercive mail
order bride arrangements.
To subscribe and unsubscribe, please go to
Stop-traffic mailing list
This archive was generated by hypermail 2a22 : Wed Aug 16 2000 - 09:23:10 EDT

domain: law


text:
An introduction to the deeper meaning
All of it can be found here. Many people think of rock music as rubbish or noise. It often takes poets a long time to unlearn this.
Meaning of life philosophy
Mainstream is something that is done, heard, or seen by the majority of this population. The mere exercise of getting as deeply into the words as possible shows them that meaning and possibility come from this act — not from a search for an interpretation, often one someone else has already made. Let us look deeper into the actual architecture. Why do we need them? Consider the following similar sentences: Have a good day and Have a great day. You will be able to understand what the rock musicians really want the people to realize. William James, the 19th Century philosophy and psychologist, writes that the happiest people are those who have gone through an intense period of suffering, marked by the search for a deeper meaning in their lives. It is capable of capturing context of a word in a document, semantic and syntactic similarity, relation with other words, etc. It is both what it is and what it means, but also something that is greater than the ordinary. Jude Hospital for Children.
One of the great pleasures of reading poetry is to feel words mean what they usually do in everyday life, and also start to move into a more charged, activated realm.
So, we have seen how word representations are generated using the context words.
Reflection about meaning of life
What is the theme or message of this poem? Some never do. Rock music, throughout the ages, has always been misunderstood. One of the great pleasures of reading poetry is to feel words mean what they usually do in everyday life, and also start to move into a more charged, activated realm. The only non-linearity is the softmax calculations in the output layer. It is both what it is and what it means, but also something that is greater than the ordinary. Rock music is compelling and enlivening. To understand what message is intended to be shouted out in every lyric. Rock is an art. It just gives you a high-level idea of what word embeddings are and how Word2Vec works. As you go on reading this paper, you will find out what lies behind all what most people see as a bedlam, what the society thinks as an upheaval. We can use multiple context words to do the same. Pages: 3 Get Full Essay Get access to this section to get all the help you need with your essay and educational goals.
Music is self-expression. When Wvn is used to calculate hidden layer inputs, we take an average over all these C context word inputs. The input or the context word is a one hot encoded vector of size V. What the people should remember is that it is never right to criticize a thing, which they themselves never understood in the first place.
In the process of predicting the target word, we learn the vector representation of the target word. The above explanation is a very basic one.
Let the input to the Neural Network be the word, great. In one hot encoding representations, all the words are independent of each other, as mentioned earlier.
based on 71 review


ARCHIVES >>> 12/2017
24.12.2017 18:00 GMT
Hello and welcome back to another Forgotten Hope 2 update.
Today we're back from the dead with another explosive render just in time for the fireworks. It's Christmas Eve, and when you have nine targets overhead, there's only one weapon you need: the Luftfaust B.
Designed in late 1944, the Luftfaust was the only one of several German man portable anti-aircraft rocket launchers that made it off the drawing board and into combat trials before the end of the war. Consisting of 9 lengths of pipe, a rudimentary sight, and a firing system taken from the Panzerschreck, it was to be fired from the shoulder at low flying aircraft.
The projectiles used a warhead derived from normal 20 mm anti-aircraft ammunition mated to a spin stabilised rocket motor. Fired as a salvo of 4, followed a fraction of a second later by the remaining 5, the rockets would spread out to a circle of 40 metres across at 200 metres distance.
It isn't known how many Luftfausts were made or used in the confusion of the last days of the war, but it is known that at least a handful were deployed in and around Berlin. Ours was made by the ever talented Seth Soldier.
However that's not all, we have another little present for you. A few screenshots taken from upcoming maps. Please mind that these are works in progress and subject to change.
Finally, since this is Forgotten Hope 2's 10th Christmas, we thought we'd dig out something from a while ago. All the way back in 2003, McGibs drew us a little Christmas scene, and we thought that 14 years later it might be time to get it out again. Enjoy the holidays everyone!
That's all for this week, but be sure to come back next time for another update. Until then, feel free to visit our IRC channel, our public forums, and/or our Twitter and Facebook pages to discuss this update and other news.


text:
Last Updated: 10/22/2016 12:31 AM
Description for 111 S Mayfield Avenue Chicago, IL 60644
NICE BRICK 2 UNIT MULTI-FAMILY HOME LOCATED IN WEST CHICAGO NEAR OAK PARK. FEATURES A FULL/UNFINISHED BASEMENT, HUGE ENCLOSED YARD AND BACK PORCH. MINUTES FROM MAJOR STREETS, PUBLIC TRANSPORTATION, COLUMBUS PARK AND THE 290 EXPY. GREAT OPPORTUNITY!!
Exterior / Lot Features
25 X 125
SOUTH ON AUSTIN, EAST ON ADAMS, NORTH ON MAYFIELD TO PROPERTY.
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Chicago Real Estate
Chicago is located in Illinois. Chicago, Illinois 60644 has a population of 2,702,471.
The median household income in Chicago, Illinois 60644 is $47,408. The median household income for the surrounding county is $54,648 compared to the national median of $53,046. The median age of people living in Chicago 60644 is 33.1 years.
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domain: geography


text:
Whether you’re an experienced camper or just getting started, there’s something special about taking your first solo camping trip.
You have the chance to take in nature at its fullest, make your own decisions during the journey, and get a little closer to finding yourself along the way.
Though it can seem overwhelming to go on such a grand adventure alone, preparation is key for ensuring everything runs smoothly and safely.
Here are eight tips to help make your first solo camping trip easier and stress-free.
8 Tips for Your First Solo Camping Trip
Choose the Right Campsite
Pick a campsite that’s close to other campers (but not too close) to ensure you can get help in an emergency. Before you go, you can also check with the park rangers or other campers for advice on good campsites.
Be sure to check what services are available at the campground of your choice, such as water and electric hookups, showers, restrooms, and other amenities like fire pits or BBQ grills.
When selecting the perfect spot, it would be best to consider factors like distance from home, trail availability, terrain, and weather conditions.
Learn Some Basic Skills
Take the time to learn how to pitch a tent, build a fire, and navigate with a map and compass if you don’t know how.
These skills will come in handy if something goes wrong, and they may even help when you’re trying to find your way around the campsite.
Additionally, it helps to practice setting up camp and breaking it down so that you know what to do once you arrive at your destination. Plenty of online tutorials and guides can help, or you can take a class from a local outfitter.
Prepare Your Route
When planning your solo camping trip, it’s important to map out a route in advance to avoid getting lost. Consider what sites you want to see and plan accordingly.
Make a list of potential stops along the way so that you have something to look forward to. It’s also a good idea to research the area so you know what wildlife and vegetation to expect.
It will help you identify any potential hazards that may be present in the area. Check the weather forecast before you set out, as it could affect your journey.
Make sure to map out alternate routes in case of an unexpected detour. You can also leave a copy of your route with someone at home in an emergency.
Pack Essential Gear
One of the most critical aspects of solo camping is ensuring you have all the gear you need before heading out into the wilderness.
You’ll need a tent, sleeping bag, cooking stove, food and water supplies, and other necessary gear like flashlights, maps, matches or lighters, and a first aid kit.
It may also be helpful to bring extra blankets for cold nights and bug spray to keep unwanted insects away.
It’s also a good idea to bring a solar generator to ensure you can access light and power during your trip. Ensure you have a checklist, so nothing is forgotten, then double-check everything before leaving.
Don’t Forget About Your Food
Consider your dietary needs and plan accordingly to have various healthy and tasty meal options during your trip. Pack non-perishable items such as dried fruits, nuts, crackers, and energy bars.
You can also bring canned goods like tuna or beans for protein and add them to your meals. Dehydrated foods are great options as they are lightweight and easy to prepare. Plus, you won’t have to worry about refrigeration or spoilage.
Bring a small cooler with ice packs to store fresh produce and other items. There are also plenty of easy recipes that can be made with just a few simple ingredients. The key is to plan ahead and ensure you have enough food for your trip.
Be Prepared for Emergencies
No matter how well-prepared you are for your solo camping trip, it’s always a good idea to be prepared in an emergency.
Ensure you have enough supplies, and bring a satellite phone or other form of communication device so that you can easily contact someone if needed. Research the area and familiarize yourself with any potential dangers that may be present.
Bring a first aid kit, but also know how to use it in case of an injury or illness. Additionally, it’s important to research local laws and regulations, so you don’t get in trouble.
Stay alert and aware of your surroundings, and be mindful of your environment.
Set Up Camp Before Dark
Setting up camp before dark is the best way to ensure you have plenty of time to settle in and make yourself comfortable before nightfall.
Start by surveying the area and selecting a suitable spot for your tent that is flat and free of debris or large rocks. Then, set up your tent and gather all of your supplies inside.
Make sure to pack away any food items in a bear-proof container. Once you’ve finished setting up camp, take the time to explore the area and get familiar with your surroundings.
Check out nearby trails and landmarks so you can easily find your way back to camp if needed.
Take the time to slow down and appreciate your surroundings, listen to birds chirping, observe animals in their natural habitat, and take in the spectacular views.
At night, you can stargaze and marvel at the beauty of the universe. Spend time reflecting on your thoughts and emotions, or bring a journal to document your journey.
If you like photography, be sure to bring a camera or a smartphone to capture special moments and places you come across during your trip.
Camping alone can be a great way to relax, explore the outdoors, and connect deeply with yourself. Set yourself up for success by researching, packing all the essential items, and being mindful of potential dangers.
Most importantly, remember to enjoy yourself by taking the time to appreciate your surroundings and have some fun.

domain: travel


text:
Location: Los Angeles, CA
Bio: Jim Markunas is a music industry futurist and editor-in-chief of Chicks With Guns Magazine. Jim has a decade of new media and music industry experience, he’s run highly successful new media campaigns and has worked with James Brown, Miles Davis, The Walt Disney Company, Sam Sparro, Mick Fleetwood, and Minty Fresh Records. Currently Jim’s focus is monetization strategies for record labels and digital business development.
Likes: Alternative, Rock, Metal, Hard Rock, Pop, Rap, Hip-Hop.

domain: artistic


text:
If you’re pondering gestation, visit your doctor for a preconception consult. they’ll give you with professional recommendation on designing your gestation.
Pregnant lady uptake a dish
Eating healthy foods can facilitate your possibilities of conceiving.
The preconception amount (three months before pregnancy) is that the time to form life changes which will facilitate boost fertility, scale back issues throughout gestation and assist in recovery from birth.
If you and your partner ar about to conceive, you ought to begin taking B-complex vitamin before you get pregnant. B-complex vitamin helps to produce the most effective health outcomes for your baby once it’s growing. Taking B-complex vitamin daily before and through gestation additionally prevents the incidence of ectoderm defects, like congenital defect, in your baby.
Watching what you eat
If you and your partner area unit making ready for gestation, you must scrutinize your diet and see wherever you’ll be able to build healthier food selections. feeding a lot of healthy foods can facilitate together with your possibilities of conceiving and having a healthy gestation.
There is no safe quantity of alcohol to drink throughout pregnancy; so, for girls World Health Organization area unit pregnant or coming up with a gestation, not drinking is that the safest choice. Alcohol will associate effect on} the health and development of an unhatched baby always.
Quitting smoking before gestation is that the single only means that of protective your baby and yourself from the event of great complications throughout gestation. By quitting smoking you’re a lot of doubtless to conceive naturally and immediately, less doubtless to suffer a miscarriage or eccyesis and fewer doubtless to deliver your baby untimely.

domain: medical


Paramore leader Hayley Williams has released a new solo single and its accompanying music video (directed by Warren Fu). Check out “Simmer” below.
“Simmer,” produced by Paramore’s Taylor York, is the first single from Williams’ debut solo album PETALS FOR ARMOR, which will arrive on May 8 via Atlantic. Williams said in a press release:
I’m so ready and so incredibly humbled to get to share this project.
Making it was a scary, empowering experience. Some of my proudest
moments as a lyricist happened while writing PETALS FOR ARMOR. And I
was able to get my hands a little dirtier than usual when it came to
instrumentation. I’m in a band with my favorite musicians so I never
really feel the need to step into a role as a player when it comes to
Paramore records. This project, however, benefited from a little bit
of musical naïveté and rawness and so I experimented quite a bit more.
I made this with some of the closest people to me. Their respective
talents really shine bright throughout the record. I like to think we
all make each other better and the result is something that sounds and
FEELS exactly as I’d hoped it would. Now that it’s time to put it all
out there, I can finally exhale. I’m excited to let people in to
experience a different side of myself that I’ve only very recently
become familiar with.
Hayley Williams has shared only a handful of solo songs in the past. In 2009, she contributed “Teenagers” to the soundtrack for Jennifer’s Body, and, in 2017, she covered “Nineteen” for Tegan and Sara present The Con X: Covers. She’s also featured on a number of tracks outside of Paramore in recent years. Last year, she appeared on American Football’s “Uncomfortably Numb,” and Williams collaborated with CHVRCHES in 2016 for a new version of “Bury It.”
Read Pitchfork’s “The 200 Best Albums of the 2010s,” featuring After Laughter at No. 169.


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Report from Prague DU Conference
I was not the only one to arrive in the beautiful city of Prague last month with very little idea about the DU conference I was there to attend. With communication about the conference done almost exclusively on email, and no programme set in advance, I wasn’t sure what to expect. In fact, as it turns out, the organisers didn’t know to expect me either, my registration having been lost in cyberspace. Lucky then, that the programme was very loosely arranged and my presentation about campaigning against DU could slot in. This open programme meant for some confusion, but also led to a relaxed and informal conference, with us working through the 15 presentations from participants. In fact, this event (more of a seminar than a conference), organised by the Czech group Res Publica, attracted a good range of DU researchers and scientists, with a smattering of journalists, observers, and a limited number of campaigners.
The majority of the presentations focused on the science of DU. Professor Schott from Germany outlined how DU induces mistakes in the chromosome repair systems, which leads to aberrations. These aberrations can be measured and analysed as a way of measuring DU contamination. His pilot study of the blood samples of nine European Gulf War Veterans showed ten times more aberrations than in the control study. He now wants to study more vets, and has remortgaged his house to pay for British veterans to travel to Germany for chromosome analysis.
Particularly interesting from a campaigning angle was the presentation by Pier Roberto Danesi, of the International Atomic Energy Authority (IAEA). He was part of the UNEP team which examined DU contamination in Kosovo (see CADU News 2 & CADU News 6), and though their report to the press earlier this year claimed that there was little to worry about, in fact their statistics prove otherwise. He outlined the way the measurements were taken, and stated that there was very definitely high levels of DU in many of the samples – 2000 times more U238 than appears normally in the environment in some samples. He also stated that this was a picture in time, in that the particles can be re-suspended (something which has been argued about by scientists). Most significantly, he said that the majority of particles present in the samples were of a size which can be inhaled, and that this is the major concern about DU. Considering the IAEA’s stance on low level radiation (that it is not a problem for human health), and their reliance on the flawed risk models of the ICRP, this was unusually frank. Their research also looked into so called ‘dirty DU’, i.e. DU contaminated with plutonium, but while there was some plutonium found in some samples, he claimed this was in the environment from the nuclear bomb tests of the 1960’s.
Dr Busby showed that the high levels of DU found by UNEP in Kosovo had been hidden in a table of incomprehensible scientific figures, which would mean little to members of the press. He went on to outline why the ICRP risk model was so flawed, and his second event theory (if cells are repeatedly hit by radiation they are more likely to mutate, whereas a huge radiation dose would cause cells to die). More detailed info is on the highly recommended low level radiation website at http://www.llrc.org.
Djordje Jovanovic, President of the World Serb Congress told of the increase in cancers and tumours in Serbia, and the woefully inadequate amount of money being put into environmental clean up by NATO forces.
Alfredo Embid, Coordinator of the Coalicion para la Abolicion de las Armas Radiactivas in Madrid outlined several studies on low level radiation including one from the Medical Research Council of Harwell published in April 2001. This study showed that alpha radiation emitted by one particle of DU causes degradation of chromosomes in the blood. More info on their website at http://www.amcmh.org
Dai Williams, independent DU researcher presented a clear and well argued case on DU & Afghanistan and Piotr Bein presented Venik’s argument as to the ineffectiveness of DU, contrary to military propaganda. Apparently in Serbia, only about 2% of bullets hit the target, with the rest ending up on the soil, and it is for reasons of ineffectiveness that Russia does not use the DU bullets in its arsenal.
Other contributors included Marek Glogoczowski a molecular physicist from Poland, a colleague of Dr Gunther’s from Germany, Marion an anti-nuclear activist from Germany, and others from Japan, Italy, and Czech Republic.
Res Publica, the organisers, will present the reports from the conference to Vaclav Havel, after his initial interest in the issue caused them to initiate the conference. They also aim to publish the report with all contributions in February next year. They can be contacted on firstname.lastname@example.org
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Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria
Antimicrobial Resistance & Infection Control volume 10, Article number: 73 (2021)
As part of the Global Action Plan against antimicrobial resistance (AMR), countries are required to generate local evidence to inform context-specific implementation of national action plans against AMR (NAPAR). We aimed to evaluate the knowledge, attitude, and practice (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians in tertiary hospitals in Nigeria, and to determine predictors of KAP of APR and AMR.
In this cross-sectional study, we enrolled physicians practicing in tertiary hospitals from all six geopolitical zones of Nigeria. Implementation of an antimicrobial stewardship programmes (ASP) by each selected hospital were assessed using a 12 item ASP checklist. We used a structured self-administered questionnaire to assess the KAP of APR and AMR. Frequency of prescriptions of 18 different antibiotics in the prior 6 months was assessed using a Likert’s scale. KAP and prescription (Pr) scores were classified as good (score ≥ 80%) or average/poor (score < 80%). Independent predictors of good knowledge, attitude, and practice (KAPPr) were ascertained using an unconditional logistic regression model.
A total of 1324 physicians out of 1778 (74% response rate) practicing in 12 tertiary hospitals in 11 states across all six geopolitical zones participated in the study. None of the participating hospitals had a formal ASP programme and majority did not implement antimicrobial stewardship strategies. The median KAPPr scores were 71.1%, 77%, 75% and 53.3%, for the knowledge, attitude, practice, and prescription components, respectively. Only 22.3%, 40.3%, 31.6% and 31.7% of study respondents had good KAPPr, respectively. All respondents had prescribed one or more antibiotics in the prior 6 months, mostly Amoxicillin-clavulanate (98%), fluoroquinolones (97%), and ceftriaxone (96.8%). About 68% of respondents had prescribed antibiotics from the World Health Organization reserve group. Prior AMR training, professional rank, department, and hospital of practice were independently associated with good KAPPr.
Our study suggests gaps in knowledge and attitude of APR and AMR with inappropriate prescriptions of antibiotics among physicians practicing in tertiary hospitals in Nigeria. Nigeria’s NAPAR should also target establishment and improvement of ASP in hospitals and address institutional, educational, and professional factors that may influence emergence of AMR in Nigeria.
The discovery of antibiotics has completely revolutionized medical practice and led to a decrease in the morbidity and mortality due to infectious diseases across the globe . However, microbial evolution, misuse of antibiotics, and poor infection control practices, among other factors, have led to global emergence of antimicrobial resistance organisms (AMRO) with attendant difficult-to-treat infections, prolonged hospital stay, higher healthcare costs and poorer health outcomes [2, 3].
While the threat of antimicrobial resistance (AMR) remains a growing global challenge, developing countries in Asia and Africa are at greatest risk. It is estimated that by 2050, if nothing is done to halt the increasing trend of AMR, about 10 million people will die from AMR globally, including about 4 million people each from Asia and Africa . At the 68th World Health Assembly, which held in May 2015, member countries endorsed a Global Action Plan (GAP) against AMR . This plan required all countries to develop and implement a National Action Plan for Antimicrobial Resistance (NAPAR). The World Health Organization (WHO) is advocating that member countries adopt and implement the revised Model List of Essential Medicines which grouped antibiotics into the Access, Watch and Reserve (AWaRe) categories . The Access group comprises essential antibiotics that should always be available. The Watch group consists of critically important antibiotics recommended only for specific limited indications, while the Reserve group are antibiotics that should be used as last resort when others have failed . The AWaRe classification is intended to improve access to lifesaving antimicrobial medicines and prevent resistance due to excessive use of some priority antibiotics.
Infectious diseases remain the commonest cause of disease morbidity and mortality in Nigeria . Following a country-wide situational analysis of antimicrobial use and resistance, Nigeria has identified AMR as an emerging health challenge deserving broad, good quality and locally relevant data to inform evidence-based interventions . The focus areas of Nigeria’s 5-year (2017–2022) NAPAR are to: improve awareness and understanding of AMR and related topics; strengthen One Health AMR surveillance and research; improve infection prevention and control (IPC) in tripartite sector; promote rational access to antibiotics and antimicrobial stewardship; and invest in AMR-related research and development . The country has since begun implementation of this plan through public and healthcare worker awareness creation and education, capacity building on laboratory surveillance and appropriate IPC. Nigeria enrolled in the Global Antimicrobial Resistance Surveillance System (GLASS) in April 2017 . The country is currently expanding its laboratory capacity for antimicrobial susceptibility testing (AST): 21 laboratories have been enrolled into the National AMR surveillance system, while three laboratories submit routine reports on six priority bacterial pathogens to the GLASS .
Several studies within and outside Nigeria have shown that AMRO occur commonly among patients admitted in intensive care units, paediatric units and other specialist units often situated within tertiary hospitals [12, 13]. The major drivers of AMR in these settings are heavy antibiotic use and cross infection from hospital environment or personnel . Tertiary hospitals are therefore potential breeding ground for the development and spread of AMRO in Nigeria.
Implementation of antimicrobial stewardship programmes (ASP) lies at the core of optimizing appropriate use of antibiotics in healthcare facilities [15, 16]. Any strategy to improve awareness and understanding of AMR and optimize the use of antibiotics among healthcare facilities in Nigeria, should evaluate implementation of ASP and ASM-related strategies among tertiary hospitals, and identify gaps in knowledge, attitude and practices (KAP) regarding antibiotic prescriptions (APR) and AMR among physicians.
Previous studies have shown that only 13–35% of tertiary hospitals in Nigeria had a formal ASP and majority did not implement most ASM-related strategies [17, 18]. Other studies conducted among physicians in tertiary hospitals in from revealed gaps in knowledge of AMR and poor practice of APR [19, 20]. However, none of these studies included participants from all six geopolitical zones of Nigeria and none assessed the predictors of appropriate KAP of APR and AMR among physicians in Nigeria.
We aimed to determine the KAP of APR and AMR, and identify sociodemographic, educational, institutional, and professional factors that may be associated with good KAP of APR and AMR among physicians in tertiary hospitals across all six geopolitical zones of Nigeria. Our overarching goal was to generate valuable sentinel national data to inform implementation of the country’s NAPAR.
This cross-sectional study was conducted between October 2018 and February 2019 among physicians practicing in public tertiary hospitals in Nigeria.
Study population and setting
Nigeria runs a federal system of government consisting of a Federal Government, 36 semi-autonomous State Governments, the Federal Capital Territory (FCT) and 774 Local Government Areas. The states and FCT are grouped into six geo-political zones: South-South, South-East, South-West, North-East, North-West, and North Central. There are 101 public tertiary health facilities across all the 36 states and the FCT of Nigeria . These public tertiary hospitals include federal and state-owned teaching hospitals, Federal Medical Centres and specialist hospitals. In Nigeria, tertiary hospitals provide both comprehensive and specialists healthcare to the general population; they are also centres for postgraduate medical training and health research.
We selected 12 tertiary hospitals across the country by convenience sampling and included at least one hospital from each of the six geopolitical zones of the country. In a bid to generate representative data, and allow for appropriate sub-group analysis, we targeted at least 40% of physicians working in each hospital. We then adopted a purposive sampling technique to guarantee inclusion of physicians of all professional ranks and departments in each of the selected hospitals. There were 4446 physicians in all 12 hospitals at the time of the study, and 1778 (40%) were eligible to be enrolled for the study.
A structured standardized self-administered pretested questionnaire was distributed to the study participants by trained research assistants who ensured that all completed questionnaires were returned the same day.
The questionnaire consisted of questions divided into four sections: (1) Implementation of antibiotic stewardship programmes (ASP) in selected hospitals and prior training on APR and AMR (2) Demographic and occupational characteristics of study participants; (3) Knowledge, attitude and practice of antibiotic prescriptions and resistance. (4) Frequency of prescriptions of 18 different antibiotics in the 6 months prior to the study.
The questionnaire was developed after reviewing qualitative and quantitative literatures for relevant items [22, 23], including prior surveys by the WHO [16, 24]. The questionnaire was further reviewed for face and content validity by experts in the field of ID and public health. This was then pre-tested in three states in a sample of 30 physicians who were not part of the study. Necessary adjustments were made before sending out the final updated questionnaires to respondents. The validity of the KAP questionnaire was confirmed by a Cronbach’s alpha internal consistency coefficient of ≥ 0.75 for each the 3 components.
Implementation of antimicrobial stewardship programmes
A checklist consisting of 12 items assessed compliance with elements of ASP (see Fig. 2). The checklist was completed by appropriate staff as designated by the hospital management, including focal person on ASP or lead IPC team or Head Pharmacy unit, whichever is applicable.
A correct response to each ASP question was scored 1 while incorrect responses were scored 0. Thus, ASP scores range from 0 to 12.
Knowledge, attitude, and practice
Participants’ knowledge of APR and AMR was assessed by a set of 28 questions covering general awareness about antibiotic use and resistance (eight questions), knowledge of rational use of antibiotics (eight questions), definition of AMR (one question) and knowledge of causes of antimicrobial resistance (11 questions). Correct responses were scored 1 while each wrong or do not know answer was scored 0. The overall knowledge score ranged from 0 to 28.
Attitude was assessed by a set of 15 positive and negative attitude questions using a five-point Likert’s scale. The scoring system used for positive attitude was: 5 = strongly agree with the statement, 4 = agree, 3 = neutral, 2 = disagree and 1 = strongly disagree with the statement. The scores were reversed for negative attitude questions. Overall attitude scores ranged from 15 to 75.
Practice was assessed by a set of 13 positive and negative practice questions using a five-point Likert’s scale. The scoring system used for correct practice was: 5 = Always, 4 = Most Often, 3 = Sometimes, 2 = Rarely and 1 = Never. The scores were reversed for wrong practice questions. Overall practice scores ranged from 13 to 65.
Frequency of antibiotic prescriptions
To determine the frequency of prescriptions of 18 different antibiotics, respondents were asked to indicate how many times they prescribed each antibiotic in the previous 6 months using a Likert’s scale of Never, Rarely, Sometimes, Most Often, Always, scored 1, 2, 3, 4 and 5 respectively. Overall prescription scores ranged from 18 to 90.
Classification of ASP, KAP and prescription scores
We calculated percentage scores for each ASP, KAP and prescription score. The 18 antibiotics were further classified into the WHO AWaRe categories . At the time of this study, Cefepime was classified as a Reserve antibiotic. Prior prescriptions of the AWaRe categories of antibiotics were expressed in percentages.
Using modified Bloom’s cut-off point , the percentage ASP/KAP scores were grouped into good ASP/KAP (scores were between 80 and 100%), average ASP/KAP (scores between 50 and 79%) and poor ASP/KAP (scores less than 50%). The percentage prescription scores were also categorized into two groups: poor/very frequent prescriptions (prescription score between 50 and 100%) and good/less frequent prescription (prescription score less than 50%).
The collected data were checked for completeness and errors before analysis. Incomplete questionnaires were excluded and counted as a non-response. All completed questionnaires were then entered into Microsoft Excel and exported to SPSS version 20 for analysis.
Study variables were summarized using frequencies, proportions, medians, and interquartile range-IQR (quantitative variables were not normally distributed). Spearman rho’s correlation coefficient was used to describe the strength and direction of the relationship among KAPPr scores. Correlations were interpreted using the following criteria: 0–0.25 = weak correlation, 0.25–0.5 = fair correlation, 0.5–0.75 = good correlation and greater than 0.75 = excellent correlation. A chi-squared test was used for bivariate analysis. For multivariate analysis, KAPPr scores were grouped into two: Good KAPPr (scores ≥ 80%) and Average/Poor KAPPr (scores < 80%). An unconditional binary logistic regression was used to determine independent variables associated with good KAPPr. Adjusted odds ratio with 95% confidence level were computed, and p value < 0.05 (two-sided) was considered statistically significant.
All potential participants who agreed to participate provided written consent before completion of questionnaire. The questionnaire was anonymized, and confidentiality of information obtained was maintained. Ethical approval for the study was obtained from National Health Research Ethics Committee (NHREC/01/01/2017).
Of 1778 questionnaires, 1324 (74% response rate) were completed and returned from 11 states and 12 hospitals across all geopolitical zones of Nigeria (Fig. 1). Of the 1324 respondents, 889 (67.3%) were males, 1003 (75.6%) were between age 25 and 39 years and 834 (63%) were of the residency professional cadre. The south-south (26.9%) and the north-west (25.8%) regions had the highest proportions of respondents (Table 1).
Implementation of antimicrobial stewardship among hospitals and AMR training
Out of a possible total score of 12, the ASP scores of hospitals surveyed ranged from 0 to 7, with median (and interquartile range-IQR) of 2 (0, 2). None of the hospitals surveyed had a formal ASP or a policy on antibiotic restrictions (Fig. 2). Three (25%) hospitals routinely monitored antibiotic consumption and had an antibiotic use policy, while four (33.3%) had a protocol for management of IDs in various departments. Although, 6 (50%) hospitals reported routine monitoring of antibiotic resistance patterns, only one (8.3%) routinely monitored specific AMRO such as ESBL, MRSA and CRE (Fig. 2). Only one hospital (UNTH) had above average ASP score (58.3%). All other hospitals had poor ASP score (between 0 and 33.3%).
Of the 1324 participants, 417 (31.5%) reported participating in a prior training on antibiotic use and resistance.
Knowledge, attitude and practice of antibiotic use and resistance
The majority (> 80%) of study participants had heard of rational antibiotic prescription and AMR, but only 40.6% had heard of ASP (Table 2). Awareness of antibiotic resistant organisms ranged from 49 to 83%. Regarding knowledge of rational antibiotic use, 85.4% knew that antibiotics should only be stopped after completion of recommended doses, but 51% did not know that parenteral antibiotics are not necessarily more effective than oral antibiotics. Although 90% of participants knew that widespread use of antibiotics could promote emergence of AMR, most participants did not know that AMR could arise from use of antibiotics in farming and animal husbandry and from poor practice of hand hygiene in hospitals. The participants had lower knowledge scores for rational use of antibiotics compared to awareness about antibiotic use and resistance, and knowledge of causes of AMR (Table 2).
Concerning attitude toward antibiotic use and resistance, majority of participants agreed that AMR is a serious public health issue in Nigeria and worldwide and could be a problem for their hospital (Table 3). However, about 79% disagreed that routine hand washing could prevent AMR, 50% agreed that pharmaceutical companies could influence their choice of antibiotic prescriptions, and 27.9% wrongly believed that antibiotic could be used to prevent bacterial infection in patients with upper respiratory tract infection (URTI) due to viruses.
Table 3 shows that about 62% of participants sometimes prescribe antibiotics because they did not trust the available laboratory results, 43% have ever prescribed antibiotics for malaria and 28% sometimes prescribe antibiotics for common cold. About 78% of participants stated that they had rarely or never stopped antibiotics immediately patient symptoms resolve, and 29.5% had sometimes prescribe antibiotics based on recommendation of pharmaceutical companies.
All study participants (100%) had prescribed one or more antibiotics in the previous 6 months. A median prescription of 15 antibiotics (IQR-13, 17) were prescribed per study participant in the previous 6 months. The prescription scores ranged from 20 to 90 with median (IQR) of 48 (43, 53). Amoxicillin-clavulanate (98%), ciprofloxacin/ofloxacin (97%), ceftriaxone (96.8%) and metronidazole (96.5%) were the most frequently prescribed antibiotics (Fig. 3). According to AWaRe categories, 100%, 99.3%, 67.8% of respondents had prescribed antibiotics from the Access, Watch and Reserve group of antibiotics, respectively.
Respondents practicing in FMC Nguru, Yobe State and AKTH, Kano and those working in Paediatrics and Internal Medicine departments reported higher rates of prescriptions of Cefepime than respondents from other hospitals and departments (Fig. 4).
Correlations between knowledge, attitude, practice, and prescription (KAPPr) scores
The correlations between KAPPr scores are shown in Table 4. There were weak positive correlations between knowledge, attitude, and practice scores, and weak negative correlations when prescriptions scores are compared with knowledge, attitude, and practice scores.
Prevalence and factors associated with good knowledge, attitude, practice, and prescription.
The descriptive statistics of KAPPr scores are summarized in Table 5. Of the 1324 study participants, 295 (22.3%), 534 (40.3%), 418 (31.6%) and 420 (31.7%) had good knowledge, attitude, practice, and prescription, respectively. The factors associated with good KAPPr on univariate and multivariate analysis are shown in Tables 6 and 7, respectively. Professional rank was independently associated with good knowledge, attitude, and prescription but not with good practice. Senior physicians (consultants and resident doctors) were between 1.6 and 3.3 times more likely to have good KAPPr than house officers. Those who previously participated in any training on antibiotic use and resistance were 2.6 times more likely to have good knowledge than those without any prior training.
Department of practice was independently associated with good prescription, but not associated with good knowledge, attitude, and practice. Respondents practicing in paediatrics departments were significantly less likely to have good prescription compared to respondents from other departments. Hospital of practice was independently associated with good KAPPr. Overall, respondents practicing in South West Hospitals (UCH and LUTH) were more likely to have good KAPPr than those respondents from other hospitals (Fig. 5). Respondents practicing in FMCN and FMCBK, both located in northern Nigeria, generally had lowest rates of good KAPPr.
To the best of our knowledge, this is the first study from Nigeria assessing both implementation of ASM among tertiary hospitals and predictors of good KAP of APR and AMR among physicians practicing in all six geopolitical zones of Nigeria.
Our results suggest significant gaps in the implementation of antimicrobial stewardship (AMS). None of the hospitals surveyed had a formal ASP program, while majority of participating hospitals were not routinely implementing one or more of the ASM-related interventions and there was poor awareness of ASM. Poor compliance with AMS was reported by another study from Nigeria where only six (35%) of 17 tertiary hospitals surveyed had a formal ASP and less than 23.5% of these hospitals implemented AMS-related interventions and policies . A nationwide survey of pharmacist’s involvement in ASP in Nigeria, revealed that only 5 (13.5%) of 37 hospitals had a formal ASP. In a study evaluating physicians’ knowledge and perception of AMS and AMR in six hospitals in three geopolitical zones of Nigeria, only 28.2% of respondents had ever heard of ASP and more respondents had good knowledge of AMR than ASP (82.7% vs 36.5%) . In line with our finding of poor implementation of AMS-related interventions, an international survey of ASP in 660 hospitals across the globe, revealed that only 14% of 43 hospitals in Africa had an ASP in place as compared to 53% (26/49), 66% (230/348) and 66% (45/67) of hospitals in Asia, Europe, and North America, respectively . This international survey reported lack of funding and personnel, a lack of information technology, prescriber opposition and lack of awareness on the part of the hospital administration as perceived barriers to the implementation of ASP among countries surveyed. Other identified challenges to implementation of ASP in developing countries include, limited diagnostic infrastructure, poor access to quality-assured antimicrobials, and gaps in antibiotic prescribing and AMR-related knowledge and attitude among prescribers [27, 28]. Although, the outcomes and impact of implementation of ASP have not been widely studied in Africa, few studies from this region suggest that African countries can successfully implement these programmes . To overcome these barriers and challenges, Nigeria ought to strengthen its antimicrobial stewardship through advocacy for institutional buy-in, training and education and appropriate funding of AMS activities.
Our study respondents had better knowledge of AMR (median score of 72.7%) than knowledge of rational APR (median score of 62.5%). Most respondents agreed that AMR is a serious problem in their various hospitals and Nigeria as a whole. However, over half of our respondents did not know that AMR could arise from antibiotic use in animal husbandry and farming. About 78% of farms in Nigeria are using antimicrobials for animal production, and 20% of these livestock have been shown to have multi-drug resistant isolates . Our results support the need to improve awareness on the association between antimicrobial use in animals and emergence of AMR in humans, and to institutionalize national antimicrobial use and resistance surveillance system in animals in Nigeria.
The gap in knowledge of the link between poor practice of IPC and AMR as observed in our study may partly explain why 79% of respondents disagreed that routine hand washing could prevent AMR and 36% were neutral or disagreed that AMR could be transmitted from healthcare worker to patient. About 83% of physicians in another study from Nigeria identified poor infection control as a possible cause of emergence of AMR in hospital settings . However, this study did not specifically evaluate hand hygiene-related knowledge and attitude. Garba et al. reported that 54.1% of healthcare workers in primary healthcare centers in Kaduna North local government area of northern Nigeria wrongly believed that practice of hand hygiene for prevention of AMR is overrated . A study from Europe reported that junior doctors rarely perceived poor hand hygiene practices as important drivers of AMR . The slogan 'Fight antibiotic resistance—it's in your hands' was formulated in 2017 by the WHO to emphasize the central role of hand hygiene in the prevention of AMR . Our study findings suggest that there is need to improve awareness among physicians in Nigeria about the importance of practice of hand hygiene and other components of IPC in reducing the transmission of AMRO in hospital settings.
The median KAP scores of respondents in our study were 71%, 75% and 77% respectively. However, only 22.3%, 40.3%, and 31.6 had good KAP (defined as score of 80% or above) of APR and AMR, respectively. In a systematic review of KAP of APR and AMR among healthcare practitioners from developing countries involving 15 studies (none from Nigeria) an average of 80.9% of respondents correctly answered questions relating to APR, whereas only 39.6% were aware of the local resistance patterns in their health facilities . About 83% of physicians working in tertiary hospitals in four geopolitical zones of Nigeria were reported to have good knowledge of AMR (defined as knowledge score of 80% or above) . Among healthcare practitioners from primary health facilities in northern Nigeria, 73% had good knowledge of AMR (defined as knowledge score between 50 and 74%), while less than 5% had very good knowledge of AMR (defined as knowledge score of 75% and above) . The variability in the proportions of respondents with good knowledge from Nigeria could be related to differences in study design. It is our view that our study findings are representative of physicians working in tertiary hospitals in Nigeria as we included hospitals and physicians across all six geopolitical zones of the country.
Excessive and inappropriate prescription of antibiotics are established drivers of AMR [35, 36]. Our results reveal that an average of 15 (83.3%) of 18 antibiotics were prescribed by each respondent in the prior 6 months. About 69% of respondents were classified as having poor prescription practice, meaning they prescribed antibiotics inappropriately. Some indicators of inappropriate APR in our study included 43% of respondents ever prescribing antibiotics for malaria and 28% sometimes prescribing antibiotics for common cold. Our results also reveal some attitudes and drivers of irrational APR including influence of pharmaceutical companies, lack of trust in laboratory test results, attempting to satisfy patient expectations, prohibitive costs of some antibiotics, and limited access to appropriate antibiotic. Penicillins with β-lactamase inhibitors, fluoroquinolones and third generation cephalosporins were the most common classes of antibiotics frequently prescribed by respondents in our study. While most respondents had prescribed antibiotics from the WHO Access and Watch categories, it is remarkable that about 63% of respondents had prescribed antibiotics in the Reserve group of the WHO AWaRe categories. The high rates of prescription of the Reserve antibiotics Cefepime without recourse to culture results could ultimately lead to high burden of ESBL.
Many studies from Nigeria have also reported overuse and irrational prescription of antibiotics among physicians, with prevalence of self-reported APR ranging from 26.8 to 97% [19, 20, 37] and point prevalence surveys (PPS) reporting APR rates of 59.6–80.1% among in-patients [38,39,40,41]. The global PPS reported a higher prevalence of antibiotic prescribing among Africa hospitals (average of 50%) compared to 27.4% among European hospitals . Most of these studies also reported Penicillins with β-lactamase inhibitors, third generation cephalosporins and fluoroquinolones as the commonest classes of antibiotics prescribed.
The determinants of inappropriate prescriptions of antibiotics have been reviewed by various authors [42, 43]. A systematic review of physicians practicing in different settings across the globe identified patients’ expectations, severity and duration of infections, uncertainty over diagnosis, potentially losing patients, and influence of pharmaceutical companies as drivers of irrational APR among physicians . A study of physicians from a tertiary hospital in Lagos, Nigeria reported factors of cost, drug availability and pressure from pharmaceutical representatives as the major drivers of irrational APR among study participants .
Educational programmes have been shown to improve awareness and knowledge of AMR among healthcare workers, as well as foster appropriate prescription behaviour [44, 45]. We found that good knowledge of AMR and APR was associated with prior training on antibiotic use and resistance. However, the lack of association between prior training and good attitude, practice, and prescription, as well as the weak positive correlations between KAP, support the role of multiplicity of factors in determining attitudes and practices regarding APR and AMR [37, 46, 47]. Additional predictive factors observed in our study were professional rank, hospital and department of practice of physicians.
Independent of other variables, more senior physicians (consultants and resident doctors) in our study had better knowledge and attitudes, and prescribed antibiotics less frequently than recently qualified medical interns. Medical interns have limited experience of clinical practice, and it is not surprising they had the lowest KAPPr scores in our study. Besides poor knowledge, the more frequent prescriptions of antibiotics among these interns compared to other physicians could be related to the hierarchical nature of medical practice in Nigeria where medical interns are in most cases required to write out prescriptions based on instructions of their supervising residents or consultants. The rotation of interns through all major medical specialties has been shown to influence their prescription practice as they are made to transcribe prescriptions from a wide variety of their supervisors in the various departments . Studies from Ghana , USA , Malaysia  and China  have also reported higher knowledge and less frequent prescriptions of antibiotic among senior physicians compared to junior physicians. Other studies have shown that prescription errors are more frequent among medical interns in hospital settings [52, 53].
Hospital of practice was independently associated with good KAPPr among physicians in our study. Physicians practicing in hospitals located in the South-West region of the country generally had better KAPPr scores than those from other hospitals. Prescriptions of Reserve antibiotic (Cefepime) were more frequently observed among physicians practicing in northern Nigeria, as all three hospitals with over 80% of physicians with prior prescriptions of Cefepime were in northern Nigeria. Among five published PPS from Nigeria [38,39,40,41, 54], the lowest prevalence of antibiotic use among inpatients of 59.5% was reported in a South-West hospital  while the highest prevalence of 80.1% was reported among three hospitals located in northern Nigeria . The reasons for the observed hospital-based and regional differences in KAPPr scores and APR are not obvious from our study data, especially as there were no remarkable differences in the implementation of AMS between hospitals surveyed.
Variabilities between hospitals in APR and knowledge of AMR have also been reported by various other studies from other parts of the world [55, 56] and they are usually fueled by contextual, cultural and behavioural factors that define the various hospitals . Differences in the burden, types, and resistance patterns of ID between hospitals could determine the frequency and type of antibiotic prescribed. Organization culture may also influence how physicians prescribe . Studies suggest that “prescribing etiquette” are usually created by senior physicians and passed on to junior physicians as part of mentorship process and to maintain the ‘culture’ of prescription within clinical groups [48, 59, 60]. Recognizing the importance of institutional context and peculiarities in the implementation of ASP, the WHO recommends institutional situational analysis and needs assessment before implementation of AMS in healthcare settings .
Our study data show that physicians practicing in paediatric department prescribed antibiotics more frequently than those from other departments, and physicians practicing in internal medicine and paediatric were more likely to prescribe the Reserve antibiotic Cefepime than those in other departments. Several PPS suggest that paediatric departments rank second only to the intensive care unit with respect to antibiotic use in hospital settings [38,39,40,41, 54]. These PPS have shown that APR are related to burden and resistance spectrum of bacterial infections among in-patients. Consequently, the observed variabilities of APR in relation to department of practice in our study could partly be due to higher burden of bacterial infections and AMR among patients in these departments. It could also be due to ‘prescription etiquette’ that favour more frequent APR in these departments.
Our study had several limitations. First, we did not evaluate all aspects of AMS in healthcare facilities as defined by the WHO . However, our results identified fundamental gaps in the implementation of AMS in Nigeria tertiary hospitals deserving corrective interventions. Second, we did not use probability sampling in selecting respondents, and we could only enroll a limited number of respondents from the north-east region of the country due to prevailing security challenges in this region. However, our study is the first on KAP of AMR to include participants from all six geopolitical zones of the country. In view of the large sample size including participants from most parts of the country, we believe our sample is largely representative of the Nigeria context. Third, the frequency of antibiotic prescription was based on a qualitative Likert’s scale which may not necessarily reflect the quantitative equivalent of antibiotic prescription among respondents. Fourth, our study was not specifically designed to evaluate predictors of institutional or regional variabilities in good KAPPr. Future studies are necessary to determine other relevant contextual, cultural and behavioural factors that could influence KAP of antibiotic prescriptions among physicians in Nigeria.
In conclusion, our study results suggest a lack of implementation of AMS among tertiary hospitals in Nigeria. Although most physicians working in these hospitals had above average KAP of APR and AMR, there were gaps in knowledge and attitude, as well as frequent and inappropriate prescriptions of antibiotics, including those in the Reserve group. Good KAPPr were associated with institutional, geographical, educational, and professional factors. Our study findings should inform interventions that optimize the use of antibiotics in healthcare facilities and improve awareness and understanding of AMR in Nigeria in line with Nigeria’s NAPAR.
Availability of data and materials
The datasets in the present study are accessible from the corresponding author on reasonable request.
Antimicrobial resistant organisms
Antibiotic prescription rate
Antibiotic stewardship programme
Access, Watch and Reserve categories
Federal Capital Territory
Global Action Plan
Knowledge, attitude, practice, and prescription
National action plan on antimicrobial resistance
Point prevalence surveys
World Health Assembly
World Health Organization
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Ogoina, D., Iliyasu, G., Kwaghe, V. et al. Predictors of antibiotic prescriptions: a knowledge, attitude and practice survey among physicians in tertiary hospitals in Nigeria. Antimicrob Resist Infect Control 10, 73 (2021). https://doi.org/10.1186/s13756-021-00940-9


INDIANAPOLIS, Ind. (December 8, 2015) – Many Hoosier parents face heavy financial burdens to cover child care costs. Some families are paying more for child care than tuition to a four-year public college, a new study finds.
The Child Care Aware of America report reveals child care is the biggest expense for most families, even beating out hosing and transportation costs.
In Indiana, a single parent with two kids pays 73 percent of their income to child care centers. The report found sending an infant and a four-year-old to a child care center costs more than $15,000 per year in Indiana.
Plus, there’s a domino effect when parents simply cannot afford the right care for their kids.
“In the US, $4.4 billion are lost each year because families are unable to have dependable child care,” said Lynette Fraga, Ph.D., Executive Director, Child Care Aware of America. “It falls through and parents are unable to get to work. So this is everyone’s issue. ”
Marion County is one of five counties spotlighted in the report to show the challenges of paying for child care in urban areas. Residents in the county pay more than 14 percent more child care than the state average, according to the report.
To read the entire report, click here.


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Here are the stories making the headlines in Scotland and across the UK this morning.
Used car retailer Cazoo seeks cash lifeline to escape insolvency
The troubled used car supermarket Cazoo is scrambling for a lifeline as it sinks further into a funding crisis.
The online dealer hopes to persuade shareholders to agree to an urgent cash injection but is preparing contingency measures. A source involved in the discussions said all options are on the table, including new investors, a sale or break-up of the company, and asset sales.
However, if fresh funds can’t be found then it will be forced to consider administration. A team of restructuring and insolvency experts is being called in to navigate the crisis.
Cazoo revealed in December that it could run out of capital by the middle of this year. The crunch is looming after years of heavy losses and amid a sharp downturn in the second hand car market.
UK employment rate in private sector falls to lowest in a decade
Employment levels in the UK’s private sector have dropped to their lowest in a decade with hiring decisions affected by uncertainty over how the economy will fare at a time of high interest rates and weak consumer demand.
The employment index from BDO, the accountancy and business advisory firm, dropped for a seventh month in a row to 98.77, its lowest point since August 2013 when the economy was still reeling from the global financial crisis.
Read more in The Times.
Cost cuts loom at The Guardian amid widening losses
Employees at The Guardian are preparing for cost cuts as the newspaper warned it is forecast to make a £39m loss.
Bosses revealed the financial challenges facing the business at a meeting last week, as they laid bare the impact of reduced revenues caused by a downturn in the advertising market.
The publisher said it had lost £36m in the first nine months of 2023, with a further £3m loss expected by the end of the year.
The paper, which does not charge for online access, has been hit hard by a drop in demand from digital advertisers.
Rwanda plan is fundamentally flawed, parliamentary report warns
A key parliamentary committee says the government's plan to send some asylum seekers to Rwanda is "fundamentally incompatible" with the UK's human rights safeguards.
The Joint Committee on Human Rights said the legislation jeopardised the UK's international reputation.
The bill will be debated in detail by the House of Lords this week and face substantial opposition.
Even if it passes, it is not clear whether flights will ever take off.

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